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  1. Clifton, Sandra L. MSN, RN
  2. Schriner, Cheryl L. PhD, RN, BC


With the focus of nursing education geared toward teaching students to think critically, faculty need to assure that test items require students to use a high level of cognitive processing. To evaluate their examinations, the authors assessed multiple-choice test items on final nursing examinations. The assessment included determining cognitive learning levels and frequency of items among 3 adult health courses, comparing difficulty values with cognitive learning levels, and examining discrimination values and the relationship to distracter performance.