MULTIPLE RECOGNITION QUESTIONS (MCR)

- Provides students with several alternatives from which to choose the correct response or
responses.
- Two types:
o Multiple-choice: have one correct answer, are used widely in nursing and in other
fields. This test-item format includes an incomplete statement or question,
followed by a list of options that complete the statement or answer the question.
o Multiple-response: more than one answer may be correct.

MULTIPLE-CHOICE ITEMS

These items have one correct answer, are used widely in nursing and in other fields. This
test-item format includes an incomplete statement or question, followed by a list of options that
complete the statement or answer the question.

There are three parts to a multiple-choice item,

a. Stem,
b. Answer, and
c. Distractors.
- The stem is the lead-in phrase in the form of a question or an incomplete statement that
relies on the alternatives for completion.
- Following the stem is a list of alternatives or options for the learner to consider and
choose from.
- These alternatives are of two types:
o Answer, which is the correct or best response to answer the question or complete
the statement, and
o Distractors, which are the incorrect alternatives. The purpose of the distractors, as
the word implies, is to distract students who are unsure of the correct answer.

Advantages:

- Useful in nursing to measure application- and analysis-level outcomes.

- The teacher can introduce new information requiring application of concepts and theories
or analytical thinking to respond to the questions.
- effective for assessing critical
- Provides essential practice for students who will later encounter this type of item on
licensure, Certification, and other commercially prepared examinations.
- Allow the teacher to sample the course content more easily than with items such as essay
questions, which require more time for responding.
- Can be electronically scored and analyzed.
Disadvantages:

- These items are difficult to construct, particularly at the higher cognitive levels.
- Teachers often experience difficulty developing plausible distractors.
- If a distractor is not plausible, it provides an unintended clue to the test-taker that it is not
the correct response
- Multiple-choice items are time-consuming to construct.
- Cannot measure attitude or motor skills
- Elements of guess work is not completely eliminated
- Students require more time to answer to.

Guidelines for construction of multiple-choice items

While writing the stem,

- The stem should present clearly and explicitly the problem to be solved.
- Although the stem should be clear and explicit, it should not contain extraneous
information unless the item is developed for the purpose of identifying significant versus
insignificant data.
- Avoid inserting information in the stem for instructional purposes.
- If words need to be repeated in each alternative to complete the statement, shift them to
the stem.
- Do not include key words in the stem that would clue the student to the correct answer.
- Avoid the use of negatively stated stems, including words such as “no,” “not,” and
“except.”
- The stem and alternatives that follow should be consistent grammatically.
- Avoid ending stems with “a” or “an” because these often provide grammatical clues as to
the option to select.
- If the stem is a statement completed by the alternatives, begin each alternative with a
lower-case letter and place a period after it because it forms a sentence with the stem.
- Each multiple-choice item should be independent of the others.
- Write the stem so that the alternatives are placed at the end of the incomplete statement

While writing Alternatives

- The alternatives should be similar in length, detail, and complexity.

- In addition to consistency in length, detail, and complexity, the options should have the
same number of parts.
- The alternatives should be consistent grammatically.
- The alternatives should sample the same domain (e.g. all symptoms, all diagnostic tests,
all nursing interventions, varying treatments, etc.)
- Avoid including opposite responses among the options.
- Arrange the options in a logical or meaningful order.
 - Options with numbers, quantities, and other numerical values should be listed
sequentially, either increasing or decreasing in value, and the values should not overlap.
- Each option should be placed on a separate line for ease of student reading.
- While writing correct answer:
o Review the alternatives carefully to ensure that there is only one correct response
o Review carefully terminology included in the stem to avoid giving a clue to the
correct answer.
o The correct answer should be randomly assigned to a position among the
alternatives to avoid favoring a particular response choice.
o The answers should not reflect the opinion of the teacher but instead should be the
ones with which experts agree or which the most probable responses are.
- While writing distractors:
o The distractors should be consistent grammatically and should be similar in
length, detail, and complexity with each other and the correct answer.
o The distractors should sample the same content area as the correct answer
o Avoid using “all of the above” and “none of the above” in a multiple-choice item.
o Omit terms such as “always,” “never,” “sometimes,” “occasionally,” and similar
ones from the distractors.
o Avoid using distractors that are essentially the same.

MULTIPLE-RESPONSE AND COMBINED-RESPONSE

In these item formats, several alternatives may be correct, and students choose either all of the
correct alternatives (multiple-response) or the best combination of alternatives (combined-
response). Multiple-response items are included on the NCLEX examination as one type of item
format. Students select all of the options that apply by checking the box that precedes each
option.

The principles for writing multiple-response items are the same as for writing multiple-choice.
Additional suggestions for writing combined- response items include the following:

- The combination of alternatives should be plausible.

- The responses should be listed in a logical order, for instance, alphabetically or
sequentially, for ease in reviewing.