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Writing Good NCLEX Style Answers and Distractors – Part 2

Nursing Tests Analysis Cards

In part 1 of this series, we talked about the proper way to write NCLEX-style exam answers and distractors.

Now let’s review things to avoid when writing distractors.

Distractors for multiple choice questions should NOT:

  • Include absolutes – words such as “never”, “none” or always
  • Be too similar or too different.
  • Use scientific-sounding jargon in wrong answers.
  • Cause any ambiguity, hesitation or misunderstanding with either the topic or the question — only causing the student distress and confusion.
  • Be written as a negative distractors. It is easier for a students to identify a correct answer rather than an incorrect answer
  • Use humor, trivia or nonsensical distractors when developing options
  • Make up diseases or medications. Always use real diseases, medications and, plausible situations.
  • Use “All of the above” and “None of the above”. This allows students to more easily guess the correct answer.
  • Combine right and wrong in the same distractor. This reduces the number of options the student has to consider.
  • Be written using “hinging” responses or distracts. These are questions that require a student to know the answer to one item in order to answer another item.
  • Contain distractors that with clues that students who are good test takers can spot.
  • Contain poor grammar or uses faulty grammatical construction.
  • Have “an” in the stem. This clues the student that the answer will start with a vowel sound such as an ileus, an isolated problem, etc. There are some exceptions for when to use “an”. Be sure to clearly understand these grammar rules.
  • Include grammatical hints such as ‘are’ or ‘is’, which suggests plural or singular answers.
  • Repeat the same word or phrase in the distractors as those are also considered hints.
  • Copy phrases directly from reference materials — books, lecture..

Considerations while writing distractors:

  • Distractors should be homogeneous or parallel. They should have the same format and same structure.
  • Avoid convergence. The appearance of similar topics in the distractors can give the test taker clues to the correct answer. This occurs when part of the correct answer appears in the distractors frequently. The National Board of Medical Examiners states, “The underlying flaw is that the correct answer is the option that has the most in common with the other options, and thus the test wise student can converge on the right answer just by counting the number of times certain terms appear.”
  • Use students’ misconceptions, homework mistakes or missed quiz questions as inspiration when writing distractors. What do students often get wrong in interprating this question? What is a common misconception in this topic?
  • Double check that the stem doesn’t contain hints that will give away the answer.
  • Write the answer and distractor at the same cognitive level. Avoid the distractors that are at a lower cognitive level if the answer is at the higher cognitive level.
  • To create plausible distractors, locate the correct answer in the reference material. Then select similar conditions or nursing measures and modify it slightly to make distractors plausible.
  • Use true statements that don’t answer the question, but seem reasonable.
  • Indent the distractors and answer.
  • Avoid complex combinations such as:
    a. a and b
    b. c and d
    c. a and c
    d. b and c
  • Avoid overlapping lengths of time. For example,
    a. 1-2 years
    b. 2-3 years
  • If the answer is a group of items, make sure to include items from the list in other distractors too so that the test-taker does not guess correctly by recognizing only one of the items in the list.
  • The key should blend in among the other options. If the answer has three parts, then all of the options should have three parts. Similarly, if one of the options is listed as a question, be sure all of the options are listed as questions.
  • Reducing items from four options to three options decreases item difficulty, increases item discrimination, and also increases reliability.

References

Brame, C., (2013) Writing good multiple choice test questions. Retrieved November 15, 2018 from https://cft.vanderbilt.edu/guides-sub-pages/writing-good-multiple-choice-test-questions/.

Burton, S. J., Sudweeks, R. R., Merrill, P.F., and Wood, B. (1991). How to Prepare Better Multiple-Choice Test Items: Guidelines for University Faculty. Provo, Utah: Brigham Young University Testing Services and The Department of Instructional Science.

Clay, B. Is This a Trick Question? A Short Guide to Writing Effective Test Questions. Kansas Curriculum Center. Retrieved from  http://www.k-state.edu/ksde/alp/resources/Handout-Module6.pdf

Cloud Community College. How to Write Better Tests: A Handbook for Improving Test Construction Skills. Cloud County Community College. Retrieved from
https://www.cloud.edu/Assets/PDFs/assessment/Inst.Strategy_How%20to%20write%20test%20questions.pdf

Collins, J. (2006) Education techniques for lifelong learning: Writing multiple-choice questions for medical education activities and self-assessment modules. RadioGraphics, 26 (2) 542-551

Farley, J.K., 1989a. The multiple-choice test: developing the test blueprint. Nurse Educator 14 (5), 3–5.

Farley, J.K., 1989b. The multiple-choice test: writing the questions. Nurse Educator 14 (6), 10–12.

Farley, J.K., 1990. Item analysis. Nurse Educator 15 (1), 8–9.

Haladyna, T.M., and Downing, S.M. (1989). A taxonomy of multiple-choice itemwriting rules, Applied Measurement in Education. p. 37-50.

Jenkins, H.M., Michael, M.M., (2016). Using and interpreting item analysis data. Nurse Educator 11 (1), 10–14. Constructing written test questions for the basic and clinical sciences. National Board of Medical Examiners. Retrieved from https://www.nbme.org/publications/item-writing-manual.html.

Tarrant M., & Ware J. (2008). Impact of item-writing flaws in multiple- choice questions on student achievement in high-stakes nursing assessments. Med Educ 2008, 42(2):198-206.

Tarrant, M., et al., (2006). The frequency of item writing flaws in multiple-choice questions used in high stakes nursing assessments, Nurse Education Today. doi:10.1016/j.nedt.2006.07.006

Tarrant, M., Ware. J., and Mahammed, A. M. (2009) An assessment of functioning and non-functioning distractors in multiple-choice questions: A descriptive Analysis. BMC Medical Education (9)40. http://www.biomedcentral.com/1472-6920/9/40

Writing Multiple-Choice Questions That Demand Critical Thinking. Boston University Medical Campus. Retrieved from http://sphweb.bumc.bu.edu/otlt/teachingLibrary/Assessment/WritingMultiple.pdf

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