How our clinical review works

Who reviews our questions today

Every practice question is reviewed by our founder, Aman Thakran, an internationally educated nurse who completed his nursing degree in India and is registered as a nurse in the UK. He is not a US-licensed registered nurse, and our questions have not been independently reviewed by a US registered nurse. Each question in the diagnostic carries a label that says exactly this.

We chose this for our free beta so that nurses can use the diagnostic now. The review records are built so that an independent, licence-verified US registered nurse can review the same questions later. If that happens, the label will change only for the questions they have actually approved.

How a question is made before anyone reviews it

1. Written from published sources. Each question is drafted from a source pack of public clinical and regulatory material, such as US drug labelling, CDC guidance and NCSBN publications. Every question lists the references it relies on.
2. Never from exam or question-bank material. We do not use recalled or leaked exam content, commercial question banks, or NCSBN sample items as sources. The person reviewing the questions is recorded as not having written them.
3. Checked against its sources. The cited sources are re-read to confirm they say what the question claims. Where a source could not be checked, that is recorded rather than assumed.
4. Checked for originality. Distinctive wording from every question is searched on the public web to look for an existing question with the same scenario and answer. Originality rests on this process and on the documented way the question was written, not on the reviewer's memory.

What the review checks

Every question is reviewed against the same eight points:

1. The answer: the keyed answer is correct.
2. The question: it is clear, not ambiguous or misleading.
3. The wrong options: each is plausible but clearly wrong, and no second option could also be right.
4. The explanation: it is correct and teaches why.
5. Safety: nothing in it is unsafe.
6. Scope and delegation: US scope of practice and delegation are described correctly, where relevant.
7. Terminology: US terms, drug names and units are used correctly.
8. Difficulty: recorded as feedback only; it never blocks a question.

A question is used only when the first seven points are all met. Before review, a question can also carry specific concerns, such as whether two options could both be defended. A question with an unresolved serious concern is not used, even if it has been approved.

Versions

An approval applies to one exact version of a question. Any change to its wording, answer, explanation or references creates a new version. That version is not used until it has been searched for originality again and reviewed again.

What review does not mean

Our review checks that a question is accurate, clear and safe as a study aid. It is not an independent clinical review, it is not endorsed by NCSBN or any board of nursing, and it does not predict or guarantee an exam result. If you think a question is wrong, please tell us: see the corrections policy. A question with a credible safety concern is withdrawn while we check it.