The aim of the study was to examine the effect of high quality multiple-choice tests on students’ learning   approach ,to identify the relationship between students’ academic achievement and their learning  approaches and to explore how assessment can be a complementary means to direct desired learning in nursing.

      From the study we knew Assessment methods can influence the learning   approaches of nursing students. Assessments designed to assess understanding rather than rote learning can contribute to a deep learning   approach. Multiple-choice questions can be formulated at high cognitive levels for nursing assessments. This   study aimed to examine the effect of high quality multiple-choice tests on the learning approaches of students   enrolled in a mental health nursing course as measured by the revised two-factor study process questionnaire (R-SPQ-2F). Data were collected from 136 students in a higher diploma (HD) in nursing programme  and 142 baccalaureate (BSN) nursing students. Two-step cluster analysis yielded three clusters represented by   students who were predominantly deep, predominantly surface or intermediate in their orientation to learning.

      As a result , There was a general decrease in the deep learning  score and an increase in the surface   learning score of the students on the course,  possibly related to the excessive workload in nursing studies.   However, there was no direct association with multiple-choice assessment.  The academic achievement of students    correlated negatively with their surface learning approach. Students  (n = 31) in four focus group interviews believed that assessments constructed using  scenario-based questions, simulated role-play situations and case  studies could  direct  desired  learning  in order to  facilitate their understanding of knowledge, their use of   critical thinking, and their application of knowledge.