Limited studies address perspectives about exam-writing practices of nursing students for whom English is an additional language. The authors conducted a program-level study of perceptions of 26 nursing students of Asian background who identified as nonnative speakers of English regarding faculty-made, multiple-choice exam questions that had been linguistically modified. Linguistic modification promoted readability and comprehensibility; students preferred the linguistically modified versions 60 percent of the time. This inquiry attends to the need for greater responsiveness to student concerns about test-taking practices and for engendering their ongoing participation in creating local evidence for improving program outcomes.