Week 3

Test Writing Strategies

Alicia Gower
Sara George
Linda Link
Gina Di Guardi
Emily Zehr

Norm-referenced testing (Billings & Halstead, 2012)

What is it?
Norm-referenced testing is used as a part of the evaluation process that translates data
against pre-established criteria for grading purposes. These standardized tests are
designed and interpreted to provide relative ranking of student achievement of rote
learning and memorization. They compare and rank test takers in relation to one another,
based on measured performance. They indicate whether students performed better or
worse than a hypothetical average student. The hypothetical average student is
determined by comparing the scores from students of the same grade level who have
already taken the exam. The score of the test reflects how many more or fewer correct
answers an individual student gives in comparison to the other students. If students did
poorly on a test, the least poorly done would be ranked in the highest percentile. And if all
students did well, the least-strong performance would be placed in the lowest percentile
(edglossary.org, 2016). This is not a measurement of mastery of information, but rather

an indication of how students compare to one another. Norm-referenced testing often

uses a multiple choice format.
Why might it be utilized?
This test is based on measurement of content that serves an intended purpose, such as
representatively sampling intended learning outcomes, evaluating teaching effectiveness,
and differences in performance among the students (Billings & Halstead, 2012).

Assess the ability of a student to pass

Provide feedback regarding areas of students strengths and weaknesses
Measure students mastery of course content
Increase NCLEX-RN pass rates among graduates
Provide a source of information for accreditation visits or program evaluation
Provide information regarding how well faculty taught the content, (unlv.edu, 2016)

Examples of uses:
Standard Achievement tests, SATs, ACTs, IQ tests, and the NCLEX-RN are all examples
of this type of test.

Criterion referenced testing(Billings & Halstead, 2012)

What is it?
Criterion referenced testing is designed to test according to a specific set of learning
outcomes. They measure the learning achievement or progress of an entire group of
students. It makes no comparisons and is interested in only one thing: did the student
meet the learning standards?

Why might it be utilized?

This type of test is used to assess mastery of subject matter in which there is an absolute
standard of performance.
Example:
Criterion-referenced testing is often used to ensure safety in areas such as drug dosage
calculation, where the standard of performance is independent of the performance of other
students, as with relative ranking of norm-referenced testing.
The difference between Norm-referenced and Criterion referenced testing:
Norm-referenced tests rank students on a bell curve a distribution of scores that
delineates performance differences between students, and does not specifically determine
if students have met the learning standards, i.e., learning the material, and acquiring the
skills and knowledge to achieve mastery of the lessons. Whereas, criterion-referenced
testing actually measures the students performance against a fixed set of standards, and
thus does assess the students mastery of the actual subject matter. The test results can
reflect the total number of correct answers in a percentage (edglossary.org, 2016).

>>Check out these two links about test writing resources that are helpful to nurse educators!
1. UNC Charlotte
This resource is helpful to a nurse educator because it highlights the advantages and disadvantages for writing
test questions in a multitude of formats. It also provides a lot of useful tips for formulating test questions as well
as a multitude of other resources potentially helpful to nurse educators including; assessment techniques,
grading systems, course development, education philosophies, instructional methods and technologies,
management of classes, resources and behaviors and teaching strategies for large vs small classes.
This resource provides a thorough explanation of each test question type and includes a thorough description
of the specific information which is suitable for each.

(UNC Charlotte, 2016).

2. Kansas State University
This is an awesome resource! Not only does it include information about the advantages and disadvantages of
various types of test questions, it also includes information about pretests, general tips about test taking (for
both students and teachers) and tips about when to incorporate essays or objective questions within
examinations. The other interesting part of this resource is that it also includes information potentially helpful to
nurse educators about overall test planning. This chapter includes information about; cognitive complexity,
fairness, content quality, language appropriateness, meaningfulness, reliability, how to defeat student guessing
and transfer/generalizability.
This resource provides a multitude of test question examples, utilizing both descriptive and visual techniques to
highlight the pros and cons of each. I think this would be an excellent site for nurse educators to refer to for
general testing information and creation.

(Kansas State University, 2016).

The NCLEX-RN exam (National Council Licensure Examination) is used to determine if

it is safe for an entry-level nurse to begin practice. The NCLEX-RN exam utilizes
application and analysis questions based on the nursing knowledge that a graduate-nurse
learned through school, and tests how well the graduate-nurse can utilize critical thinking
skills and make safe nursing judgments (Kaplan, 2016).
The framework of the NCLEX-RN exam is organized according to "Meeting Client
Needs." There are four major categories and eight subcategories in which all of the
content is integrated. Everyone must answer a minimum of 75 questions, with a maximum
of 265 questions. There is a maximum of 6 hours to complete the exam and it is graded
on a pass/fail basis. A pass grade will be given when the graduate-nurse has
successfully answered enough questions with the set level of difficulty to determine the
ability to practice safe patient care. A fail grade will be given when the graduate-nurse
cannot maintain the ability to answer questions close to the level of difficulty needed to
pass. (Kaplan, 2016).
Questions are mostly multiple-choice with four possible answer choices and there are also
alternate question types. Alternate question types include multiple-response, fill-in-theblank, hot spots, chart/exhibit and drag-and-drop. All questions involve integrated nursing
content (Kaplan, 2016).

Below is an example of a NCLEX formatted question (Kaplan, 2016):

A 23-year-old woman with insulin dependent diabetes mellitus (IDDM) is returned to the
recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse
would expect the woman's blood sugar to

(1) rise
(2) fall
(3) remain stationary
(4) fluctuate
For the graduate-nurse to appropriately answer this question, she/he must decide if the
question is an obstetrical question or a medical/surgical question, and then must consider
the pathophysiology of diabetes along with the principles of labor and delivery.

Please click on the links from the National Counsel of State Boards of Nursing for
additional information regarding the NCLEX exam.

Rules: https://www.ncsbn.org/1268.htm
Passing Standards: https://www.ncsbn.org/2630.htm

Test Plans: https://www.ncsbn.org/testplans.htm

NCLEX Pass Rates: https://www.ncsbn.org/exam-statistics-and-publications.htm

Locate a recent and relevant article on the testing in nursing pre-licensure nursing
education; provide the full reference and a summary of the article.
Within numerous nursing programs throughout the country, standard examinations for
student remediation are used to predict passage of the NCLEX-RN. HESI is a series of
computerized exam products. The goal of this type of testing is to increase the past rate
for the NCLEX-RN.
The reports that were evaluated within this article showed that HESI is widely used to
predict NCLEX pass rates within RN students and various remediation plans have been
adopted from this. Some interventions within these plans include review sessions,
evaluation of students learning styles, and test taking strategies with mandatory tutoring.
Some require repeating the HESI until the benchmark school is achieved. This research
from this integrated review also found that nursing schools that offered remediation
policies had a significantly higher scores on HESI and NCLEX examinations.
Although HESI scores predicts NCLEX pass rates with a high degree of validity, there is
few research on the correlation between lower HESI scores and NCLEX pass rates. The
value of HESI related NCLEX pass rates must be further explored and extended to these

areas. With the changes in health care rising, an increase in the need for highly proficient
nurses rises. With these rises, the use of standardized testing in nursing education needs
to continue to be explored in order to properly prepare students for success with the
NCLEX testing and success with transition into a the role as a nurse.
Sosa, M., & Sethares, K. A. (2015). An Integrative Review of the Use and Outcomes of
HESI Testing in Baccalaureate Nursing Programs. Nursing Education Perspectives,36(4),
237-243.

Locate a second recent and relevant article on the testing in nursing pre-licensure nursing
education and its connection to preparation for success with the NCLEX examination;
provide the full reference and a summary of the article.
The HESI Exit Exam: progression benchmark and remediation guide
Nursing programs are continuously making efforts to improve NCLEX passing rates. The Health Education
Systems Inc (HESI) Exit Exam (E2) is a type of computerized adaptive testing (CAT) that is used to assess
NCLEX candidacy and graduation requirements in nursing programs across the country. The E2 has been
determined to be a reliable measure of students NCLES preparedness. The use of such computerized testing
systems have been gaining popularity and nursing programs are no longer using paper and pencil exams for a
graduation and NCLEX preparedness benchmark. The adoption of these exams are in an effort to remediate
students who need it prior to graduation and avoid NCLEX failure.
These types of exams are unique in the sense that they do not score based on a 0-100% scale. The HESI
score is based on the HESI Predictability Model (HPM). This model considers the difficulty of each test
question and scores the students performance accordingly. The scores range from 0 to 99.99; students who
score in the 90.00-99.99 range are predicted to attain a passing score on the NCLEX without further
preparation.
Nursing programs have adopted this as an exit exam for graduation with its own designated benchmark score.
As such for students who do poorly on the exam programs have established consequences. Some of these
consequences include being denied eligibility to graduate, a failing or incomplete grade for the capstone
course, and withholding NCLEX candidacy. However, before these consequences are enacted levels of
remediation are established by the nursing program to aid the nursing student. Many nursing programs are
now tying the success of such remediation methods to candidacy for graduation and NCLEX seating.

References
Kaplan Nursing (2016). The NCLEX-RN exam. Retrieved
from: http://www.kaptest.com/nursing/nclex-prep/nclex-rn/about-the-nclex-rn

Kansas State University. (2016). A Short Guide to Writing Effective Test Questions. Retrieved from:
http://www.k-state.edu/ksde/alp/resources/Handout-Module6.pdf

National Counsel of State Boards of Nursing. (2016). NLCEX and Other Exams. Retrieved
from: https://www.ncsbn.org/nclex.htm
Billings, D. & Halstead, J. (2012). Teaching in nursing: A guide for faculty. (4th Edition),
Elsevier.
Retrieved 3/13/16 from: http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?
article=3072&context=thesesdissertations
Nibert, A., Young, A., & Britt, R. (2003). The HESI Exit Exam: progression benchmark and remediation guide.
Nurse Educator, 28(3), 141-145 5p.
UNC Charlotte. (2016). Designing Test Questions. The Center for Teaching and Learning: Division of
Academic Affairs. Retrieved from: http://teaching.uncc.edu/learning-resources/articles-books/bestpractice/assessment-grading/designing-test-questions