1. Multiple Choice Item (MCI) Quick Reference Guide
NURS 5328
Tracy Nash, Holly Northcutt, Robin Roberts, Cheryl Sheffield, & Elizabeth Tilley
General Writing
Guidelines
Guidelines for Writing
Good Alternatives/Options
Considerations for Writing
Critical Thinking MCIs
• Make all answers grammatically similar
• Each answer should have the same number of parts.
• All alternative/options should sample the same
domain (i.e., assessment finding, diagnostics, or other).
• If repeating words in each alternative/option, move
those words to the stem.
• If the stem is a sentence or a question, end it with the
appropriate terminal punctuation.
• Ranges in values should not overlap each other.
• Make sure each choice is numbered or lettered.
• Avoid using “none of the above” or “all of the above.”
• If asked to choose the “best” answer there must be
scientific evidence to support it.
• Keep succinct: shorter than 1 line; shorter than stem
• Number of options -Four options reduce the chance
of guessing, but use three options if you can’t come
up with a fourth plausible option.
○ Plus side of three options - reduces reading
time, covers a wider range of content, and
increases validity of the test.
• Place those with a value in numerical, chronological,
or sequential order (ascending or descending).
• Positive statements- avoid negativity; avoid double
negatives = impossible confusion.
• Retain information in the stem and avoid overlapping.
• Homogeneous appearance- Alternatives/options
should be equally attractive, meaning parallel in
length, grammatical structure, content, and
complexity. If use opposite options consider:
○ Rule of Two Sets - two sets of opposites attract
the uninformed student to all four options).
Use medical terminology and technical
language consistently.
Sequential Reasoning
• This is the key to writing questions that
require critical thinking
• Requires two logical steps: remember
then analyze (students must apply their
knowledge)
• Lower levels of cognition require only
memorization
Writing Original Critical Thinking Items
• Must apply sequential reasoning
• Identify the competency and course
objective
Novel Problems
• If students are presented with a higher
level problem, yet they are familiar with
the problem the question is still a recall
item
• Do not convert a situation used in class
into a test question
• The more unique the question, the more
critical-thinking is involved
Follow these general rules when writing test items:
• Every item should measure something important.
• Every item should have a correct answer.
• Use simple, clear, concise, grammatically correct
language; eliminate unnecessary information
• Avoid jargon, slang, and unnecessary
abbreviations.
• Use positive wording.
• Items should not contain irrelevant cues or
correct answers.
• Ensure each item can stand alone.
• Peer critique of test item: Ask colleague critique
your questions (Do they agree on the correct
answer?)
• Prepare more test items than the blue print calls
demands.
Parts of a Multiple Choice
Item (MCI)
MCI Format Consists of 2 Parts:
1. The Stem (identifies the problem or question)
2. The Options (presents the response alternative)
Also contains a key and distractors. Every test item
should represent BOTH course content and a learning
outcome.
Framing Questions in the
Nursing Process
Guidelines for Writing
Effective Question Stems
• Complete – Student should understand what stem is
asking before reading the options.
• Keep clear and to the point! Use several short
sentences if one long sentence is too confusing.
Students should be able to read and answer the item
in less than one minute.
• Do not use the stem to teach.
• Eliminate key words that may cue the answer.
• Avoid negative wording - If you use a negative word
make sure it so it REALLY stands out.
• Avoid ending the stem in a incomplete sentence.
• If it must be an incomplete sentence; provide
alternative answers that would make a complete
sentence.
• Stay focused – each item should serve one purpose.
• Present tense- avoid a passive voice.
• Avoid bias and homonyms.
• If use the completion format, do not leave a blank
at the beginning or middle of a stem.
Designing Distractors
Plausibility → All distractors must be plausible
without being too tricky
Misconceptions → Keep log of common
misconceptions students express in
the clinical setting to create
effective distractors
Sound bites → Use a distractor that is word for
word what is said in class, but is
not the answer
Seek help → Students must discriminate among
appropriately other nurse action items and
recognize the need to call the MD
Quote the RN/ → Quotes need to represent real life
patient situations