There is nearly a century of educational research that has demonstrated that three option multiple-choice questions (MCQs) are as valid and reliable as four or five option, yet this format continues to be underutilized in educational institutions. This replication study was a quasi-experimental between groups research design conducted at three Canadian schools of nursing to examine the psychometric properties of three option MCQs when compared to the more traditional four option questions. Data analysis revealed that there were no statistically significant differences in the item discrimination, difficulty or mean examination scores when MCQs were administered with three versus four option answer choices.