Dara Yastrzemski

Assignment 2-Objective Test Item Analysis

NURS-603-11253-201709

SUNY Delhi

Dr. Digger

November 11, 2017

 Distractor Analysis

Taking tests is a way to insure that a student is learning or has learned the material for the course.

Each question has a correct response and several wrong answers. These wrong answers or wrong

"clues" in the test question itself, are known as "distractors" and challenge the student to use all

their knowledge to correctly answer the question. When building a test questions, instructors

must analyze and evaluate the questions for validity. Teachers use distractors as a way to reduce

the amount of "correct guessing" and truly challenge the student to utilize all their knowledge

base of the subject.

In the following sample test, it was determined through adding the P values (percentage of

questions that students answered correctly) and the D values (discrimination values-those that

determine a combination of high scoring items and low scoring items as shown by high scorers

and low scorers on the test answers).

The following questions were examined and edited for their inability to discriminate well

between the high and low scorers.

Question 6

A client with an injury to T2 spinal cord tells the nurse, I feel awful today, my head is
throbbing, and I feel sick to my stomach. Which nursing action should be taken first? This
question was answered incorrectly by 3 of the high scorers. This could be an indication that this
is a poor question because of the distractors. One distractor that I would eliminate is the
extraneous information of "feeling sick to my stomach". The answer of fecal impaction also is a
red herring which "distracts" from the queuing of the question, " which nursing action should be
taken first?". The question may be more effective if stated as, "which of the following nursing
actions is the highest priority?".

a. Notify the clients health care provider

 b. Check the blood pressure
c. Administer the ordered analgesic
d. Assess for fecal impaction

Question 7

A client is receiving total parenteral nutrition (TPN). Which of the following is essential to the
clients care? The first two answers do not pertain to total parenteral nutrition. TPN solutions are
concentrated and can cause thrombosis of peripheral veins, a central venous catheter is usually
required. Patients should be monitored closely for glucose levels, electrolyte and mineral levels,
hepatic function and glucose abnormalities. The question should be edited to eliminate the first
two answers-which can make it too easy to guess the correct answer-not truly gauging the
students' knowledge. New distractors could include answers such as strict I & Os and BMI
calculations-two answers that are correct but, monitoring fluid and electrolyte levels is the best
answer.
a. Evaluation of the peripheral infusion site
b. Confirmation that the tube is in the stomach
c. Checking daily weights
d. Monitoring fluid and electrolyte levels

Question 13

Which client would be assigned to a nurse employed for two months, and who floated from a
surgical unit to a medical unit? Removing the last part of the question, "and who floated from a
surgical unit to a medical unit" could eliminate the possible confusion of the question. I would
state the question as "Which client would be assigned to a nurse who has been employed for two
months?". An even better option would be to ask, "Which client should be assigned to an
inexperienced RN employed for two months?".

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

The nurse would place which of the following clients in highest priority for medical attention?
The distractors in this question are too close in medical urgency to evaluate. This question had a
low D value (.84), which indicates that 2 of the higher scorers got the question wrong as well as
two of the lower scorers. Answer A could also be an emergent situation-if there were other
symptoms. This question could be considered poor because it encourages the student to read too
much into the possibilities of highest priority. That being said, this question could also be used to
demonstrate the importance of NOT reading too much into a question. Strictly speaking, this
question may be too ambiguous to be truly analyzed.
a. A 20 year old with a pruritic rash covering the entire body
b. A 43 year old with sudden onset of unilateral facial drooping
c. A 24 year old with a 3cm bleeding head laceration
d. A 32 year old with sudden onset of a whitish vaginal discharge

Question 24

A client has a normal cardiac rhythm strip except that the PR interval is 0.34 seconds. Which
action by the nurse would be most appropriate? This question was answered incorrectly by both
high scorers and low scorers. This can indicate a poorly used distractor in answer C. Many
students opted for that response as the correct answer-which was not an immediate concern. The
key words in the question are "normal" and "most appropriate". Even though this question was
answered incorrectly and it had a low discrimination score, it still may have validity and may be
useful to keep the question (Oermann & Gaberson, 2014).

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. Administer atropine per protocol.

Conclusion

Keeping questions that are very easy or very difficult may be beneficial, despite discriminating

indicators. Measurement of student learning outcomes can still be obtained, as can student

abilities, quality of instruction, while the content of each question should be measured

independently for effectiveness.

References

Oermann, M.H., & Gaberson, K.B. (2014). Evaluation and testing in nursing education (4th ed.).

Springer: New York