Box Edition Guide

Using Intellistem Writer® Box Edition will enable you to develop new questions from scratch and to revise existing questions quicker than before.

Intellistem Writer Box Edition

How to Use Intellistem Writer® to Develop Exam Questions

Question Development Process:

  • Step 1

    Select a topic from your test blueprint.

  • Step 2

    Determine the key point to be tested.

  • STEP 3

    Keeping in mind the nursing process being tested, select a stem from the set of cards.

  • Step 4

    Add a client situation or description to the stem by changing blue text.

  • Step 5

    Decide on the answer(s) and write the rationale.

  • Step 6

    Write the distractors and rationales for each.

  • Step 7

    Since each stem is already aligned with established standards, each final question will have a stem that is aligned to established standards, correct answer(s) and believable distractors.


  • Stem

    The initial part of the item is which a question or an incomplete statement about something the student must solve

  • Options

    All of the answer choices for an item

  • Key/Answer

    Correct option

  • Distracters

    The incorrect options

  • Rationales

    One per distractor and answers

  • Standards

    Alignment of standard components


Intellistem Writer Implementation Card Front Example

The client with Gastroesophageal Reflux Disease (GERD) is experiencing heartburn, eructation, and feeling of flatulence. In addition to taking his medications, what advice would it be most appropriate for the nurse to provide?

Stem From The Card

  • a

    Encourage the client to eat three large meals daily.


  • b

    Ensure the client knows to always lie flat at night.


  • c

    Provide directions on how to reduce intake of foods that contain caffeine.


  • d

    Tell the client to each a heavy snack before going to bed to reduce the gastric acid.


  • Answer

    c. p. 189 Cooper, K., Gosnell, K. (082014). Adult Health Nursing, 7th Edition [VitalSource Bookshelf version]. Retrieved from

Answer Key and Rationale Reference


  • a

    Wrong Answer

    Eating large meals causes an increase in gastric acids. Encourage the client to eat six small meals a day.

  • b

    Wrong Answer

    Lying flat can cause an increase in gastric acid reflex. Have the client sleep with the head of the bed evaluated at least 6-8 inches.

  • c

    Right Answer

    Client should be encouraged to reduce intake of chocolate, tea, and other foods and beverages that contain caffeine. This will reduce gastric acid formation.

  • d

    Wrong Answer

    Client should not eat 2-3 hour before bedtime. Having a heavy snack before going to bed to increase the chances the gastric acid reflux.

Alignment to National Standards:

NCLEX-Standard: (SECE) Psychosocial Integrity

Cognitive – Level: Create

NLN-Standard: Nursing Judgment

AACN – Standard: III-Evidence-Based Practice

QSEN-Standard: Evidence-Based Practice (EBP)

Implementation Card

Revise an Existing Question

Example Revision of Question

10 Easy Steps to Revise a Test Question

  • Step 1

    Read the stem found in the exam being rewritten.

  • Step 2

    Review the question alignment in the test blueprint.

  • Step 3

    Is the alignment acceptable or do you need to revise the question or delete it? Review your question analytics to determine if the question should be kept.

  • Step 4

    If you keep the question, read all of the options. Determine if test analysis is favorable. Decide if you are going to keep question.

  • Step 5

    If you keep the questions, pick one of the options as the correct option. Are there errors?

  • Step 6

    Are other options plausible?

  • Step 7

    Decide to keep or reject question based on the distractors and answers.

  • Step 8

    If you keep the question, keep as written or revise it.

  • Step 9

    Rewrite question and align standards using the Intellistem Writer box edition.

  • Step 10

    Read the question. Does it meet all of the guidelines. Keep and move to new question or repeat steps.