From the desk of Adrianne E. Avillion, DEd, RN

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 23, 2012

Editor's note: This feature is written by nursing professional development expert Adrianne E. Avillion, DEd, RN. Each week, Adrianne writes about an important issue in the area of professional development or answers reader questions. If you have a question for Adrianne, e-mail her at

Tips for writing multiple choice questions
On the occasions when we must develop our own tests, most of us rely on multiple choice questions. We need to develop questions that assess achievement of learning objectives, but are also easy to grade. Carefully written multiple choice questions seem to be the most efficient way of assessing learning in the written format. Here are some guidelines for writing multiple choice test questions:

  • Multiple choice questions consist of a question or an incomplete statement referred to as the "stem" of the question. The stem is followed by four choices, only one of which is the correct or best possible answer. Although the NCLEX exam questions now offer options such as all of the above, or a combination of answers such as a, b, and c, it is still recommended, in the professional setting, that only one choice is the best possible answer.
  • Make sure that all of the four choices "fit" grammatically with the stem.
  • Use simple sentence structure.
  • Place most of the words in the stem of the question.
  • Keep all answer choices the same length as much as possible. If this isn't possible write two long and two short choices.
  • Avoid double negatives and negative stem statements. Negatives are confusing.
  • Mix up the order of the correct answers. For example, don't have the correct answers follow a logical path such as the first question's correct answer is choice a, the second question's correct answer is b, and so on.
  • Using the same or similar words in both the stem and the right answer can "give away" the correct answer.
  • Avoid options such as none of the above, some of the above, and all of the above.

Here are some good resources when writing test questions.

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