This study investigates the effect of several design and administration choices on item exposure and person/item parameter recovery under a multistage test (MST) design. In a simulation study, we examine whether number-correct (NC) or item response theory (IRT) methods are differentially effective at routing students to the correct next stage(s) and whether routing choices (optimal versus suboptimal routing) have an impact on achievement precision. Additionally, we examine the impact of testlet length on both person and item recovery. Overall, our results suggest that no single approach works best across the studied conditions. With respect to the mean person parameter recovery, IRT scoring (via either Fisher information or preliminary EAP estimates) outperformed classical NC methods, although differences in bias and root mean squared error were generally small. Item exposure rates were found to be more evenly distributed when suboptimal routing methods were used, and item recovery (both difficulty and discrimination) was most precisely observed for items with moderate difficulties. Based on the results of the simulation study, we draw conclusions and discuss implications for practice in the context of international large-scale assessments that recently introduced adaptive assessment in the form of MST. Future research directions are also discussed.