Test-Taking Tips from a Test Writer

These are a few tips I've learned from writing test questions for various organizations, including the American Nurses Association and HealthStream. Nurses General Nursing Article


Test-Taking Tips from a Test Writer

These are a few tips I've learned from writing test questions for various organizations, including the American Nurses Association and HealthStream. There are also insights gained from coaching nurses in employment entrance exams like Prophecy.

Some language I've learned: Test questions (questions and answers) are called items. The question posed is the stem, and the responses or options are distractors.

When item writers create questions, their purpose is not to trick the test-taker. The goal of well-constructed test questions is to separate those with a solid grasp of the content from those without. A good item writer tries to avoid flaws that clue "test-wise" students to the correct answer. Those of you who are "testwise" know what these flaws are!

Collectively exhaustive options

If the responses include collectively exhaustive options, such as a decrease in serum glucose, an increase in serum glucose,  or no change in serum glucose, then the correct answer is likely one of these options.

Avoid exceptions to the rule

Do not choose answers that are an exception to the general rule. Test questions assume ideal conditions, not real-life, nuanced conditions.

Recognize poor rationale

When choosing an answer, avoid selecting options that use hospital rules and regulations to justify actions.

Most inclusive answer

Read all of the options. Select the most inclusive option. For example, a question might read, "A toddler's development is influenced by which?" Three options might be genetics, environment, and nutrition. The correct answer is the fourth option, multiple factors, as it's a more inclusive choice.

Don't overthink

Do not look for hidden meanings. All the information required to answer the question is included in the stem. Research shows that test takers gain more by sticking with their original choice. Anecdotally, I've heard so many nurses say, "I knew the right answer, but I changed my mind!" when they were shown their test results on specific questions they missed.

False components

The entire statement is false if any part of the answer is false. 


Well-designed test questions have incorrect options that are plausible or represent common misconceptions. This is not to trick candidates but to identify test takers who know the information from those who don't.

No pattern of correct answers

In computerized tests, the correct answer position is selected randomly. Even if the letter "a" was correct two times in a row,  the letter "a" is still an option for the next question. Each question should be approached independently. The old advice to "choose "c" when in doubt" is incorrect.

No wild guesses

If you are uncertain about a multiple-choice question, first eliminate the choices you believe are wrong. Narrowing down the options increases the likelihood of selecting the correct answer. 

Avoid absolute terms

In nursing, as in real life, very few things are considered absolute. Answers that contain words like "always," "never," or "none" are not the correct choice in most cases.


It is essential to take note of key phrases such as "first," "primary," and "early in the postoperative period" in the question. The test writer included the keyword or phrase as an important clue to the correct answer. 


Make sure your answer is reasonable and can be carried out under ordinary circumstances. Test questions are typically based on straightforward situations. Avoid considering exceptional situations.

Grammatical inconsistencies

If the question is an incomplete sentence, each option should be able to complete the sentence grammatically correctly. If there are options that do not match the stem's grammar, they are probably incorrect. For example, if the incomplete sentence reads "A factor in successful breastfeeding is…" an option that reads "medical checkups" is probably wrong.

Longest option

There may be instances where the longest option is correct, but in a well-designed question, the answers are the same length. Students who are "testwise" choose the longest answer, but it is a design flaw that good test writers avoid.

Negative terms in the stem

If you feel confused, reread the question, as you may have missed negative words like" not" or "except" in the statement. Negative terms can be confusing, so test writers are often instructed to avoid negative terms and frame questions positively. Likewise, well-written test questions should not include "all of the above" or "none of the above."

I hope these tips help in your next test!

Career Columnist / Author

Hi! Nice to meet you! I especially love helping new nurses. I am currently a nurse writer with a background in Staff Development, Telemetry and ICU.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Is point biserial something that's utilized in all tests? I'm a test writer/content editor for one of the NCC OB certification exams, and it was fascinating learning about what goes into test creation, the statistical evaluation that takes place, etc. Definitely learned a bunch of new words and phrases!

Specializes in Nurse Leader specializing in Labor & Delivery.

 If there are options that do not match the stem's grammar, they are probably incorrect.

That is actually an example of poor content editing - all distractors should be grammatically correct and fit the stem. That's one of the things we do in my group - make sure that the grammar is consistent and correct.