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Education Introduction Instructor’s manuals that accompany nursing education textbooks frequently offer banks of test questions for use in student examinations. Writing effective multiple-choice questions can be difficult and time-consuming for instructors, and test banks offer a way to make the process less laborious. However, test banks should not be considered a panacea for instructors who have to develop multiple-choice test items. Instructor’s manuals with test banks are fairly common adjuncts to nursing textbooks,
and publishers often market the manuals together with the textbooks as a package (Masters et al., 2001). For example, the Instructor’s Resource that accompanies Potter and Perry’s (2005) Fundamentals of Nursing textbook comes with a test bank CD-ROM so that instructors can download the questions directly onto their word processors (Castaldi, 2005). It could be assumed that questions derived from textbook test banks would accurately reflect the content in the textbook, but a literature search performed by Masters et al. failed to find any studies that explored this area. The purpose of this study was to evaluate multiple-choice questions from test banks accompanying selected nursing textbooks.
Background Information Multiple-choice questions are the most frequently used examination format currently used in nursing education (Masters et al. 2001). Multiple choice questions offer several benefits for educators, including objectivity, efficiency, and ease of grading (Farley, 1989; Hoepfl, 1994). Multiple choice questions also allow instructors to test a wide variety of topics in a short time and assess higher level cognitive skills such as problem-solving, prioritizing, and application of concepts to scenarios (Morrison & Free, 2001; Schick, 1990). However, multiple choice questions may encourage guessing by students, and are time-consuming to write for educators (Farley). Test banks that accompany texts are convenient tools for busy educators, as the ready-
Using test bank questions
made questions can dramatically reduce test preparation time. Test bank questions can also help ensure that test questions correlate with material presented in the text (Clute & McGrail, 1989). However, educators should review questions that are provided in test banks to ensure that they are of high quality and able to test higher level cognitive levels (Clute & McGrail; Ellsworth, Dunnell, & Duell, 1990; Masters et al.; McAfee, 1979). The cognitive levels within Bloom’s (1984) taxonomy may be utilized by educators to evaluate the difficulty of multiple choice questions (McDonald, 2002). Bloom’s taxonomy divides learning into three domains: cognitive, affective, and psychomotor. Each of these domains is also divided into multiple levels of increasing complexity. The cognitive domain is split up into six levels: knowledge, comprehension, application, analysis, synthesis, and evaluation. Knowledge is the simplest level, in which the learner is merely required to recall previously learned facts and figures. Comprehension requires the learner to demonstrate understanding of the meaning of the material. Questions that test at the comprehension level may ask students to interpret, discuss, or paraphrase the information. Application requires the learner to relate concepts or theories to new situations that have not been previously discussed in the reading or classroom. Analysis requires the learner to dissect learned material into smaller elements so that patterns may be identified. Questions that test at the analysis level may ask students to make inferences to determine causes of events, or differentiate between several contributory factors within a scenario. Synthesis requires the learner to make generalizations from given information, or integrate knowledge from different areas of study. Evaluation requires the learner to determine the value of information, discriminate between several different concepts, or make choices based on reasoning and logic (Bloom, 1984; Jeffries & Norton, 2005; McDonald). Multiple choice questions may be written at the knowledge, comprehension, application, and analysis levels. The multiple choice question format is not recommended for the synthesis and evaluation levels, as they “require divergent thinking, and lead to unique responses that are not likely to be determined in advance” (Hoepfl, 1994, p. 25).
Because nursing practice is rarely absolute. Testwise students are quick to rule out options that are inconsistent with the stem. This is particularly important when students have been instructed to select the best possible answer from the available options. the stem and the correct answer are grammatically consistent. 1994). Numerous guidelines and principles have been proposed for multiple-choice question development. Questions should be phrased whenever possible so that . p. Farley (1989) and Hoepfl (1994) recommend that educators avoid using negative statements in multiple choice questions. all) in multiple choice questions. “Almost always. never. According to McDonald (2002). 3). none. Frary (1995) and Hoepfl (1994) state that multiple choice questions must be written using correct rules of language. testwise students will select it even if they do not know the correct answer. as students often tend to select the longest answer. Farley (1989) and McDonald (2002) counsel against the use of specific determiners (always. Dewey (2004) and Farley (1989) recommend that all of the options should be approximately the same length. Similarly. Frary (1995) and Kehoe (1995) advise against the use of “all of the above” and “none of the above” in multiple choice questions. and all of the options must match up to the stem. as test results play a major role in student grading as well as admittance to professional programs (Hoepfl.Using test bank questions 3 Guidelines for Multiple Choice Question Development Educators must be conscientious when developing examinations. often produced as afterthoughts. it is critically important that multiple-choice questions be well written to ensure reliability and validity. “None of the above” should also be avoided if the question requires calculations or estimation (Kehoe. 1995). McDonald (2002) also noted that if only one option is consistent with the stem. For example. but distractors. may not mesh properly with the stem” (Frary. specific determiners often indicate incorrect answers for testwise students. Testwise students know that “all of the above” can be ruled out as the correct answer if any of the options are wrong.
instructors’ manuals. bold type. The analysis level requires students to compare and contrast components of nursing theories or scenarios (Demetrulias & McCubbin. Ultimately. By utilizing negative questions. 16). educators may reinforce incorrect information (Farley. p. Kehoe (1995) and McDonald (2002) stated that educators should randomize the correct answers to questions on multiple choice tests. and multiple choice test development. Farley (1989) and Morrison and Free (2001) stated that the majority of multiple-choice questions should be written at the application and analysis levels for nursing examinations to facilitate the development of higher level cognitive skills. multiple choice questions and nursing education. 4 “Students believe that instructors have an unconscious tendency to make C or D the correct answer in multiple-choice examinations” (Clute & McGrail. p. The application level goes beyond the regurgitation of information necessary for the comprehension and knowledge levels and requires students to apply concepts to new clinical circumstances or patient conditions. Kehoe (1995) noted that bias may be introduced into the test through the use of negative questions because students routinely look for options that make the stem true. Farley and Schick (1988) both recommended that if negatives must be used in questions. This tendency may introduce a significant bias into the examination and undermine test reliability and validity. The search revealed only one review . McDonald (2002) pointed out that questions that contain negatives in both the stem and options should never be used because they greatly confuse students.Using test bank questions students will look for the correct answer. or capital letters. “when the nurse educator’s goal is to teach a thinking process or the use of knowledge for nursing intervention. 1982). 1989. p. they should be emphasized with underlines. and ensure that answers are assigned equally to each of the option choices. the evaluation instrument should require the student to use the same process” (Demetrulias and McCubbin. Literature Review A literature review was done using the CINAHL and WilsonSelectPlus databases with the following search terms: test banks. 245). 11).
(2001) reviewed 2913 multiplechoice test questions randomly obtained from 17 undergraduate nursing textbook test banks. Masters et al. & 1990) that included broad overviews of textbook test question bank usage. and management. and negative phrasing in the questions. A broader search of the literature was performed by reviewing the references listed in the Masters et al. One significant finding was that more than 70% of the questions were written at the knowledge and comprehension levels. This search revealed a series of three articles written by Schick (1988. “Questions were evaluated on (a) adherence to generally accepted guidelines for writing multiple-choice questions. The findings of the Masters et al. 25).. including nursing fundamentals. marketing. rather than the application and analysis levels used for the NCLEX-RN examination (Masters et al. providing only one correct answer. suggesting a lack of up to date clinical expertise by the author. (2001) research study demonstrated 2233 instances where the questions did not comply with the general guidelines used for the study. including only essential material in the stem or options.B. unequal option lengths. or D” (Masters et al. and ensuring that all of the options were plausible. Hansen (1997) reviewed 440 auditing textbook test questions from five textbooks to . The ERIC database was then searched using the following terms: instructor’s manuals. Based on these findings. it was noted that 120 questions had more than one correct answer and 21 questions listed the wrong correct answer.Using test bank questions of nursing or healthcare textbook test banks. p.C. recommended that nursing educators review test bank questions carefully before including them in examinations with students. 1989. (2001) article. test banks. Masters et al. The 30 guidelines utilized for the research study included: using proper grammar. and multiple choice questions. health assessment. (b) cognitive level as defined by Bloom’s taxonomy. 2001). Masters et al. and (c) distribution of correct 5 answers as A. also noted that several test questions included outdated material and procedures. psychology. and medical-surgical nursing. While most of the problems were minor. The most common violations were inadequate spacing. Six additional studies were also located that analyzed textbook test bank questions in a variety of areas including accounting.
this study contrasts with the Masters et al. The findings revealed a total of 490 violations. The results showed that “option C was used as a correct answer more frequently than options A. using seven educational psychology textbooks. The findings revealed that out of 1. approximately 60% contained at least one guideline violation. with approximately 75% of the questions containing at least one guideline violation. Again. These results are consistent with those found by Masters et al. The findings revealed that 87% of the management questions tested at the knowledge level of Bloom’s taxonomy. in which 70% of the questions were written .080 questions. (2001). Clute and McGrail (1989) reviewed cost accounting textbook test banks to determine if the correct answers were randomly placed. answer E was correct only 5% of the time. 291). The most common violations were grammatical errors and using negative phrasing in the stem. (2001) study. (2001) study in which the answers were found to be evenly distributed. The most common violations were failure to emphasize negatives within the questions. Specifically. and option A was used the least” (Ellsworth et al. and Martin (1993) evaluated marketing and management textbook test banks to determine the cognitive levels of the questions. it was found that in questions with 5 possible options. These findings differ from the Masters et al. Krentler. in which the correct test answers were found to be evenly distributed but almost 76% of the questions contained at least one guideline violation. p. These findings differ from the Masters et al. The researchers also examined the questions to determine that the correct answers were randomly placed within the test. although the guideline violations differed slightly. B. The review of the marketing textbooks found that 65% of the questions tested at the knowledge level.Using test bank questions determine if test bank questions violated 17 standard guidelines for writing multiple-choice questions. (2001) study. The researchers assessed 32 textbook test banks using 37 commonly accepted guidelines. The findings showed that almost all of the test banks contained significant bias in the placement of the correct answers. Dunnell. or D. and using options that included all or none of the above. and Duell (1990) evaluated test banks for guideline violations as well. Hampton.. 6 Ellsworth.
The results were then compiled and compared to the findings of the Masters et al. D and E? How many guideline violations will be found within the questions? The study examined the questions to determine if they include the following violations: use of specific determiners or negative questions. This is problematic because educators may overestimate the ability of their examinations to evaluate higher level thinking skills in their students. Results . 10 chapters were chosen from each of the test banks. 7 Methodology The study explored test bank questions from a convenience sample of five undergraduate nursing textbooks listed in Appendix A. this author experienced difficulty evaluating of some of the test bank questions due to unfamiliarity with the textbook. pediatric. grammatical incorrectness. also noted that the marketing and management test bank authors overrated the cognitive level of approximately 18% of the questions.Using test bank questions at the knowledge or comprehension level. Another limitation was the potential for bias when determining the cognitive level of the test bank questions. heterogeneity of option lengths. Limitations A major limitation of this study was the small number of test banks reviewed. For the study. as all of the questions were reviewed by this author only. Additionally. (2001) study. No test banks were reviewed that covered maternal-child. All of the questions within each chapter were examined by this author employing the criteria listed above. B. C. The research questions included: What percentage of the questions assess above the comprehension level of Bloom’s (1984) taxonomy? Are the correct answers randomized and evenly distributed between options A. and use of all or none of the above. or psychiatric nursing. Hampton et al.
The low cognitive level of the questions may be due to the fact that the Leonard (2003b) textbook and instructors’ manual were developed for use by a variety of health care professional training programs. not just nursing education. however. These findings differ from those of the Masters et al. in which only 28% of the questions tested above the . 2005) Medical-surgical nursing (Ignatavicius & Workman. 2003) Medical terminology (Leonard. Table 1 Cognitive Level of Test Bank Questions Total number of questions Textbook Pathophysiology (Doig. 2004) Number of application level questions 66 245 127 280 0 716 Percentage of application level questions 14% 59% 60% 67% 0% 36% 469 414 210 419 500 2012 Health assessment (Plowden & Hausauer. 2000) Fundamentals (Castaldi. it was found that 48% of the questions tested at or above the application level (Table 2). 2003a) Totals When the Leonard (2003b) textbook was removed from the equation. This value is skewed by the Leonard (2003a) medical terminology test bank.Using test bank questions COGNITIVE LEVEL OF QUESTIONS Examination of the cognitive levels of the test bank questions revealed that 36% of the 8 questions tested at the application level or higher (Table 1). which contained 500 questions that tested exclusively at the comprehension and knowledge levels. (2001) study.
contained 58% application and analysis level questions. (2001) and this author. almost 60% of the questions in the Castaldi (2005) nursing fundamentals test bank tested at application and analysis levels. 2004) 9 Number of application level questions 64 245 127 280 Percentage of application level questions 14% 59% 60% 67% 469 414 210 419 Health assessment (Plowden & Hausauer. This author noted that 59% of the questions in the Plowden and Hausauer (2000) test bank for the 3rd edition of the Jarvis (2000) health assessment textbook tested at or above the application level. The Plowden and Hausauer (2000) health assessment test bank chapters ranged from 14% to 84% application and . While several of the test banks contained large numbers of questions that tested above the comprehension level. Table 2 Cognitive Level of Nursing-Specific Test Bank Questions Total number of questions Pathophysiology (Doig. 2005) Medical-surgical nursing (Ignatavicius & Workman. 2000) Fundamentals of nursing (Castaldi. 2003) Totals 1512 716 48% A significant finding was that 67% of the questions in the Ignatavicius and Workman (2003) medical-surgical nursing test bank tested at or above the application level. An interesting finding was also noted regarding the health assessment test banks evaluated by Masters et al.Using test bank questions comprehension level. they were not consistent from chapter to chapter. Additionally. The test bank for the 2nd edition of the Jarvis (1996) health assessment textbook that was evaluated by Masters et al.
and 23% as option D. Remarkably. C and D (Table 3). (2001) study. Likewise. Interestingly. These findings correspond with the Masters et al. with 30% as option B. and were relatively evenly distributed as options A. in contrast to the Doig pathophysiology test bank which had no questions that tested at the higher cognitive levels. in the chapter on critical thinking. the Ignatavicius and Workman chapter on dysrhythmias included 89% application and analysis level questions. with 30% as option B. the Plowden and Hausauer (2000) health assessment test bank was written to accompany the Jarvis textbook which is used for both graduate and undergraduate education. and 21% as option D. 26% as option C. it was noted that in the chapter on critical thinking in the Castaldi test bank. 77% of the questions tested above the comprehension level. The questions for the chapter on pain included 67% that tested above the comprehension level. On the other hand. Interestingly. B. RANDOMIZATION OF CORRECT ANSWERS Analysis revealed that the correct answers appeared to be randomized. 26% as option C. in which option A was used 25% of the time. The Doig (2004) pathophysiology test bank ranged from 0% to 31% application and analysis level questions. The high percentage of application and analysis questions in the Ignatavicius and Workman medicalsurgical nursing test bank most likely reflects the focus on critical thinking that is a major feature of their 2002 textbook. Option A was the correct answer 23% of the time. the Ignatavicius and Workman (2003) medicalsurgical nursing test bank ranged from 42% to 89% application and analysis level questions. The Castaldi (2005) nursing fundamentals test bank ranged from 31% to 77% application and analysis questions. Only a very few questions required the student to simply recall information about medications or dysrhythmias. .Using test bank questions 10 analysis level questions. it was noted that only 14% of the questions tested above the comprehension level. The majority of the questions required students to interpret and decide on a nursing intervention based on EKG tracings.
2003a) Total # Total % 23% 30% 26% 21% 100% GUIDELINE VIOLATIONS Only a small number of negative questions were found in the test bank chapters that were reviewed. 2004) B 148 124 52 135 137 596 C 136 122 55 99 121 533 D 84 83 60 97 104 428 Total 469 414 210 419 500 2012 101 85 43 88 137 454 Health assessment (Plowden & Hausauer. 2000) Fundamentals of nursing (Castaldi. Table 3 Randomization of Correct Answers A Pathophysiology (Doig.Using test bank questions While the correct answers were evenly distributed overall. For example. Chapter 42 in the 11 Ignatavicius and Workman (2003) medical-surgical nursing test bank had 37% of the questions (14 out of 38) had the correct answer as option C. while only 13% (5 out of 38) had the correct answer as option B. 2003) Medical terminology (Leonard. while only 11% of the questions (5 out of 45) had the correct answer as option A. 2005) Medical-surgical nursing (Ignatavicius & Workman. The Plowden and Hausauer (2000) health assessment test bank and the Castaldi . chapter 10 in the Plowden and Hausauer (2000) health assessment test bank had 47% of the questions (21 out of 45) with the correct answer as option C. some chapters were quite skewed.
These questions also required the student to select the client statement that was incorrect.Using test bank questions (2005) nursing fundamentals test bank each contained one negative question. or options that included all or none of the above. requiring the student to select patient statements indicating that additional client teaching was required. all of which failed to highlight the negative wording. one question in the Ignatavicius and Workman medical-surgical nursing test bank was missing the question mark at the end of the stem. The Ignatavicius and Workman (2003) medical-surgical nursing test bank contained eight negative questions. When heterogeneity of option lengths was assessed. No inequality of option lengths were found with the other test banks. In each case. the correct answer was included as an option. but the answer key listed . No negative questions were found in the Leonard (2003a) medical terminology test bank. Five other questions in the Ignatavicius and Workman test bank presented a variation on negative question phrasing. and it was noted 12 that neither test bank highlighted the negative wording. and the Ignatavicius and Workman (2003) medical-surgical nursing test bank contained only one. however. it was noted that the Plowden and Hausauer (2000) health assessment test bank contained three questions in which the option lengths were markedly unequal. None of the test bank chapters that were reviewed utilized specific determiners. the Plowden and Hausauer (2000) health assessment test bank. Eight incorrect answers were found in the Doig (2004) pathophysiology test bank out of the 469 questions that were reviewed. Additionally. but the negative wording was italicized in each. The Doig (2004) pathophysiology test bank. The Doig (2004) pathophysiology test bank contained three negative questions. No typographical errors were found in the Castaldi (2005) nursing fundamentals test bank or the Leonard (2003a) medical terminology test bank. making them difficult to read. and two others were poorly worded. Six incorrect answers were found in the Ignatavicius and Workman (2003) medicalsurgical nursing test bank out of the 419 questions that were reviewed. and the Ignatavicius and Workman (2003) medical-surgical nursing test bank each contained one typographical error. although the negative aspect was stated more clearly.
2003. Which intervention should you teach the client to prevent injury as a result of this complication? A) “Examine your feet daily” B) “Rotate your insulin injection sites” C) “Wear white socks instead of colored socks” D) “Use a bath thermometer to test water temperature” Correct answer: D (Ignatavicius and Workman. diabetics should also examine their feet daily to check for hammer toes or bunions that can lead to blister formation or sharp toenails that can cause skin irritation (University of Michigan Health System. question 48) Option D is correct. both options A and D are correct for this question. Some of the questions had more than one correct or best answer. as diabetics should always use a bath thermometer to test water temperature because of decreased thermal sensitivity due to peripheral neuropathy. the limited information presented in the stem and the . 1988. However. Violation of this guideline can be seen in the following question from the Ignatavicius and Workman (2003) medical-surgical nursing test bank: The diabetic client has severe peripheral neuropathy resulting in numbness and reduced sensation. No incorrect answers were found in the other test banks. Neither test bank included page references or rationale for the correct answers in the answer key. However. Therefore. chapter 65. other problems were noted with some of the questions in the Ignatavicius and Workman (2003) medical-surgical nursing test bank. One important guideline for multiple choice questions is that each question should have only one correct answer. “Care must be taken to see that other responses do not confuse the issue from a logical perspective” (Shick. Several other questions asked the student to select the nursing diagnosis with the highest priority from the option list. In addition to the violations listed above. p.Using test bank questions 13 the wrong one. 42). 2003).
Sheldon & Thirlby. as seen with this question from the Ignatavicius and Workman (2003) medical-surgical nursing test bank: Which nursing diagnosis has the highest priority for the client who is receiving epidural analgesia with fentanyl (Sublimaze) for acute postoperative pain? A) Risk for Respiratory Depression related to opioids administration B) Risk for Impaired Skin Integrity related to immobility C) Risk for Infection related to epidural catheter location D) Risk for Confusion related to opioids administration Correct answer: C (Ignatavicius and Workman. both options A and C would be appropriate answers to this question. chapter 7) While risk for infection is certainly an important concern for patients receiving epidural analgesia. Therefore. 2003. question 28.Using test bank questions 14 option choices made it difficult to determine exactly which diagnosis was the most important. respiratory depression is a significant side effect of epidural narcotic administration that requires close monitoring (Moraca. Another example of a poorly written nursing diagnosis question from the Ignatavicius and Workman (2003) medical-surgical nursing test bank is this question: . 2003).
as compared to patients with chronic bronchitis. it is not clear whether or not barrel chest or chronic coughing would be significant symptoms for this patient. With the two questions listed above. chapter 30) Again. 1994). one answer should be listed that is clearly the best option (Hoepfl. One additional problem was also noted with this question from the Doig (2004) pathophysiology test bank regarding the options list: . the information in the stem does not state whether or not the patient lives alone. the authors did not provide enough information for the students to select one nursing diagnosis that takes priority over the others.Using test bank questions 15 What is the priority psychosocial nursing diagnosis for a person with moderate COPD who lives in his or her own home? A) Disturbed Body Image related to presence of a barrel chest B) Social Isolation related to embarrassment from chronic coughing C) Impaired Home Maintenance related to activity intolerance D) Ineffective Role Performance related to change in physical condition Correct answer: B (Ignatavicius and Workman. Patients with emphysema do not have significant coughing and little sputum production. making it impossible to tell if disturbed body image or social isolation are even appropriate diagnoses. 2004). Impaired home maintenance would be much less of a concern if the patient was living with other healthy family members. question 17. Additionally. it is difficult to determine which nursing diagnosis is the most important based on the information provided in the stem. Therefore. Patients with chronic bronchitis also do not typically develop barrel chests as there is no hyperinflation of the lungs (Boyle & Locke. 2003. For the “best answer” format to be effective with multiple choice questions.
1988). A) B) C) D) 16 K D E B12 Correct answer: A (Doig. or logically to facilitate the ease of response (Shick. It is vitally important for educators to review questions taken from . Discussion Multiple choice test questions are most effective when they are carefully developed by educators (McDonald. The options would be more easily understood if they were listed in the following order: Vitamin ____ is required for normal clotting factor synthesis by the liver. numerically. question 65. A) E B) B12 C) K D) D Correct answer: A This order matches vitamin B12 with option B. making it easier for the student to transcribe the answer onto the test copy.Using test bank questions Vitamin ____ is required for normal clotting factor synthesis by the liver. Options A and C were simply listed in alphabetical order. Multiple choice options should be ordered alphabetically. 2004. chapter 20) The ordering of the options can make it difficult for the student to mark the correct answer on the test sheet. 2002). and vitamin D with the option D.
only 14%. Conversely. the Castaldi (2005) test bank for Potter and Perry’s (2005) medical-surgical nursing textbook included 67% application and analysis . This study found that 48% of the questions tested at the application level or higher. Most worrisome were the questions with wrong answers or more than one correct answer. Several differences were noted when comparing the results of this study with those of Masters et al. study were written between 1991 and 1997. The Castaldi (2005) nursing fundamentals test bank was available in paperback as well as CD-ROM format. The Doig (2004) pathophysiology test bank had the lowest percentage of questions that tested above the comprehension level by far. book. and internet website. While most of the 17 questions from the test banks were found to be acceptable. (2001) study found only 28% of the questions tested above the comprehension level. with critical thinking exercises at the end of each chapter. including CD-ROM. while the test banks for this study were written between 2000 and 2005. resulting in higher percentages of questions that require the use of advanced cognitive skills. While all of the test banks that were reviewed for this study were designed for use with undergraduate nursing students. (2001). The Ignatavicius and Workman (2003) medical-surgical nursing test bank was on CD-ROM. The instructors’ manuals and test banks were available in a variety of formats.Using test bank questions textbook test banks prior to using them in examinations with students. but this author found it very difficult to formulate the questions into test format and print them out. as the Heuther and McCance (2003) pathophysiology textbook is written for baccalaureate nursing students. This may be due to the fact that the test banks used in the Masters et al. which allows instructors to read and highlight questions in the book. some variation may be noted between the textbooks. some significant guideline violations were noted. while the Masters et al. as these questions are frustrating for the students and have the potential to bring down students’ grades if left unchecked. It is possible that the test bank authors are reflecting the recent emphasis on critical thinking in nursing education. and then download selected questions directly to Word from the CD-ROM. This is surprising.
as compared to the total average of 59%. For instance. The Plowden and Hausauer (2000) health assessment test bank was the most significant. This may be due to the fact that the textbook is geared for beginning students to learn basic medical terms. wide variations were noted between chapters in the percentages of questions that tested above the comprehension level. as the Jarvis text was written for use at the undergraduate as well as the graduate levels. Within each of the test banks. as compared to the overall average of 14%.Using test bank questions 18 questions. and may be used for any of the allied health care professions. It can be expected that this test bank would include a high percentage of questions that utilized higher cognitive functions. Within the Ignatavicius and Workman (2003) medical- . 8% of the questions in the cardiac chapter tested above the comprehension level. the Leonard (2003b) test bank for the Leonard (2003a) medical terminology textbook had no questions that tested above the comprehension level. 55% of the questions in the cardiac chapter tested at the application or analysis levels. as well as critical thinking models and concept maps to help students understand the theoretical foundations for nursing practice. Reasons for these variations were not clear. This is very consistent with the textbook focus on critical thinking and application of the nursing process for patient care. three of the chapters in the different test banks reviewed covered content about care and assessment related to the cardiac system. Conversely. the highest percentage of the test banks reviewed in this study. Within the Plowden and Hausauer (2000) test bank for the Jarvis (2000) health assessment textbook. The Potter and Perry textbook includes critical thinking exercises in each chapter. 59% of the questions reviewed for this study tested at the application or analysis level. When analysis was done across chapter content. Within the Plowden and Hausauer health assessment test bank. which raises the question of whether or not the same questions are appropriate for both levels of study. no pattern was readily apparent. ranging from 14% in the critical thinking chapter to 84% within the chapter on neurological assessment. The Plowden and Hausauer test bank was designed for use by both undergraduate and graduate nurse educators. Within the Doig (2004) pathophysiology test bank.
2005) % of questions that test above the comprehension level Average % of questions that test above the comprehension level Range 0%-31% 31%-77% 42%-89% 18%-84% 14% 60% 67% 59% 31 46 47 70 The Doig (2004) pathophysiology test bank was also on CD-ROM. 2000) (Doig. 2004) (Castaldi. 2003) (Plowden & Hausauer. as compared to the overall average of 67%. table four 19 shows that the test banks with two authors had a larger range of differences (47 percentage points for the Ignatavicius and Workman medical-surgical nursing test bank and 70 points for the Plowden and Hausauer health assessment test bank) than the test banks with only one author (31 percentage points for the Doig pathophysiology test bank and 46 points for the Castaldi fundamentals test bank). However.Health assessment of nursing surgical nursing (Ignatavicius & Workman. Similar findings were noted with other content areas that were tested by multiple test bank chapters. Table 4 Range of Questions that Test above the Comprehension Level Pathophysiology Fundamentals Medical.Using test bank questions surgical nursing test bank. 89% of the questions in the cardiac chapter tested above the comprehension level. but required Internet .
This feature is useful for instructors who wish to put together an answer key to go along with the examination copy. the significance remains clear. This author found it helpful when the authors put rationales and/or page numbers along with the correct answers for the questions. Instructors should evaluate all of the questions carefully to ensure that they follow general guidelines for multiple-choice question development and accurately reflect the content presented in the course. the test questions were available in RTF or PDF formats. Recommendations Further research is needed into the use of instructors’ test banks for undergraduate nursing education. as the instructor can readily find the correct information to change the answer key. The Doig test bank also offered true/false. but should be reviewed carefully before use. Test banks of multiple choice questions available for use by nurse educators are a helpful resource for examination development. Although the research findings of Masters et al. which was time-consuming. which allow instructors to copy and paste questions for their examinations. i. This is very helpful when there is an incorrect answer listed. The page numbers are also helpful for when instructors conduct reviews after the test is administered. the questions could be accessed and printed either with or without the correct answers visible. (2001) did not exactly correlate with the observations of this author. and multiple answer questions for instructors. References . However. although this study only reviewed the multiple choice questions.Using test bank questions 20 Explorer to access the questions on the internet.e. Each chapter had to be downloaded separately. The students can be easily referred to the correct page in their textbooks to clarify any confusion about the material. Larger studies may be conducted that compare test banks from several textbooks in the same specialty. various medical-surgical nursing test banks. Additionally. fill in the blank.
Krentler. 21 Castaldi. Louis: Mosby. 69(1). Ellsworth. 13(1). Update on chronic obstructive pulmonary disease. . from http://www. Dewey. (3rd ed. Instructor’s course resources to accompany Huether and McCance’s understanding pathophysiology. G.. The Technology Teacher. P. A. MEDSURG Nursing. B.. (1984). & Duell. S.net/ericdigests/ed398238. D.com/selfquiz/aboutq. (1989). Demetrulias. & Martin. & McCubbin. 42-48. 2004. M. K. 73. A. 83.).Using test bank questions Bloom. Frary. Constructing test questions for higher level thinking. (1997). (2004).. & McCance. D. K. (1989). 94-97.. Louis: Elsevier Mosby. 245-247. 14(5). Nurse Educator. 53(7). (1993).psychwww. D. Journal of Education for Business..). P. (1995). More multiple-choice item writing do's and don'ts. The multiple-choice test: Developing the test blueprint. R.htm Doig. St.). 3-5. 13-17. L. O. R. (2004). A. Clute. Boston: Allyn and Bacon. Dunnell.ericfacility. Bias in examination test banks that accompany cost accounting texts. (1994). & McGrail. Heuther.html Hampton. (2003). 2004. Understanding pathophysiology (3rd ed. 64. Quality multiple-choice test questions: Item-writing guidelines and an analysis of auditing test banks. 7. Journal of Education for Business. Developing and evaluating multiple choice tests. R. The use of management and marketing textbook multiple-choice questions: A case study. Taxonomy of educational objectives.. 289-293. (2005). Instructor's resource manual and test bank to accompany Potter and Perry’s fundamentals of nursing (6th ed.. (1990). Farley. Journal of Education for Business. from ERIC Clearinghouse on Assessment and Evaluation Web Site: http://www. Nurse Educator. 25-26. & Locke. J. Hoepfl. Hansen. Retrieved October 18. Writing multiple choice items which require comprehension. J. (1982). 40-43. St. St. K. R. Retrieved October 8. (2004). Multiple-choice test items: What are textbook authors telling teachers? Journal of Educational Research. Louis: Elsevier Mosby. Boyle.
). J. R. D. (2001). College text test validity. Brownstone computerized test bank CD-ROM for medical-surgical nursing. St. (2nd ed. A.).medscape. Journal of Nursing Education. Plowden. (2002). K. Jarvis.Using test bank questions Ignatavicius. & Verst. (3rd ed. & Free. Masters. pp. Retrieved October 18. McDonald.. Hulsmeyer. Louis: Elsevier Saunders. (1996). R. McAfee. (3rd ed.net/ericdigests/ed398236. & Workman. (2003). (2003). 22 Jarvis. K. Physical examination and health assessment.html Leonard. (1995). (2001). Louis: Elsevier Saunders. Writing multiple choice test items that promote and measure critical thinking.. P. (2003a). (1979). J. K. Quick and easy medical terminology (4th ed. C. 18-19. & Thirlby.ericfacility. Philadelphia: W. (2000). 40(1). St. Saunders. 187-212). M.). Assessment of multiple-choice questions in selected test banks accompanying text books used in nursing education. & Norton. & Hausauer. 2004.B. 40(1). In D. Boston: Jones and Bartlett. Potter. P.. L. Louis: Elsevier Mosby.. D. St.. from ERIC Clearinghouse on Assessment and Evaluation Web Site: http://www. 17-24. M. D.. Moraca. Fundamentals of nursing (6th ed.. M. Kehoe. retrieved December 20. 25-32. Systematic assessment of learning outcomes: Developing multiple-choice exams. (2003b). S. 10(2).. Writing multiple-choice test items. Billings & J.). Leonard. Sheldon. (2005). Instructor’s manual and test questions for Jarvis’ physical examination and health assessment. B. Physical examination and health assessment. Journal of Nursing Education. Annals of Surgery. Health Education. Philadelphia: Saunders. D. (4th ed. Louis: Saunders. Jeffries. A.). 242(5). St. (2000).). Instructor’s curriculum resource to accompany quick and easy medical terminology. St. Selecting learning experiences to achieve curriculum outcomes.. Teaching in nursing: A guide for faculty (2nd ed. (2005). Miller. 2005 from the Medscape website http://www. P. Pike. & Perry.com/viewarticle/464150_1 Morrison. Louis: Elsevier Saunders. C. .. J. Halstead (Eds.).. Leichty. St. P. Louis: Saunders. The role of epidural anesthesia and analgesia in surgical practice.
Textbook tests: The right formula? The Science Teacher. (2003). (1990). Tantalizing textbook tests. J.Using test bank questions Schick. proper foot care can save life and limb. (1988). 20(2). 23 Schick. University of Michigan Health System. (1989). Those tantalizing textbook tests.umich. part II: True-false. 57(6). J.htm . J. For diabetics. 18-20. Schick. Health Education. Health Education. 42-45.edu/opm/newspage/2002/diabeticsfoot. 33-39. 18(6). matching. completion and essay.med. Retrieved December 20 from the University of Michigan website http://www.
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