Chapter 5 ppt eval & testing 4e formatted 01.10 mo edits

© 2013 Springer Publishing Company, LLC.
Chapter 5
Multiple-Choice
and Multiple-Response
&Oermann Gaberson
Evaluation and Testing in Nursing Education
4th edition

Multiple-Choice Items
♦ Multiple-choice
– One correct or best answer
♦ Multiple-response
– May be several correct responses
2

Multiple-Choice Items (cont’d)
♦ Used for testing many types of learning
outcomes
– In nursing education, particularly useful for
measuring application- and analysis-level
outcomes
• At this level, can assess higher-level thinking skills
3

Advantages
•Good practice for NCLEX®
and certification exams
•Allow good sampling of
content
•Easy to score
Disadvantages
•Difficult to construct,
especially at higher
cognitive levels
•Difficult to write plausible
distractors
•Difficult to identify only
one correct or best
answer
4

♦ Parts
– Stem
• Lead-in phrase in form of question, sentence, incomplete
statement
• Relies on responses for completion
– Answer
• Correct response
– Distractors (2-4)
• Incorrect responses
• Plausible to learners who are unsure of answer
5

Writing Multiple-Choice Items
♦ Avoid clues to the correct answer
– All options should be equally attractive to the
student who does not know the content
– Clues can be in the stem or options
– Clues may give advantage to testwise students
6

Writing the Stem
♦ Write stem FIRST
♦ Include subject and verb
♦ Student should be able to read stem and
easily understand what is expected
– Stem should be able to stand alone as a short-
answer item
7

Stem—Poor Example
Cataracts:
a.are painful.
b.may accompany coronary artery disease.
c.occur with aging.*
d.result in tunnel vision.
8

Revision
Causes of cataracts include:
a.aging.*
b.arteriosclerosis.
c.hemorrhage.
d.iritis.
9

Multiple-Choice Items: Stem
A patient is being observed for early symptoms
of insulin reaction. The nurse should be alert for:
a.abdominal pain and nausea.*
b.dyspnea and lethargy.
c.perspiration and trembling.
d.thirst and flushing of skin.
10

Writing the Stem
♦ Avoid extraneous information in stem
– Unless assessing ability to distinguish relevant
from irrelevant information
– No need for patient names or initials
– No humorous content
• Distraction
• May be confusing for ESL students
11

Stem—Poor Example
You have a new patient through the home health
agency. She lives alone although her son visits
frequently. She has congestive heart failure and was
told recently that she has cataracts. Causes of cataracts
include:
a.aging.*
b.arteriosclerosis.
c.hemorrhage.
d.iritis.
12

Writing the Stem
♦ Avoid including content for instructional
purposes
– Purpose of the test is assessment, not teaching
– Excess wordiness requires more reading time
13

Stem—Poor Example
Cataracts are an opacity of the lens or capsule of
the eye leading to blurred and eventual loss of
vision. Causes of cataracts include:
a.aging.*
b.arteriosclerosis.
c.hemorrhage.
d.iritis.
14

Writing the Stem
♦ Always include concept, idea, or word after
“following” in stem
♦ Example:
In obtaining a health history from a patient with
a suspected hiatal hernia, the nurse should
collect which of the following information?
15

Writing the Stem (cont’d)
♦ Avoid the use of negative words such as “no,”
“not,” and “except”
– Sometimes unclear
– Requires change in thought pattern
♦ If negatively stated stem is unavoidable,
underline or capitalize negative word or use
bold font
– Better to rewrite as a different item format
16

Stem—Poor Example
The pain of angina is caused by an:
a. inadequate supply of oxygen to
myocardium.
b. inefficiency of the valves.
c. pressure on the diaphragm.
d. spasms of the muscles.
17

Revision
The pain of angina is caused by:by:
a. inadequate supply of oxygen to
myocardium.
b. inefficiency of the valves.
c. pressure on the diaphragm.
d. spasms of the muscles.
18

Writing the Stem
♦ Avoid repeating words at the beginning of
each alternative to complete the statement
– Shift them to the stem
♦ Concept included in each alternative does not
test students’ knowledge of it
– No discriminating power
– Move to stem
19

Stem—Poor Example
An early and common sign of pregnancy:
a. is amenorrhea.*
b. is morning sickness.
c. is spotting.
d. is tenderness of the breasts.
20

Stem—Poor Example
Clinical manifestations of Parkinson’s disease include:
a.decreased perspiration, tremors at rest,
muscle rigidity. *
b.increased salivation, muscle rigidity, diplopia.
c.muscle rigidity, decreased salivation, nystagmus.
d.tremors during activity, muscle rigidity, increased
perspiration.
21

Revision
Clinical manifestations of Parkinson’s disease include
muscle rigidity and which of the following signs and
symptoms?
a.Decreased salivation and nystagmus
b.Increased salivation and diplopia
c.Tremors at rest and decreased perspiration*
d.Tremors during activity and increased perspiration
22

Writing the Stem
♦ Each item should stand alone
– Not dependent on information in other
item stems
– May develop a series of multiple-choice items that
relate to a patient scenario, clinical situation, or
common data set (context-dependent item set)
23

Writing Alternatives
♦ Use consistent verb form in stem and each
option
♦ Similar in length, detail, and complexity
♦ If stem is an incomplete statement, each
response should complete stem grammatically
24

Poor Example
A patient is undergoing a right carotid endarterectomy.
Prior to surgery, which information would be most
important to collect as a baseline for the early recovery
period? Her ability to:
a. follow movements with her eyes
b. move all four extremities*
c. rotating her head from side to side
d. swallow and gag
25

Revision
A patient is undergoing a right carotid endarterectomy.
Prior to surgery, which information would be most
important to collect as a baseline for the early recovery
period? Her ability to:
a. follow movements with her eyes
b. move all four extremities*
c. rotate her head from side to side
d. swallow and gag
26

♦ If stem is an incomplete statement, begin
each alternative with a lowercase letter and
end with terminal punctuation
– Form sentence with stem
– At end of stem, use comma or colon as
appropriate
27

♦ Use uppercase letters to begin alternatives
that do not complete the stem
– If stem is a question, end it with a question mark
♦ No terminal punctuation with incomplete
sentences
28

♦ Do not use opposite responses
– Clue to choose one of them
♦ Poor example:
When giving nasogastric tube feedings, the nurse
should:
a.check for proper placement after each feeding.
b.check for proper placement before each feeding.
c.dilute the feeding with water.
d.heat each feeding.
29

♦ Same number of “parts” as answer
♦ Poor example:
a. aging and steroid therapy.
b. arteriosclerosis.
c. hemorrhage.
d. iritis.
30

Alternatives
♦ Arrange alternatives in logical order (alphabetical or
chronological)
♦ Poor example:
The adult dose of penicillin is 600,000 units. What is the dose
for a 35-pound child?
a.40,000 units
b.140,000 units
c.400,000 units
d.14,000 units
31

Revision
The average dose of penicillin is 600,000 units. What is
the dose for a 35-pound child?
a.14,000 units
b.40,000 units
c.140,000 units
d.400,000 units
32

Writing the Answer
♦ Answer = correct response
♦ State simply
♦ Should not be ambiguous
♦ Do not repeat concept, idea, or word from
stem in responses
– Clue to the correct answer for the testwise but
uninformed student
33

Answer—Poor Example
A 69-year-old patient is admitted with restlessness,
dyspnea, and anxiety. He has a history of emphysema.
Which of the following symptoms would be indicative
of hypoxia?
a.Abdominal distention
b.Agitation
c.Electrolyte imbalance
d.Restlessness*
34

An elderly client who lives alone was told recently that
she has cataracts. Causes of cataracts include:
a. aging.*
b. arteriosclerosis.
c. hemorrhage.
d. iritis.
35

You are teaching a patient how to cough and deep
breathe after abdominal surgery. Which of the
following measures will decrease discomfort in the
incisional area when the patient coughs?
a.Bending the patient’s head toward his chest
b.Lowering the head of the bed
c.Supporting the incision with a pillow
d.Turning on the left side
36

Writing the Answer
♦ Simple multiple-choice format—only ONE
correct response
♦ Poor example:
Symptoms of increased intracranial pressure include:
a.blurred vision.*
b.decreased blood pressure.
c.disorientation.*
d.increased pulse.
37

Revision
Symptoms of increased intracranial pressure
include:
a.blurred vision and decreased blood pressure.
b.decreased blood pressure and increased
pulse.
c.disorientation and blurred vision.*
d.increased pulse and disorientation.
38

Writing the Answer
♦ Randomly assign answer to different positions
among alternatives
– Alphabetical or chronological order of all
alternatives
• Tends to distribute the answer position randomly,
especially on lengthy tests
39

Writing the Answer
♦ Frequently, the correct answer is the longest
alternative
♦ Count number of words in each option
– Goal: approximately the same for each one
40

You are assessing a 12-year-old girl who appears
emaciated. She has had a 30-lb. weight loss over the
last year and tells you she watches what she eats
because she is so fat. Her weight loss is likely from:
a.needing her mother’s attention.
b.other GI problems.
c.perceiving herself as “fat all over” and being
fearful of gaining weight.*
d.recurring nausea.
41

Writing Distractors
♦ Incorrect although plausible alternatives
♦ Distract student who is unsure of content
♦ Same domain/content area as answer,
e.g., all symptoms, all diagnoses, varying
treatments
42

Writing Distractors (cont’d)
♦ Avoid using always, never, sometimes,
occasionally, and other similar terms in
distractors
– Provide clues to correctness of option
♦ Avoid using distractors that are essentially
the same
43

Distractors—Poor Example
A student comes to see the school nurse complaining of
a severe headache and stiff neck. Which of the following
actions would be most appropriate?
a.Ask the student to rest in the clinic for a few hours.
b.Collect additional data before deciding on actions.*
c.Have a family member take the student home to rest.
d.Prepare to take the student to the emergency room.
44

Revision
A student comes to see the school nurse complaining of
a severe headache and stiff neck. Which of the following
actions would be most appropriate?
a.Ask the student to rest in the clinic for a few hours.
b.Check the student’s records for identified health
problems.*
c.Prepare to take the student to the emergency room.
d.Send the student to class after medicating for pain.
45

Writing Distractors
♦ Define group or category to which all
alternatives must belong
– If stem asks about side effects of erythromycin,
develop plausible distractors from side effects of
other antibiotics or antibiotics as a group
46

Writing Distractors (cont’d)
♦ If answer is quantitative, distractors should be
points along same scale
– Example: varying blood pressures,
temperatures, weights
♦ If unable to identify plausible distractors,
rewrite stem or change item format
47

Multiple-Response Items
♦ Student selects all correct options
♦ Do not specify the number of correct options
♦ List responses in logical order
– Alphabetical or chronological
♦ Scoring
– Student must select all correct options and no
incorrect options to score 1 point
48

Example
The preliminary diagnosis for your patient, a 20-year-old college
student, is meningitis. Which signs and symptoms should you
anticipate finding? Select all that apply:
 1. Abdominal tenderness
 2. Fever
 3. Lack of pain with sudden head movements
 4. Nausea and vomiting
 5. Nuchal rigidity
 6. Sensitivity to light
 7. Sudden bruising in neck area
49

Combination of Responses
♦ Student chooses best combination of responses
♦ Combinations of alternatives should be
plausible
– Group options logically
♦ Use alternatives a similar number of times in
the combinations
– An alternative in every combination has no
discrimination power
50

Combination of Responses (cont’d)
♦ Number the options and use letters for the
combinations
♦ Arrange combinations chronologically
by length
51

Example
1.aging.
2.arteriosclerosis.
3.hemorrhage.
4.iritis.
5.steroid therapy.
a. 1, 2
b. 1, 5 *
c. 2, 4
d. 1, 3, 4
e. 2, 3, 5
52

Example
A patient is being observed for increased intracranial pressure.
Which of the following changes should the nurse be alert to?
1.Decreasing drowsiness
2.Decreasing respiratory rate
3.Increasing drowsiness
4.Increasing respiratory rate
5.Narrowing pulse pressure
6.Widening pulse pressure
a. 1, 2, 5
b. 1, 2, 6
c. 2, 3, 6
d. 3, 4, 5
e. 3, 4, 6
53

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