Writing Multiple Choice Test Items - Part Three: The Application Question

Questions asking students to solve nursing math problems, determine the most appropriate action, or verify the correct step in a nursing procedure is considered application-type test items.

Learning at the application level requires a higher level of understanding ("critical thinking") than the reasoning required at the "beginning" knowledge level of Bloom's taxonomy.

In application processes, the student must be able to:

1. Prioritize information, ideas, or principles
2. Utilize understanding to perform an action or select the key
3. Remember and apply general facts, rules, and principles to produce desired results
4. Demonstrate, interpret, or predict situations or steps in a procedure
5. Use known strategies to problem solve

Examples:

Evaluating client responses or statements.

Determining which client situation requires immediate action.

Examples of application-level qualifiers useful in item construction: apply, practice, choose, determine, demonstrate, solve, modify, arrange, operate, and relate.

Examples of application-level nclex-style questions:

The client states, "I usually administer my regular insulin upon rising at 6 a.m., go for my morning walk and have breakfast with my wife around 8:30 a.m." the nurse understands the client:

1. Is doing everything correctly
2. Needs further teaching on peak, onset and duration of regular insulin*
3. Would benefit from a public health nurse caseworker assignment
4. Should eat a snack at 7 a.m. And then breakfast at 8:30 a.m.

In this item, the examinee must have the following knowledge: the pharmacokinetics of regular insulin (a common medication) and proper client education regarding diabetes, exercise, and insulin administration times. The test taker must then determine the appropriate nursing action based on this prerequisite knowledge and client data.

A client's 0730 blood glucose reading was inaccurately documented as 450 instead of 180. This error was not discovered until 0900. The nurse administered the sliding scale insulin for a blood sugar of 450 instead of 180. The nurse should first?

1. Take the client's vital signs
2. Check the client's blood glucose*
3. Notify the primary health care provider
4. Call the charge nurse to fill out an incident report

In this example, the examinee must recognize that a medication error has taken place and then apply knowledge of the actions of insulin to determine the correct intervention.

In nursing, application skills are critical because safe, effective client care depends upon the correct application of nursing knowledge, abilities, and skills in clinical settings.

A key to fair item writing for educators is to be sure that the levels of questioning used for instruction match the levels used for testing. Intersperse your lecture or class time with real-life applications of the content. This helps the class to become a more interactive, meaningful learning experience for students.