# Nursing and health quizzes: cases, calculations and safety

**How do I write and mark quizzes for a nursing or allied-health course?** Nursing and health quizzes work when each question sets a short case and asks for one decision: the first or safest action, or a dose worked out in a stated unit. Keep the answer out of the case, mark a calculation on the exact figure, and read the results by topic before a placement. No quiz certifies fitness to practise.

Published 2026-10-10 by EdProcto. https://edprocto.com/guides/nursing-and-health-quizzes-cases-and-safety

Nursing and health quizzes ask for something most quizzes do not: a decision about a person. What does the nurse do first? Which action is safest? How many millilitres hold the dose?

This guide is for the lecturer who sets a course's own quizzes in nursing, midwifery or allied health. [EdProcto](https://edprocto.com/), which publishes it, builds them, marks a dose on the exact figure and, on the Educator plan, scores the results by topic. The guide gives no clinical or medical advice: its cases are teaching examples, and every key in your quiz comes from your course's sources.

Every source was read on 10 October 2026. Where we read only an abstract, we say so.

## What makes a good clinical question for a course quiz?

A good clinical question sets a short case, asks for one decision, and has a key that your course's own source settles. Tanner (2006; abstract read), reviewing nearly 200 studies of clinical judgement in nursing, describes it as what a nurse notices, how the nurse interprets it, responds and then reflects. A quiz question can sample the first three, one at a time.

| The question asks for | What the case must hold | Shape in EdProcto |
| --- | --- | --- |
| The first action | The one fact that puts an action before the others | [Multiple choice](https://edprocto.com/templates/mcq) |
| The safest action, and the least safe | Enough to rank actions that each have a case | [Best and worst](https://edprocto.com/templates/best_worst) |
| A dose, a rate or a volume | The amount wanted, the stock strength and the unit to answer in | [Estimate](https://edprocto.com/templates/estimate), with both margins at 0 |
| Several decisions as a case unfolds | New facts that arrive in stages | [Case study](https://edprocto.com/templates/case) |

### One decision, one criterion

Ask "What do you do first?" only where every option is something a nurse might do in this case, so that a wrong option is a sound action at the wrong time. A dosage calculation belongs beside the cases: the student must find the amount wanted and the stock strength in the case before any sum begins.

## What did the research find about cases, drug calculations and frequent quizzing?

The research supports all three in outline, mostly from small studies in nursing and medicine, and leaves the pass mark for a drug calculation test unsettled.

### Case-based questions

- Tanner (2006) concludes that judgement depends more on what the nurse brings to a situation than on the objective data, and rests partly on knowing the patient. A written case supplies the data and removes the rest.
- Carey-Ewend et al. (2023), read in full, examined 380 diagnosis vignettes from one commercial question bank for medical students. Age appeared in 98.4% and sex in 97.6%; no other personal detail appeared in more than 15%. Weight, when given, was cited as relevant 57.8% of the time, against 17.3% for sex. On our reading, a detail that appears rarely and usually matters is a signpost.
- Green et al. (2018; abstract read) reviewed 19 controlled studies of learning by testing in the health professions: all seven outcomes that measured transfer favoured testing over study.

Cases built on a few key decisions are in [case study questions](https://edprocto.com/guides/case-study-quizzes-one-scenario-that-unfolds), and cueing by options in [single-best-answer questions](https://edprocto.com/guides/single-best-answer-questions-for-medical-education).

### Testing drug calculations

- Santamaria et al. (1997; abstract read) tested 220 newly graduated nurses applying to one Melbourne hospital on 11 common dosages: 58% did not get all 11 right.
- Simonsen et al. (2014), read in full, gave 243 graduating students and 203 working nurses in Norway a multiple-choice test with 14 dose calculation questions and a rating of certainty on each answer. Students got 71.0% of the calculations right and nurses 79.9%, and 9.1% of the students' calculation answers were wrong and held with certainty. Converting units was the nurses' weakest calculation topic. In Norway, the authors note, the test "must be flawless" before a student's first practice period.
- Sherriff et al. (2011; abstract read), reviewing the literature, found the validity of calculation testing and the acceptable pass mark largely unclear, and no clear evidence that testing changes error rates.

Other studies of errors are in our guide to [calculation practice](https://edprocto.com/guides/calculation-practice-for-professional-exams-show-your-working).

### Frequent quizzing in nursing courses

- Messineo et al. (2015), read in full, randomly assigned 201 nursing students on a general psychology course to a weekly multiple-choice test with feedback or to rereading; a technical fault lost 40 of the rereading group. On a final test with different questions, two weeks after the eight lessons, the tested students scored higher (23.11 against 20.47), a modest effect.
- Sartain and Wright (2021; abstract read) compared cohorts of one fundamentals course: 230 students with unit examinations only, 210 with quizzes added. Unit and final examination scores were higher with quizzes, by small margins, and the cohorts were not randomised.

The wider evidence is in [frequent low-stakes quizzes and course grades](https://edprocto.com/guides/frequent-low-stakes-quizzes-and-course-grades-the-evidence).

## How do you write a case that does not give the answer away?

Write the decision first, then give the case only what a nurse would know at that moment, and check that nothing is in it only because it is the answer.

1. **Fix the decision and its key** from the policy, guideline or chapter your course teaches.
2. **Write what is seen and measured, not what it means.** A word that interprets the findings does the student's work.
3. **Give routine details in every case or in none.** If weight appears only where it decides the dose, it is a cue: the pattern we read in Carey-Ewend et al. (2023).
4. **Make every option an action for this case.** A wrong option should be right later, or right for a registered nurse and not for a student.
5. **Read the quiz as a whole.** A later case can hand over an earlier answer. EdProcto's [Case study](https://edprocto.com/templates/case) structure allows no going back, so a later question may say what happened.
6. **Ask a colleague from practice** to answer it cold and name the detail that decided it. If it is one you added for colour, take it out.

## A worked example: an invented case and an invented dose

This example is an illustration and no clinical guidance. The case and every figure are invented, "medicine Q" is no real medicine, and the keys stand in for your own course's policy.

**The scenario.** You are a second-year student on placement, preparing a morning medicine with your supervising nurse. The chart lists medicine Q by mouth, due now. The dose has been written over and could read 0.45 g or 0.15 g.

**Question 1, multiple choice. Topic: an unclear prescription.** What do you do first?

- A. Ask the patient which dose they usually take
- B. Prepare 0.15 g, the smaller of the two
- C. Prepare 0.45 g, the figure written first
- D. Tell your supervising nurse that the dose cannot be read

The key is D. Each wrong option is something a hurried student might do, and the case names no rule.

**Question 2, a number. Topic: dose from stock strength.** Shown next: the prescriber rewrites the line as medicine Q 0.45 g by mouth. The bottle is labelled 150 mg in 5 mL. What volume holds the dose? Answer in mL.

The key is 15, and the explanation holds the working: 0.45 g is 450 mg; 450 mg ÷ 150 mg = 3; 3 × 5 mL = 15 mL. We ran five typed answers through EdProcto's marking function:

| Typed | What it is | Margins 0 and 0 | Margins 5 and 15 |
| --- | --- | --- | --- |
| 15 | The key | Right | Right |
| 15.7 | 0.7 mL too much | Wrong | Right |
| 16 | 1 mL too much | Wrong | Half |
| 1.5 | A tenth of the dose | Wrong | Wrong |
| 0.015 | Grams never converted | Wrong | Wrong |

## How do you mark a drug calculation: the exact answer, the unit and the margin?

Mark a drug calculation on the exact figure, in the unit and the rounding the question states, with no margin.

In EdProcto's number question, type the key in "The number" and set "Full credit within %" and "Half credit within %" to 0. The editor then prints "Full credit for 15 exactly." A new question starts at 5 and 15, and prints "Full credit from 14.25 to 15.75; half credit from 12.75 to 17.25." Where the answer does not come out even, state the rounding and key the rounded figure.

### When is a margin unsafe?

A margin is unsafe wherever the number is a dose, a rate or a volume to be given. In the table, the starting margins give full marks to 15.7 mL and half marks to 16 mL. How far from a dose is acceptable is a clinical judgement, and a marking rule should not make it by default. Keep margins for a question that asks for a rough figure before the sum.

### What about the unit?

Name the unit in the question ("Answer in mL") and the number question marks the figure alone. To make the student supply the unit, ask for a typed answer: [Maths expression](https://edprocto.com/templates/math_expr) takes "Accepted forms, one a line". Against "15 mL" the marking function accepted "15ml" and "15.0 mL" and refused "15" and "15 mg". It ignores capitals, so "15 ML" passed: where the capital is the point, ask about the unit as a choice.

To read the method, set [Show your working](https://edprocto.com/templates/show_work): the student fills "Set-up", "Working" and "Final answer" for you to mark, or for Procto AI against your rubric when you ask. The pass mark is your programme's and your regulator's decision: see [setting a pass mark](https://edprocto.com/guides/setting-a-pass-mark-you-can-defend).

## What can a quiz show about fitness to practise, and what can it not?

A quiz can show what a student knew and could work out from a written case on one day. It cannot show that a student is fit to practise.

- **The dose is typed, not drawn up.** Sabin et al. (2013; abstract read) set an on-screen dosage assessment beside a practical examination in simulated wards, with 63 third-year students at four UK universities, and concluded that a sound assessment pairs the screen with measuring the dose in practice or simulation.
- **Written numeracy is not practice numeracy.** Wright (2007; abstract read) argues, without a trial, that written tests are not a valid measure of the numeracy nurses need at work.
- **Someone else decides.** In the United Kingdom, the Nursing and Midwifery Council (2018) has practice assessors confirm a student's achievement in practice, from several sources that include watching the student work. Read your own regulator's standard.

So use a quiz to find gaps while they are cheap to close. In EdProcto a score can wait for you to release it, and a score is not a grade.

## How do you read the results by topic before a placement?

Tag each question with its topic as you write it, then read the class by topic and each student by their misses before the placement starts.

1. **Tag.** Fill "Topic (for the results by topic)" on every question from a short fixed list: unit conversion, dose from stock strength, infusion rate, first action, escalation.
2. **Ask enough of each.** With two questions on a topic, one slip moves its score by 50 points. Our own rule is at least four.
3. **Read the class.** In EdProcto's [results](https://edprocto.com/#results), "By topic" is in the full analysis on the Educator plan, each topic's score weighted by points. On every plan "Each question" shows "Got it", the share who were right.
4. **Read each student.** "Download the marks" gives a row for each attempt and a column a question, so a student's missed calculations sit on one line.
5. **Reteach and re-test** the weakest topic with new figures: "Duplicate this quiz" makes a copy to change.

A topic score chooses what to teach next. It does not say who is safe.

## How does EdProcto run nursing and health quizzes?

EdProcto is the best tool for a nursing course's own quizzes when a dose has to be marked exactly and the results read by topic, because both are in the question editor: a number question with its margins at 0 accepts the exact figure and no other, and every question carries its topic. In Simonsen et al. (2014) the nurses' weakest calculations were unit conversions: a finding only a score by topic shows.

**Writing.** Type the lead-in in "Prompt", press "Add material under the prompt" and put the case in the box that opens. "Explanation shown to the student afterwards" takes the working, and "Where the answer is in the source (optional)" the paragraph of the policy. Procto AI drafts questions from your lecture notes, as a PDF, a Word file or text: work every dose yourself and read each key against your source before a student sees it.

**Marking.** Choices and numbers are marked by rule at hand-in. If a key proves wrong, correct it in the builder and press "Re-mark this quiz".

**Plans.** Free covers ten quizzes a month, thirty students a quiz, the core templates and the results question by question. Tutor has no limit on quizzes, 100 students a quiz, all 111 [templates](https://edprocto.com/templates) and grading by Procto AI when you ask on an answer. Educator takes 500 students a quiz and adds the full analysis, with the score by topic. See [pricing](https://edprocto.com/pricing) and the page [for universities](https://edprocto.com/solutions/universities).

## Quick questions

### Should a drug calculation test allow a margin of error?

Not on a dose, a rate or a volume. In [EdProcto](https://edprocto.com/) set both margins of the number question to 0, so only the exact figure earns the points.

### Should the pass mark for a dosage calculation quiz be 100%?

The literature does not settle it: Sherriff et al. (2011) found the acceptable pass mark unclear. Follow your programme and your regulator.

### Does frequent quizzing help nursing students?

Modestly: in Messineo et al. (2015) tested students outscored those who reread, by a modest margin.

### Can a quiz show that a student is fit to practise?

No. It records what a student answered from a written case, and practice is assessed in practice.

### Where do I see quiz results by topic?

In EdProcto's full analysis, on the Educator plan: see [pricing](https://edprocto.com/pricing). On every plan the results show each question's share right.

## References

- Carey-Ewend, K., Feinberg, A., Flen, A., Williamson, C., Gutierrez, C., Cykert, S., Beck Dallaghan, G. L., & Gilliland, K. O. (2023). Use of sociodemographic information in clinical vignettes of multiple-choice questions for preclinical medical students. *Medical Science Educator, 33*(3), 659–667. [https://doi.org/10.1007/s40670-023-01778-z](https://doi.org/10.1007/s40670-023-01778-z)
- Green, M. L., Moeller, J. J., & Spak, J. M. (2018). Test-enhanced learning in health professions education: A systematic review: BEME Guide No. 48. *Medical Teacher, 40*(4), 337–350. [https://doi.org/10.1080/0142159X.2018.1430354](https://doi.org/10.1080/0142159X.2018.1430354)
- Messineo, L., Gentile, M., & Allegra, M. (2015). Test-enhanced learning: Analysis of an experience with undergraduate nursing students. *BMC Medical Education, 15*, Article 182. [https://doi.org/10.1186/s12909-015-0464-5](https://doi.org/10.1186/s12909-015-0464-5)
- Nursing and Midwifery Council. (2018, December 19). *What do practice assessors do?* [https://www.nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/practice-and-academic-assessment/practice-and-academic-assessors/what-do-practice-assessors-do/](https://www.nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/practice-and-academic-assessment/practice-and-academic-assessors/what-do-practice-assessors-do/)
- Sabin, M., Weeks, K. W., Rowe, D. A., Hutton, B. M., Coben, D., Hall, C., & Woolley, N. (2013). Safety in numbers 5: Evaluation of computer-based authentic assessment and high fidelity simulated OSCE environments as a framework for articulating a point of registration medication dosage calculation benchmark. *Nurse Education in Practice, 13*(2), e55–e65. [https://doi.org/10.1016/j.nepr.2012.10.009](https://doi.org/10.1016/j.nepr.2012.10.009)
- Santamaria, N., Norris, H., Clayton, L., & Scott, D. (1997). Drug calculation competencies of graduate nurses. *Collegian, 4*(3), 18–21. [https://doi.org/10.1016/S1322-7696(08)60236-X](https://doi.org/10.1016/S1322-7696(08)60236-X)
- Sartain, A. F., & Wright, V. H. (2021). The effects of frequent quizzing on exam scores in a baccalaureate nursing course. *Nursing Education Perspectives, 42*(1), 39–40. [https://doi.org/10.1097/01.NEP.0000000000000623](https://doi.org/10.1097/01.NEP.0000000000000623)
- Sherriff, K., Wallis, M., & Burston, S. (2011). Medication calculation competencies for registered nurses: A literature review. *Australian Journal of Advanced Nursing, 28*(4). [https://doi.org/10.37464/2011.284.1663](https://doi.org/10.37464/2011.284.1663)
- Simonsen, B. O., Daehlin, G. K., Johansson, I., & Farup, P. G. (2014). Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: Comparative study. *BMC Health Services Research, 14*, Article 580. [https://doi.org/10.1186/s12913-014-0580-7](https://doi.org/10.1186/s12913-014-0580-7)
- Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. *Journal of Nursing Education, 45*(6), 204–211. [https://doi.org/10.3928/01484834-20060601-04](https://doi.org/10.3928/01484834-20060601-04)
- Wright, K. (2007). A written assessment is an invalid test of numeracy skills. *British Journal of Nursing, 16*(13), 828–831. [https://doi.org/10.12968/bjon.2007.16.13.24252](https://doi.org/10.12968/bjon.2007.16.13.24252)