Writing Multiple Choice Test Items: Part One

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.

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 lady partsl 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.