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.


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