Item Analysis Test Questions

Whitney Hyde
Assignment 2
Nurs 603/Measurement and Evaluation in Nursing Education
Dr. Digger
 Item Analysis Test Questions
After calculating the P-values and D-values for the 25-question test taken by 43 students, I
was able to identify five questions that should be edited to improve the quality of the questions.
According to Oermann and Gaberson (2017), desirable P-values should be between 0.30-0.70
and desirable D-values are greater than 0.20 and the closer the D-value is to 1.0, the better.
Based on the statistics, the following questions should be edited.
Question 9
A triage nurse in a busy emergency department assesses a client who complains of 6/10 abdominal
pain and states, “I had a temperature of 104.6oF at home." Which action would the nurse perform
first?

a. Inform the client that it may be several hours before being seen by the doctor.
b. Obtain a clean-catch urine for urinalysis culture.
c. Assess the client’s current vital signs.
d. Ask the doctor to order an antipyretic for the client.

P-value: 0.98
D-value: 0.05
The P-value of this question was above 0.70 and the D- value was below 0.2. Therefore, this
question was relatively easy and that did not discriminate well between the high- and low-test takers. For
this question, only one student chose answer b and all the other students chose the correct answer. To
make the question more difficult and improve the quality of the question, the patient situation should have
more detail. Based on the patient situation, I would not think to choose b because I do not associate
abdominal pain with urinalysis cultures, however, if the patient was complaining of 6/10 back pain,
burning pain with urination, and frequent urination, I would be more likely to choose the distractor
answer b.
Question 15

The charge nurse of a surgical unit has been notified of an external disaster with multiple
casualties. Which client should the charge nurse request to be discharged from the
hospital?

a. The client scheduled for a repair of an abdominal aortic aneurysm (AAA) in the
morning and whose preoperative teaching has not been started
b. The client who had an abdominal hysterectomy two days ago and whose catheter
was removed this AM.
c. The client who has a bleeding peptic ulcer and now has a hemoglobin of 7mg/dL and
a hematocrit of 22.1%
d. The client who was in a motor vehicle accident and has a 6 on the Glasgow coma
scale and intermittent decorticate posturing

P-value: 0.98
D-value: 0.05
This question’s P-value was above 0.70 and D- value was below 0.2, making it a relatively easy question
that did not discriminate well between the high- and low-test takers. For this question, 42 students
answered b and one student answered incorrectly and chose c. Normal hemoglobin for men is 13.5-
17.5g/dL and for women 12.0-15.5 g/dL and normal hematocrit for men is 38.8-50 percent and for
women 34.9-44.5 percent (Mayo Clinic, 2018). To increase the distractibility of incorrect answer c, the
lab levels could be increased closer to normal and it could mention that the patient is able to ambulate.
For example, answer c can be modified to “the client who has a bleeding peptic ulcer who can ambulate
to the bathroom on their own and has a hemoglobin of 9mg/dL and hematocrit of 26.3%”. Answer b can
be edited to increase its quality such as including that the post-op patient is in 5/10 abdominal pain with
movement. By including more information in the answers, the students would have to spend more time
prioritizing which patient would be the best patient to discharge. Some students may not know normal
lab values and may choose answer c because the patient is able to ambulate to the bathroom.
Question 16
The client is to undergo surgery for a cataract in the left eye. Which of the following instructions
should be included in the teaching plan for the client?

a. Cough and deep breathe every two hours

b. Perform prescribed eye exercises daily
c. Use a saline eye irrigation as needed
d. Take the prescribed stool softener as ordered

P-value: 0.98
D-value: 0
In question 16, 42 students chose the correct answer and one student chose answer c. All of the students
in the top 10 and bottom 10 answered the question correctly. According to Oermann and Gaberson
(2017), a distractor that is not chosen by at least one lower group student may contain a technical
flaw or is so obvious that even a student who lacks knowledge can correctly answer. To better
test students’ knowledge on cataract surgery and patient teaching, the quality of the distractors
needs to be improved. One way to increase the quality of this question would be to make it a
select all that apply question. This would make the students have to pick all of the correct
answers and would make it more difficult for students to discern which answers were the correct
answers and which ones were distractors.
Modified: 16. The client is to undergo surgery for a cataract in the left eye. Which of the following
instructions should be included in the teaching plan for the client? Select all that apply.

a. Use a saline eye irrigation as needed

b. Client can return to normal activity immediate after surgery
c. A protective eye patch should be warn for 24 hours after surgery (Belleza, 2017)
d. Slight morning discharge, redness, and scratching feelings are expected for a few
days (Belleza, 2017)
Question 19

The nurse is caring for the following clients. After receiving shift report, which client
should the nurse assess first?
a. The client whose scheduled IV antibiotic is one hour late.
b. The client diagnosed with renal colic pain who is scheduled for a lumbar CT scan
c. The client with a total knee replacement who is complaining of a painful, cold
foot on the operative extremity
d. The client diagnosed with ulcerative colitis who is complaining of severe abdominal
pain

P-value: 0.91
D-value: 0.05
This question has a P-value greater then 0.70 and a D-value less then 0.20. For this question, 39 students
answered correctly, two students picked b and two students picked d. All of the top students chose the
correct answer and only one of the lower ten students chose incorrectly. Therefore, the correct answer
was too obvious. The correct answer for this question is too obvious because it if a student applies
airway, breathing, or circulation to this question, answer c is the only obvious answer. To improve the
quality of the distractors, they need to be closer in urgency:

a. A client whose temperature is 38.5 degrees Celsius is one hour late for their scheduled IV
antibiotics.
b. The client diagnosed with renal colic pain who is scheduled for a lumbar CT scan and
who is having 8/10 burning pain with urination.
c. The client with a total knee replacement who is complaining of a painful, cold foot
on the operative extremity
d. The client diagnosed with ulcerative colitis who is complaining of severe 10/10
abdominal pain

Question 20
The nurse would place which of the following clients in highest priority for medical attention?

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

P-value: 0.95
D-value: 0
For question 20, 41 students answered correctly, one student chose answer a and two students chose
answer d (there is only supposed to be 43 students and this equals 44). Two of the top and two of the
bottom 10 students answered this question incorrectly (based on the p-value, only three students
incorrectly answered the question, not four). If the same amount of higher scoring students are choosing
the same incorrect answers as the lower scoring students, the distractor is ambiguous (Oermann &
Gaberson, 2017). According to Oermann and Gaberson (2107), if a large number of high scoring
students are selecting an incorrect answer, the instructor should look to see if that answer is
correct. For this question, the patient that is the highest priority for medical attention is answer
b, the 43-year-old with sudden onset of unilateral facial drooping because of the risk for stroke.
To me, there is no obvious reason why two of the higher scoring students answered incorrectly.
For this question, I think their may be outliers that are altering the statistics and I do not think
that this question requires any modifications.
 References

Belleza, M. (2017). Cataracts. Retrieved from https://nurseslabs.com/cataract/

Mayo Clinic. (2018). Complete blood count.. Retrieved from https://www.mayoclinic.org/tests-

procedures/complete-blood-count/about/pac-20384919

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

ed.). New York, NY: Springer.