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The purpose of this study was to compare certain characteristics of multiple-choice (MC) and complex multiple-choice (CMC) achievement tests designed to measure knowledge in medical-surgical nursing. Each of 268 junior and senior nursing students from four midwestern schools responded to one of four test forms. MC items were developed by converting original CMC items with four different systematic procedures. Results showed that: (1) students responded to five MC items for every four CMC items, (2) MC tests were at least as reliable as CMC tests though they did not measure exactly the same traits, and (3) CMC tests were at least as difficult as MC tests. Recommendations were made for test users. (Author)