Multiple Choice Test Items - Response Options

The response (answer) options follow the stem. the answer selection part of the test item contains several (usually three) incorrect choices (distracters), plus one correct answer (the key).

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The nurse educator should use clear and direct terminology in crafting the response options. Response options should not be verbose or contain overly scientific jargon or colloquial speech. They should be written as precisely, clearly, and simply as possible. Unusual words, flowery phrases, or idioms should be avoided. The students are being tested on their nursing knowledge, not on their reading comprehension or English linguistic ability. The language level should be consistent with the undergraduate college level.

The key must be the one and only response that is correct unless a qualifier is used in the stem. In this case, the distracter, while technically being "correct," is incomplete. If the stem contains a qualifier such as most or best, then the key must clearly be the most complete or best answer.

The correct response should not stand out as "different" in length, complexity, style, detail, syntax, or in any other manner from the incorrect options. The key should not be the only answer that clues back to the stem by certain words or phrases. Avoid grammatical inconsistencies that may "give away" the correct answer (such as "a" or "an").

The options should be sequenced in a logical, systematic order, such as ascending or descending rank. An example of this is a numeric sequence, such as a listing of ages.

The incorrect choices (distracters) should be reasonable, believable and attractive to examinees who are unfamiliar with the content or who do not know the correct response.

Distracters should display a logical association with the stem and the correct response.

Distracters should be mutually exclusive and not overlap in content. Content needs to be unambiguous and clearly distinguishable. The options should not be partially duplicated or appear as a subset of another.

Avoid "all of the above" or "none of the above" answer choices. Test-savvy students may correctly answer the question by identifying just one of the response options while only possessing a limited understanding of the content information.

The determiners "always" and "never" should be avoided. These words allow students to discard distracters by making the correct answer more conspicuous.

Avoid the use of double negatives, as these are very confusing to test takers.

Avoid the inclusion of humor in distracters (a "funny" or "off-key" response). The use of humor, though therapeutic in many situations, is inappropriate here. Taking a multiple-choice examination is serious business and not a laughing matter.

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