Running head: TEST QUESTION ANALYSIS

Test Question Analysis

Assignment 2: Objective Test Item Analysis
Christine Dunning
SUNY Delhi
NURS 603, CRN 11373, Measurement and Evaluation in Nurse Education
Kirsty Digger
November 12, 2016

TEST QUESTION ANALYSIS

Test Question Analysis

Difficulty Index (P-Value) by Question
Number of students who
selected each distractor
Questio
Pn#
A
B
C
D
Value
1
2
7
0
34
0.79
2
5
1
7
30
0.70
3
0
1
42
0
0.98
4
4
29
0
10
0.67
5
6
9
28
0
0.65
6
2
29
0
12
0.67
7
2
6
27
8
0.63
8
19
15
5
4
0.44
9
0
1
42
0
0.98
10
36
1
2
4
0.84
11
1
3
8
31
0.72
12
1
0
0
42
0.98
13
14
3
25
1
0.33
14
0
7
36
0
0.84
15
0
42
1
0
0.98
16
0
0
1
42
0.98
17
16
27
0
0
0.63
18
3
37
1
2
0.86
19
0
1
41
1
0.86
20
1
42
0
0
0.98
21
2
1
36
4
0.84
22
1
0
13
29
0.67
23
2
3
6
32
0.74
24
2
30
9
2
0.70
25
17
0
21
5
0.49
Discrimination Index by Question
Questio D-Value
1
0.3
2
0.3
3
0.1
4
0.6

TEST QUESTION ANALYSIS

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

0.7
0.3
0.3
0.6
0.1
0.2
0.6
0.2
0.3
0.2
0.1
0
0.5
0.4
0.1
0
0.2
0.2
0.3
0.1
0.6
Question Evaluation

According to Oermann and Gaberson (2014), the ideal range for difficulty index is
between 0.20 and 0.80, indicating that between 20% and 80% of the students answered the
question correctly. Additionally, questions are evaluated based on the discrimination index,
which is a measure of the higher performing students against the lower performing students to
indicated a difference in answerability. The ideal range for the discrimination index is > +0.20.
Based on these values, some of the questions that require further review are questions 9,
12, 20, and 24. Additionally, question 13 requires review of the correct answer selection
indicated.

Question #
9
12
13

P-Value
0.98
0.98
0.33

D-Value
0.10
0.20
0.30

TEST QUESTION ANALYSIS

20
24

0.98
0.70

4
0
0.10
Question 9 Analysis

The difficulty index for question number 9 is 0.98. In this case, 98% chose the correct
answer, which could determine that the question and answers were too easy. Only one student
selected the distractor, answer B. While a urinalysis may be necessary, it is first important to
assess the patients vital signs (answer C). A better choice of distractors might include additional
interventions, rather than instructing the client to wait. Additionally, using the word assesses in
the question might lead the student to believe that vital signs were already obtained. Here is an
alternate option for phasing the question and answers.
9. A client visits a busy emergency room complaining of 6/10 abdominal pain and

states, I had a temperature of 104.6oF at home." Which action would the nurse
perform first?
a.
b.
c.
d.

Ask the physician to order a STAT abdominal ultrasound.

Obtain a clean-catch urine for urinalysis culture.
Assess the clients current vital signs.
Obtain an order for an antipyretic for the client.

Question 12 Analysis

TEST QUESTION ANALYSIS

Question 12 may be considered too easy because it shows a difficulty index of 0.98, with
only one student answering incorrectly. However, the discrimination index is measuring at 0.20,
indicating that at least two of the lower performing students answered incorrectly. The student
test papers should be re-examined to determine where the discrepancy lies. Regardless, the
question still may require some editing to enhance the attractiveness of the distractors. The
choices listed in the revision below incorporate the understanding of nursing best practices.
Students should know that using restraints and catheters are not best practices in this case.
12.
An 82 year-old client has been admitted to the hospital for
hypertension and complains of dizziness and weakness. When providing
ongoing care which intervention will the nurse implement?
a. Place a bedside commode next to the clients bed
b. Use four-point bed restraints to prevent injury.
c. Insert a foley catheter and document intake and output.
d. Check on the client every 2 hours and assist with toileting.

Question 13 Analysis

While this question appears to have a 33% difficulty index based on the data provided,
further evaluation is necessary. According the data, 58% of students chose option C, while 33%
chose option A. The p-value table indicates that A is the correct answer, while the test questions
answer guide indicates option C. It is difficult to evaluate the discrimination index because it is
unclear which answer was used. Assuming that she has experience with both types of patients,
the nurse from the surgical unit may be well equipped to care for either postoperative patient A or
C, so an alternative format for this question might be appropriate. Consider revision of the
question and answers as such:

TEST QUESTION ANALYSIS

13. Which client would be assigned to a nurse employed for two months, and who floated
from a surgical unit to a medical unit? Select all that apply:
a. A 65 year old client just returned from bronchoscopy and
biopsy
b. A 58 year old client on airborne precautions for tuberculosis (TB)
c. A 72 year old client who needs teaching about the use of
incentive spirometry
d. A 69 year old client with COPD who is ventilator dependent

Question 20 Analysis

Question 20 may be considered too easy because of the p-value of 0.98. It also holds no
discrimination power (D-value = 0). Only one student selected the incorrect distractor, option A.
This data may also be incorrect, however, because the D-value data shows that two students in
each the highest performing group and the lowest performing group selected incorrect answers,
meaning that at least four students in total answered incorrectly.
Because the answer to this question is clearly option B, based on the acuity of the
patients condition, perhaps a distractor revision is necessary. Unilateral facial droop could be
indicative of stroke, which is a much higher priority that the other options. Consider revision of
the question and answers as follows, which incorporates some additional potential emergent
situations, prompting more thought from students:
20.

The nurse would place which of the following clients in highest priority
for medical attention?
a. A 20 year old with low-grade fever, headache, and myalgias for the
past 72 hours.
b. A 43 year old with sudden onset of unilateral facial drooping
c. A child with a 3cm bleeding head laceration, but otherwise well after
falling while jumping on his bed.
d. A 32 year old who is unable to bear weight on the left foot, with
swelling and bruising following a running accident.

TEST QUESTION ANALYSIS

Question 24 Analysis

This question has an appropriate and ideal difficulty index of 0.70, however, the
discrimination index is 0.10, which means that there is minimal difference in how top scoring
students and bottom performing students answered the question. A possible cause for this result
could be instructor and coursework focus on this particular topic. Essentially, there is no
significant difference in the way students answered this question in regards to their test scores.
This question requires students to understand that the PR interval assessed is outside of the
normal parameters, and that further assessment is needed. Using the word normal in the
question might lead the student to the correct answer. The question may be revised to read:
24.

A client on a 12-lead EKG has a PR interval of 0.34 seconds. Which

action by the nurse would be most appropriate?
a. Prepare the patient for temporary pacemaker insertion.
b. Document the finding and continue to monitor the patient.
c. Notify the health care provider immediately.
d. Remove and reapply EKG leads.

References
Billings, D., & Halstead, J. (2015). Teaching in nursing: A guide for faculty (5th ed.) St. Louis,
MI: Elsevier

TEST QUESTION ANALYSIS

Oermann, M., & Gaberson, K. (2014). Evaluation and testing in nursing education (4th ed.).
Springer: New York,