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Examinations are used throughout the prelicensure nursing education curriculum to measure student competency and monitor performance throughout a given program. Various exam item types are used to assess student knowledge and have differing effects on student response time. Students' cumulative performance on these item types determines whether their test-taking abilities are satisfactory for the respective licensure examination.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN®), administered by the National Council of State Boards of Nursing (NCSBN), uses computerized adaptive testing (CAT) to test RN competency in the four major Client Needs categories: (1) Safe and Effective Care Management; (2) Health Promotion and Maintenance; (3) Psychosocial Integrity; and (4) Physiological Integrity. In April 2023, the latest iteration, Next Generation NCLEX® (NGN), became effective. The new exam format includes case studies and bowtie item types to assess students' application of the clinical judgment measurement model (CJMM). It employs several new exam item types to measure these core competencies, including extended multiple response, cloze, enhanced hot spot, and matrix question types (NCSBN, 2023). Thus, with the new exam format, nursing candidates are now required to answer more types of items in different formats than in previous iterations. The new format calls into question how the amount of time allotted per exam item is determined, and this may affect how nursing programs design their own exams and prepare students to sit for the licensure examination.
Students differ in their speed of answering questions during exams, and different item types require varying amounts of cognition efforts and speed to respond (Klein Entink et al., 2009). Students do not divide their time evenly between exam items, as some items require steps and working memory capacity to arrive at an answer (Klein Entink et al., 2009). This factor makes calculating how much time is required per question increasingly complicated. Item complexity and difficulty, along with the examinee's academic abilities and speed, must be included when considering the effects of test format and question types to calculate response time.
Instructors often employ a “rule of thumb” to give students approximately 1 minute per multiple-choice question (Brothen, 2012). Several education instruction manuals reference this general rule, yet none cite any source from...