+/- scoring · 26 questions in 6 sets
NCLEX Matrix Multiple Response Practice Questions
Practice NCLEX matrix multiple response questions: several answers per row, scored +/-, with a rationale for every cell. Sets 1 and 2 are free, with no sign-up.
The format
What is a Matrix Multiple Response question on the NCLEX?
Matrix multiple-response grids let you select more than one column per row, for example linking each finding to every condition it could indicate.
Every column must have at least one selection.
Practice sets
26 Matrix Multiple Response questions in 6 sets
Each set covers one clinical topic and opens in the NCLEX-style test interface. Submit each answer to see the correct answer and a rationale for every option. Your progress and score are saved in this browser.
Neuro
Maternity
Pediatrics
Mental Health
Sample question
Try a Matrix Multiple Response question
Open the sample to see the format on the exam screen, with the correct answer marked and the reason each option is right or wrong. To answer questions yourself, start a set above.
Sample question: answer and rationaleFor each specimen collection step below, click to specify the specimen(s) to which the step applies. Each step may apply to more than 1 specimen.
The nurse in the medical unit is caring for a 71-year-old female client.
For each specimen collection step below, click to specify the specimen(s) to which the step applies. Each step may apply to more than 1 specimen.
| Specimen Collection Steps | Blood Culture | Sputum Culture | Urine Culture |
|---|---|---|---|
| Collect at least 2 sets. | ✓ | ||
| Have the client rinse the mouth with water only. | ✓ | ||
| Label the container in the presence of the client. | ✓ | ✓ | ✓ |
| Collect the specimen before the first antibiotic dose. | ✓ | ✓ | ✓ |
| Clean the skin with an antiseptic such as chlorhexidine. | ✓ | ||
| Clean the sampling port and withdraw the specimen with a sterile syringe. | ✓ |
Note: Each column must have at least 1 response option selected.
Correct answer and rationale
Matrix Multiple Response · +/- scoring
The orders call for three cultures and an antibiotic, so two rules apply to every specimen. Ordered cultures are collected before the first antibiotic dose, and each container is labeled in the client's presence, using two identifiers. The other steps belong to one specimen each. For a blood culture the skin is cleaned with an antiseptic such as chlorhexidine, because a contaminated culture can lead to unnecessary antibiotics, and at least 2 sets are recommended. Before a sputum specimen the client rinses the mouth with water only, with no mouthwash or toothpaste, then takes slow deep breaths and coughs deeply. Urine from an indwelling catheter is withdrawn from the cleaned sampling port with a sterile syringe; a culture specimen is not taken from the drainage bag.
Takeaway: every culture is collected before the first antibiotic dose and labeled in the client's presence; the collection technique depends on the specimen.
Why each option is right or wrong
- Collect at least 2 sets.: Blood culture only. At least 2 sets of blood cultures are recommended before antibiotics are started.
- Have the client rinse the mouth with water only.: Sputum culture only. The client rinses the mouth with water only, without mouthwash or toothpaste, before coughing up the specimen.
- Label the container in the presence of the client.: All three. Blood and other specimen containers are labeled in the client's presence, using two identifiers.
- Collect the specimen before the first antibiotic dose.: All three. Ordered cultures are collected before the first antibiotic dose, here before the ceftriaxone is started.
- Clean the skin with an antiseptic such as chlorhexidine.: Blood culture only. The skin is cleaned with an antiseptic such as chlorhexidine before the blood is drawn, because a contaminated culture can lead to unnecessary antibiotics.
- Clean the sampling port and withdraw the specimen with a sterile syringe.: Urine culture only. With an indwelling catheter, the sampling port is cleaned and the urine is withdrawn with a sterile syringe; a culture specimen is not taken from the drainage bag.
Sources
- ANA and CDC: white paper on nurses and antibiotic stewardship
- StatPearls: Septic Shock
- Comparison of Chlorhexidine and Tincture of Iodine for Skin Antisepsis in Preparation for Blood Sample Collection (J Clin Microbiol)
- Open RN Nursing Skills, 19.5 Sputum Specimen Collection (LibreTexts mirror)
- CDC Guideline for Prevention of Catheter-Associated Urinary Tract Infections: Summary of Recommendations
- The Joint Commission: National Performance Goals effective January 2026, Hospital Program
- DailyMed: Ceftriaxone for injection label
Scoring
How Matrix Multiple Response questions are scored
Scored +/- column by column: correct selections add a point, incorrect selections subtract one. Each column is floored at 0 separately, and the column scores are added together.
On-screen note: “Each column must have at least 1 response option selected.”
Scoring rules: NCSBN, Next Generation NCLEX. Last reviewed October 13, 2026.
How to answer Matrix Multiple Response questions
- Work down one column at a time: for this condition, which findings fit?
- A finding can belong to more than one column. Don't stop at the first match.
- Because wrong selections cost points within their column, leave a cell empty if you can't justify it.
FAQ
Matrix Multiple Response questions: FAQ
What's the difference between matrix multiple choice and matrix multiple response?
How is a matrix multiple-response question scored?
How do you answer a matrix multiple-response question?
Keep practicing
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