Multiple-choice questions (MCQs) are commonly employed tests configuration in healthcare sciences for several years. They are efficient means for formative and summative evaluation of the students in nursing education. If the MCQs are designed competently, it will be a resourceful measurement for a valid assessment of the nursing students. The present study aimed to evaluate the construction quality of MCQs and its common item flaws in core nursing subjects at Faculty of Nursing, then develop an instructional plan for MCQs construction (one best answer format) to guide nursing educators. The study passed through exploratory-descriptive and methodological research designs at the Faculty of Nursing, Alexandria University, Egypt. Two samples were selected: First, 253 MCQs were selected from the different final exams (2017-2018) of the core twelve nursing subjects; Second, 21 academic nursing educators for evaluating of the suggested instructional plan. Both samples were chosen by convenience sampling technique. MCQs Assessment Form (MCQAF) was the first tool used to assess the construction quality of MCQs development and its items flaws. The second tool was MCQs' Instructional Plan Evaluation Sheet (MCQ IPES) which measured the content and face validity of the suggested instructional plan. The results revealed that 45.5% (115 MCQs) of the study sample contained ten item flaws. As regards the assessment of MCQs construction quality, evidently, the majority of nursing subject's exams has mean scores around a satisfactory level in MCQs quality construction. After submitting the developed plan to the expert group, almost the entire group found that the developed plan is accurate, with sound information, considered the useful and valued educational resource. Moreover, it has appropriate content in vocabulary, sentence structure, grammar, and concepts. Likewise, the experts reported that the developed plan is clear enough to be used by nursing educators and it is attractive and interesting self-reference tool. Conclusion & recommendation: less than one half of the study MCQs has ten item flaws and almost all of them obtained satisfactory mean scores in MCQs quality construction. The developed instructional plan is a beginning and beneficial step for nursing educators and considered an instructional mean for MCQs construction guidance. Further studies are application of the developed plan among nursing educators and investigation of the awareness and compliance of nursing educators with the MCQs construction rules is needed.