| Course | NR 537 Assessment and Evaluation in Education |
|---|---|
| Week | 2 |
| Paper type | Test item set with rationales |
| Length | About 1,230 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Nurse Educator |
| Updated | September 2026 |
Free sample paper for NR 537 Week 2
Test Item Set: Five Maternal-Newborn Multiple-Choice Items, Each With a Written Defense of Why the Key Is the Only Defensible Answer and Why Every Distractor Would Tempt a Student Who Half-Knows the Content
Student Name
College of Nursing, Chamberlain University
NR 537: Assessment and Evaluation in Education
Instructor Name
Month Day, Year
Test Item Set: Five Maternal-Newborn Multiple-Choice Items, Each With a Written Defense of Why the Key Is the Only Defensible Answer and Why Every Distractor Would Tempt a Student Who Half-Knows the Content
Purpose and Rules
These five items are drafted for the midterm examination of the third-year maternal-newborn course in our BSN program. Each item targets one course objective at the application or analysis level. Under each item is a short defense: why the keyed answer is the only defensible one and why each distractor is plausible to a student who half-knows the content but wrong to one who knows it. Writing the defense is the test of the item. If I cannot say why a distractor is wrong in one sentence, or why a student might choose it, the item needs to change.
The items follow published item-writing guidelines, which include writing a clear stem that poses a single problem, avoiding cues such as unequal option length and grammatical mismatch, making all distractors plausible and avoiding options such as all of the above (Haladyna et al., 2002). Each item has four options. A study of four-option items in nursing and health sciences examinations found that only about one item in seven had three distractors that were actually chosen by students, and that items with more functioning distractors discriminated better (Tarrant et al., 2009). The defenses below are written to make every distractor functional.
Item 1: Postpartum Hemorrhage
Stem. Two hours after a vaginal birth, a patient's fundus is boggy and two fingerbreadths above the umbilicus, and the pad is saturated in 15 minutes. A second nurse has gone to call the provider. Which action should the nurse at the bedside take first?
A. Massage the fundus until it is firm. (key)
B. Increase the rate of the oxytocin infusion.
C. Take the patient's blood pressure and pulse.
D. Assist the patient to empty the bladder.
Defense. The stem removes the usual ambiguity by stating that the provider is already being called, so the question is what the bedside nurse does first. Fundal massage is the immediate nursing action for uterine atony and acts within seconds. Option B is tempting because oxytocin treats atony, but changing an infusion rate usually needs an order and acts more slowly. Option C is tempting because assessment often comes first, but here the cause is evident and bleeding is active. Option D is tempting because a full bladder can cause atony, but the stem does not suggest bladder distention, and emptying it takes longer than massage.
Item 2: Magnesium Sulfate
Stem. A patient with severe preeclampsia is receiving magnesium sulfate. The respiratory rate is 10 breaths per minute and patellar reflexes are absent. What should the nurse do first?
A. Stop the magnesium sulfate infusion. (key)
B. Prepare calcium gluconate for administration.
C. Reduce the infusion rate by half.
D. Obtain a serum magnesium level.
Defense. Depressed respirations and absent reflexes are signs of magnesium toxicity, and the first action is to stop the drug that is causing it. Option B is the most tempting distractor, because calcium gluconate is the antidote and students learn it as a pair with magnesium. It follows stopping the infusion, not before it. Option C is tempting to students who think in terms of titration, but a patient with toxicity should not continue to receive the drug. Option D is tempting because a level confirms toxicity, but waiting for a result delays the essential action.
Item 3: Rh Immune Globulin
Stem. A postpartum patient is Rh-negative, the newborn is Rh-positive and the mother's indirect Coombs test is negative. What is the nurse's priority regarding Rh immune globulin?
A. Administer it within 72 hours of birth. (key)
B. Withhold it because the Coombs test is negative.
C. Administer it to the newborn.
D. Withhold it until the newborn's Coombs test is available.
Defense. An Rh-negative mother who has not been sensitized, shown by the negative indirect Coombs test, and who has an Rh-positive newborn needs Rh immune globulin within 72 hours to prevent sensitization. Option B is tempting because students confuse a negative Coombs with no need for treatment, when it is the reason the treatment can still work. Option C is tempting to students who remember that the newborn is the Rh-positive one. Option D is tempting because it sounds cautious, but delay is unnecessary.
Item 4: Newborn Temperature
Stem. A term newborn, four hours old, has an axillary temperature of 36.2 °C (97.2 °F). Respirations and color are normal. What should the nurse do first?
A. Place the newborn skin to skin with the parent and recheck in 30 minutes. (key)
B. Place the newborn under a radiant warmer and notify the provider.
C. Obtain a blood glucose level before warming.
D. Give a feeding of formula to increase heat production.
Defense. Mild hypothermia in a stable term newborn is managed first by skin-to-skin contact, which warms effectively and supports bonding and feeding. Option B is tempting because a radiant warmer is familiar and notifying the provider sounds safe, but it separates the infant from the parent without need. Option C is tempting because cold stress and low glucose are linked, and a glucose check may follow, but warming should not wait. Option D is tempting because feeding supports heat production, but it is not the first action and the stem gives no reason for formula over breastfeeding.
Item 5: Postpartum Blood Pressure
Stem. On the second postpartum day, a patient who had no hypertension in pregnancy reports a severe headache and blurred vision. Blood pressure is 164/108. What is the priority action?
A. Notify the provider immediately for urgent treatment. (key)
B. Give acetaminophen and reassess in one hour.
C. Encourage the patient to rest in a darkened room.
D. Recheck the blood pressure in four hours.
Defense. Severe-range blood pressure with headache and visual changes after birth suggests postpartum preeclampsia, which needs prompt treatment to prevent stroke or seizure. Option B is tempting because headache after birth is common. Option C is tempting because it is a comfort measure used for headaches. Option D is tempting to students who know that a single reading should be confirmed, but the symptoms make a four-hour wait unsafe. This item tests the analysis objective: recognizing a dangerous pattern in a setting where students do not expect it.
Review Before Use
Each item was reviewed against the guidelines by a colleague who teaches the course, and two changes resulted: the stem of item 1 was rewritten to remove the ambiguity about calling for help, and an option in item 4 was shortened because it was noticeably longer than the others. After the examination, each item's difficulty and discrimination will be reviewed, and any distractor chosen by fewer than 5% of students will be considered nonfunctional and rewritten. Evaluation texts for nurse educators recommend this cycle of review before and after use, because the quality of an examination depends on the quality of its individual items (Oermann & Gaberson, 2019).
References
Haladyna, T. M., Downing, S. M., & Rodriguez, M. C. (2002). A review of multiple-choice item-writing guidelines for classroom assessment. Applied Measurement in Education, 15(3), 309-333. https://doi.org/10.1207/S15324818AME1503_5
Oermann, M. H., & Gaberson, K. B. (2019). Evaluation and testing in nursing education (6th ed.). Springer Publishing.
Tarrant, M., Ware, J., & Mohammed, A. M. (2009). An assessment of functioning and non-functioning distractors in multiple-choice questions: A descriptive analysis. BMC Medical Education, 9, Article 40. https://doi.org/10.1186/1472-6920-9-40
What the NR 537 Week 2 assignment asks for
Writing test items is the core task this week. Prompts typically ask for a set of multiple-choice items aligned with course objectives, at stated cognitive levels, with rationales for correct and incorrect options. Write each stem so it poses one clear problem, removing ambiguity about what is being asked, as when two actions would both be done at once. Make every distractor plausible to a student with partial knowledge; a distractor no one chooses adds nothing. Avoid cues such as unequal option length. Under each item, defend the key and each distractor in a sentence. Have a colleague review the items. Cite item-writing guidance in APA 7, and label each item's objective and level.
How the NR 537 Week 2 example is put together
The set begins with its purpose and rules, supported by item-writing guidelines and research showing that few four-option items have three working distractors. Five items follow, each with a stem, four options and a defense. The postpartum hemorrhage item removes the massage-versus-call ambiguity by stating that help is being called. The magnesium item places calcium gluconate as the most tempting distractor. The Rh item exploits the common confusion about a negative Coombs test. The newborn temperature item favors skin-to-skin warming over a radiant warmer. The postpartum blood pressure item tests pattern recognition in an unexpected setting. A final section describes colleague review and the post-test cycle.
NR 537 Week 2 rubric: what full points look like
Test item rubrics usually reward alignment with objectives, appropriate cognitive level, clear and correct stems, plausible distractors, absence of item-writing flaws and accurate rationales. Graders look closely at the distractors, so a defense explaining why each would attract a partially prepared student earns credit. Clinically accurate content is essential, since a flawed key undermines the item. Removing ambiguity from stems shows skill. Evidence from item-writing guidelines and distractor research supports the rationale. Describing review before and analysis after use shows understanding of item quality as an ongoing process. Clear formatting, with each item's objective noted, supports readability. Items that span several levels, from application to analysis, also show the writer can target the stated objective precisely.
NR 537 Week 2 help: mistakes that cost points
The most frequent weakness is distractors that no informed student would choose, which turns a four-option item into a two-option guess. Write distractors from real misconceptions. Another is a stem with two defensible answers, which penalizes students who know the most. Test each stem for ambiguity. Students also write rationales only for the key; defend every option. Avoid cues such as a longer, more qualified key or grammatical mismatch. Check clinical accuracy with a current source. Do not write only recall items when the objective asks for application. Finally, ask a colleague to answer the items cold, since their hesitations reveal flaws you cannot see. Keep a log of changes each item goes through, so its history travels with it in the bank.
Get a NR 537 Week 2 example written to your instructions
Send the assignment instructions, the objectives your section is testing and any rubric attached to them, and a custom NR 537 Week 2 item set is written against those objectives and returned inside 24-48h, the first one free. If you have already drafted stems and want the option sets and rationales built around them, send the drafts.
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NR 537 Week 2 questions, answered
How many items does the assignment usually ask for?
Sections differ, and the count is normally published with the instructions rather than fixed by the course. The example is written to the number you send. What stays constant is the ratio of work: the option set takes minutes and the rationale takes the rest, because the rationale is the part the rubric is actually reading.
Should every question be multiple-choice?
Most sections center the set on that format because it is where option quality can be judged, and some invite one or two alternatives such as multiple response or a short ordered task. The example follows what your instructions permit. Formats without wrong options still need the same defense, written against the objective and against the errors the question is meant to expose.
Does the example use a real test bank?
No. Items are written fresh against the objectives you send, which matters here because published bank questions arrive without the rationale that this week is grading. Reusing one would leave the defense to be reverse engineered from somebody else's reasoning, and that shows up immediately as notes describing an option rather than the misunderstanding behind it.
Where can I find a free NR 537 Week 2 sample paper?
The five-item maternal-newborn set above, rationales included, is the complete NR 537 Week 2 sample, published openly here. If you need items for another course, send us your objectives and a set with defended options can be written.
Do NR 537 test items need rationales for wrong answers?
Yes. Defending why each distractor is wrong, and why a student might choose it, is how you show the item works. The sample gives a one-sentence defense for every option on all five items.