Writing Multiple-Choice Questions

Multiple choice items are a common way to measure student understanding and recall. Wisely constructed and utilized, multiple choice questions will make stronger and more accurate assessments.

At the end of this activity, you will be able to construct multiple choice test items and identify when to use them in your assessments.

Let’s begin by thinking about the advantages and disadvantages of using multiple-choice questions. Knowing the advantages and disadvantages of using multiple choice questions will help you decide when to use them in your assessments.


  • Allow for assessment of a wide range of learning objectives

  • Objective nature limits scoring bias

  • Students can quickly respond to many items, permitting wide sampling and coverage of content

  • Difficulty can be manipulated by adjusting similarity of distractors

  • Efficient to administer and score

  • Incorrect response patterns can be analyzed

  • Less influenced by guessing than true-false


  • Limited feedback to correct errors in student understanding

  • Tend to focus on low level learning objectives

  • Results may be biased by reading ability or test-wiseness

  • Development of good items is time consuming

  • Measuring ability to organize and express ideas is not possible

Multiple choice items consist of a question or incomplete statement (called a stem) followed by 3 to 5 response options. The correct response is called the key while the incorrect response options are called distractors.

For example: This is the most common type of item used in assessments. It requires students to select one response from a short list of alternatives. (stem)

  1. True-false (distractor)

  2. Multiple choice (key)

  3. Short answer (distractor)

  4. Essay (distractor)

Following these tips will help you develop high quality multiple choice questions for your assessments.

Formatting Tips

  • Use 3-5 responses in a vertical list under the stem.

  • Put response options in a logical order (chronological, numerical), if there is one, to assist readability.

Writing Tips

  • Use clear, precise, simple language so that wording doesn’t effect students’ demonstration of what they know (avoid humor, jargon, cliché).

  • Each question should represent a complete thought and be written as a coherent sentence.

  • Avoid absolute or vague terminology (all, none, never, always, usually, sometimes).

  • Avoid using negatives; if required, highlight them.

  • Assure there is only one interpretation of meaning and one correct or best response.

  • Stem should be written so that students would be able to answer the question without looking at the responses.

  • All responses should be written clearly, approximately homogeneous in content, length and grammar.

  • Make distractors plausible and equally attractive for students who do not know the material.

  • Ensure stems and responses are independent; don’t supply or clue the answer in a distractor or another question.

  • Avoid “all of the above” or “none of the above” when possible, and especially if asking for the best answer.

  • Include the bulk of the content in the stem, not in the responses.

  • The stem should include any words that would be repeated in each response.

Examine the examples below and think about the tips you just learned. As you look at each one think about whether or not it ’s a good example or does it need improvement?

    As a public health nurse, Susan tries to identify individuals with unrecognized health risk factors or asymptomatic disease conditions in populations. This type of intervention can best be described as

A. case management
B. health teaching
B. advocacy
D. screening
E. none of the above

This item should be revised. It should not have “none of the above” as a choice if you are asking for the “best” answer.

A. is an approach to teaching and learning based on feminist ideology that embraces
egalitarianism by identifying and overcoming oppressive practices.
B. is an approach to teaching and learning based on sociopolitical theory that
embraces egalitarianism through overcoming oppressive practices.
C. is an approach to teaching and learning based on how actual day-to-day
teaching/learning is experienced by students and teachers rather than what could
or should be experienced.
D. is https://www.the-essays.com/professional-writers to teaching and learning based on increasing awareness of how
dominant patterns of thought permeate modern society and delimit the contextual
lens through which one views the world around them.

This item should be revised because the repetitive wording should be in the stem. So the stem should read “Clinical pedagogy is an approach to teaching and learning based on:”

    Katie weighs 11 pounds. She has an order for ampicillin sodium 580 mg IV q 6 hours. What is her daily dose of ampicillin as ordered?

A. 1160 mg
B. 1740 mg
C. 2320 mg
D. 3480 mg

This example is well written and structured.

    The research design that provides the best evidence for a cause-effect relationship is an:

A. experimental design
B. control group
C. quasi-experimental design
D. evidence-based practice

This example contains a grammatical cue and grammatical inconsistency. Additionally, all distractors are not equally plausible.

    The nurse supervisor wrote the following evaluation note: Carol has been a nurse in the post-surgical unit for 2 years. She has good organizational and clinical skills in managing patient conditions. She has a holistic grasp of situations and is ready to assume greater responsibilities to further individualize care.

Using the Dreyfus model of skill acquisition, identify the stage that best describes Carol’s performance.

A. Novice
B. Advanced beginner
C. Competent
D. Proficient
E. Expert

This is a good example.

Multiple choice questions are commonly used in assessments because of their objective nature and efficient administration. To make the most of these advantages, it’s important to make sure your questions are well written.


Bosher, S. (2003). Linguistic bias in multiple-choice nursing exams. Nursing Education Perspectives, 24(1), 25-34.

Case, S. M. & Swanson, D. B. (2003). Constructing written test questions for the basic and clinical sciences, 3rd edition (revised). Philadelphia: National Board of Medical Examiners. http://www.nbme.org/about/itemwriting.asp

Clegg, V. L. & Cashin, W. E. Improving multiple-choice tests. Idea paper No. 16, Center for Faculty Evaluation & Development. Manhattan, KS: Kansas State University.

Cohen, A. S. & Wollack, J. A. Handbook on test development: Helpful tips for creating reliable and valid classroom tests. Testing & Evaluation Services, University of Wisconsin-Madison. http://wiscinfo.doit.wisc.edu/exams/instructional_support.htm

Jacobs, L. C. How to write better tests: A handbook for improving test construction skills. Evaluation Services and Testing, Indiana University-Bloomington. http://www.indiana.edu/

Research: Brenda Kupsch

Design: Eileen Horn

Development funded through a grant from the Health Resources and Service Administration (1D09HP03288-01-00).