Select all that apply (SATA) questions used to be the most feared item on the NCLEX because they were all-or-nothing: miss one option and you got zero. That is no longer true. Since the Next Generation NCLEX launched in April 2023, SATA items use partial credit, and the right strategy has changed with it.
How SATA is scored now
Standalone SATA items use what NCSBN calls +/- scoring:
- +1 for every correct option you select
- −1 for every incorrect option you select
- 0 for correct options you leave blank
- The item score cannot go below zero
So on a question with five options where three are correct:
| You select | Score |
|---|---|
| All three correct, nothing else | 3 of 3 |
| Two correct, nothing else | 2 of 3 |
| All three correct plus one wrong | 2 of 3 |
| One correct plus two wrong | 0 of 3 |
Two things follow. A confident partial answer is worth more than a guess-everything answer. And a wrong selection costs as much as a missed one, so you should only select options you can defend.
“Select N” items inside case studies, where the stem says “Select 3” or “Select 4,” are scored the same way, with the added rule that you must select exactly N.
The true/false method
Treat a SATA question as four, five, or six separate true/false questions that happen to share a stem. For each option, ask one question: “Is this statement true for this client?” Do not compare options to each other, and do not try to guess how many are supposed to be correct.
Take a stem like “Which findings would the nurse expect in a client with left-sided heart failure?”
- Pulmonary crackles: true, left-sided failure backs up into the lungs
- Dyspnea on exertion: true, same mechanism
- Jugular vein distention: false, that is right-sided failure backing up into the venous system
- Pitting edema in the lower extremities: false, also right-sided
- Frothy pink-tinged sputum: true, pulmonary edema
Three true, two false. You never needed to know “how many” in advance.
Five mistakes that cost points
1. Looking for a pattern in the count. There is no rule that at least two options are correct, and no rule that not all of them are. One correct option is rare but possible. All correct is possible.
2. Reading options in relation to each other. Two options can both be true. Two can both be false. If selecting one makes you want to deselect another, you have slipped from true/false mode into multiple-choice mode.
3. Skimming for keywords. An option that contains a word from the stem is not automatically true. Distractors are written to look familiar.
4. Selecting on partial knowledge. With +/- scoring, “I think so” selections are net negative over a whole exam. If you cannot name the reason an option is true, leave it.
5. Spending five minutes. A SATA item is worth the same as any other item toward the ability estimate. Budget two and a half minutes, make your true/false calls, and move on.
Practicing SATA effectively
- Practice in mixed sets, not SATA-only blocks. On the real exam they arrive unannounced among multiple-choice items.
- After each one, check the rationale for every option, including the ones you correctly left blank. The rationale for a false option is often the highest-value sentence on the page.
- Track your SATA accuracy separately. If it lags your multiple-choice accuracy by more than ten points, the issue is usually mistake 2 or 4 above, not content.
Try a few: the free NCLEX practice questions page includes SATA items from every category, each with a rationale per option.
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