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The purpose of our study was to holistically examine the issue of item review in relation to the student’s ability to monitor their behavior accurately while responding to multiple-choice tests. More specifically, this study examined the relationship between examinee item review practices in relation to their answer confidence and item difficulty. The sample consisted of 120 undergraduate students in education. The results of the study found that on the task level, item difficulty was a significant predictor in whether item review was beneficial to the students or not. At the person level though, confidence was related to the non-correctness of students’ item review practices. Furthermore, lack of confidence was associated with low levels of achievement, making more right-to-wrong answer changes.