| Course | NU 600 Teaching/Learning Strategies |
|---|---|
| Unit | Unit 7 |
| Paper type | Examination item analysis |
| Length | About 940 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Nurse Educator |
| Updated | October 2026 |
Free sample paper for NU 600 Unit 7
Item Analysis of a 25-Item Diabetes Care Examination: Difficulty, Discrimination, Distractors, and the One Item That Was Keyed Wrong
Student Name
Department of Nursing, Herzing University
NU 600: Teaching/Learning Strategies
Instructor Name
March 3, 2026
Item Analysis of a 25-Item Diabetes Care Examination: Difficulty, Discrimination, Distractors, and the One Item That Was Keyed Wrong
The Test and the Conditions
The examination was a 25-item multiple-choice test on diabetes care, given on paper in the fourth week to all 44 second-semester BSN students in the medical-surgical course, across four clinical groups including mine. Each item had four options. Students had 40 minutes; none ran out of time. The mean score was 18.2 of 25 (73%), the standard deviation 3.1, and the internal consistency reliability (KR-20) was 0.71, which is acceptable for a short classroom test but indicates that decisions about individual students should not rest on this test alone. The test counted for 5% of the course grade.
For discrimination, students were ranked by total score, and the top and bottom 27%, 12 students each, formed the upper and lower groups. The upper-lower method is simple to calculate by hand and gives results close to more complex indices for classroom tests (Haladyna & Rodriguez, 2013).
What the Two Numbers Mean Together
Difficulty, p, is the proportion of all students who answered correctly; a higher p means an easier item. Discrimination, D, is the proportion of the upper group answering correctly minus the proportion of the lower group; it shows whether the item separates students who know the material from those who do not. A commonly used guide treats D of 0.40 or higher as very good, 0.30 to 0.39 as reasonably good, 0.20 to 0.29 as marginal, and below 0.20 as poor (Ebel & Frisbie, 1991). The two numbers must be read together. A very easy item cannot discriminate much, because almost everyone gets it right; that is not a flaw if the item tests something every student must know. A negative D is always a warning: it means the stronger students did worse than the weaker ones.
Results for Ten Items
The table shows the ten items discussed below; the other fifteen had p between 0.55 and 0.90 and D between 0.20 and 0.45, and are not discussed individually.
| Item | Content | Correct (of 44) | p | Upper correct (of 12) | Lower correct (of 12) | D |
|---|---|---|---|---|---|---|
| 1 | Symptoms of hypoglycemia | 43 | 0.98 | 12 | 11 | 0.08 |
| 3 | Glucose target before meals in hospital | 40 | 0.91 | 12 | 9 | 0.25 |
| 7 | Onset of rapid-acting insulin | 30 | 0.68 | 11 | 5 | 0.50 |
| 9 | Correction dose calculation | 22 | 0.50 | 10 | 3 | 0.58 |
| 12 | Bedtime basal insulin with glucose of 95 | 18 | 0.41 | 4 | 7 | -0.25 |
| 14 | Sick-day rules | 26 | 0.59 | 9 | 6 | 0.25 |
| 17 | Foot inspection teaching | 35 | 0.80 | 11 | 8 | 0.25 |
| 19 | Diabetic ketoacidosis versus hyperosmolar state | 15 | 0.34 | 6 | 3 | 0.25 |
| 21 | Treating level 1 hypoglycemia | 38 | 0.86 | 12 | 8 | 0.33 |
| 24 | Insulin storage | 29 | 0.66 | 10 | 6 | 0.33 |
Reading the Items
Item 1 was answered correctly by 43 of 44 students and does not discriminate. It tests a fact every student must know before giving insulin, so it stays as a mastery item, but it adds almost nothing to separating students and should not be one of many such items.
Items 7 and 9 are the test's best items: moderately difficult and strongly discriminating. Item 9, the correction dose calculation, was answered correctly by half the students, with 10 of the upper group and only 3 of the lower. That result matches the calculation weakness identified earlier in the semester and supports continuing the practice sets.
Item 19, on distinguishing diabetic ketoacidosis from hyperosmolar hyperglycemic state, was the hardest item, with p of 0.34 and marginal discrimination. That suggests the content was not yet learned rather than that the item is flawed; it had been taught in one lecture only, and it will be revisited in the week 8 simulation.
Distractors
For item 9, option A was chosen by 8 students, B by none, C, the key, by 22, and D by 14. Option D represented the most common real error, counting one band too few on the correction scale, and drew many students, which makes it a useful distractor. Option B drew no one and is non-functioning. A study of nursing examinations defined non-functioning distractors as those chosen by fewer than 5% of examinees and found that many items had at least one (Tarrant et al., 2009). Option B will be replaced with another plausible error, such as applying the scale to the previous glucose reading.
What the Test as a Whole Shows
Taken together, the items suggest a test that is somewhat easy, with a mean of 73% and several items above 0.85, and adequately reliable for its purpose. Its weaker spots are concentrated in content taught once and quickly, such as the hyperglycemic emergencies, and its strongest items test the calculation and timing knowledge that was practiced repeatedly. For the next version, I will replace two of the easiest mastery items with application items at moderate difficulty, which should raise reliability without making the test longer, and I will have every key checked by a second faculty member against current guidance before the test is printed.
The Item to Rewrite: Item 12
Item 12 had a negative discrimination of -0.25: only 4 of the upper group answered correctly compared with 7 of the lower group. The distractor analysis explains why. The stem described a patient with a bedtime glucose of 95 mg/dL and a scheduled dose of basal insulin, and the keyed answer, B, was to hold the dose and notify the provider. Option A, give the basal dose as ordered, was chosen by 21 students, including 8 of the upper group. On review with two colleagues, the key was wrong: basal insulin covers background glucose needs and is generally given as ordered at this glucose level, and holding it risks hyperglycemia overnight. The stronger students recognized this; the key reflected an outdated habit of holding insulin for any glucose near normal.
Action: item 12 was rekeyed to A, all students' scores were recalculated, and 21 students gained a point. The item will be rewritten for future tests with a stem that states the order and the unit's hypoglycemia protocol, so that the correct answer depends on knowledge of basal insulin rather than on guessing the writer's intent. A negatively discriminating item is most often a key error or an ambiguity, and it should be reviewed before any score is released.
References
Ebel, R. L., & Frisbie, D. A. (1991). Essentials of educational measurement (5th ed.). Prentice Hall.
Haladyna, T. M., & Rodriguez, M. C. (2013). Developing and validating test items. Routledge.
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
NU 600 Unit 7 instructions, in plain terms
Unit 7 asks you to analyze examination items using statistics such as difficulty and discrimination indices and distractor analysis. Expect to describe the test and conditions, explain the statistics, present results for selected items, interpret them, examine distractors, judge the test as a whole and recommend revisions. Many versions provide data; others ask you to use a test you gave or realistic constructed data. Check whether your section requires reliability coefficients. Small groups make statistics unstable, so note that limit. Interpretation matters more than calculation: an easy item may be worth keeping if it tests essential safety knowledge. Recommend specific rewrites for flawed items, showing the original and the revised version with the reason for each change.
Inside the NU 600 Unit 7 example
The analysis opens with the test, the students and the conditions, so the numbers have context. A section explains difficulty and discrimination and how to read them together, which helps the grader see the interpretation is informed. A table shows ten items with their statistics. Each item discussed gets a short paragraph explaining what the numbers mean and whether to keep, revise or drop it. The distractor section counts choices for one item and shows how a well-written wrong option reflects a real error. The whole-test section summarizes the mean and spread and comments on reliability. The rewrite section takes the negatively discriminating item, identifies the flaw, a key that was wrong, and gives the corrected item and why.
NU 600 Unit 7 rubric: what full points look like
Herzing's rubric for item analysis usually covers the description of the test, the explanation of statistics, the accuracy of results, the interpretation of items, distractor analysis, recommendations and writing. Explanation points reward correct definitions of difficulty and discrimination and how the upper and lower groups were formed. Interpretation tends to decide the grade: the top band goes to papers that read each statistic in light of how important the content is, rather than applying cutoffs mechanically. Distractor analysis points go to actual counts for each option with an explanation of what drew students to the wrong ones. Recommendation criteria look for specific revisions with reasons, ideally with the rewritten item shown. Whole-test judgments about mean, spread and reliability may be credited within interpretation. References in APA 7 include Ebel and Frisbie and Haladyna and Rodriguez on item writing.
Common NU 600 Unit 7 mistakes, and how to avoid them
Item analyses in Unit 7 most often lose points by applying cutoffs mechanically, such as dropping every item above 0.90 difficulty, without considering whether the content is essential. Another frequent error is confusing difficulty and discrimination, or reading a high difficulty index as a hard item when it means an easy one. Students often skip distractor analysis, though it shows which errors are common. Negative discrimination is sometimes reported without checking the answer key, the most likely cause. Small group size is rarely acknowledged as a limit on how stable the numbers are. Recommendations are vague, such as revise item 12, without a revised version. Finally, keep test security in mind, because graders prefer composite or retired items over live examination content.
Get a NU 600 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NU 600 classroom, along with whatever item data you are permitted to use or the format you have been given. We write a custom example with difficulty and discrimination interpreted together, distractors examined, decisions defended and the teaching implications drawn, returned in 24 to 48 hours. The first custom sample is free.
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NU 600 Unit 7 questions, answered
Where do the item numbers come from if I have no test data?
Many sections supply a data set, and where none is given a clearly labeled illustrative set works, provided the figures behave the way real ones do. Build in a couple of items that misbehave, since a fabricated table where everything performs well gives you nothing to examine. Never present invented figures as results from a real classroom, and say in the paper where your data came from.
How small a group can be analyzed this way?
Small groups produce unstable figures, and the honest version of the report says so. With twenty learners a discrimination index moves considerably on one changed answer, so treat the numbers as a prompt for inspecting the item rather than as a verdict on it. Say what the group size does to your confidence, because a reader who knows the statistics will look for that sentence.
Should the analysis recommend rewriting items?
Where the instructions ask for it, yes, and a proposed revision is usually more convincing than a criticism. Quote the original stem and options, name the flaw precisely, whether it is a clued answer, an implausible distractor or two defensible keys, and show the rewritten version beside it. What to avoid is a general recommendation to improve question quality, which points at nothing.
Where can I find a free NU 600 Unit 7 sample paper?
The full NU 600 Unit 7 diabetes exam item analysis is on this page at no charge, the statistics table, distractors and the rewrite of item 12. A custom analysis can work from your own test data or constructed items.
What do item difficulty and discrimination mean on a nursing exam?
Difficulty is the share of students who answer correctly; discrimination compares how often stronger and weaker students get it right. This sample keeps an easy safety item that does not discriminate and rewrites one that weaker students answered correctly more often.