MCI Quick Reference Guide

It e
m

Indicate Y for Yes or N for No in each

box.

Ite 1
m
Ite 2
m
Ite 3
m
4
Ite
m
Ite 5
m
Ite 6
m
Ite 7
m
Ite 8
m
Ite 9
m
10

Nurs 5328
Angela Preston, Natalie Starkey, Elizabeth Starr, Paula Wyman

STEM
Identifies the problem or question
Relates to current learning outcome
Asks for appropriate nursing action or critical
thinking expected for entry-level practice
The problem/question is clearly defined
Is an incomplete statement or question asking
for BEST possible answer
Two or more sentences are used
Does not present extraneous information
Is not written in negative format
Does not end with letters "a" or "an"
Example "The patient taking pain medicine is a"

DISTRACTOR
Shorter than the stem (Preferably less than one
line)
All options are comparable in length, structure,
content, complexity
Which of these client manifestations would support a nursing diagnosis of fluid volume deficit? (McDonald, pg 115)
A. Tachycardia*
B. Decreased respiratory rate with prolonged
expiratory phase- cues students to select this choice
because of how long it is.
C. Dysuria
D. Diaphoresis

All options are either general or specific

these symptoms indicate a possible:
A. Pelvic fracture- general
B. Comminuted intracapsular fracture- specific
C. Tibial fracture- general
D. Hip fracture- general

Use 2 set of opposites if opposites are used

Designed below the reading level of student but
including medical terminology
Avoid bias (foods, homonyms, colloquialisms)
Avoid redundancy in options
Options are exclusive, do not overlap, and are
not partially correct
Avoid all of the above answers
Avoid none of the above answers (except in
math questions)
Avoid trick answers

MCI Quick Reference Guide

Nurs 5328
Angela Preston, Natalie Starkey, Elizabeth Starr, Paula Wyman

Example "A client who is receiving an intravenous infusion develops dyspnea and increased blood
pressure. A nurse should recognize that which of these problems may be developing?(Mcdonald, pg 115)
A. Infection
B. Air embolism- dyspnea in the stem is misleading
the student to believe embolism would be the
answer
C. Fluid overload*- need to have another symptom
leading to fluid overload to avoid tricking students
D. Hypovolemia

KEY ANSWER

9 10

is completely correct and cannot be argued by

students
avoids confusing or biased vocabulary.
is in random letter location.
meets a course objective.
can be referenced from available source(s) and
current lecture material
has a level of difficulty assigned.

OVERALL APPEARANCE OF MULTIPLE

CHOICE ITEMS
Answer options are listed in ascending order by
length
Answer options are listed in ordered structure
(numerically smallest to largest)
Values are labeled accurately
Homogeneous appearance
Present tense used throughout stem, key
answer and distractors.
Distractors and key answer are proportional
length
Stem, distractors, and key answer are
grammatically correct with appropriate
punctuation.
The key answer is clearly marked (*)
The action is in the option (not the stem)

HELPFUL TIPS FOR CREATING MULTIPLE CHOICE ITEMS:

The distractor needs to be made alongside the correct answer so they all have similar formats.
Look for common misconceptions voiced by students
Use Sound Bites from lecture or reading that are unrelated to question as distractors
Describe pathology or interventions that are unrelated to the question as distractors
Write a few exam questions after each teaching session
Effective Stems are complete, succinct and use a focused, positive approach in the present tense
REFERENCES
McDonald, M. E. (2014). The nurse educator's guide to assessing learning outcomes. (3rd ed.).
Sudberry, MA: Jones and Bartlett.