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Assessments can be comprised of objective and subjective test items to determine their understanding of the presented concepts derived from the course learning outcomes.  True and false items consist of a statement that the student evaluates is either true or false (Oermann & Gaberson, 2017).  These types of questions give the student a fifty percent chance of answering the question based on root memory.  It is the most basic level of learning according to Bloom’s taxonomy focusing on recognizing and recalling information (Armstrong, 2010).  This type of test item is not as useful in the clinical setting since clinical performance assessments require a higher level of learning and understanding.  In the theory course, it could be used on formative assessments which would help demonstrate initial basic learning of concepts rather than more complex learning and understanding in a summative assessment. 

Multiple choice items that uses a question, followed by multiple options for the one correct answer, usually A, B, C, etc.  These types of questions can vary from root memory, applying knowledge, analyzing data or even case studies (Oermann & Gaberson, 2017).  As a result, in the application of Bloom’s taxonomy, the student must be able to remember, understand, apply, analyze, and evaluate (Armstrong, 2010).  However, developing complex questions can be difficult and time consuming for the instructor since there is only one correct answer (Oermann & Gaberson, 2017).  The instructor must create creative and complex distractors or incorrect answers to that appear credible to the unprepared student (Oermann & Gaberson, 2017).  These items could be used on a clinical performance assessment if there was a written portion to show the student can proficiently identify concepts of assessment in this question format.  Otherwise, it is much more coming in nursing theory courses and the primary item type on the NCLEX. 

Short answer or fill-in-the-blank, are short answer items with a short one word or number, with one correct answer (Oermann & Gaberson, 2017).  These types of questions can focus on root memory or require more complex level learning application if the student is required for example to solve a medication math exam.  Resulting in higher level learning from remembering to evaluating according to Bloom’s hierarchy (Armstrong, 2010).  Short answers questions may include concepts such as medication math, application of formulas and calculations, and understand data (Oermann & Gaberson, 2017).  This item type could be used both theory and clinical courses to ask the student a medication calculation or analyzing a lab result.

Essay questions requires the student to have a deeper understanding of the presented concepts to synthesize their own complex analysis of the question in a multi-sentence or paragraph format (Oermann & Gaberson, 2017).  These types of questions require all levels of Bloom’s framework from remembering to creating and demonstrates a higher level of learning and understanding (Armstrong, 2010).  These questions require the student to discuss, analyze, critique, develop their own thoughts and perceptions of the concepts while applying what they have learned in the course.  These types of questions could be used in either theory or clinical to demonstrate the student’s highest level of understanding their patient in the clinical setting or a specific theory or concept in their theory course. 

Each question type has its pros and cons in their demonstration of higher learning and understanding of the course learning outcomes evaluated in the assessment.

Armstrong, P. (2010). Bloom’s taxonomy. Vanderbilt University Center for Teaching.

Oermann, M., & Gaberson, K. (2017). Evaluation and testing in nursing education (5thed.) [Epub]. Springer Publishing Company, LLC.

There are several different ways that examination questions can be written, and each has their strengths and weaknesses. True-false are questions that student identifies simply as either true or false. These types of questions are useful to assess recollection of facts rather than complex thinking (Oermann, 2016). Other benefits are that students can complete many in a short frame of time, which can increase an assessment’s reliability and that they are easy to write and score which helps with practicality. True-false questions address the remembering portion of Blooms taxonomy since its strength is recollection versus critical thinking. Its use is likely beneficial in both theory as well as clinical performance. In theory, it can quickly assess knowledge of important topics and in clinical, it can establish knowledge of simple ideas like highlighting important steps during a nursing intervention.

In contrast to true-false questions, multiple choice questions are useful in testing for application of knowledge and analyzing situations (Oermann, 2016). The largest disadvantage for multiple choice is the fact that creating a sufficient question takes much time to create distractor answers that won’t relegate the question to a simple knowledge recollection type question. These types of questions fulfill remembering, understanding, applying, and analyzing in Bloom’s Taxonomy. Multiple choice questions can be useful in both theory as well as clinicals for the same reasons as true-false. In the clinical setting they can highlight analysis of important steps or rationales for nursing interventions.

Short answer can be any question that requires a simple word or phrase to fill in the blank for the answer. These are particularly useful when assessing for interpreting dada, correct formula usage, calculations, labeling diagrams. These fulfill Bloom’s Taxonomy for recollection and understanding as there is some data interpreting involved at times. These can be useful in both theory as well as clinicals. For the clinical setting, short answer can show student recollection of various anatomic landmarks, or selecting the correct instrument, etc.

Essay questions require the students to explicitly show their entire understanding of the content. They are useful in assessing a students understanding of complex learning outcomes (Oermann, 2016). They can be utilized to fulfill all of Blooms Taxonomy levels from remembering to creating, depending on the scenario provided. Drawbacks to essay questions have to do with their reliability as they are time consuming, grading can be difficult to remain objective and poor student writing ability. These are likely better suited for the theory setting as clinical competencies can be evaluated better with physical practice


Oermann, M. (2016).  Evaluation and Testing in Nursing Education (5th ed.). Springer Publishing LLC. 


In my role potentially as a Pediatric Intensive Care Unit Nurse Educator, I would encounter a variety of learners from new graduate nurses that are just beginning their professional journey following the completion of a new graduate program to experienced nurses that have many years of experience.  The specific cohort I would focus on are the nurses with approximately two to three years’ experience, which is the point in their nursing career in the PICU they have enough hours (1,750 to be exact) to sit for the American Association of Critical Care Nurses Certified Critical Care Registered Nurse Exam in Pediatrics.  On their website, the AACN has specific documents to prepare you for the concepts presented on the examination. The blueprint of the examination outlines that 80% of the examination focuses on clinical judgement in the areas of cardiovascular, respiratory, endocrine, hematology, gastrointestinal, renal, integumentary, musculoskeletal, neurological, psychosocial, and multisystem ( CCRN Pediatric Certification, n.d.).  Then the remaining 20% of the examination focuses on advocacy, caring practices, diversity, facilitation of learning, collaboration, systems thinking and clinical inquiry ( CCRN Pediatric Certification, n.d.).  In addition, the organization offers specific review books and practice tests to prepare for the examination.  As the clinical educator, I would take the blueprint of the examination and create a review course that incorporates the specific concepts as well as practice questions to prepare them for the examination.  Also, since I have also taken the examination myself, I would share my own experiences preparing for the certification exam.  I would share that it is like NCLEX, but more focused on your clinical judgement based on the advanced concepts in the blueprint of the exam.  I would also share that following review of the material, that I found that practice questions with detailed rationales were far more helpful than just reading the available review books.  Although, they are helpful for reviewing concepts that you are struggling in.  I most definitely would share all available resources to help them be successful and my unit currently has an established library of resources to support colleagues preparing for the exam.  I believe that the sharing of resources among colleagues is important demonstrates that I am committed to their growth and success as their educator.

CCRN pediatric certification. (n.d.). American Association of Critical Care Nurses.

A population of learners that a nurse educator will encounter is the population that speaks English as a second language. The first factor that must be considered is the test length and time given. Those that are considered English as a second language, may have accommodations with the university that will need to be followed by the instructor. This includes giving extra time to ensure the students can complete the examination. The students must be given a fair chance to complete the exam and since English is their second language they may need extra time to comprehend the question before answering it. Next, the second factor is ensuring the questions are written using concise, clear, simple, grammatically correct, and precise terminology  This will allow the students to clearly understand the questions being asked of them (Oermann & Gaberson, 2016). The instructors must understand that the wording of the question can alter how a question is interpreted by the students and this can be prevented by following the requirements already stated and using enough detail to write the question. The detail must be sufficient to get the intent of the question across and errors in grammar can cause the students to get frustrated. The third factor includes avoiding slang, jargon, and abbreviations. This can cause massive amounts of confusion for students who speak English as their second language. It may allow the instructor to communicate the question quickly, however, it is not effective for the students who speak English as their second language. These students can struggle to understand the abbreviations unless they are approved for use by most nursing organizations as universally accepted abbreviations.

The English as a second language course for instructors that I found was This website provides courses, lesson plans, and resources. This course had resources that assist professors in learning how to create tests that are English as a second language friendly. I would use these lesson plans to ensure my tests and examinations are easy to understand, have enough detail, have proper grammar, have proper directions, and will give the students the correct amount of time for each question based on test length and answers required for each question format. The materials directly from the website I would incorporate into my planning is the lesson plans pack volume 1-3. These lesson plans include multiple lesson plans, and student hand-outs, and provide me with ideas on how to improve my teaching, test writing skills, and engaging activities to use these lesson plans to translate the information from terminology to nursing terminology. I would use these resources because they will allow me to fully communicate with students who speak English as a second language. This will also motivate my students because I am meeting their needs, allowing them to succeed in the classroom, and encouraging them to continue to work on their skills with the English language. I want to share these with my learners so I am preparing them for the NCLEX which may not meet the needs these students need to succeed on an examination as the NCLEX is universal and not for specific populations. It is my responsibility to meet their needs and improve their English skills to prepare for future examinations and their careers as registered nurses. (Oermann & Gaberson, 2016).



Oermann, M. H., & Gaberson, K. B. (2016). Evaluation and Testing in Nursing Education (5th ed.). Springer Publishing Company.

TEFL. (2021, August 5). TEFL resources. The TEFL Org. Retrieved June 5, 2023, from

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