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

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Chapter 5Multiple-Choiceand Multiple-ResponseOermann & GabersonEvaluation and Testing in Nursing Education4th edition


Multiple-Choice Items

♦ Multiple-choice– One correct or best answer

♦ Multiple-response– May be several correct responses

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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

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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

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♦ 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

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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

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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

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Stem—Poor Example

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

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Revision

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

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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.

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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

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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.

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Writing the Stem

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

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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.

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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?

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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

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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.

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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.

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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

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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.

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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.

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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

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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)

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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

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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

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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

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♦ 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

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♦ 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

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♦ 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.

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♦ Same number of “parts” as answer♦ Poor example:

Causes of cataracts include:a. aging and steroid therapy. b. arteriosclerosis.c. hemorrhage.d. iritis.

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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 unitsb.140,000 unitsc.400,000 unitsd.14,000 units

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Revision

The average dose of penicillin is 600,000 units. What is the dose for a 35-pound child?a.14,000 unitsb.40,000 unitsc.140,000 unitsd.400,000 units

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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

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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 distentionb.Agitationc.Electrolyte imbalanced.Restlessness*

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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.

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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 chestb.Lowering the head of the bedc.Supporting the incision with a pillowd.Turning on the left side

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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.

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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.

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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

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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

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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 beingfearful of gaining weight.*d.recurring nausea.

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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

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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

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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.

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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.

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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

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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

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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

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ExampleThe 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

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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

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Combination of Responses (cont’d)

♦ Number the options and use letters for the combinations

♦ Arrange combinations chronologically by length

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ExampleCauses of cataracts include:1.aging. 2.arteriosclerosis. 3.hemorrhage.4.iritis.5.steroid therapy.

a. 1, 2b. 1, 5 *c. 2, 4 d. 1, 3, 4e. 2, 3, 5

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ExampleA patient is being observed for increased intracranial pressure. Which of the following changes should the nurse be alert to?1.Decreasing drowsiness2.Decreasing respiratory rate3.Increasing drowsiness4.Increasing respiratory rate5.Narrowing pulse pressure6.Widening pulse pressure

a. 1, 2, 5b. 1, 2, 6c. 2, 3, 6d. 3, 4, 5e. 3, 4, 6

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