Every format the NCLEX® uses.
Single Best Answer
4 options · 1 correct · Bloom's levels 1 through 5
The foundation of NCLEX® testing. You read a clinical scenario and choose the one best answer from four options. Every option is clinically plausible. Wrong answers reflect real misconceptions, not obvious throwaways.
At lower difficulty, SBA questions test recall and comprehension. At higher difficulty, they test prioritization and clinical evaluation. This format primarily exercises Recognize Cues, Analyze Cues, and Take Action.
Select All That Apply
5 to 6 options · 2+ correct · +/− partial credit scoring
You read a clinical scenario and select every correct answer. You earn a point for each correct option you pick, but each wrong option subtracts a point. Your score can never go below zero. This is the real NCLEX® +/− scoring model. You have to be right about what to include and what to leave out.
With SBA, you can sometimes eliminate wrong answers to find the right one. With SATA, you must evaluate each option independently. There's no shortcut. This format heavily tests Generate Solutions and Take Action. You're not just picking the best option, you're assembling a complete clinical response.
BowTie
16 options across 3 columns · 5 correct · All 6 CJMM steps
The most complex format on the NCLEX®. A single item that exercises all 6 CJMM steps at once. You read a clinical scenario, then work across three columns simultaneously.
Actions to Take
6 options. Select the 2 best nursing interventions for the identified condition.
Potential Condition
4 options. Identify the most likely condition from competing differential diagnoses.
Parameters to Monitor
6 options. Select 2 parameters that confirm your treatment is working.
Wrong answers aren't random.They're differential diagnoses that share real clinical cues with the correct condition. The actions and monitoring parameters for the wrong conditions are included as options. This is the same reasoning you'll use at the bedside when two conditions look similar but require different interventions.
Matrix/Grid
4 to 6 rows · Radio per row · Polytomous 0/1 scoring
A grid of clinical items with one decision per row. You read the scenario, then sort each finding, medication, or intervention into the right column. Every row is scored independently, so partial credit is baked into the format.
Matrix trains the chart-review reflex. You are not picking one best answer, you are working through a list the way you would on rounds. This format exercises Analyze Cues, Prioritize Hypotheses, and Generate Solutions.
Drop-Down Cloze
Inline blanks · Dropdown per blank · Polytomous 0/1 scoring
A short clinical note with blanks embedded in the sentence. Each blank is a dropdown. You pick the option that makes the note clinically accurate, one word at a time.
Cloze is the closest thing to finishing a handoff report. You have to keep the whole scenario in your head while you fill in the right details. This format heavily exercises Analyze Cues, Generate Solutions, and Take Action.
Unfolding Case Studies
Multi-phase · Evolving scenarios · All 6 CJMM steps across phases
A single patient scenario that evolves over multiple phases. You assess, intervene, monitor, and reassess as the clinical picture changes. Each phase builds on your previous answers.
Initial Assessment
“68 y/o presents with fatigue and irregular pulse”
Recognize Cues
New Information
“K+ 6.2 mEq/L. ECG shows peaked T waves”
Analyze & Prioritize
After Intervention
“Heart rate normalized. K+ trending down”
Evaluate Outcomes
Patients don't arrive with a diagnosis and a care plan. They arrive with symptoms that shift, labs that come back unexpected, and conditions that overlap. Case studies prepare you for that complexity in a way standalone questions can't.
More formats are on the way.
The NCSBN continues to expand Next Gen item types. As new formats are introduced, Lily will add them with the same 7 validation checks and adaptive difficulty engine.
How Lily uses them together
Lily doesn't give you 50 SBA questions in a row. Formats are rotated within each sessionbased on your difficulty level and the topic you're studying.
At lower difficulty levels, you'll see more SBA questions to build foundational knowledge. As you improve, Lily introduces SATA to test comprehensive thinking, then Matrix, Cloze, BowTie, and Case Studies to challenge your full clinical judgment. The format mix evolves with your skills.
Every format uses the same 7 validation checksand the same adaptive difficulty engine. The question type changes. The rigor doesn't.
Keep exploring
Practice every format.
SBA, SATA, BowTie, Matrix, Drop-Down Cloze, and Case Studies. Free to start, no credit card required.
Study With Lily is an independent study tool. NCLEX® is a registered trademark of the National Council of State Boards of Nursing (NCSBN®). Study With Lily is not affiliated with or endorsed by NCSBN. Questions are original practice items built with smart technology and validated for clinical accuracy. They are not derived from actual NCLEX® exam content.