Nick Item-Writing Academy
About 40 minutes · Academy module: Cloze Workshop.
The NGN cloze item embeds one or more drop-down menus inside a clinical sentence — typically a nurse's note or a handoff summary. Each blank offers a short list of options (often three to five), and the examinee completes the sentence by choosing the best fit for each blank. The format tests precise clinical language: the right word in the right place.
Every option in a drop-down must fit the sentence grammatically. If the sentence reads "the nurse should monitor for ___" and the options are "hypotension," "signs of bleeding," "a drop in blood pressure," and "carefully," the adverb is eliminable without reading the scenario — a grammar giveaway. Write all options as the same part of speech and the same kind of phrase, so the choice turns on clinical meaning, not syntax.
The same applies to articles and prepositions around the blank: if the sentence supplies "an," every option must take "an." Read the completed sentence aloud with each option inserted; any version that sounds wrong is a flaw, not a distractor.
When a cloze sentence has two or three blanks, each blank should be decidable on its own. Linked blanks — where choosing the first blank determines the second — collapse the item: the examinee answers one question and gets the others free. Our read: test this by covering all but one blank. If the remaining blank cannot be answered from the scenario alone, the blanks are linked and the sentence needs restructuring.
The cloze format tempts authors into vocabulary testing: blanks filled with near-synonyms ("dyspnea" vs. "shortness of breath") or with terms from unrelated domains. The blank should turn on a clinical distinction that matters — the finding that changes the action, the intervention the situation demands — not on whether the examinee prefers Latinate or plain terms.
(intended key: "hypoglycemia")
Stem: The nurse is caring for a client with type 1 diabetes who is diaphoretic, tremulous, and confused 2 hours after a meal. The nurse recognizes these findings as signs of [___] and prepares to intervene.
Drop-down options: hypoglycemia · hyperglycemia · a stroke · checking the blood glucose
grammar giveaway — two options do not fit the sentence.
"A stroke" needs the article the sentence already supplies ("as signs of a stroke" reads wrong), and "checking the blood glucose" is a verb phrase where nouns are required. A test-wise examinee eliminates both on grammar, leaving a 50/50 item. The rewrite makes all four options parallel nouns naming conditions — so the choice turns on recognizing the clinical picture, not on parsing the sentence.
— cold-solve verified: 2/2 (solvers chose hypoglycemia, hypoglycemia)
Stem: The nurse is caring for a client with type 1 diabetes who is diaphoretic, tremulous, and confused 2 hours after a meal. The nurse recognizes these findings as signs of [___] and prepares to intervene.
Drop-down options: hypoglycemia · hyperglycemia · hypokalemia · dehydration
Key: hypoglycemia
Diaphoresis, tremor, and confusion after a meal in type 1 diabetes is the hypoglycemia triad. Hyperglycemia presents with polyuria and fruity breath rather than acute neuroglycopenic signs; hypokalemia and dehydration do not explain the picture. Both independent cold solvers selected hypoglycemia and named no other defensible option.
Recording it adds the module to your Academy completion record on this device — module, track, level, and date, ready to download from your account page for faculty-development documentation.