Field NotesJun 2026

How to Answer Select All That Apply (SATA) NCLEX® Questions

Students think SATA is all-or-nothing. Since 2023, NCLEX® Select All That Apply questions get partial credit. Here's how +/- scoring works and how to answer.

June 21, 202610 min readBy Harrison HesslinkReviewed for accuracy

TL;DR: Select All That Apply (SATA) questions are "multiple response" items on the NCLEX®, and since April 1, 2023 they earn partial credit, not all-or-nothing. NCSBN scores them with the +/- method: you gain a point for every correct option you pick and lose one for every wrong option, with the item floored at zero (NCSBN, 2023). The winning strategy: treat every option as its own true-or-false question.

If one question type keeps nursing students up at night, it is Select All That Apply. You read five or six options, any number of them can be right, and it feels like a coin flip you are guaranteed to lose.

Here is the part almost nobody updated their notes for. The old rule that you had to get every single option right or score zero is gone. It went away on April 1, 2023, when the Next Generation NCLEX launched (NCSBN, 2023). SATA now gives you partial credit. That single fact changes how you should answer.

And the pressure is lower than the rumors suggest. First-time US-educated candidates passed the NCLEX-RN at 87.1% as of November 1, 2025 (Nurse.org, 2025). SATA is learnable. This guide breaks down what these questions actually are, how the new scoring works, and a repeatable method you can use on every one.

A nursing student reviewing NCLEX practice questions on a laptop with a stethoscope nearby

What does "Select All That Apply" mean on the NCLEX?

A Select All That Apply question is a multiple response item on the NCLEX®: it gives you a list of options, usually five or six, and asks you to choose every option that is correct (Kaplan, 2023). There is no fixed number of right answers. It could be two. It could be five. You have to decide each one on its own.

This is the format students fear most, and the fear makes sense. A standard multiple-choice question lets you pick the single best answer and move on. A SATA item asks you to make a separate yes-or-no call on every option in the list. One question, five or six small decisions.

A few mechanics worth locking in before test day:

The correct count is hidden. The screen never tells you how many to pick. If you walk in expecting "probably three," you will talk yourself into a wrong one.
You cannot leave it blank. You have to make at least one selection to move forward.
Options are independent. Each one is either in or out on its own merits. Two options being similar does not mean both are right or both are wrong.
SATA shows up everywhere. You will see standalone SATA items and SATA built into the unfolding case studies, especially in the "Recognize Cues" step of the clinical judgment model (ATI, 2023).

Does the NCLEX give partial credit for SATA questions?

Yes. As of April 1, 2023, NCLEX® Multiple Response Select All That Apply items are scored with the +/- method, which awards partial credit. Before that date, these items were all-or-nothing: you scored the point only if every selection was perfect (NCSBN, 2023). This is the single most important update to how you should think about SATA.

The Next Generation NCLEX uses three scoring rules across its item types: 0/1 scoring, +/- scoring, and rationale scoring (Nurse Plus, 2023). SATA uses +/- scoring. Here is exactly how it works:

You earn +1 point for each correct option you select.
You lose 1 point for each incorrect option you select.
The points are summed for a total item score.
If that total is negative, it is floored at zero. You can never score below zero on a single item.

So a wrong selection costs you, but it can only cost you within that one question. It cannot drag your score into the negative or bleed into the next item. Picture a SATA item with five options where three are correct. The maximum score is 3.

What you select	Correct picked	Wrong picked	New +/- score	Old all-or-nothing
All 3 correct, 0 wrong	3	0	3 of 3	Full credit
2 correct, 0 wrong	2	0	2 of 3	0
3 correct, 1 wrong	3	1	2 of 3	0
1 correct, 2 wrong	1	2	0 (floored)	0

Illustrative example based on the +/- scoring rule. Not an official NCSBN sample item.

Look at row two. You knew two of the three answers cold and skipped the one you were unsure about. Under the old rules that was a flat zero. Under +/- scoring, it is two-thirds of the credit. Partial knowledge now earns partial points.

How to answer SATA questions: a 6-step method

The best way to handle a Select All That Apply item is to stop treating it as one big question and start treating it as a stack of small ones. Below is a repeatable method you can run on every SATA item, on standalone questions and inside case studies alike.

1. Read the stem, then cover the options

Before you look at the choices, answer the question in your head. What is this item actually asking? What is the patient situation, and what would safe care look like? Forming your own answer first keeps the option list from leading you somewhere you would not have gone on your own.

2. Turn each option into its own true-or-false question

This is the core move. Go down the list one option at a time and ask: "Is this statement true for this specific patient, yes or no?" Decide each one in isolation. Do not compare options against each other. A SATA item is not "pick the best ones," it is "judge each one." Five options becomes five clean decisions.

3. Ignore how many you have selected

There is no magic number. If you finish and you have selected two, that is fine. If you have selected five, that is fine too. The moment you think "I have four, there is probably one more," you start hunting for an answer that may not be there. Trust the true-or-false call you made on each option.

4. Watch the absolutes

Options with absolute words like "always," "never," "all," or "none" are often wrong, because nursing rarely deals in absolutes. Options with measured language like "usually," "may," or "can" are more often defensible. This is not a guarantee, but when you are stuck on one option, the wording is a useful tiebreaker.

5. Default to safety, airway, and the least invasive action

When an option leaves you genuinely unsure, run it through the nursing safety lens. Does it protect the airway, breathing, and circulation? Does it follow Maslow, meeting physiological and safety needs first? Is it the least invasive, most patient-centered choice? Options that violate basic safety are almost always "false," even when they sound reasonable.

6. For case-study SATA, use the clinical judgment steps

Inside an unfolding case study, SATA items usually live in the early "Recognize Cues" and "Analyze Cues" stages of the NCSBN Clinical Judgment Measurement Model: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes (ATI, 2023). Ask which pieces of patient data are relevant and abnormal. Those cues are usually your correct selections.

Why partial credit should change how you answer

Partial credit rewards confident knowledge and quietly punishes wild guessing, so your job is to select what you genuinely believe is correct and leave the rest alone. Because each wrong pick subtracts a point under +/- scoring, "select everything just in case" is the worst possible approach (NCSBN, 2023).

Think about the math from the scoring table. Every correct option you select adds a point. Every wrong option you select takes one away. So two behaviors hurt you:

Over-selecting. Adding a shaky option you do not really believe risks a wrong pick that cancels out a right one.
Freezing. Refusing to commit to options you actually know wastes the partial credit that is now on the table.

The sweet spot is honesty. Select the options you can defend with a reason. Skip the ones you cannot. You no longer need certainty across the whole list to score, you just need to be right about the ones you choose.

A nurse reviewing patient information on a mobile device between tasks

How to practice SATA before test day

The students who stop fearing SATA are the ones who have answered enough of them that the format feels boring. Familiarity is the whole game here. You want the six-step method to run on autopilot so test-day nerves cannot knock you off it.

A few ways to build that reflex:

Drill SATA on purpose. Filter your practice to multiple-response items and do sets of them, instead of waiting for them to show up at random.
Review by option, not by question. When you miss a SATA item, go through every option and write one sentence on why it was true or false. The miss is usually one or two options, not the whole question.
Practice the case-study version. Standalone SATA and case-study SATA feel different under time pressure. Rehearse both.

This is where studying from your own course material pays off. Study With Lily turns your class notes and lecture slides into adaptive NCLEX® practice, so the SATA items you drill match the content your program actually tests, and the difficulty adjusts as you improve. Lily tracks which option types trip you up and brings them back until they stick.

Start practicing SATA free

Frequently Asked Questions

Does the NCLEX give partial credit for Select All That Apply questions?

Yes. Since April 1, 2023, NCLEX Multiple Response SATA items use +/- scoring, which awards partial credit (NCSBN, 2023). You earn a point for each correct option and lose one for each incorrect option, with the item score floored at zero. The old all-or-nothing rule no longer applies.

How does +/- scoring work on SATA?

You gain +1 for every correct option you select and lose 1 for every wrong option. The points are summed for the item, and if the total is negative it is set to zero (Nurse Plus, 2023). A wrong selection only costs you within that single question and never carries over to another item.

How many options does a SATA question have, and how many are correct?

Most SATA items present five or six options (Kaplan, 2023). The number of correct answers is not fixed and is never shown to you. It could be as few as one or as many as all of them, so judge each option on its own rather than aiming for a target count.

Should I guess on SATA questions?

Select every option you can defend with a clinical reason, and leave the rest. Because each wrong pick subtracts a point, selecting options you do not believe in can cancel out the credit you earned on the ones you do. Honest, reasoned selection beats both over-selecting and freezing.

Can I leave a SATA question blank?

No. You must make at least one selection to advance to the next question. Even when you are unsure, choose the options you are most confident are correct rather than skipping, since partial credit means a single right selection still scores.

Is SATA the hardest part of the NCLEX?

Many students find SATA the most intimidating format, but it is very learnable, and first-time US-educated candidates pass the NCLEX-RN at about 87.1% (Nurse.org, 2025). A consistent method plus repeated practice removes most of the difficulty well before test day.

Sources

About the Author

Harrison is the founder of Study With Lily. He built the platform after watching his wife and her nursing school classmates wrestle with expensive, outdated prep tools. He writes about NCLEX® strategy, test-plan changes, and evidence-based study methods, drawing on NCSBN primary sources and firsthand experience supporting a nursing student through the exam.

Last updated: June 21, 2026 · 9 min read