Multiple choice questions are used as evaluations in nursing schools. Nursing instructors and nursing book publishers develop exam questions. The specific problem addressed by the study was how best practice in multiple choice test items, item analysis, and revision of choice test items used by nursing instructors. Using a survey method, this correlational design research looked at the relationship of faculty use of best practice in test item construction, analysis, and revision of multiple choice test item in nursing programs in the United States. Even though a relationship was noted, the statistical effect level was minimal. There was no correlation between grading practices and the use of best practices in test construction, test analysis and test revisions. The research results provide insight into the use of best practices and the prevalence of the inconsistencies in test construction, item analysis, and revision by nursing instructors. A gap in literature was noted on the use of best practice with developing and evaluation of nursing examinations. The data reviewed did not have a statistical correlation between the demographic variables and the use of best practices in test construction, item analysis, and revision of multiple choice questions. This study identified current practices of nursing instructors developing, analyzing and revising multiple choice questions. Nursing educators can use the information to help develop plans for consistent grading practices in the future and prevent future grade inflation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]