Examine your course textbook and materials. A significant amount of your examination should cover information and topics in the texts. Many instructors choose to focus their lectures on certain subjects contained in their readings but still hold students responsible for reading and understanding all the course materials including those not covered in lecture.
Consider your course syllabus and any university- or college-issued curricula. Your questions should search for understanding and competency in key areas required for graduation and later licensing. Always adhere to school standards which in turn mirror state nursing board and often American Nursing Association standards.
Get copies of test questions from former NCLEX-RN -- the national nurse license -- exam. Pick out questions that correspond with your course materials and modify them slightly. Using questions in the format used in the NCLEX will help prepare students for challenges ahead. The National Council of State Boards of Nursing that designs the NCLEX sells books of former questions on its website. Most nursing colleges have these in their faculty resource and medical libraries.
Write questions of your own mimicking the situational, decision-making style of the NCLEX. Unlike many standardized exams, NCLEX questions ask examinees to choose the best answer among several answers that could be correct or several solutions of which none is ideal. If your course matter lends itself to this kind of reasoning, it can be a great way to challenge students.
Borrow previous exams from other instructors who have taught your course. There's no need to reinvent the wheel if the class has been taught successfully in the past. Ask your department head for information and an introduction to other faculty members who have taught your course.