Writing Good NCLEX Style Answers and Distractors – Part 1

Student deep in thoughtOften writing strong distractors take a lot of time to get them just right. The distractors strengthen the question and allow students who know the information to pick the correct answers and to succeed on the test.

However, writing distractors for nursing NCLEX style questions is often just as hard or even harder than writing the stem part of the question. The stem should be able to stand by itself. Without this, the student may not be able to clearly understand the question.

This is the first part of a series on how to write good distractors.  I will post the second part in a few weeks.

Distractors for multiple choice questions should be:

  • Plausible.
  • The same type or category. A different distractor that clearly doesn’t fit the question will be eliminated easily. Thus, reducing the number of plausible answers by one.
  • Of similar length. If there is a long answer that is correct, be sure to have other questions that have the longer length as correct.
  • Written clearly, concisely, and do not have clues about the correct
  • Free of “clang clues”. This occurs when there are words in the stem that are repeated in the distractors/answers.
  • Written in alphabetical or numerical order. This will reduce the bias toward certain positions being correct. There has been a practice to randomize the distractor position to keep students from finding a pattern that can be detected. This method can be done, of course. However, by using alphabetical or numerical order students will see very quickly all answers are in this pattern and there is no pattern for correct answers to be noted. This consistency will replace the belief that alternating the distractors.
  • Grammatically correct with the stem or completes the question.
  • What a client would understand. Don’t add medical or nursing terms that would not be understood by the client.
  • Have only one correct or best response.
  • Provide a minimum of three, but not more than five, plausible and attractive options for each item
  • Be sure to be consistent in options. For examples, if one of the distractors is “increase” then all of the distractors should have the word “increase” in the option. Don’t use decrease as an option.

In order to have a valid and high-quality assessment, the distractors also must be written with precision and expertise.  To ensure valid and high-quality assessments, rigorous processes need to be implemented to review test quality prior to administration and to review test results after administration. Following these guidelines will help you develop sound NCLEX style exam questions.