A critique and revision of test questions

1. Running head: CRITIQUE OF TEST QUESTIONS 1
Critique of Test Questions
J’Andra Antisdel
Bethel College

2. CRITIQUE OF TEST QUESTIONS 2
Critique of Test Questions
Examinations are one of the major forms of evaluation of almost every nursing program.
Through a well-constructed examination, an educator can determine if learning objectives were
achieved while also noting if teaching strategies were effective. A poorly constructed test serves
no purpose and may derail student learning. Test items that are not written clearly may unfairly
affect the otherwise prepared learner. This may lead them to select incorrect answers when they
truly have the necessary knowledge, skill, and attitude to answer correctly (Miller, M. &
Stoeckel, 2019).
Practicing writing and critiquing test questions is important in creating examinations that
are challenging while also fair, valid, and reliable. The well-constructed test can measure
learning in the cognitive domains of knowledge, comprehension, application, and analysis
(Billings & Halstead, 2016, pp. 427-429). Examinations may also serve to increase self-efficacy
and engagement when written so that those who are truly prepared with knowledge and critical
thinking skills can succeed. The purpose of this exercise is to build skills in analyzing, revising
and creating test questions as part of an endeavor to provide students with a quality nursing
education
Test Question One
1. The head-to-tail direction of growth is referred to as which of the following:
a. cephalocaudal
b. proximodistal
c. mass to specific
d. sequential
Analysis
This lower level recall question is in the cognitive domain of knowledge within Bloom’s
taxonomy pyramid (Armstrong, 2018). Students would only need to recall information to

3. CRITIQUE OF TEST QUESTIONS 3
answer this question. Questions for nursing school should be at least at the cognitive domain of
comprehension.
The test item is mostly succinct and clear except for the use of the phrase “which of the
following.” The question is written positively with the intent for the student to determine the
correct answer. The words “nurse”, “client” or “patient” are not used in the stem. It is
independent of other questions with all the required information without containing cues. There
appears to only be one correct answer and the options do not overlap and are independent of each
other. The distractors are plausible for students not familiar with content but only one answer is
correct. Concerning issues include the options being displayed in lowercase, making them
inconsistent with the stem. Stylistically if the options are not a completion of the stem, each
option should be capitalized. There are no further grammatical or spelling errors.
Revision
1. Which term describes the direction of growth from head-to-tail?
a. Cephalocaudal
b. Proximodistal
c. Mass to specific
d. Sequential
Test Question Two
2. When taking the pulse of a 4- year- old child, for most accuracy, it should be taken for:
a. 30 seconds and double the number.
b. 60 seconds.
c. 15 seconds and quadruple the number.
d. any of the above are acceptable.
Analysis
Initially this test item seems difficult to read. It is unclear and does not end with a
question. It is a lower level recall question requiring only knowledge of content (Armstrong,
2018). Low level questions may be appropriate for nursing students in fundamentals nursing

4. CRITIQUE OF TEST QUESTIONS 4
classes, but all students should be introduced to tests that require application and critical thinking
(McDonald, 2016). In the revision the question slightly more complicated to elevate the level of
cognitive domain.
The test item is written independently of other questions. The question is written
positively with the intent for the student to determine the correct answer and all the necessary
information is provided to answer the question without providing cues. Stylistically ‘4- year-
old” should be written 4-year-old. The word “child” is also unnecessary.
The options are dependent and at least one is overlapping with an option for all the
above. Due to this the distractors are not completely incorrect. An option that was essentially an
“all of the above” answer was removed for the revision. Distractors are not completely incorrect.
The options should also be written so that numbers appear to be in a sequential order
(McDonald, 2017).
Revision
2. Which option is the most accurate for taking the pulse of a four-year-old with a
congenital heart disorder?
a. 15 seconds and quadruple the number.
b. 30 seconds and double the number.
c. 60 seconds.
d. 90 seconds
Test Question Three
Written
3. The nurse is admitting a 15- year- old to the Pediatric unit. What is the primary
developmental task for this age group:
a. intimacy
b. identity
c. industry
d. initiative

5. CRITIQUE OF TEST QUESTIONS 5
Analysis
This question is simply asking the primary developmental task of a 15-year-old. To
answer this question the student is only required to recall information, placing it in the cognitive
domain of knowledge within Bloom’s taxonomy pyramid. The question would be more
appropriate if it required a higher cognitive domain. In the revision the question has been altered
to increase the level to application (Armstrong, 2018).
This test item is wordy and not focused as there is unnecessary and distracting
information. The fact that the patient is being admitted is not necessary to answer the question.
The question is written positively with the intent for the student to determine the correct answer.
The word “nurse” does appear in the stem and will be removed in the revision. The test item is
independent of other questions with all the required information without containing any cues
leading to the correct answer.
The options do not overlap and are independent of each other. The distractors are
plausible for students not familiar with content but only one answer is correct. Concerning
issues include the options displayed in lowercase, making them inconsistent with the stem and
the stem not ending with a question mark. Stylistically if the options are not a completion of the
stem, each option capitalized. There are no further grammatical or spelling errors.
Revision
3. During an assessment a 15-year-old male states, “I just don’t fit in anywhere. Everyone
seems to know what they want to do with their life, but I just feel lost.” Which psycho-
social crisis is he experiencing?
a. Intimacy vs. isolation
b. Initiative vs. guilt
c. Industry vs. inferiority
d. Identity vs. role confusion
Test Question Four
Written

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4. Which of the following vital signs indicates that a 5 year old child requires immediate
attention:
a. Systolic blood pressure of 80 mmHg
b. Diastolic blood pressure of 60 mm Hg
c. Pulse of 94 beats per minute.
d. Respiratory rate 62 breaths per minute.
Analysis
This lower level recall question is near the bottom of the of Bloom’s taxonomy pyramid
but moving towards the domain of comprehension. The student must know the normal range of
vital signs and be able to recognize when immediate attention is needed. In the revision the
question was altered to an application level question with the intention students would utilize
acquired knowledge to select the highest priority patient (Armstrong, 2018). The test item is
mostly succinct and clear except for the use of the phrase “which of the following.”
Grammatically “5 year old” should be written “5-year-old”. The words “nurse” and “patient” do
not appear in the stem but the word “child is unnecessary. The stem should end with a question
mark while all the options should be uniform in punctuation. As written some options end with a
period while others do not. The test item is written positively with the intent for the student to
determine the best answer. It is also written independently from the other questions, not
requiring knowledge of previous questions to answer the current test item.
The options are plausible and independent of each other. They do not overlap and only
allow for one correct answer. All the necessary information is provided in the stem without
providing any cues that would lead students to the correct answer (McDonald, 2017).
Revision
4. Which patient should be given priority?
a. A 5-year-old with a systolic blood pressure of 80 mmHg
b. A 20-year-old with a diastolic blood pressure of 60 mm Hg
c. A 15-year-old with a pulse of 94 beats per minute

7. CRITIQUE OF TEST QUESTIONS 7
d. A 4-year-old with a respiratory rate of 62 breaths per minute
Test Question Five
5. The nurse should suspect a hearing impairment in an infant who demonstrates which of
the following behaviors? SELECT ALL THAT APPLY:
a. Absence of the rooting reflex
b. Absence of babbling by age 7 months.
c. Lack of response when being spoken to.
d. Absence of startle reflex
Analysis
This test item is at the lower level of blooms taxonomy period closer to the domain of
application. This is an appropriate level question as students would require background
knowledge concerning the normal development of children then understand what would
constitute abnormal results (Armstrong, 2018). This question could be clearer and succinctly
worded if the word “nurse” was removed. There is no further extraneous information. The
question is also a ‘select all that apply’ type question with only four options. In the revision a
fifth option was added (McDonald, 2016). Punctuation should be uniform, some of the options
end with a period while others do not. This question stands independently of other questions and
the stem was written positively with the intention for students to pick the best answer. All
information to answer the question is available without providing any cues that would reveal the
answer.
The options are independent of each other and do not overlap. The distracters are
completely incorrect, meaning there is only one correct answer. Despite this the distractors are
plausible to students who may be unprepared. Option C has an extra space between words,
following this there are no further grammatical or spelling errors in the stem or options
(McDonald, 2017).

8. CRITIQUE OF TEST QUESTIONS 8
Revision
5. Which signs may indicate a hearing impairment in an infant? SELECT ALL THAT
APPLY:
a. Absence of the rooting reflex
b. Absence of babbling by age 7 months
c. Lack of response when being spoken to
d. Absence of startle reflex
e. Missing communication milestones
Test Question Six
6. A 6-year-old boy comes into the clinic to receive his immunizations for Kindergarten.
The nurse will administer which of the following immunizations, assuming he is up to
date on his shots? SELECT ALL THAT APPLY:
a. DTaP ( Diphtheria, Tetanus, acellular Pertussis)
b. Hib ( Haemophilus influenzae type b)
c. MMR ( Measles, Mumps, & Rubella)
d. IPV ( Inactivated Polio)
e. PCV (Pneumococcal)
Analysis
This independent question stands on its own and is at the lower level of blooms
taxonomy pyramid in the cognitive domain of knowledge. This question is inappropriate as a
student is only required to remember content to answer this question (Armstrong, 2018). Some
clarity is lost as this question is unnecessarily wordy and uses the phrase, “which of the
following.” The information about kindergarten can be removed. The words “nurse” and “boy”
can also be removed. This test item has all the necessary information without revealing cues and
is written positively with the intent students will select the best answer.
Each option is independent of the other with plausible distractors. The options do not
overlap and there appears to be one correct answer. Concerning grammar and spelling,
diphtheria and tetanus are spelled incorrectly. There is also inconsistency in the spacing within
several parenthesis.
Revision

9. CRITIQUE OF TEST QUESTIONS 9
6. A 6-year-old is receiving scheduled immunizations. Which immunizations will be
administered? SELECT ALL THAT APPLY:
a. DTaP (Diphtheria, Tetanus, acellular Pertussis)
b. Hib (Haemophilus influenzae type b)
c. MMR (Measles, Mumps, & Rubella)
d. IPV (Inactivated Polio)
e. PCV (Pneumococcal)
Test Question Seven
7. The nurse is evaluating the developmental level of a 2-year-old. Which of the following
does the nurse expect to observe in this child?
a. Walks up & down stairs
b. Turns door knobs
c. Puts two words together
d. All the above
Analysis
This test item is succinct but unclear with some use of unnecessary words such as
“nurse.” and the use of the phrase, “which of the following.”. It is a lower level recall question
requiring only knowledge of content which may be inappropriate for nursing school, as nursing
students should be introduced to questions requiring critical thinking in preparation for
qualifying exams (Mcdonald, 2016). The test item is written independently of other questions
and contains no further extraneous information. The question is written positively with the intent
for the student to determine the correct answer and all the necessary information is provided
without cues.
The options are dependent and at least one is overlapping and not completely correct as
there is an “all the above” choice. For clarity it would be better improved if the question were
instead a “select all that apply.” Stylistically option A uses the ‘&’ sign instead of the word
“and”. Doorknob is also one word.

10. CRITIQUE OF TEST QUESTIONS 10
Revision
7. Which activities are expected when evaluating the developmental level of a 2-year-old?
SELECT ALL THAT APPLY:
a. Walks up and down stairs
b. Turns doorknobs
c. Puts two words together
d. Balances on one foot
e. Waits their turn for activities
Test Question Eight
8. An infant who weighs 7 pounds at birth would be expected to weigh how much at 1 year
of age?
a. 14
b. 16
c. 18
d. 21
Analysis
This question is at the bottom level of the pyramid within the cognitive domain of
knowledge. This question may be inappropriate as students are only required to recall content
(Armstrong, 2018). Though this question is succinct, it is lacking clarity in the awkward way it
is written. The fact that it is a question seems ambiguous and it may be better written if the
beginning of the sentence lead with an interrogative term. Although present terms are used in
test items, the comparison is between past and present weights. The question would be clearer
stating “An infant who weighed 7 pounds at birth would be expected to weigh….” It is also
suggested that numbers below ten that do not have decimals, are not percentages, ages,
temperatures, dates or times of day be spelled out. The weight “7” pounds should be spelled out.
If not implied in the stem the options should include the unit of measurement. With these minor
corrections the test item otherwise contains all necessary information while standing on its own.
The question does not contain extraneous information or cues that would reveal the answer. It
also does not use the words “nurse” or “patient” and the question is written positively with the
intent to choose the correct or best choice.

11. CRITIQUE OF TEST QUESTIONS 11
The options are independent of each other without overlapping. There appears to be only
one correct answer and distracters are completely incorrect but plausible to students that may not
have properly prepared. There are no further grammatical errors.
Revision
8. What would be the expected weight in pounds of a 1-year-old who weighed 7 pounds at
birth?
a. 14
b. 16
c. 18
d. 21
Test Question Nine
9. The developmental task with which the child of 15 to 30 months is likely to be struggling
is sense of what?
a. Trust
b. Initiative
c. Autonomy
d. Intimacy
Analysis
This question is at the bottom level of Bloom’s taxonomy pyramid at the knowledge
stage as it simply requires recalling content. The revision addresses this by altering the stem to
make it more appropriate for nursing students who need to become more familiar with applying
acquired knowledge (Armstrong, 2018). This test item is similar to test item nine, succinctly
written but unclear. The interrogative word should be at the beginning of the sentence instead of
at the end. The word “child” is also unnecessary. The words “nurse” or “patient” do not occur
in the stem or the options and the test item is positively written with the intent for the student to
choose the correct or best option. The student has all the necessary information required to
answer the question without revealing information that would provide cues to the answer.

12. CRITIQUE OF TEST QUESTIONS 12
This options and distractors are similar to question three, and the answer for one may
assist in determining the answer for the other. The revision addresses this by altering the options
so they are not the same as the options in test item three. The options are also independent of
each other and do not overlap. All the options are plausible but there is only one correct answer.
No further grammatical errors are noted.
Revision
9. When discussing care for an infant a new mother states, “My mother always said I should
let them cry for a while, so I don’t spoil them.” Which developmental task might the
mother’s actions interfere?
a. Trust vs mistrust
b. Independence vs dependence
c. Autonomy vs shame
d. Abuse vs neglect
Test Question Ten
10. A 7 year old presents to the office with Rheumatic fever. You suspect the child had?
a. Rocky Mountain Spotted fever
b. Strep throat in the past 2 weeks
c. A virus
d. Mononucleosis
Analysis
Though this test item is written succinctly with all necessary information, the test item
would be clearer without the use of the word, “You.” This question is at the bottom level of the
pyramid in the cognitive domain of knowledge. The learner must simply recall that rheumatic
fever may develop from untreated strep throat. In the revision the question has been altered to
the level of an application question. The information that this is a 7-year-old is unnecessary.
Test items are also clearer when the interrogative word is near the beginning of the stem. The
stem is also incomplete, leaving the options to be answered as completion to the stem instead of
an answer. Stylistically, “7 year old” should be written “7-year-old.” The test item does stand
independently of the other questions and does not contain any cues that would lead the student to

13. CRITIQUE OF TEST QUESTIONS 13
the correct answer. The words “nurse” or “patient” are not included in the stem. The test item is
also positively written with the intent for the student to choose the correct or best option.
Item options are independent of each other with only one correct answer. Each distractor
is incorrect but plausible to the unprepared. No further style or grammar issues are noted.
Revision
10. What topic should be included when providing teaching to a parent after their child is
diagnosed with a streptococcal infection?
a. Importance of stopping antibiotics when symptoms subside
b. Common signs and symptoms of antiviral medications
c. Risks of developing rheumatic fever
d. Preparation for a tonsillectomy as the first line cure
Discussion and Conclusion
In critiquing test questions, one must consider what the item is testing and what the
student is expected to know. Once this is understood it is possible to assess the cognitive domain
required of students to answer the test item. For this assignment the cognitive domain of test
items was increased by utilizing scenarios that would require students to apply acquired
knowledge and problem solve. Test items were then assessed for proper style, grammar and
spelling (McDonald, 2017).
As initially presented, all questions were written at the lowest cognitive domain of
knowledge. While it is important that knowledge is tested, nursing students must also be
prepared for questions requiring critical thinking. Nursing is a demanding career where simply
knowing is not enough. Nurses must be able to comprehend, apply, analyze, synthesize, and
create new information. Examinations serve to evaluate student learning in multiple domains to
prepare them for their career working in the healthcare environment (Billings & Halstead, 2016)

14. CRITIQUE OF TEST QUESTIONS 14
References
Armstrong, P. (2018). Bloom's Taxonomy. Retrieved from https://cft.vanderbilt.edu/guides-sub-
pages/blooms-taxonomy/
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (4th ed.). St.
Louis, MO: Elsevier Health Sciences.
Dennison, R., Rosselli, J., & Dempsey, A. (2015). Evaluation beyond exams in nursing
education: Designing assignments and evaluating With rubrics. New York, NY: Springer
Publishing Company.
Mcdonald, M. (2017). The nurse educators guide to assessing learning outcomes (4th ed.).
Retrieved from https://www-r2library-
com.proxysb.uits.iu.edu/Resource/Title/1284113361
Miller, M. & Stoeckel, P. (2019). Summative evaluation: evaluation of client learning. Client
Education. Retrieved July 7, 2019 from https://www-r2library-
com.proxysb.uits.iu.edu/Resource/Title/1284142639/ch0014s0512