Nick Item-Writing Academy
About 40 minutes · Academy module: SATA Workshop: Select All That Apply.
The Next Generation NCLEX multiple-response item presents a clinical scenario with typically five to seven options, of which more than one is correct — the examinee selects all that apply. Unlike a traditional item, there is no single key; each option is an independent true/false judgment against the lead-in. That independence is the whole design: a SATA item is really five to seven mini-items sharing one stem.
Because every option must stand alone, each one must be a complete, unambiguous statement. "Monitor the client's weight" is evaluable; "check vitals" is not (which vitals, how often, against what threshold?). Write each option as if it were the only option.
The cardinal SATA sin is telling the examinee how many answers to select ("select 3 options"). On the NGN, the count is not given — the examinee must decide for each option. Cueing the count converts the item from seven independent judgments into a process of elimination: pick the three most plausible and stop thinking.
The lead-in should name the decision, not the number: "Which actions should the nurse take? Select all that apply." Every option then earns its selection on content alone.
SATA options must not be logically linked. If option B ("administer oxygen") is only correct when option A ("raise the head of the bed") is also correct, the options cue each other — selecting one hands the examinee the other. Similarly, avoid options that are mutually exclusive unless the scenario genuinely supports it; two options that cannot both be true turn the item into a single-choice item wearing a SATA costume.
Our read: linked options are the flaw SATA authors defend as "clinical realism" ("in practice you'd do both"). In practice you would — but the item then measures one decision twice. Split linked pairs into separate options or separate items.
A well-built SATA item rewards complete knowledge and punishes partial knowledge — that is the design. But authors sometimes build items where every option is correct (a checklist, not a test) or where the incorrect options are so implausible that the item collapses into "select the plausible ones." Aim for a mix: clearly correct actions, clearly incorrect actions, and at least one near-miss that only the well-prepared examinee resolves correctly.
(intended keys: A, C, E)
Stem: A nurse is preparing to administer a blood transfusion. Which actions should the nurse take? Select the 3 correct actions.
A. Verify the blood product with another registered nurse at the bedside B. Prime the transfusion tubing with dextrose solution C. Stay with the client for the first 15 minutes of the transfusion D. Administer the transfusion over 8 hours E. Obtain baseline vital signs before starting the transfusion
the lead-in cues the count ("select the 3 correct actions").
Naming the count converts seven independent judgments into elimination: once the examinee identifies two correct actions, only one slot remains, and the hardest decision is made by arithmetic. The NGN never states the count. The rewrite removes it — and fixes option B's content trap in passing (blood is primed with normal saline, never dextrose, which hemolyzes red cells).
— cold-solve verified: 2/2 (solvers chose A, C, E — both)
Stem: A nurse is preparing to administer a blood transfusion. Which actions should the nurse take? Select all that apply.
A. Verify the blood product with another registered nurse at the bedside B. Prime the transfusion tubing with dextrose solution C. Stay with the client for the first 15 minutes of the transfusion D. Administer the transfusion over 8 hours E. Obtain baseline vital signs before starting the transfusion
Keys: A, C, E
Two-nurse bedside verification, staying for the first 15 minutes (when most reactions occur), and baseline vitals are all correct. Dextrose hemolyzes red cells (normal saline only), and a unit must infuse within 4 hours — 8 hours risks bacterial growth. Both independent cold solvers selected exactly A, C, and E.
Recording it adds the module to your Academy completion record on this device — module, track, level, and date, ready to download from your account page for faculty-development documentation.