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Test Item Construction Assignment
Tina Campbell
Galen College of Nursing
November 24, 2020
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Test Item Construction
The purpose of this assignment is to develop a total of 24 selected response question exam
with answers and rationales using the testing blueprint assignment we completed in week two, unit two
of this course. Some of the questions we were asked to construct were multiple response, fill in the
blank, chart or exhibit items, graphic interpretation items, ordered response items, true-false items, and
constructed-response test items. All of the test questions are to include distractors and a key for student
testing purposes.
Construct Multiple-Response Items
1. An adult with asthma requires education about using how to use a peak flow meter. What
information does the nurse communicate to the client? Select All That Apply
a) Regular use of the peak flow meter can reduce the number of asthma attacks
experienced.
b) Initially, use the peak flow meter twice a day for at least two weeks when asthma is wellcontrolled.
c) Comparing ongoing results with the best, stable result helps determine medication
requirements.
d) The peak flow meter estimates lung function by determining how much air is inspired into
the lungs.
e) If the peak flow is less than 80% of personal best, administer reliever drug and retest in a
few minutes.
Correct answers b, c, e
Rationale:
Answer b is done to determine a baseline and a “personal best” against which subsequent
results will be compared.
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Answer c When the client has a result less than their recognized “personal best”, this
indicates a need for a modification in treatment. This may be a single use of a reliever
drug, or in the case of a sustained reduction in performance, an adjustment in their
prescription.
Answer e A reduction of under 80% of “personal best” shows airflow obstruction requiring
bronchodilator therapy. The client should then assess response to treatment.
The nurse should educate the client that the purpose of the peak flow meter is to assess
asthma-related airflow limitation which helps guide treatment decisions. It suggests a
warning sign of poorer asthma control by creating a baseline of the client’s personal best
that can be compared to subsequent readings. Please note that this is a very different
purpose compared to using an incentive spirometer for opening collapsed alveoli
(atelectasis) in the postoperative client (Kaplan Incorporated, 2015).
2. A new client is admitted to the hospital for complications due to chronic emphysema. The
nurse describes to the family which associated characteristic? Select All That Apply
a) Loss of lung elasticity
b) An arterial partial pressure of oxygen (PaO2) of 65 mm Hg
c) An excess of the protease enzyme
d) Hyperinflation of the lungs
e) Manifestation of bradypnea
Correct answers a, b, c, d
Rationale: Emphysema causes loss of lung elasticity and hyperinflation of the lungs
developing from excess protease. Clients with emphysema frequently have "air hunger" due
to flattening of the diaphragm and the subsequent muscle weakening that transpires from
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lung hyperinflation. To compensate for the weak diaphragm muscles, accessory muscles are
utilized in the neck, chest wall, and abdomen during inhalation and exhalation. This
amplified respiratory effort increases oxygen needs, giving the client an "air hunger"
sensation (Kaplan Incorporated, 2015).
3. A nurse is caring for a client whose endotracheal tube is being removed after successful
weaning off mechanical ventilation. Which immediate post-extubation actions should the
nurse perform? Select All That Apply
a. Administer oxygen at 2 liters per minute (LPM).
b. Auscultate breath sounds frequently.
c. Encourage the client to take small sips of water.
d. Monitor continuous pulse oximetry.
e. Position the client in the side-lying position.
Correct Answers:
b. It is important to auscultate the client's breath sounds frequently in the immediate postextubation period in order to determine if the client's condition is worsening.
d. The client is being extubated and weaned from mechanical ventilation. Very close
monitoring by the nurse is essential, including monitoring continuous pulse oximetry in
order to ensure that the client is able to maintain adequate oxygenation while ventilating.
Rationale: Extubation is the removal of the advanced airway, usually an endotracheal tube
(ETT). Depending on the state and individual facility, this procedure may be performed by
either a respiratory therapist or an RN. Prior to extubation, the nurse should position the
client in the high-Fowler's position to allow for optimal diaphragmatic excursion.
Additionally, placing the client on continuous pulse oximetry ensures adequate monitoring
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of the client's oxygen level. Once extubated, 100% oxygen is administered by mask and the
nurse frequently assesses the client's breath sounds. A high-pitch inspiratory sound may
indicate stridor, a severely narrowed airway which may occur after extubation. Stridor is a
medical emergency and assessing breath sounds frequently helps to identify this lifethreatening condition. The client should not be offered oral hydration in the immediate
post-extubation period as the client may not have an adequate gag reflex and is at risk for
aspiration (Kaplan Incorporated, 2015).
Constructed Fill-In-The-Blank Items.
4. A client is recovering from total hip arthroplasty surgery that was performed 6 hours ago and
has an oxygen saturation of 84%. The nurse should perform what action first?
______________________
Elevate the head of bed to 70 degrees. Elevate head of bed 70 degrees
Correct Answer: Elevate the head of bed to 70 degrees. Elevate head of bed 70 degrees
Rationale: Elevating the head of bed lowers the diaphragm and reduces work of breathing.
This should be done prior to any other intervention. However, the nurse will avoid placing the
client at 90 degrees to reduce the risk for postoperative dislocation of the hip joint which
increases when the hip is flexed beyond 90 degrees.
By first placing the client in an optimal position to offload respiratory effort, the nurse is
addressing the priorities of breathing and comfort. Proper positioning will allow for better
inspiration of the oxygen that is applied, facilitates ease of access for auscultation, and will
make it easier for the client to conduct any breathing exercises indicated by the assessment
findings (Kaplan Incorporated, 2015).
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5. The nurse infuses a 30 mL/kg 0.9% normal saline bolus for a client with severe sepsis. Which
action does the nurse take next in response to this intervention?
_____________________________
Obtain the client’s blood pressure. Take patient’s blood pressure.
Correct answer: Obtain the client’s blood pressure. Take patient’s blood pressure.
Rationale: Taking vital signs is important after the administration of any fluid bolus to assess
the client’s response, but it is especially important with hypotensive, severe sepsis clients.
Septic shock is sepsis with hypotension persisting after a 30 mL/kg bolus or severe sepsis with
a lactate > 4.0 mmol/L (Kaplan Incorporated, 2015).
A bolus of 30 mL/kg is recommended for severe sepsis clients with hypotension. When this
bolus completes, if the client is still hypotensive with a systolic blood pressure <90 or MAP
<65, then the client is in septic shock. Note that after any medication or therapy, it is
important to evaluate and document the client's response (Kaplan Incorporated, 2015).
6. The nurse assesses the urinary output of a client weighing 210 lb., using the recommendation
of 0.5 mL/kg/hr to decide the minimum acceptable total urinary output for the client. How
much urine must the client generate in eight hours? Record your answer rounding to the
nearest whole number.
___________ mL
Correct answer 382 mL
To calculate the minimum acceptable total urinary output for the client over eight hours, follow
these steps:
1. 210 lb. ÷ 2.2 kg/lb. = 95.45 kg
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2. 95.45 kg × 0.5 mL/kg/hr = 47.73 mL/hr
3. 47.73 mL/hr × 8 hr = 381.84 mL
4. Round to 382 mL.
(Kaplan Incorporated, 2015)
Constructed Chart or Exhibit Items.
Client Chart
Medical History
Home Medications
Labs
-Hypertension
-Diabetes Mellitus Type 2
-Hypothyroidism
-Metoprolol 25 mg Daily
-Metformin 500 mg BID
-Levothyroxine 88 mcg Daily
-Aspirin 81 mg Daily
-Glucose 106 mg/dL
-TSH 7.2 mIU/L
-Free T4 0.2 ng/dL
-Hemoglobin 10.7 mg/dL
-Hematocrit 33%
(Kaplan Incorporated, 2015)
7. The patient presents to the doctor’s office complaining of fatigue, hair loss, and cold
sensitivity. The nurse anticipates that the physician will make a change to which of the
patient’s home medications?
a) Metoprolol
b) Metformin
c) Levothyroxine
d) Aspirin
Correct answer: c
Rationale: You can see from looking at the information included on the chart, that the
patient’s TSH is raised and Free T4 is lower than the normal values, this is typical with
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hypothyroidism. This patient also has a known history of hypothyroidism and is already
taking Levothyroxine. However, when you consider the lab work along with the patient’s
indications, it is evident that the Levothyroxine dosage needs to be augmented (Kaplan
Incorporated, 2015)
8. The nurse is caring for a client who abruptly indicated palpitations and dizziness. The client’s
blood pressure is 100/48 mm/Hg. The rhythm presented on strip below is displayed on the
client’s monitor. What is the most suitable action by the nurse?
a) Prepare client for synchronized direct-current (DC) cardioversion.
b) Administer adenosine and metoprolol (Lopressor) as ordered.
c) Prepare and administer intravenous diltiazem (Cardizem) as ordered.
d) Continue to monitor the client for hemodynamic instability.
Correct answer a
Rationale: the client is in A-fib with an expansive QRS complex which may indicate WolffParkinson-White (WPW) syndrome. Do not give digoxin or nondihydropyridine calcium
channel blockers (e.g., verapamil, diltiazem) to clients with atrial fibrillation and WPW because
these drugs may cause dangerous arrhythmia such as in ventricular fibrillation (Kaplan
Incorporated, 2015)
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9. A newly graduated nurse is on orientation in the medical unit and calls you into the room of a
client who is showing signs of the rhythm in below on the monitor. What is the most
appropriate initial nursing action to be done by the nurse?
(Kaplan Incorporated, 2015)
a) Call for help and start chest compressions.
b) Assess the client for respiration and pulse.
c) Prepare to defibrillate the client.
d) Prepare and administer prescribed antidysrhythmic drug.
Correct answer: b
Rationale: The client is in Ventricular fibrillation. The nurse immediately checks for client’s pulse
and respiration, if absent, then calls for help, starts CPR, and prepares to defibrillate as soon as
the defibrillator is obtainable (Kaplan Incorporated, 2015).
Constructed Graphic Interpretation Items
10. The nurse completes a physical evaluation on an adult male. Pinpoint the area where the
nurse should position the stethoscope to auscultate heart sounds heard in the tricuspid area.
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(Kaplan Inc., 2020)
Rationale: It is essential for you to know where to listen to specific heart sounds. In addition to
the tricuspid area, you should be able to detect other anatomical landmarks to assess heart
sounds:
Angle of Louis: The manubrial sternal junction at the second rib,
Aortic Area: The second intercostal space to the right of the sternum,
Pulmonic Area: The second intercostal space to the left of the sternum,
Erb’s Point: The third intercostal space to the left of the sternum,
Mitral Area: The fifth intercostal space at the left midclavicular line,
(Kaplan Incorporated, 2015).
11. To implement cardiopulmonary resuscitation (CPR), the nurse should use the method pictured
to open the airway in which situation? Refer to figure below.
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(Elsevier Health Sciences, 2019).
a. If neck trauma is suspected
b. In all situations requiring CPR
c. If the client has a history of seizures
d. If the client has a history of headache
Correct Answer: a
Rationale: The jaw thrust without the head tilt maneuver is used when head or neck trauma is
suspected. This maneuver opens the airway while providing appropriate head and neck
alignment, decreasing the risk of further damage to the neck.
Options 2, 3, and 4 are not correct. Furthermore, it is improbable that the nurse would be able
to obtain data about the client’s history (Elsevier Health Sciences, 2019).
12. The primary health care provider prescribes erythromycin suspension 800 mg by mouth. After
reconstitution, how many milliliters should the nurse pour into the medicine cup to deliver the
prescribed dose? Refer to figure. Fill in the blank. Refer to the picture provided below.
Answer: _____ mL
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(Elsevier Health Sciences, 2019).
Correct answer: 20
Rationale: Use the medication calculation formula.
Formula:
(Elsevier Health Sciences, 2019).
13. Insert the Signs & Symptoms on the proper sides of heart failure
Right-Sided Heart Failure
Left-Sided Heart Failure
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Increased BP (from fluid volume excess) or
decreased BP (from pump failure)
Increased BP (from fluid volume excess) or
decreased BP (from pump failure)
(Elsevier Health Sciences, 2019).
Dependent edema (legs and sacrum)
Jugular venous distention
Splenomegaly
Dyspnea
Tachypnea
Hepatomegaly
Abdominal distention
Nocturnal diuresis
Crackles in the lungs
Dry, hacking cough
Anorexia and nausea
Paroxysmal nocturnal dyspnea
Weight gain
Swelling of the fingers and hand
Signs of pulmonary congestion
Correct Answers table
Right-Sided Heart Failure
Dependent edema (legs and sacrum)
Jugular venous distention
Abdominal distention
Hepatomegaly
Anorexia and nausea
Nocturnal diuresis
Swelling of the fingers and hands
Splenomegaly
Weight gain
Increased BP (from fluid volume excess) or
decreased BP (from pump failure)
Left-Sided Heart Failure
Signs of pulmonary congestion
Dyspnea
Tachypnea
Crackles in the lungs
Dry, hacking cough
Paroxysmal nocturnal dyspnea
Increased BP (from fluid volume excess) or
decreased BP (from pump failure)
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(Elsevier Health Sciences, 2019).
Rationale:
1. Left-sided heart failure: pulmonary edema (left ventricular failure),
a. Description: Results in pulmonary congestion due to the inability of the left ventricle to pump
blood to the periphery,
b. Symptoms: Dyspnea, Orthopnea, “Wet” lung sounds, Cough, Fatigue, Tachycardia, Anxiety,
Restlessness, Confusion, Paroxysmal nocturnal dyspnea (PND,) (Elsevier Health Sciences, 2019).
2. Right-sided heart failure: peripheral edema (right ventricular failure),
a. Description: Results in peripheral congestion due to the inability of the right ventricle to pump
blood out to the lungs; often results from left sided failure or pulmonary disease,
Symptoms: Peripheral edema, Weight gain, Distended neck veins, Anorexia, nausea, Nocturia,
Weakness, Hepatomegaly, Ascites, Enlargement of ventricles as indicated by chest radiograph
(Elsevier Health Sciences, 2019).
Constructed ordered response items
14. A client on telemetry reports that he has been having chest pains. The hospital unit has
standing orders that allows the nurse to begin treating the client before notifying the
physician. Place the following nursing action in proper chronological order. Use all options.
1. Administer sublingual nitroglycerin
2. Report findings to the physician
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3. Check vital signs, particularly blood pressure
4. Document the effectiveness of the treatment given
5. Evaluate the effectiveness of the treatment given
Answer
3. Check vital signs, particularly blood pressure,
1. Administer sublingual nitroglycerin,
5. Evaluate the effectiveness of the treatment given,
4. Document the effectiveness of the treatment given.
2. Report findings to the physician (de Alencar Neto, 2018).
15. The nurse is assisting a client who has had a spinal fusion apply a back brace. In which order of
priority should the nurse assist the client applying the brace?
1. Assist the client to log roll and rise to a sitting position
2. Have the client in a side-lying position
3. Ask the client to stand with arms held away from the body
4. Verify the order from the settings for the brace
Answer
4.Verify the order from the settings for the brace
2. Have the client in a side-lying position
1. Assist the client to log roll and rise to a sitting position
3. Ask the client to stand with arms held away from the body
(Kaplan Incorporated, 2015).
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16. A client is having a blood transfusion reaction. The nurse must do the following in what order
of priority from first to last.
1. Stop the transfusion
2. Keep the IV open with normal saline infusion
3. Notify the attending physician and blood bank
4. Complete the appropriate Transfusion Reaction Form(s)
Answer
2. Keep the IV open with normal saline infusion
4. Complete the appropriate Transfusion Reaction Form(s)
3. Notify the attending physician and blood bank
1. Stop the transfusion
(Kaplan Incorporated, 2015).
Constructed true-false items
17. Arteries always carry blood away from the heart.
True (Kaplan Incorporated, 2015).
18. The pulmonary arteries carry deoxygenated blood to the lungs.
True (Kaplan Incorporated, 2015).
19. Systole means contraction of the ventricles.
True (Kaplan Incorporated, 2015).
Construct Three matching items
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20. Match the item with the structure of the heart
1. Papillary muscle
13. Epicardium
2. Superior vena cava
14. Aortic valve
3. Right pulmonary veins
15. Left pulmonary veins
4. Tricuspid valve
16. Left subclavian artery
5. Right ventricle
17. Left common carotid
6. Inferior vena cava
artery
7. Aorta
18. Descending aorta
8. Left pulmonary artery
19. Pulmonary trunk
9. Mitral valve
20. Brachiocephalic Artery
10. Myocardium
21. Pulmonary valve
11. Left ventricle
22. Papillary muscle
12. Interventricular septum
21. Antihypertensives:
Doxazosin (Cardura) _1__
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Metoprolol (Lopressor, Toprol) _2_
Hydralazine HCl (Apresoline) __3__
Clonidine (Catapres) 5___
Losartan (Cozaar) _4__
Lisinopril (Zestril) __6_
Amlodipine (Norvasc) _7__
Answers:
1 Alpha-Adrenergic Blockers
2 Beta Blockers
3 Vasodilators
4 Angiotensin II Receptor Antagonists
5 Central-Acting Inhibitors
6 Angiotensin-Converting Enzyme (ACE) Inhibitors
7 Calcium Channel Blockers
(Elsevier Health Sciences, 2019).
22. Diuretics
Potassium-Sparing _c__
Loop __b_
Combination Thiazide and Potassium-Sparing __d_
Thiazides _a_
a. Observe for postural hypotension; can be potentiated by: Alcohol, Barbiturates,
Narcotics, Caution with: Renal failure, Gout, Client taking lithium. Hypokalemia increases
risk for digitalis toxicity. Administer potassium supplements. Encourage intake of
potassium rich foods.
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b. Volume depletion and electrolyte depletion are rapid. All nursing implications cited for
thiazides.
c. Watch for hyperkalemia and renal failure in those treated with ACE inhibitors or NSAIDs.
Watch for increase in serum lithium levels. Give after meals to decrease GI distress
d. Caution client previously on a loop or thiazide alone not to overdo K+ foods now
because of K+-sparing component in new drug. Follow scheduling doses to avoid sleep
disruption (Elsevier Health Sciences, 2019).
Constructed-Response Test Items
23. Remember MONA when administering medications and treatments in the patient with
myocardial infarction. What does MONA stand for?
________, _______, _________, ________
Answers: morphine, oxygen, nitroglycerin, aspirin
Rationale: Universities, websites, and educational videos commonly use a mnemonic for
morphine, oxygen, nitrates, and aspirin (MONA) to refer to the adjuvant treatment used for
the management of ACS (de Alencar Neto, 2018).
24. A client who has been treated for endocarditis is receiving his follow up orders before being
released to go home. He understands all the follow up orders and you overhear him talking
with his wife about his upcoming dentist appointment. What is something you should remind
him about before leaving the hospital?
____________________________________________________________
Answer: Instruct client to inform dentist and other health care providers of history.
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Rationale: Endocarditis: Monitor hemodynamic status (vital signs, level of consciousness,
urinary output). Administer antibiotics IV for 4 to 6 weeks. The American Heart Association
recommends administration of antibiotics before dental or genitourinary procedures in highrisk patients. Clients may be instructed in IV therapy for home health care. Teach clients
about anticoagulant therapy if prescribed. Encourage client to maintain good hygiene.
Instruct client to inform dentist and other health care providers of history. (Elsevier Health
Sciences, 2019).
25. Use of the Glasgow Coma Scale eliminates confusing words to describe neurologic status, such
as ________, _________, or _________.
Answer:
lethargic, stuporous, or obtunded (Elsevier Health Sciences, 2019).
(Elsevier Health Sciences, 2019).
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Reflection
Assessment, better known as testing, is an analytical component of education. When
appropriately used, it can assist in achieving significant curricular purposes. A principal intention of
examination is to communicate what the instructor and item writer, views as essential. Examinations are
a formidable motivator, and test-takers or learners will ascertain the educational conceptions they
believe an educator value (National Board of Medical Examiners, 2016).
I found this task of constructing exam questions was honestly a monstrous feat to accomplish. I
had no references to pull information from and searching the internet was gruesome for any valuable
sources. The only references I could rely on were a few of my exam practice manuals that from classes
that I have from nursing school. I found this difficult and took about 12 hours to complete. I found the
instructions for this assignment confusing, frustrating, unit module unit confusing and uninteresting. I
found the format for lining up the questions and answers for this paper hard to accomplish as well.
In my research for information for this assignment I found numerous select all that apply
questions in my research. I also found the other types of questions as in the we were to construct were
very hard to find examples, even in my nursing exam books. I know I will be writing test questions in the
future and I will be looking into investing more time and finding extra instruction to do this task better
for my students.
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References
de Alencar Neto J. N. (2018). Morphine, Oxygen, Nitrates, and Mortality Reducing Pharmacological
Treatment for Acute Coronary Syndrome: An Evidence-based Review. Cureus, 10(1), e2114.
https://doi.org/10.7759/cureus.2114
Elsevier Health Sciences. (2019). HESI comprehensive review for the NCLEX-RN® examination Book:
edition 6 (6th ed.).
Kaplan, Inc. (2020). NCLEX-RN® hot spot questions. https://www.kaptest.com/study/nclex/nclexalternate-format-questions-hot-spot/
Kaplan Incorporated (Ed.). (2015). NCLEX-RN strategies, practices, & review: with practice tests (1st
ed.). Kaplan Publishers.
National Board of Medical Examiners. (2016). Constructing written test questions for the basic and
clinical
sciences. https://www.unmc.edu/facdev/_documents/ConstructingWrittenTestQuestions_Writi
ngManual.pdf