Writing Multiple Choice Test Items – Part One

by VickyRN 22,016 Views | 2 Comments Senior Moderator

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    you, the nurse educator, must compose 50 multiple choice test items for your course content. you don’t trust the test bank questions, as some of these are being sold over the internet. also, you want questions that most accurately represent what you have presented in class. here are some tips on successful item writing.

    in writing quality multiple choice test items, the first thing is to review bloom's taxonomy - this is the guide to gauging critical thinking in the cognitive domain. please check out these helpful links:

    http://faculty.washington.edu/krumme/guides/bloom1.html
    http://www.officeport.com/edu/bloomq.htm
    http://projects.coe.uga.edu/epltt/index.php?title=bloom's_taxonomy

    the cognitive domain, according to bloom, is divided into 6 levels of difficulty: knowledge (remembering), comprehension (understanding), application (applying), analysis (analyzing), synthesis (creating), and evaluation (evaluating). most students (outside of nursing) are used to multiple-choice questions written on the knowledge level, which is "simple" memorization of facts, or at the level of comprehension, which advances one step further toward understanding. the instructor lectures the material, and the student simply "regurgitates" it back on a test.

    critical thinking, according to bloom, is only accessed on the "higher" levels of application and above. to encourage critical thinking, therefore, the majority of the questions that students will encounter in nursing school will be at the level of application and analysis. also, the majority of the questions on the nclex-rn and nclex-pn are written at the level of application and analysis. very few nclex questions are "mere" knowledge questions.

    for these types of questions (especially analysis), there will often be more than one "right" answer; the student will need to choose the "best" or "top priority" answer. these "higher order" type questions create quite a culture shock for the first semester nursing student. there are many students with 4.0 averages prior to nursing school who barely squeak by with a "c."

    prioritization questions may be written as:

    the nurse (charge nurse) is overseeing care of ___ clients on __________. or, concerning which of the following patient-care situations should the nurse notify the physician first?

    an example of prioritization question from this template:

    the charge nurse is overseeing care of 10 clients on a general obstetrical floor. concerning which of the following patient-care situations should the nurse notify the physician first?
    • prenatal client at 7 weeks gestation with nausea and vomiting and a whitish vaginal discharge.
    • a gravida 2 para 1 client at 28 weeks gestation with brownish facial blotches and +1 glucose and trace protein in a random urinalysis.
    • seventeen-year-old client at 15 weeks gestation with missed abortion and bleeding from iv site.
    • rh-negative client at 38 weeks gestation with blood pressure of 150/105, brisk reflexes, and generalized edema in hands and ankles.
    prioritization may also take this form on a question (written from a different angle):

    you are the charge nurse on a unit and need to make a bed available for a new admission. which of the following patients are you going to discharge first?

    i hope this has been helpful to you. stay tuned: more tips on writing quality multiple-choice questions will follow.

    helpful references

    2007 nclex-rn detailed test plan
    includes a comprehensive listing of content for each client needs category and subcategory, sample items, and an item writing guide along with sample case scenarios that provide nurse educators with hands-on experience in writing nclex® style test questions.

    “the examination consists of items that use bloom’s taxonomy for the cognitive domain as a basis for writing and coding items (bloom, et al., 1956; anderson & krathwohl, 2001). since the practice of nursing requires application of knowledge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing.” (p. 3)

    2008 nclex-pn detailed test plan
    includes an item writing guide along with sample case scenarios which provide nurse educators with hands-on experience in writing nclex® style test questions.

    “the practice of practical/vocational nursing requires the application of all levels of cognitive ability. the majority of items are written at the application or higher levels of cognitive abilities.” (p. 3)
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    VickyRN joined Mar '01 - from 'Under the shadow of His wings...'. VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. Posts: 12,043 Likes: 6,420; Learn more about VickyRN by visiting their allnursesPage


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    2 Comments so far...

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    I am in school to get my master in nursing education, the one thing I found was there are no questions on how to write test questions. These titles will be very helpful for me thanks df
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    Quote from dflowersrn
    I am in school to get my master in nursing education, the one thing I found was there are no questions on how to write test questions. These titles will be very helpful for me thanks df
    I am glad you have found this helpful. I have written a whole series of articles on item writing in my blog, so be sure to check these out. Best wishes to you in your future career as a nurse educator


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