Running Head: TEST QUESTIONS

Test Questions

Assignment 2: Objective Tests Item Analysis

Melissa Ackerly

SUNY Delhi

NURS-603-11253-201709

Kirsty Digger

Measurement and Evaluation in Nursing Education

November 10, 2017

TEST QUESTIONS 2

Test Questions

Item selection for the five test questions to follow was based on the P-value of greater

than 0.70 for each question. The range for P-values is 0.30 to 0.70 on test items to assure the

question is not too easy or too difficult. All of the following questions are associated with a P-

value of greater than 0.70 indicating the exam was too easy and an unreliable predicator of

student learning. Both the high scoring and low scoring students were able to select the correct

answers. This confounds the ability to determine what students learning needs are. Every test

item selected also had a D-value of 0.05 or less. The D-value proposes items that score over 0.20

are most reliable and anything less is subject to scrutiny. A range of -1.0 to 1.0 is used to

determine the validity of the question based on numbers of high and low scoring students

selection of the correct answer. Answers scoring a D-value of less than 0.20 can be an indication

the question was problematic in some way forcing student to interpret the question, take a guess

at the question, or the question itself led them to the answer. All of the selected test items

suggest the need to revisit the questions to improve the D-value in order to provide evidence for

student learning or improvements in teaching content. The P-value and D-value of the selected

items are out of range and need assessment and adjustments (Oermann, & Gaberson, 2014).

Question 7

A client is receiving total parenteral nutrition (TPN). Which of the following is essential to the

clients care?

a. Evaluation of the peripheral infusion site

b. Confirmation the tube is in the stomach
c. Checking daily weights
d. Monitoring fluid and electrolyte levels

A client is receiving total parenteral nutrition (TPN). Which of the following is most essential to

the clients care?

TEST QUESTIONS 3

a. Evaluation of the peripheral infusion site

b. Monitoring hemoglobin and hematocrit
c. Monitoring pulse and blood pressure
d. Monitoring fluid and electrolyte levels

Rationale for changes: The stem of the question lacked clarity. Adding the word most directs

the learner to select the correct response if the content has been adequately learned. It appears 3

students were not familiar with TPN administration as they selected a and b which neither was

the typical route of TPN administration. Noted were 5 students who selected c, which is also a

correct answer as essential to the clients care. Eliminating the distractor unrelated to, another

which was a correct answer, and adding one word to the stem strengthens the questions

reliability (Oermann, & Gaberson, 2014).

Question 9

A triage nurse in a busy emergency department assesses a client who complains of 6/10

abdominal pain and states, I had a temperature of 104.6 at home. Which action would the nurse

preform first?

a. Inform the client it may be several hours before being seen by the doctor
b. Obtain a clean catch urine for urinalysis culture
c. Assess the clients current vital signs
d. Ask the doctor to order an antipyretic for the client

A triage nurse in a busy emergency department assesses a client who complains of 6/10

abdominal pain and states, I had a temperature of 104.6 at home. Which priority action would

the nurse preform first?

a. Ask the client what kind of thermometer was used

b. Obtain a clean catch urine for urinalysis culture
c. Assess the clients current vital signs
d. Ask the doctor to order an antipyretic for the client

Rationale for changes: The stem of the question did not state clear direction for the student to

make an educated choice. Using priority clarifies the stem and elimination of an obvious
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alternative of selection a, improves the reliability of the question (Oermann, & Gaberson, 2014).

Question 15

The charge nurse of a surgical unit has been notified of an external disaster with multiple

casualties. Which client should the charge nurse request to be discharged from the hospital?

a. The client scheduled for repair of an abdominal aortic aneurysm (AAA) in the morning
and whose preoperative teaching has not been started
b. The client who had an abdominal hysterectomy 2 days ago and whose catheter was
removed this am
c. The client who has a bleeding peptic ulcer and now has a hemoglobin of 7mg/dL and a
hematocrit of 22.1%
d. The client who was in a motor vehicle accident and has a 6 on the Glasgow coma scale
and intermittent decorticate posturing

The charge nurse of a surgical unit has been notified of an external disaster with multiple

casualties. Which client should the charge nurse request to be discharged from the hospital?

a. The client scheduled for repair of an abdominal aortic aneurysm (AAA) in the morning
b. The client who had an abdominal hysterectomy 2 days ago and whose catheter was
removed this am
c. The client who has a peptic ulcer and with a hemoglobin of 7mg/dL and a hematocrit of
22.1%
d. The client who was in a motor vehicle accident and has a 6 on the Glasgow coma scale

Rationale for changes: The distractors for a, c, and d included too much information. The

elimination of the extraneous details removed the urgency of those distractors leveling the

question and alternatives. This will assist to identify the students ability to analyze the

alternatives and select the appropriate response without clues (Oermann, & Gaberson, 2014).

Question 16

The client is to undergo surgery for a cataract in the left eye. Which of the following instructions

should be included in the teaching plan for the client?

a. Cough and deep breathe every 2 hours

b. Perform prescribed eye exercises daily
c. Use saline irrigation as needed
d. Take the prescribed stool softener as ordered
TEST QUESTIONS 5

The client is to undergo surgery for a cataract in the left eye. Which of the following
instructions should be included in the teaching plan for the client?

a. Do not bend over for 10 days

b. Wear your prescription eyeglasses as usual
c. Use saline irrigation as needed
d. Take the prescribed stool softener as ordered

Rationale for changes: The distractors a and b are not relevant to cataract surgery and too easily

eliminated by the student. Providing alternatives that assist the student in application of their

knowledge to answer the question as they may or may not be influential to the clients recovery

(Oermann, & Gaberson, 2014).

Question 19

The nurse is caring for the following clients. After receiving shift report, which client should the

nurse assess first?

a. The client whose scheduled IV antibiotic is one hour late

b. The client diagnosed with renal colic pain who is scheduled for a lumbar CT scan
c. The client with a total knee replacement who is complaining of a painful, cold foot
on the operative extremity
d. The client diagnosed with ulcerative colitis who is complaining of severe abdominal pain

The nurse is caring for the following clients. After receiving shift report, which client should the

nurse assess first?

a. The febrile client whose IV antibiotic has not been administered in 24 hours
b. The client suffering renal colic pain who is due for narcotic pain medication
c. The client with a total knee replacement who is complaining of a painful, cold foot
on the operative extremity
d. The client diagnosed with ulcerative colitis who is complaining of severe abdominal pain

Rationale for changes: In order to level the distractors the alternative options should reflect

only options that are relative in complexity. The length and structure of the alternative answers

should be in similar format in providing information and be believable options. This provides

the reliability of the test item and opportunity to examine the teaching methods of the topic if the
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question is deemed reliable but students do not fare well on the item (Oermann, & Gaberson,

2014).
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References

Oermann, M. H., & Gaberson, K. B. (2014). Evaluation and testing in nursing education (4th

ed.). Springer: New York, NY.