We performed 4 experiments assessing the learning that occurs when taking a test. Our experiments used multiple-choice tests because the processes deployed during testing can be manipulated by varying the nature of the choice alternatives. Previous research revealed that a multiple-choice test that includes "none of the above" (NOTA) produces better performance on a subsequent test only when the correct answer is something other than NOTA (Odegard & Koen, 2007). However, when NOTA was an incorrect choice alternative, the correct answer was the only familiar alternative. Thus, familiarity may have allowed participants to identify the answer, which was then restudied. In other words, the testing benefit might have reflected a familiarity-guided restudy process rather than retrieval practice. In the current study, we examined the role of familiarity in the multiple-choice testing effect, manipulating the familiarity of alternatives. If NOTA was the correct answer, there was no testing benefit when the alternatives were all novel (Experiment 1) or all familiar (Experiment 3). Familiarity-guided restudy predicts memory impairment when there is a single familiar alternative for a NOTA-correct question. In contradiction to this hypothesis, there was a testing benefit for this condition (Experiments 2 and 4). Experiment 4 further collected metacognitive confidence ratings during the multiple-choice test, providing evidence of a recall-to-reject strategy for this condition. These results suggest that learning from multiple-choice tests is mainly due to retrieval practice rather than the use of familiarity.