In an NMCN except question, three options are true and one is false. The answer is the false one. That sounds obvious, and it is exactly why candidates lose the mark: the moment your eye lands on a statement you know is correct, your hand wants to choose it. Everything below is about breaking that reflex. This page does not contain past questions or leaked papers, and it covers only negative stems. For the wider range of formats you will meet, see our guide to NMCN exam patterns. Try free NMCN past/practice questions.
Why NMCN Uses Negative Question Stems
A positive question asks you to recognise the right answer. A negative one asks you to judge four statements on their own merits and then pick the odd one out. Those are different skills, and the second is harder to fake.
Whatever the examiners' exact intention, the practical effect of an EXCEPT stem is that one item tests four facts at once. You cannot score it by spotting a familiar phrase. You have to know whether each statement is true. That is a reasonable thing to test in a nurse, because the alternative — pattern-matching on keywords — is how people answer confidently and wrongly.
There is a second, quieter reason. Nursing work punishes skim-reading. A single word in an instruction, a prescription or a handover changes what you do. A stem that hinges on one small word trains the same attention. Treat negative items as reading tests wrapped around content, not as trick questions to be resented.
Common Negative Words to Circle Before You Answer
The word that flips the question rarely shouts. It is usually one short word sitting in the middle of a long stem. Before you evaluate any option, find it.
- EXCEPT — as in "All of the following are true except".
- NOT — "Which of the following is not a sign of…"
- FALSE or INCORRECT — "Which statement is false?"
- LEAST — "Which is the least appropriate action?" This is a ranking stem. It reads as positive but behaves like a negative one, because you are looking for the weakest option, not the best.
- CANNOT, SHOULD NOT, AVOID — each one reverses the direction of the question.
Then watch for the double negative, which is where even careful candidates fall. "Which of the following is not an inappropriate action?" Two reversals cancel out, and the question actually wants the appropriate action. If a stem contains two negatives, slow right down and rewrite it.
The mental mark matters more than the physical one. If you are working on paper, circle the word. If you are on a screen that will not let you mark anything, say the rewritten stem silently in your head before you look at the options: "Three of these are true. I want the false one." Do it every single time until it stops feeling necessary — which is usually never.
How to Eliminate Three True Options Safely
Elimination is the whole method. You are not hunting for the answer; you are proving that three options are correct so that the fourth must be the one.
- Read the stem to the last word before you look at the options. Many misreads happen in the half-second where the eye jumps ahead to option A.
- Rewrite the stem in positive form. One short line: "Three of these are true. One is false." Keep that line in front of you.
- Judge each option on its own. Beside A, B, C and D write T or F. Do not decide anything yet. You are marking statements, not answering a question.
- Count. Three T and one F means you are finished. The F is your answer.
- If you get two F's, stop. That is a signal, not an answer. Either you misread the stem, or you do not know the content well enough for that item. Reread the stem first, then the options.
- Put your chosen option back into the stem as a sentence and check it reads correctly. "The following are acceptable practice except… using an alcohol-based hand rub on visibly soiled hands." That sentence is coherent, so the choice holds.
Common mistakes, all of which cost marks you already earned:
- Choosing an option because it repeats a word from the stem. That is familiarity, not truth.
- Choosing the first option you are certain is true, forgetting the EXCEPT you read ten seconds ago.
- Treating LEAST as MOST, which flips a ranking item inside out.
- Changing a correct answer during the last minutes because a different option started to feel right. Change only when you can point to a reason.
Worked Example: An 'EXCEPT' Item
The item below was written for teaching. It is not a past question and it is not taken from any NMCN paper.
All of the following are acceptable when cleaning the hands EXCEPT:
- Removing hand and wrist jewellery before cleaning the hands
- Using an alcohol-based hand rub when the hands are visibly soiled with blood
- Cleaning the hands before and after touching a patient
- Cleaning the hands after removing gloves
Step one. Mark the word EXCEPT. It is the fourth word from the end of the stem, which is exactly where people stop reading.
Step two. Rewrite: "Three of these are acceptable. One is not."
Step three. Judge each option separately. Removing jewellery before cleaning the hands is standard practice, so A is true. Cleaning the hands before and after patient contact is core practice, so C is true. Cleaning the hands after removing gloves is also expected, so D is true. That leaves B: an alcohol-based rub is not the right choice when hands are visibly soiled with blood or body fluids, because the physical soiling has to be washed off with soap and water. B is false.
Step four. B is the answer.
Now look at why B is dangerous. It contains a phrase — alcohol-based hand rub — that appears in dozens of correct hand hygiene statements. A candidate answering by recognition sees it and feels a pull towards it. That pull is the trap. Content knowledge says the statement is false; stem-reading says the question is asking for the false statement. You need both to score it, and you need neither if you answer on instinct.
Notice also what happens if you forget the EXCEPT halfway through. You would land on A or C as a confident, correct statement and lose the mark while believing you knew the content. That is the most frustrating way to fail an item, and it is entirely preventable.
Practice Routine for Negative Questions
Reading carefully is a habit, and habits are built by repetition rather than by deciding to be more careful on exam day.
- Write your own EXCEPT items. Take one topic. Write four true statements about it. Change one word in one statement to make it false. Now write the stem with EXCEPT. Doing this a few times shows you where the false option normally hides, and you stop being surprised by it.
- Mark the negative word every time you practise. On paper, circle it. On a screen, restate the stem silently before answering. If you skip the mark, the practice is not training the habit you need.
- Keep an error log with three columns: misread the stem, did not know the content, changed a correct answer. This page fixes the first column only. If most of your errors sit in column two, the problem is content, not question-reading, and more practice questions will not help until you go back to the material.
- Practise in blocks, then mix. Do a set of negative items until the routine is automatic, then work through mixed papers. Real papers switch between positive and negative stems without warning, and that switching is the part that catches people.
- Budget the extra seconds. A negative item costs a little more time than a positive one. Plan for that instead of rushing to keep pace with a clock you are imagining.
One last thing worth saying plainly. Exam formats, instructions and sitting arrangements change, and nothing on this page is a substitute for the current guidance from the Nursing and Midwifery Council of Nigeria and your own school. Confirm the details with them before your exam. FreshNote does not supply leaked or actual exam questions — what you get here is a method for reading the questions you are given.