Many test developers suggest that multiple-choice items can be used to evaluate critical thinking if the items are focused on measuring higher order thinking ability. The literature supports the use of alternate item types to assess additional competencies, such as higher level cognitive processing and critical thinking, as well as ways to allow examinees to demonstrate their competencies differently. This research study surveyed nurses after taking a test composed of alternate item types paired with multiple-choice items. The participants were asked to provide opinions regarding the items and the item formats. Demographic information was asked. In addition, information was collected as the participants responded to the items. The results of this study reveal that the participants thought that, in general, the items were more authentic and allowed them to demonstrate their competence better than multiple-choice items did. Further investigation into the optimal blend of alternate items and multiple-choice items is needed.