NCLEX trend questions

A trend item shows the same findings at several points in time, often as tabs or columns, and asks what the change means or what to do next. The answer can use any response format. When it has one correct answer, it is simply right or wrong, because NCSBN gives partial credit only where more than one key exists.

Sources: NCLEX.com, Frequently Asked Questions; NCSBN, 2026 NCLEX-RN Test Plan (PDF); NCLEX.com, Prepare (tutorial and sample items). Checked against NCSBN as of October 29, 2026.

What it looks like

The data come in time order: vital signs, labs or assessment findings at, say, three times during a shift. The question asks what the pattern shows.

In our practice case studies, a trend is often the last step: deciding whether the care that was given is working.

How to work one

Compare each finding across the times before you read the options.
Note what is getting better, what is getting worse and what has not changed.
Pick the answer that the whole trend supports, not one single value.

How it is scored

NCSBN gives partial credit on items that have more than one correct answer, under three rules, and ties each rule to what the instructions ask you to do. Its current pages do not publish a format-by-format table, so read the instructions on each item.

Zero/one (0/1)
NCSBN uses it when you are told to choose a specific number of responses. You earn a point for each correct response and nothing for an incorrect one. On an item worth several points, the item score is the sum of the correct responses.
A trend item that asks for a set number of responses is scored zero/one. With only one correct answer, as in the example below, there is no partial credit: it is worth 1 point.
Plus/minus (+/-)
NCSBN uses it when you may select an unspecified number of options. You earn a point for each correct option you select and lose a point for each incorrect one. The most you can earn is the number of correct options; the lowest score is zero.
If the trend question lets you select all that apply, the plus/minus rule fits instead.

The example below is a one-answer item, worth 1 point.

Sources: NCLEX.com, Frequently Asked Questions; NCSBN, 2026 NCLEX-RN Test Plan (PDF); NCLEX.com, Prepare (tutorial and sample items). Checked against NCSBN as of October 29, 2026.

Example

A practice item from our own NCLEX-RN practice exams, written to the published test plan. It is not a real NCLEX question. Try it before you open the answer.

Practice item from our practice exam 9, case study step 6 of 6

Sudden Eye Pain and Vomiting in an Older Adult. 71-year-old female, emergency department: Emergency department visit for severe right eye pain, headache, and vomiting that began the previous evening.

Client chart up to this step

Nurses’ notes

Triage note (Day 1, 0110): Arrives with her daughter. Reports severe right-sided eye pain and headache that began at about 2200 while watching television in a dim room, about an hour after taking her nonprescription sleep aid, followed by 2 episodes of vomiting. Rates pain 9/10. Wears glasses for farsightedness. Denies injury to the eye or head. Triage acuity level 2.
ED primary health care provider exam (Day 1, 0140): Intraocular pressure by tonometry: right eye 62 mm Hg, left eye 17 mm Hg. Right anterior chamber shallow. Ophthalmology paged.
Status note (Day 1, 0145): Vomited 100 mL of clear fluid. Rates right eye pain 9/10. Stood to use the bathroom and reached for the wall to steady herself. Asks why her "sleeping pill" would matter.
Ophthalmology phone consult (Day 1, 0150): Ophthalmologist reviewed the findings by phone and will evaluate the client in the ED within the hour. Medication prescriptions to follow.

Vital signs

Vital signs (Day 1, 0110): T 98.2°F (36.8°C), HR 94/min, RR 18/min, BP 172/92 mm Hg, SpO2 97% on room air
Vital signs (Day 1, 0125): HR 96/min, RR 18/min, BP 170/90 mm Hg; pain 9/10
Vital signs (Day 1, 0200): HR 92/min, BP 168/88 mm Hg, RR 18/min; pain 9/10

Laboratory results

Point-of-care glucose (Day 1, 0115): 146 mg/dL
Basic metabolic panel (Day 1, 0135): Sodium 138 mEq/L; potassium 4.2 mEq/L; chloride 102 mEq/L; bicarbonate 24 mEq/L; BUN 18 mg/dL; creatinine 0.9 mg/dL; glucose 152 mg/dL

Medications

Home medication: lisinopril: 20 mg orally once daily
Home medication: metformin: 1,000 mg orally twice daily
Home medication: diphenhydramine (nonprescription sleep aid): 50 mg orally at bedtime, started 4 nights ago on her own for trouble sleeping; last dose about 2100 last night
ED prescriptions: None yet
New prescriptions (Day 1, 0155): Timolol 0.5% ophthalmic solution, 1 drop in the right eye now. Acetazolamide 500 mg IV now. Ondansetron 4 mg IV now. Pilocarpine 2% ophthalmic solution, 1 drop in the right eye when directed by ophthalmology after the pressure begins to fall. Repeat right intraocular pressure every 30 to 60 minutes. Repeat basic metabolic panel at 0400. Discontinue diphenhydramine.

History

Medical history: Hypertension; type 2 diabetes mellitus (hemoglobin A1C 7.1% 3 months ago); farsightedness (hyperopia). No asthma, COPD, or heart block. No previous eye surgery or glaucoma diagnosis. No known drug allergies.
Social history: Lives with her daughter; independent in daily activities; does not drive at night.

The timolol drop, IV acetazolamide, and IV ondansetron were given at 0205. The ophthalmologist examined the client at 0240 and directed the first pilocarpine drop at 0300. Review the serial findings. Which conclusion is best supported by the trend?

Finding	0230	0300	0400
Right intraocular pressure	48 mm Hg	36 mm Hg	24 mm Hg
Pain / nausea	7/10; nausea improved, no further vomiting	5/10; no nausea	2/10; no nausea
Right pupil	About 5 mm, nonreactive	About 5 mm, sluggish; pilocarpine 2% drop given at 0300	About 3 mm, reactive
Right cornea	Hazy	Slightly clearer	Mostly clear
Right-eye vision	Counts fingers at 3 feet	Counts fingers at 6 feet	20/80
Basic metabolic panel	—	—	Potassium 3.7 mEq/L; sodium 137 mEq/L; glucose 168 mg/dL

The attack is responding to medication, but the angle is still narrow, so she still needs a laser iridotomy.
Because the pressure is nearly normal, she can go home without further eye treatment or follow-up.
A potassium of 3.7 mEq/L shows acetazolamide toxicity, so no further doses of the drug should be given.
A pressure still above 21 mm Hg at 0400 shows that medical therapy has failed and emergency surgery is required.

Show the answer and rationale

The attack is responding to medication, but the angle is still narrow, so she still needs a laser iridotomy.

Within 2 hours the pressure falls from 62 to 24 mm Hg, pain and nausea resolve, the pupil constricts and reacts after pilocarpine, the cornea clears, and vision improves. Those are the expected responses to effective pressure-lowering drugs. Medication, however, only breaks the attack; the anatomically narrow angle remains, so laser iridotomy is still required to prevent another closure, and the other eye is usually assessed for preventive treatment. A potassium of 3.7 mEq/L is within normal limits, and a pressure that is falling steadily toward normal is a response, not a failure.

The other formats

Practice the formats

Try NCLEX-style questions in these formats, with a rationale for every answer.

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