Multiple Choice Questions

Multiple Choice Questions: Multiple choice items provide the most useful format for
measuring acheivement at various levels of learning. They are most widely used for
measuring knowledge, comprehension and application outcomes.
Strengths:
1. Learning outcomes from simple to comlex can be measured.
2. Highly structured and clear tasks are provided.
3. A broad sample of acheivement can be measured.
4. Incorrect alternatives provide diagnostic information.
5. Scores are less influenced by guessing than true-false items.
6. Scores are more reliable than subjectively scored items(e.g essays).
7. Scoring is easy, objective and reliable.
8. Item analysis can reveal how difficult each item was and how well it discriminated
between the strong and weaker students in the class.
9. Performance can be compared from class to class and year to year.
10. Can cover a lot of material very efficiently(about one item per minute of testing item).
11. Items can be written so that students must discriminate among options that vary in
degree of correctness.
12. Avoids the absolute judgement found in True-False tests.
Limitations:
1. Constructing good items is time consuming.
2. It is frequently difficult to find plausible distractors.
3. This item is ineffective for measuring some types of problem solving and the ability
to organize and express ideas.
4. Real-world problem solving differs- a different process is involved in proposing a
solution versus selecting a solutionfrom a set of alternatives.
5. Scores can be influenced by reading ability.
6. There is lack of feedback on individual thought processes- it is difficult to determine
why individual students selected incorrect responses.
7. Students can sometimes read more into the question than was intended.
8. Often focus on testing factual information and fails to test higher level of cognitive
thinking.
9. Sometimes there is more than one defensible “correct answer”.
10. They place a high degree of dependence on the student’s reading ability and the
instructor’s writing ability.
11. Does not provide a measure of writing ability.
12. May encourage guessing.

Multiple Choice Item writing Guidelines

Multiple choice queations typicall have three parts:
 A stem (queation or statement)
 The key (correct answers)
 Distractors ( several wrong answers)
Example:
Stem What is the radius of the circle you’d draw with a compass set at 1 inch?
A. ½ inch
B. About 3.14 inches Distractors
C. 2 inches
D. 1 inch Key
Procedural rules:
 Use either the best answer or the correct answer format.
 Best answer format refers to a list of options that can all be correct in the sense
that each has an asdvantage, but one of them is the best.
 Correct answer format refers to one and only one right answer.
 Format the items vertically, not horizontally.
 Allow time for editing and other types of items revision.
 Use good grammar, punctuation and spelling consistently.
 Minimize the time required to read each item.
 Avoid trick items.
 Use the active voice.
 Have the questions peer reviewed.
 Avoid giving unintended cues-such as making the correct answer longer in length
than the distractors.

Content-related Rules:
 Base each item on an educational or instructional objective of the course, lt trivial
information.
 Test for important or significant information.
 Focus on a single problem or idea for each test item.
 Keep the vocabulary consistent with the examinee’s level of understanding.
 Avoid cueing one item with another; keep items independent of one another.
 Avoid textbook, verbatim phrasing when developing your items.
 Avoid items based on opinions.
 Be sensitive to cultural and gender issues.
Stem construction rules:
 State the stem in either question form or completion form.
 When using a completion form, don’t leave a blank for completion in the beginning or
middle of the stem.
 Ensure that the directions in the stem are clear, and that wording lets the examinee
know exactly what is being asked.
 Avoid window dressing (excessive verbiage) in the stem.
 Include the central idea and most of the phrasing in the stem.
 Avoid giving clues such as linking the stem to the answer.

General option development rules:

 Place options in logical or numerical order.
 Keep options independent; options should not be overlapping.
 Keep all options homogenous in content.
 Keep the length of the options fairly consistent.
 Avoid, or use sparingly, the phrase “all of abov”e.
 Avoid,or use sparingly, the phrase “none of the above.”
 Phrase options positively or negatively.
 Avoid giving clues through the use of faulty grammatical construction.
 Avoid specific determinants, such as never and always.
 Make sure that there is always only one correct answer.
Distractor(incorrect options) Development rules:
 Use plausible distractors.
 Incorporate common errors of students in distractors.
 Avoid technically phrased distractors.
 Use familiar yet incorrect phrases as distractors.
 Use true statements that do not correctly answer the item.
 Avoid use of humor when developing options.
Types of Multiple Choice questions:
1. Alternative response(True/False): Essentially a two-option MCQ, these
questions may require to select either the ‘true’(correct) or the
false(incorrect)answer.
Examples:
1) Genes that occupy corresponding loci are called alleles.
a) True
b) False
2) Phosphate is an organic, negatively charged molecule.
a) True
b) False
3) The thymus is the part of the body where T-cell mature and
differentiate.
a) True
b) False
4) The human skeleton system accounts for about 50% of the body
weight.
a) True
b) False
5) The spinal and cranial nerves are part of the central nervous system.
a) True
b) False
2. Multiple True False:
3. Odd one out: In some MCQs, there is need to establish a pattern amongst answer
alternatives, and then choose which answer option is the ‘odd one out’-the one
that doesn’t.

Examples:
1) Choose the odd one out
 a) Geometry
b) Algebra
c) Thermodynamics
d) Calculas
2) Choose the odd one out
a) Square
b) Triangle
c) Cuboid
d) Rectangle
3) Choose the odd one out
a) Spoon
b) Sword
c) Knife
d) Fork
4) Choose the odd one out
a) Dollar
b) Peso
c) Ounce
d) Euro

5) Choose the odd one out

a) A.B Vajpayee
b) Pratibha Patil
c) Rajiv Gandhi
d) Manmohan Singh

4. Most accurate/ Best answer: In this, the ‘most accurate’ or ‘best’ answer to a
question has to be selected. For ‘best’ answer MCQs, there may seem to be more
than one correct answer; the trick is to choose the most correct.
Examples:
1) The healthcare provider is caring for a patient diagnosed with a mild
cognitive impairment. Which would be the most effective intervention
for this patient?
a) Relaxation therapy
b) Behavior modification
c) Frequent reorientation
d) Application of soft restraints
2) The pediatric nurse is caring for a 9 year old girl with a known
history of having been abused. Whicg therapeutic action the nurse
include in the child’s care plan?
a) Encourage the child to identify potential abusive settings
b) Ask the child to call the nurse if the abuser visits the unit
c) Instruct the child on typical characterstics of abusers
d) Ensure that the care setting allow the child to redevelop trust.
 3) When caring for a patient during an acute panic attack, which of the
following actions by the healthcarw providers is most appropriate?
a) Explore common phobias associated with panic attacks
b)Use distraction techniques to change the patient’s focus
c) Ask open ended questions to encourage communication
d) Offer the patient reassurance of safety and security
4) Which of the following goals woulde be the healthcare provider
identify as realistic for a patient with a substance abuse problem?
a) Explore genetic anomalies associated with substance abuse
b) Identify situations that trigger a desire to use the substance
c) Focus on how cravings can be eliminated by enhancing willpower
d) Use the substance only in moderation and in certain situations
5) When planning care of a patient diagnosed with Alzheimer disease
which of these interventions is most therapeutic?
a) Encouraging both verbal and nonverbal communicstion
b) Giving the patient several directions at a time to improve memory
c) Speaking in loud, clear voiice when talking to the patient
d) Proving immediate feedback by correcting errors in the patient’s speech.

5. Single correct answer form: Single correct answer in items of the single-correct
answer variety, all but one of the alternativesis correct; the remaining alternative
is the correct answer.
Examples:
1) For administration of BCG vaccine, the nurse should select
a) Intradermal site
b) Intramuscular
c) Subcutaneous
d) Intravenous
2) Which of the folllowing is the meaning of PRN?
a) When advise
b) When necessary
c) Immediately
d) Now
3) Bone deformities occur due to the excessiveintake of
a) Phosphorus
b) Potassium
c) Fatty acid
d) Fluorine
4) How many teeth will the children have?
a) 10
b) 15
c) 28
d) 20
5) A sticky substance in saliva and provides easy movement of food is
a) Insulin
 b) Amylase
c) Mucin
d) Pepsin

6. Extension question: These require to ‘extend’ the stem by choosing the correct
completion option.
Examples:
1) The type of mania in which the individual is habitual of stealing
articles repetetively called
a) Hypomania
b) Kleptomania
c) Logomania
d) Stelomania
2) Irrational fear of being in places away from the familiar setting of
home, in crowds or in situations that one cant escape easily called
a) Claustrophobia
b) Algophobia
c) Agoraphobia
d) Nyctophobia
3) Integrating the beliefs and values of another individual into one’s
own ego structure called
a) Suppression
b) Rationalization
c) Introjection
d) Repression
4) The false personal beliefs that are inconsistent with the person’s
intelligence or cultural background called
a) Hallucination
b) Delusion
c) Illusion
d) Depersonalization
5) The therapeutic communication technique in which the patient is
asked to verify the nurse’s understand of what the patient is
thinking of feeling called
a) Reflection
b) Focusing
c) Broad opening
d) Sharing perceptions

7. Statements and logical relations questions: In this, consider a sentence

comprising two statements connected by a word or phrase showing logical
relation.
Examples:
1) Statements: The old order changed yeilding place new.
Conclusion: 1. Change is the law of nature.
 2. Discard old ideas because they are old.
a) Only conclusion 1 follows
b) Only conclusion 2 follows
c) Either 1 and 2 follows
d) Both 1 and 2 follow
2) Statements: Quality has a price tag. India is allocaing lots of funds to
education.
Conclusion: 1. Quality of education in India would improve soon.
2. Funding alone can enhance quality of education.
a) Only conclusion 1 follows
b) Only conclusion 2 follows
c) Either 1 and 2 follows
d) Neither 1 nor 2 follows

3) Statement: Domestic demand has been increasing faster than the

production of indigenous crude oil.
Conclusion: 1. Crude oil must be imported.
2. Domestic demand should be reduced
a) Only conclusion 1 follows
b) Only conclusion 2 follows
c) Either 1 or 2 follows
d) Both 1 and 2 follows.

4) Statement: Jade plant has thick leaves and it requires little water.
Conclusion: 1. All plants with thick leaves requires little water
2. Jade plants may grown in places where water is not aburdance.
a) Only conclusion 1 follows
b) Only conclusion 2 follows
c) Neither 1 nor 2 follows
d) Both 1 and 2 follow.
 6) Statements: Modern man influences his destiny by the choice he makes
unlike in the past.
Conclusion: 1. Earlier there were fewer options available to man
2. There was no desire in the past to influence the destiny.
a) Only conclusion 1 follows
b)Only conclusion 2 follows
c) Either 1 and 2 follows
d) Both 1 and 2 follow.

8. Negative form: In items of the negative variety, the students is directed to

identify either the alternative that is an incorrect answer, or the alternative that is
worst answer.
Examples:
1) Pain assessment is done by all scales except
a) Visual Analog Scale
b) Wong Baker Facing Rating Scale
c) Numerical Rating Scale
d) Braden Scale

2) The diseases caused by bacteria are all except

a) Tuberculosis
b) Leprosy
c) Tetanus
d) Measles
3) Atypical antipsychotic drugs include all except
a) Duloxetine
b) Clozapine
c) Resperidone
d) Quetiapine
4) Extrapyramidal symptoms of antipsychotics include all except
a) Dementia
b) Tardive dyskinesia
c) Akinesia
d) Akathesia
5) The drug choice for mood disorder are except
a) Sodium valproate
b) Lithium
c) Amantadine
d) Carbamazepine

.
 NATIONAL INSTITUTE OF NURSING EDUCATION

PGIMER, CHANDIGARH

Assignment On

“Multiple Choice Question”

SUBMITTED TO: Dr. Manju Dhandapani

(LECTURER), NINE
PGIMER, Chandigarh

SUBMITTED BY: MS. MADHU BALA

MSc. NURSING 1ST YEAR
NINE, PGIMER
CHANDIGARH.
 References
1. Sodhi JK. A comprehensive textbook of nursing education. New
Delhi: Published by Jaypee brother’s medical publishers
(P) Ltd.; 2017.
2. Raj DEB, Bhaskar N. Textbook of Nursing education. Bangalore:
EMMESS Medical publishers; 2013.
3. Multiple choice questions. Available On:
Wikipedia-[Link]