View guidance on planning, writing and evaluating multiple choice questions to test knowledge and higher order thinking.

What are Multiple Choice Questions (MCQ)?

An MCQ (Multiple Choice Question) is a test of knowledge and understanding where the student is required to select the correct answer/s from a list.

MCQ questions are made up of two elements: the stem and the responses offered. Ideally you will provide three to five responses that are all plausible, with the incorrect choices (the distractors) based on common misconceptions.


Which of the following assessment findings is characteristic of a client with Parkinson’s disease?  (* marks correct answer)

Responses (correct answer and distractors)

  1. Night blindness 
  2. Pain in the lower extremities
  3. Shuffling gait*
  4.  Incontinence 

The development of an MCQ

These are steps in developing an MCQ.

Step 1: Develop the MCQ items

In developing the MCQ items:

  1. draft the stem and the correct answer 
  2. create alternative options / distracters
  3. review and revise with colleagues to check the potential ambiguity of questions. 

Step 2: Design the test

When designing the test:

  1. put the test together on Canvas
  2. build question banks.

Step 3: Evaluate the test

When evaluating the test, remember to do the following.

  1. Pilot it in formative assessments and/or with colleagues, checking for timings, and difficulty
  2. Evaluate using this MCQ evaluation form.

During each step: Think about inclusion and accessibility. Ask yourself: 

  • if the language is accessible
  • if you have avoided language-based tricks (such as similar sounding words); these should be avoided, especially for distracters. 
  • if the material is accessible. For guidance see the Digital Accessibility Toolkit 
  • how you will give students the opportunity to practice MCQs through formative assessment
  • if your questions are representative of your students 
  • if media used, has alternative text.

Higher order thinking and MCQs

People often assume that MCQs can only test lower order thinking, such as remembering and understanding. However, students are also able to apply, analyze and evaluate information in an MCQ. These target verbs may help when writing your MCQs.

For lower order learning, like remembering and understanding, the stems you can use include to:

  • select the best description
  • select the best explanation. 

For higher order learning, like applying and evaluating, the stems you can use include to:

  • select the best solution
  • select the best plan
  • select the best modification. 

A comparison between a lower order MCQ and a higher order MCQ

These questions deal with similar content. However, the second question requires the student to apply the knowledge in the first answer to a scenario. 

  1. Which of the following assessment findings is characteristic of a client with Parkinson’s disease?  (* indicates correct answer)


  1. Night blindness 
  2. Pain in the lower extremities
  3. Shuffling gait*
  4.  Incontinence  
  1. A nurse is making a home visit to a 75‐year old male who has had Parkinson’s disease for the past five years. Which of the following has the greatest implication for this client’s care? (* indicates correct answer)


  1. The client’s wife tells the nurse that the grandchildren have visited for over a month. 
  2. The nurse notes that there are numerous throw rugs throughout the client’s home *
  3. The client has a towel wrapped around his neck that the wife uses to wipe her husband’s face 
  4. The client is sitting in an arm chair, and the nurse notes that he is gripping the arms of the chair

Reviewing your MCQs

To ensure that you are assessing each of your learning outcomes at varying levels of cognitive complexity (according to your year group), you could create a test blueprint similar to the one below.

The top row of the table lists the levels of learning according to Bloom’s taxonomy: remember, understand, apply, analyse, evaluate.

Use the left hand column to map out each of your learning outcomes each row with the number of MCQs on your test which assess at each of level of cognitive complexity.

Content/Learning OutcomeRememberUnderstandApplyAnalyseEvaluateTotalPercentage
Identify the major concepts, theories,
and topics in Psychology


4 0 0 0 8 20%
Distinguish between the 
relative strengths and weaknesses of 
theories in Psychology
2 3 2 1 0 8 20%
Apply concepts and theories from 
Psychology to everyday problems
0 1 4 3 0 8 20%
Interpret statistical information 
presented in tables or graphs
1 1 3 3 1 8 20%
Ask questions about topics in 



2 3 2 1 8 20%
Total 7 11 12 9   40  
Percentage 17.5% 27.5% 30% 22.5% 2.5%   100


Top tips for desigining MCQs

In designing MCQs, there are some tips remember, such as:

  • as with any online assessment tools, limit the use of knowledge recollection questions, as those can easily be found online with the use of search engines. If this is unavoidable, consider mechanisms to mitigate academic misconduct, such as limiting the time of the exam, or formulating the question in a way that it wouldn’t be easy to search online
  • to help avoid collusion, choose the option to “Shuffle Answers” on Canvas. You may also wish to build up a question bank, so that students answer 10 questions out of a bank of 30. This will give each student a random combination of questions
  • with True or False and MCQ questions, consider adding images or graphs that require interpretation, to evaluate a deeper level of understanding
  • consider adding problem-solving questions that students may need to draw on their knowledge on various areas in order to provide the correct answer
  • with MCQs, students can be rewarded for guessing, as such, alternative answers need to be carefully formulated and plausible. Ensure that incorrect choices cannot be easily be discounted, as this would decrease the difficulty of the question and make answering correctly the question purely by guessing easier.

How To: 

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