Rules for Writing Test Items*
Determine level of difficulty using Bloom’s revised taxonomy.
Remembering—memorized facts
Understanding—just a rewording of memorized facts
Applying and analyzing—most questions should be at these two levels
Evaluating and creating—usually best examined in the clinical area
Examples of multiple choice questions demonstrating level of difficulty
PLEASE NOTE: Just because a question has a word from Bloom’s taxonomy in it, it does not mean that the question is at that level. For example, the word prioritize:
EXAMPLE 1: The nurse is reviewing the laboratory results of a patient who is scheduled for surgery. Which laboratory value would be priority for the nurse to report to the healthcare provider?
A) low high-density lipoproteins
B) low potassium *
C) high red blood count
D) low iron level
This is really a remembering level question. The student is choosing the laboratory value that places the patient at the highest risk.
EXAMPLE 2: The nurse is reviewing the laboratory results of a patient who is scheduled for surgery. Which laboratory value would be a priority for the nurse to report to the healthcare provider?
A. Creatinine of 4.0 mg/dl
B. Potassium of 4.5 mEq/L
C. Blood urea nitrogen (BUN) of 20 mg/dl
D. White blood cell count of 12,000/mm3
This is now an understanding question. The student needs to know the standard values and classify them as being high or low. It is still not a higher-level question.
EXAMPLE 3: A nurse has been assigned four patients. Which patient would have the priority for the nurse to assess? A patient who is
A. admitted with chronic renal failure with a blood urea nitrogen (BUN) of 20 mg/dl.
B. receiving gentamycin IV with a creatinine of 4.0 mg/dl. *
C. scheduled for surgery with a potassium of 4.7 mEq/L.
D. on chemotherapy with a white blood cell count of 4,000/mm3.
This is an evaluating question. The student needs to know what the normal levels are and be aware of what risks are involved. They can see that the BUN is high, but this is expected with chronic renal failure. The potassium level is normal. The WBC is low, but not significantly low. Gentamycin is a nephrotoxic drug, and the high creatinine level may indicate kidney damage.
Styles
Multiple choice: Always use 4 options
Stem
Make it a question, not a completion.
Be sure it is clear what you are asking.
Don’t use the words “of the following.”
Distractors
All answers should be plausible.
Avoid using the same words over and over in the options—include them in the stem.
Make the distracters homogenous (similar).
Make the answers consistent in length, OR 2 short and 2 long, or pyramid-shaped (first answer short, next longer, 3rd longer still, and 4th the longest).
Don’t use “all of the above” or “none of the above.” If you want the student to choose multiple answers, then write a multiple response question (Select all that apply.).
If the answers are numbers, list them in numerical order—lowest to highest.
Fill-in-the-blank questions: The answer should be a single word, phrase, or number
(i.e., dosage questions)
Multiple answer, multiple choice: Have 5 or more options. For the NCLEX, the correct answer can be anywhere from one to all the options.
Language
Person-first language—don’t label people according to their disease; don’t name clients.
Use gender-neutral language whenever possible.
Active voice—use present tense as much as possible.
Avoid second person—instead of saying “you should,” state “the nurse should.”
Always use the generic name for medications, but include both the trade and generic names in the question.
Use the standard order for vital signs—TPR and BP.
Don’t use italics, bold, underline, all caps, or small caps. These give away hints to the students. They need to learn to pick out those important words on their own.
Avoid negative questions. Instead of stating what prescription the nurse should not give, ask what prescription the nurse should question.
Don’t use the word except; rather, change it to a “Choose all that apply” question.
Do Not Use
Use Instead
Disease-first language
Person-first language
Doctor
Physician or healthcare provider
Orders or ordered
Prescription or prescribed
What action
Which action
Would be
Should
Hold
Withhold
The client
A Client
Of the following
(Rewrite the question)
Finish by checking for grammar errors.
*Developed by Dr. Virginia Hallenbeck, Visiting Professor, Chamberlain University; used with her permission.
NR537: Week 3 Rules for Writing Test Items 2/24/19/2019 (JAR)
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