Literature supports the inclusion of multiple response type questions to assess critical thinking and higher level of cognitive processing in nursing programs. These questions are often developed with five or more responses and several correct answers. Following exam completion, exam analysis is conducted to assess the quality of the questions. When evaluating multiple response questions, p-values are often significantly lower than those of multiple-choice items. Multiple response questions with a p-value of less than 0.30 would likely be thrown out. Such extreme modification or removal of multiple response items will reduce the effectiveness of the test and has the potential to weaken a nursing program’s success in achieving curricular goals.