The use of multiple-choice items for classroom testing is firmly established for many good reasons. The content any unit or course of study can be well sampled. Test scores can be reliable (trusted). And time spent administering and scoring can be minimized. This article provides a current review of best practices in the design and use of a variety of multiple-choice formats for classroom assessment of student learning. One of the most serious problems facing current educators is developing test items that measure more than simple factual recall. It is important to measure understanding, comprehension, critical thinking, and problem solving. Not only are these types of higher-level thinking described, but items are presented that illustrate how this is done. These best practices are continually evolving. The objective is always to use tests to measure validly what students have learned as well as help students learn what they have not yet learned. We call this formative and summative assessment. Guidelines are presented showing good and bad practices. What may be surprising to readers is the extensive variety of formats and methods for gathering or generating new test items. Readers are encouraged to experiment with these formats. Some formats can very efficiently measure what students were supposed to learn.