The Effectiveness of Multiple-Choice Test Items in Assessing the Clinical Judgment Abilities of Prelicensure Registered Nursing Students

Abstract

The purpose of this study was to evaluate the effectiveness of multiple-choice questions in assessing the clinical judgment abilities of prelicensure registered nursing students. Nurse educators are responsible for ensuring fairness in testing and evaluating the development of clinical judgment abilities of students throughout the nursing program of study. This study compared multiple-choice test items developed using the current NCSBN® NCLEX-RN test item writing guidelines to multiple-choice test items developed using the new guidelines proposed by the NCSBN® Next Gen NCLEX-RN® project. The results indicated a statistically significant difference between the two types of multiple-choice items in the measurement of clinical judgment. Participants answered all the items developed according to the current NCSBN® NCLEX-RN test plan correctly within each of the five physiological categories 41% of the time, as compared to only 14% of the time on the items written according to the recommendations of the NCSBN® Nursing Clinical Judgment Model in the Next Gen Project. These findings indicate the participants understood the theoretical knowledge of the physiological concepts but could not apply the theoretical knowledge to the clinical scenario presented in the multiple-choice questions created using the NCSBN® Nursing Clinical Judgment framework. The information gained from this study provides evidence of a process that nurse educators can follow using the NCSBN® Nursing Clinical Judgment model as a guide to create multiple-choice test items to assess the clinical judgment level of nursing students.