Over the last several years, as we prepared for the implementation of the Next Generation NCLEX, the Collaborative Momentum Blog has intermittently focused on strategies to write test questions that mirror clinical practice. Now that the NGN has been implemented, we believe it might be helpful to review some of the types of questions the students must answer. 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 requires the test-taker to use at least one cognitive skill to answer the question. Anywhere from 0 to 7 Trend questions are 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:
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- 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.
Scenario
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.
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Provider Order:
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- 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.
- Clear Liquid Diet
- First dose Imodium 4mg (ii capsules), then 2mg (i capsule) after each loose stool (No more than 16 mg in 24 hr. period)
- Surgical Consult
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The Question
CMC recommends that faculty keep practicing various types of NGN questions. Practice—and requesting feedback from your colleagues—will enhance your test writing skills. To read about crafting test questions at a higher cognitive level, refer to this article.
If you are seeking additional support with writing NGN-style Trend questions, or any other type of NGN test questions, we are here to help. Reach out to us to learn more test writing strategies, to collaborate or to enhance faculty development in your program.