Development and content validation of the NEIA tool: An instrument to evaluate NCLEX-style exam items

This study aimed to develop and establish content validity for the NCLEX-Style Exam Item Assessment (NEIA) Scoring Tool, a structured rubric for evaluating the quality of NCLEX-style multiple-choice items.

Despite established guidelines for writing NCLEX-style exam items, many nursing school items contain flaws such as ambiguous stems, implausible distractors, grammatical cues and linguistic bias that may disadvantage diverse learners and compromise exam validity.

An expert content validation process informed by Delphi methodology was used to establish content validity with a panel of six expert nurse educators.

The NEIA tool was developed based on Bloom's Taxonomy, the NCSBN Test Plan and the Clinical Judgment Model. Six expert nurse educators rated each subcategory on a four-point Likert scale for clarity and relevance. The Content Validity Index (CVI) was calculated at both item (I-CVI) and scale (S-CVI) levels.

All subcategories achieved I-CVI values ≥ 0.83 and the overall S-CVI/Average exceeded 0.90, demonstrating strong content validity. Qualitative feedback supported the tool's usability and identified areas for targeted refinement.

The NEIA Scoring Tool provides nursing educators with an evidence-based framework to improve the validity, fairness and rigor of NCLEX-style exam items, ultimately enhancing student preparation for licensure and safe professional practice.