Question # P-Value D-Value Questions Rationales

9 0.98 0.05 Original Question: With a p-value of 0.98, this question was too
A triage nurse in a busy emergency department easy. With a d-value of 0.05, the question did not
assesses a client who complains of 6/10 abdominal differentiate between high and low scorers. In
pain and states, I had a temperature of 104.6oF at fact, only one student got the question wrong.
home." Which action would the nurse perform first?
a. Inform the client that it may be several
hours before being seen by the doctor.
b. Obtain a clean-catch urine for urinalysis
culture.
c. Assess the clients current vital signs.
d. Ask the doctor to order an antipyretic for
the client.
Revised Question: This question is asking the student to prioritize
A triage nurse in a busy emergency department care, but in the original version, two choices (a &
assesses a client who complains of 6/10 abdominal d) were obviously wrong. Therefore, students
pain and states, I had a temperature of 104.6oF at were only left with two options, which makes it a
home." Which action would the nurse perform first? 50-50 chance that they will guess the correct
a. Assess when patient had last BM answer. To make this question more difficult, I
b. Obtain a clean-catch urine for urinalysis added in two new distractors, which are good
culture. actions, but not appropriate for the first action.
c. Assess the clients current vital signs.
d. Assess patient history of UTIs
10 0.93 0.1 Original Question: This question is too easy, as shown by a 0.93 p-
After receiving morning report on a medical/surgical value. With a d-value of 0.1, this question does
unit, which of the following clients should the nurse not differentiate between high and low scorers.
see FIRST? Three students got this question wrong.
a. A 36 year old man who underwent surgery
for multiple fractures in his left leg after an
automobile accident who reports coughing
up a small amount of blood
 b. A 56 year old woman newly diagnosed with
diabetes mellitus Type II who has a fasting
blood sugar of 83mg/dL
c. A 68 year old man with head and neck
cancer receiving a continuous 5-flouracil
infusion who reports feeling very nauseous
d. A 28 year old woman with sickle cell anemia
who reports a pain level of 8 on a scale of 1-
10
Revised question: This question is asking students to prioritize and
After receiving morning report on a medical/surgical determine which patient in a riskier situation. For
unit, which of the following clients should the nurse choices b and c, the situations were obviously not
see FIRST? serious. So, to make the question harder and to
a. A 36 year old man who underwent surgery make sure that students really know the material,
for multiple fractures in his left leg after an I made the distractors more distracting. I
automobile accident who reports coughing increased the blood sugar in b to a level which
up a small amount of blood would require attention, but is not an emergency.
b. A 56 year old woman newly diagnosed with That patient needs coverage, but not
diabetes mellitus Type II who has a fasting immediately. For choice c, the patient is
blood sugar of 150mg/dL experiencing expected side effects of
chemotherapy, but he probably needs an
c. A 68 year old man with head and neck
antiemetic medication. He needs attention, but
cancer receiving a continuous 5-flouracil
can wait. Choice d is something that needs
infusion who reports feeling nauseated and
relatively quick attention, but not as urgently as a.
vomited after breakfast
d. A 28 year old woman with sickle cell anemia
who reports a pain level of 8 on a scale of 1-
10
15 0.93 0.05 Original Question: This question is both too easy (p-value=0.93) and
The charge nurse of a surgical unit has been notified does not differentiate between high and low
of an external disaster with multiple casualties. scorers (d-value=0.05). Three students got it
Which client should the charge nurse request to be incorrect.
discharged from the hospital?
 a. The client scheduled for a repair of an
abdominal aortic aneurysm (AAA) in the
morning and whose preoperative teaching
has not been started
b. The client who had an abdominal
hysterectomy two days ago and whose
catheter was removed this AM.
c. The client who has a bleeding peptic ulcer
and now has a hemoglobin of 7mg/dL and a
hematocrit of 22.1%
d. The client who was in a motor vehicle
accident and has a 6 on the Glasgow coma
scale and intermittent decorticate posturing
Revised Question: This question is asking students to determine
The charge nurse of a surgical unit has been notified which patient is the most stable, but the choice of
of an external disaster with multiple casualties. b is quite obvious. So, to make the choices
Which client should the charge nurse request to be harder, I made two of the distractors less serious,
discharged from the hospital? though still unstable. A & C are still not
a. The client who had a repair of an abdominal appropriate for discharge, but it requires students
aortic aneurysm (AAA) that morning and to understand the material to eliminate them as
whose postoperative teaching has not been possibilities.
started
b. The client who had an abdominal
hysterectomy two days ago and whose
catheter was removed this AM.
c. The client who has a bleeding peptic ulcer
and now has a hemoglobin of 8.5mg/dL and
a hematocrit of 30.1%
d. The client who was in a motor vehicle
accident and has a 6 on the Glasgow coma
scale and intermittent decorticate posturing
16 0.98 0 Original Question: This question does not differentiate between low
The client is to undergo surgery for a cataract in the and high scores at all and is too easy. Only one
left eye. Which of the following instructions should student got this wrong.
be included in the teaching plan for the client?
a. Cough and deep breathe every two hours
b. Perform prescribed eye exercises daily
c. Use a saline eye irrigation as needed
d. Take the prescribed stool softener as
ordered
Revised Question: All of the answers involved pressure post-surgery
The client is to undergo surgery for a cataract in the and all the student needed to do was play which
left eye. Which of the following instructions should one is not like the others. To make this question
be included in the teaching plan for the client? harder and to really make sure that students
a. Cough and deep breathe every two hours understood the material, I made the actual
b. Continue taking all home medications answer a bit less obvious (it is common to take
c. Use a saline eye irrigation as needed stool softeners after lots of surgeries) and to
d. Avoid bending over for 24 hours after make the distractors a bit harder. For choice b,
surgery students may consider cataract surgery to be
minor and therefore not require changes in
medications. But, in fact, there are some
medications that patients need to dc.
19 0.95 0.05 Original Question: This question is too easy (p-value=0.95) and does
The nurse is caring for the following clients. After not differentiate between high and low learners
receiving shift report, which client should the nurse (d-value=0.05). Only two students got this
assess first? question incorrect.
a. The client whose scheduled IV antibiotic is
one hour late.
b. The client diagnosed with renal colic pain
who is scheduled for a lumbar CT scan
c. The client with a total knee replacement
who is complaining of a painful, cold foot
on the operative extremity
 d. The client diagnosed with ulcerative colitis
who is complaining of severe abdominal
pain
Revised Question: This question is also about prioritization. The
The nurse is caring for the following clients. After student needs to determine which patient is at
receiving shift report, which client should the nurse highest risk. Choice C was too obvious, so I made
assess first? two of the distractors more difficult. The client in
a. The client whose scheduled IV antibiotic is choice D is showing expected signs of ulcerative
two hours late. colitis, but we are still concerned about the
b. The client diagnosed with renal colic pain bleeding. It is not something that must be dealt
who is scheduled for a lumbar CT scan with immediately, because it is a small amount as
well as an expected find. I increased the lateness
c. The client with a total knee replacement
of the antibiotic, making it something more
who is complaining of a painful, cold foot
important to deal with, but still not a priority.
on the operative extremity
d. The client diagnosed with ulcerative colitis
who is complaining of abdominal pain and a
small amount of bright red blood in their
stool