An item generation procedure is described which was utilized in the development of Computer Managed Review and Examination courses for the education of nurses in remote areas. The major emphases are the processes of domain definition, item writing, and item edition. Specific discussion is presented concerning methods of item construction to assess technical vocabulary, concept learning, and the application of nursing principles to the solution of problems. The entire test construction procedure is briefly reviewed; this procedure includes numerous quality checks to insure the production of both high caliber instructional materials and domain-referenced tests. The criteria used at various editing and review stages are mentioned. An initial evaluation of the items is made, and problems inherent in the item generation procedure are offered. (Author/JY)