Outcomes Evaluation in Nursing Education and Multiple Choice, Multiple Response, Chart & Exhibit Questions and Fill-in-the-Blank

Multiple Choice, Multiple Response, Chart and Exhibit Questions and Fill-in-the-Blank for Outcomes Their Advantages and Disadvantages Evaluation in Nursing Education

Understanding the Structure of Multiple Choice and Alternative Format Test Questions

Writing most types of test items used by nurse educators involves creating a scenario, a description of a nursing care situation that requires problem-solving, making judgments and clinical decisions; a stem, or question; and a set of answers, or options, one or more of which are correct and others that are incorrect (distractors).

Writing Multiple Choice and Alternative Format Test Items

The most common types of questions used by nursing faculty are multiple-choice and alternative-format questions. Alternative-format questions include chart and exhibit, short-answer and fill-in-the blank, hotspot (rollover), drag and drop or ordered response, graphic and graphic response, audio, video, and multiple choice.

Multiple choice and alternative-format items are used on licensing exams. Multiple-choice questions are typically used in certification exams. The definitions, advantages, disadvantages, guidelines for writing, and an example of each of these types of test items follow.

Multiple Choice Items for Test Format in Nursing Education

A multiple-choice item consists of a scenario, which provides data about a client situation; a stem, which can be a question or an incomplete statement; and options (answers), one of which is correct and three of which are incorrect (distractors). Multiple-choice items, when carefully constructed, can measure critical thinking and higher levels of the cognitive domain (McDonald, 2013; Su et al., 2009).

Advantages of Multiple-Choice Questions

Multiple-choice items allow faculty to sample a large amount of content in a single test. Test items can be scored easily and objectively. Scores on multiple-choice tests are less influenced by guessing than scores on true–false tests. These items are versatile because they can measure learning of several levels of cognitive processes.

Disadvantages of Multiple-Choice Questions

Writing good articles with plausible distractors can be time consuming. This item type takes more time for the student to read and understand. These items may discriminate against the creative, verbal student. Scores can be affected by students’ reading ability and the instructor’s writing style. This item type can raise the score of the student who can recognize rather than produce the correct answer.

An older adult is admitted to the hospital because of severe diarrhea. The client is thirsty, and skin turgor is poor. The blood pressure is 92/64 and pulse is 100. The serum sodium (Na+) level is 165 mmol/L. The nurse should develop a plan to:

1. Protect the skin from friction.
2. Increase fluids.
3. Prevent excoriation of the rectal area.
4. Place the client on “falls alert.”

Multiple Response Items for Test Format in Nursing Education

A multiple response item, like a multiple-choice item, has a scenario, stem, and options; However, there are more than four options (usually five or six) and the options are written so that two or more of the answers are correct. Students are instructed to choose all correct answers (“select all that apply”) to receive credit for the question.

Advantages of Multiple Response Items

Multiple-response items allow for several correct answers and require students to cluster correct responses. There is less opportunity for choosing options by process of elimination than with standard multiple-choice items. The use of multiple-response items avoids using “all of the above” as an option.

Disadvantages Multiple Response Items

Multiple-response items require more options (usually five or six) and thus more distractors than standard multiple-choice items. Scoring, particularly by computer, may be more difficult.

The nurse implements a medication safety teaching plan for an older adult. Which statements by the patient indicate that the teaching has been effective? “I will” (Select all that apply.)

1. throw away any medications I am no longer using.”
2. have my prescriptions filled at different pharmacies to get the best price.”
3. Tell my physician about any nonprescription medications I am taking.”
4. crush any medications that I have difficulty swallowing.”
5. take all my medications with food to avoid stomach upset.”
6. Report possible side effects of my medications to my physician.”

Chart and Exhibit Questions for Test Format in Nursing Education

These questions, an example of
interpretive questions, assess the test taker’s ability to seek and use data presented on a client’s chart or health record. The data will be presented from one or more chart “tabs”: prescriptions, history and physical, laboratory results, miscellaneous reports, imaging results, flow sheets, intake and output, medication administration record, progress notes, and vital signs.

When the test is administered by computer, the test-taker will be required to search in a way that simulates search through a client’s chart or computerized patient record. The question may be similar to a multiple-choice question with four answers, with one correct answer, or a multiple-response question with more than four options that asks the test taker to “select all that apply.”

Advantages of Chart and Exhibit Questions

Chart and exhibit questions test the ability to consider which data are needed for client care and to test in higher levels of cognitive domain. These questions require test-takers to use data for clinical decision making and use them to interpret a set of data, for example, trend data on a vital signs record.

These questions also simulate obtaining data from a client’s chart; test-takers can be timed to ascertain whether they know what data to obtain and where on a chart to find it.

Disadvantages of Chart and Exhibit Questions

Chart and exhibit questions are time consuming to develop. Chart and exhibit questions may require duplicating chart forms to develop the test questions.

A parent has brought a 4-month-old to the immunization clinic. The nurse is reviewing the immunization record on the progress notes.

Which immunization(s) will the infant receive at this visit? (Select all that apply.)

1. DTaP #3
2. HepB #2
3. IPA #2
4. MMR #1
5. Varicella

Fill-in-the-Blank Questions for Test Format in Nursing Education

The short answer or fill-in-the-blank item requires the student to produce an answer (Miller et al., 2012). The question can have a scenario and a stem, but the “answer” is constructed by the student. This item type is used when the instructor wants the student to recall or calculate the answer (fill in the blank).

The student could also be asked to visually represent the answer, for example, “Calculate a drug dosage, then mark the answer on a picture of a syringe.” When fill-in the blank questions are used on the licensing exam, the test-taker provides one answer that can be noted to be either correct or incorrect, and typically includes calculation of intake and output, drug dose, or drip rate for intravenous infusions.

Advantages of Fill-in-the-Blank Questions

This item type reduces guessing. This item type works well for math problems because it requires the student to work out the answer. A wide range of materials can be tested.

Disadvantages of Fill-in-the-Blank Questions

It is difficult to phrase the question so there is only one correct answer. Scoring can be time consuming because the student may provide an answer the instructor had not considered. The student’s spelling can make it difficult to score.

The nurse is to give morphine elixir, 4 mg, sublingually. The drug available is morphine, 20 mg/mL. How much should the nurse give? (Round to the nearest tenth.) _____________________________ mg.