Assessing the quality of multiple-choice test items

With the focus of nursing education geared toward teaching students to think critically, faculty need to assure that test items require students to use a high level of cognitive processing. To evaluate their examinations, the authors assessed multiple-choice test items on final nursing examinations. The assessment included determining cognitive learning levels and frequency of items among 3 adult health courses, comparing difficulty values with cognitive learning levels, and examining discrimination values and the relationship to distracter performance.