Writing good test questions is a skill that can be improved by
practice and feedback from others. Many faculty members have
their test questions reviewed by another faculty person not
directly involved in the delivery of a particular course. Kaplan
Nursing works with nurse educators to improve their skill at
writing questions to produce valid, reliable and efficient
tests.
The questions included in this area are submitted by nursing
faculty from schools that currently use Kaplan Nursing for
Integrated Testing and/or NCLEX®* review.
Each month two new questions will be reviewed, revised, and
posted to this site. If you would like a question to be
considered for inclusion in the Test Construction Zone, please
email the question and correct answer to nclexexpert@kaplan.com.
Original question:
Oxygen toxicity can occur from administering high concentrations
of oxygen over extended periods of time. At what time frame
should the nurse begin to look for oxygen toxicity in a
patient?
1. 12 hours
2. 24 hours
3. 48 hours (Correct)
4. 72 hours
Discussion:
The stem should contain only relevant information and should not
"teach" information. In this question, the information concerning
the cause of oxygen toxicity is both superfluous to the question
and teaches information.
Keep the language simple and remove extra words. "At which
time frame" is easily changed to "When."
Reworded question:
The nurse assesses a patient receiving oxygen for signs of
toxicity. When would the nurse expect symptoms of oxygen toxicity
to occur?
1. 12 hours
2. 24 hours
3. 48 hours (Correct)
4. 72 hours
Original question:
A 50-year-old patient undergoes a thoracentesis with removal of
300 ml of fluid. Three hours following the test which assessment
finding by the nurse should not be reported immediately to the
physician?
1. Asymmetry of the chest.
2. Pain at needle insertion site. (Correct)
3. Uncontrollable cough.
4. Syncope upon standing.
Discussion:
Negative words in the stem can be confusing and should be
avoided. If negative determiners, such as not, except, or least
are used, they should be CAPITALIZED, italicized, or
underlined.
If possible, reword the question so the negative determiner is
eliminated. If it is unnecessary for the nurse to report a
symptom to the physician that means the symptom is expected.
It is unnecessary to include gender and age of patients or
clients, unless it is relevant to the question being asked. In
this situation it is immaterial.
Reworded question:
The nurse is caring for a patient three hours after a
thoracentesis in which 300 ml of fluid was removed. Which of the
following assessments, if made by the nurse, is expected
following the procedure?
1. The patient's chest is asymmetrical with respirations.
2. The patient complains of pain at the needle insertion site.
(Correct)
3. The patient has an uncontrollable cough.
4. The patient experiences syncope when standing.
Original question:
Following a cystoscopic examination the patient complains of
burning upon voiding and is alarmed to find a small amount of
blood in her urine. The nurse bases her intervention on what
conclusion about these complaints?
1. The complaints are abnormal and require immediate
interventions.
2. The complaints are abnormal but do not require immediate
interventions.
3. The complaints are normal but require notification of the
physician.
4. The complaints are normal and require monitoring.
Discussion:
Using opposites as answer choices results in a student correctly
answering the question with less knowledge. If the student knows
the symptoms are normal, s/he can eliminate two of the answer
choices immediately. If this is an important concept, use
synonyms of abnormal, such as "complication."
The symmetry of the answer choices is good. They are all about
the same length, and contain two phrases connected by an "and" or
"but."
It is best to ask a question rather than provide a sentence
completion. This mirrors the format used on the
NCLEX-RN® exam.
Reworded question:
An hour after returning to the room following a cystoscopy, the
patient voids 220 ml of blood-tinged urine and complains of
burning during urination. The nurse should take which of the
following actions?
1. Report the symptoms to the physician because they are
abnormal.
2. Document the symptoms in the chart because they are expected.
(Correct)
3. Monitor the symptoms because they indicate a
complication.
4. Administer analgesics because the patient is in pain.
Original question:
A critical care nurse immediately administers intravenous
medications to her patient after diagnosing a cardiac dysrhythmia
according to the critical care unit's approved policies and
protocols. Unfortunately the outcome is poor and the patient does
not recover. This critical care nurse is
1. diagnosing and, therefore, practicing medicine without a
license.
2. implementing treatment measures according to standardized
procedures within California's scope of nursing practice.
3. guilty of assault and battery.
4. guilty of limiting her scope of practice to the critical care
unit's approved policies and protocols.
Discussion:
Several changes improve this question.
It is best to ask a question rather than provide a sentence
completion. This mirrors the format used on the
NCLEX-RN® exam.
It is better if the answer choices are similar in length.
It is important not to show gender bias when writing
questions. Often a question writer is unaware that s/he has
specified a gender.
Reworded question:
A critical care nurse administers intravenous medications to a
patient immediately after diagnosing a cardiac dysrhythmia
according to the critical care unit's approved policies and
protocols. Despite the intervention, the patient dies. Which of
the following statements is accurate about the nurse's
actions?
1. The nurse practiced medicine without a license.
2. The nurse implemented standardized treatments within the scope
of nursing practice. (Correct)
3. The nurse is liable for assault and battery.
4. The nurse acted outside of the responsibilities delegated to a
registered nurse.
* NCLEX-RN®
is a registered trademark of the National Council of State Boards
of Nursing, Inc.
