Mastering NCLEX®-Style Sequencing Questions

The National Council of State Boards of Nursing (NCSBN) no longer administers just single-option multiple choice questions on the NCLEX® exam. For several years, alternate format style questions have been included on the NCLEX® exam. Just mentioning "alternate format" often sends nursing students into ORBIT!

At Hurst Review, we understand why.

Nursing students are more accustomed to single option multiple choice questions. However, alternate format style questions are not going away. Since these questions are here to stay, let's learn how to deal with them. If you know your nursing content, then it does not matter how NCLEX® asks you a question.

Facts about Sequencing Questions:

1. Also called Drag and Drop questions or ordered response.
2. Answers are placed in a particular order as requested in the question. a. Highest to lowest priority b. Steps in a process or procedure
3. All options are used.
4. There is no partial credit.

Strategies for Mastering Sequencing Questions

1. Carefully read the question. Make sure you understand what you are to do with the options. Are you prioritizing the options, or are you providing the proper steps or sequence in a procedure?
2. Read all of the options carefully.
3. If you are prioritizing, decide what the safest thing for you to would be. Which option, if chosen first will save a life? Remember Maslow's hierarchy of needs and your ABCs. If it is sequencing the steps in a process or procedure, remember what you learned about sterile technique, the safety of client and nurse, universal precautions, etc.

Practice Sequencing Questions

A female client has a prescription for the insertion of a foley catheter. After positioning and prepping the client, and washing hands, in what order should the nurse complete this procedure? Place in chronological order.

1. Inflate the catheter balloon.
2. Remove and dispose of gloves.
3. Pour betadine over cotton balls.
4. Using the non-dominate hand, separate and clean labia using one swipe per cotton ball.
5. Apply sterile gloves.
6. Using the sterile dominant hand, insert catheter 1-2 inches past where urine is noted in the urethra.

With this question, you need to remember the proper sterile technique and universal precautions. So, do you remember the proper way to put in a foley catheter? Give it a try with this sequencing question.

Correct Answer Order: 5, 3, 4, 6, 1, 2

1. Apply sterile gloves.
2. Pour betadine over cotton balls.
3. Using the non-dominate hand, separate and clean labia using one swipe per cotton ball.
4. Using the sterile dominant hand, insert catheter 1-2 inches past where urine is noted in the urethra.
5. Inflate the catheter balloon.
6. Remove and dispose of gloves.

Now, let's do a priority question.

After receiving a report on assigned clients, in what order should the nurse assess the clients? Place in priority order from first to last.

1. Post-op abdominal hysterectomy client needing a dressing change due to quarter size bloody drainage.
2. A client scheduled for EGD requesting more information about the procedure that is scheduled today.
3. A client with pneumonia who reports difficulty breathing.
4. Client 6 hours post tracheostomy with a copious amount of sputum.
5. New admit diagnosed with stable chronic angina reporting chest pain.

So here is how you approach this question. Look at the options. Of these five clients, which one could die first if the nurse does not intervene? Go back to your ABCs. Airway, breathing, circulation, bleeding, and shock. So who could die? Number 4 – that's the airway!

Now, look at the four options that are left and ask yourself the same question. Who could die?

Do this for the last three options, then the last two, etc. See what you come up with.

Correct Answer Order: 4, 3, 5, 1, 2

1. Client 6 hours post tracheostomy with a copious amount of sputum. This is an airway problem.
2. A client with pneumonia who reports difficulty breathing. This is a breathing problem.
3. New admit diagnosed with stable chronic angina reporting chest pain. This is a circulation problem.
4. Post-op abdominal hysterectomy client needing a dressing change due to quarter size bloody drainage. This is a bleeding problem.
5. A client scheduled for EGD requesting more information about the procedure that is scheduled today. Teaching, so this is last.

Now you know the best way to answer sequencing questions!

February 06

Debra S. McDonough, RN, MSN, EdD