Writing NGN-Style Trend Questions

By Susan Sportsman, PhD, RN, ANEF, FAAN

 Over the past few months as we prepare for the launch of the Next Generation NCLEX (NGN), the Collaborative Momentum blog has been focusing on strategies to write clinical judgment-type questions. We have already discussed Knowledge questions and Case Studies. This month we will focus on one of the clinical judgment standalone questions, the Trend question. This type of question provides an opportunity for the test-taker to evaluate the client’s condition over a period of time, making clinical judgments as scenarios develop in actual clinical situations.

The Trend question will require the test-taker to use at least one cognitive skill to answer the question. Anywhere from 0 to 7 Trend questions will be included in the NCLEX NGN, depending on the number of questions required for an individual test-taker. The scenario for a Trend question must have the following components:

    • A stated or implied diagnosis
    • Clinical information related to the client’s condition
    • Components that require the nurse to make one or more decisions

Let’s look at the Trend question appropriate for students in a beginning level course, such as Fundamentals of Nursing. The complexity of the clinical information necessary to answer the question will, of course, increase as students increase their competencies in the nursing program. When preparing students to take the NGN, they should know that the questions on the licensing examination will reflect competencies that a novice nurse should have.

Note: The templates used in this post can be found on our Resources page. Feel free to use them.


A seventy-five-year-old client is admitted to the hospital from a Senior Living Facility after a serious bout of nausea, vomiting and diarrhea which has lasted  continuously over an 18 hour period. The client  has been a resident in the facility for two years. Initially, client C/O nausea and vomiting x2, which subsequently was followed by abdominal pain and frequent stools. Eight hours after the initial complaint, stools became more frequent (q 1 hour) and watery. Abdominal pain remained constant, as did nausea and vomiting.  Although typically lucid, client became  lethargic 10 hours after onset of N,V, D. Transfer was made to hospital for observation and treatment.


Provider Order:

    1. IV Bolus of 0.9% saline in boluses of 20 mL/kg body weight until mental status improves, then 100mL/kg body weight Oral Perfusion salts (0RS) over 4 hours.
    2. Clear Liquid Diet
    3. First dose Imodium 4mg (ii capsules), then 2mg (i capsule) after each loose stool (No more than 16 mg in 24 hr. period)
    4. Surgical Consult



The Question

Next month we will take a look at the other Clinical Judgment standalone type of questions, the Bow Tie. In the meantime, keep practicing the NGN type of questions. Practice—and requesting feedback from your colleagues—will begin to show dividends to your test writing skills.

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