NGN Trend Questions: Patient Trajectory Assessment

1. A patient's hemoglobin has decreased from 11.8 to 10.5 to 9.2 g/dL over 48 hours. What trend interpretation is most clinically significant?

Mild anemia; no intervention needed

Ongoing blood loss or bone marrow suppression; notify provider and monitor for symptoms

Normal post-transfusion level

Expected laboratory variation

2. A patient's lower extremity has progressed from normal color to pale to cyanotic over 2 hours, with decreased warmth and absent pedal pulse. What is the priority action?

Massage the limb to improve circulation

Elevate limb above heart level

Notify provider immediately; this may indicate arterial occlusion or compartment syndrome

Apply warm compress

3. A patient's mental status has changed from baseline: oriented to person/place/time, then confused about place, then confused about person and place over 4 hours. What is the most important next step?

Assume dementia is progressing

Conduct rapid assessment for delirium causes: infection, hypoxia, medication, metabolic abnormality

Sedate patient for safety

Wait for provider rounds in morning

4. A patient's INR has risen from 1.8 to 2.3 to 3.1 over 48 hours while on warfarin. What action is most appropriate?

Increase warfarin dose to reach goal faster

Notify provider immediately; assess for bleeding; adjust anticoagulation per protocol

Discontinue warfarin without provider order

No intervention needed; INR will stabilize

5. A patient's platelet count has declined from 180 to 140 to 95 K/µL over 72 hours. What is the nurse's priority concern?

Patient will develop spontaneous bleeding immediately

Assess for bleeding signs; monitor trend; notify provider; avoid invasive procedures if possible

Continue routine care without modification

Administer platelets preemptively

6. A patient's skin turgor has progressed from normal to slightly slow to markedly slow over 24 hours. What does this trend suggest?

Improved hydration status

Dehydration is worsening; assess fluid intake, output, and vital signs; increase fluids as appropriate

Skin aging only

No clinical concern

7. A post-operative patient's wound has changed from pink, dry, and healing to red, edematous, with purulent drainage over 3 days. What is the most appropriate nursing response?

This is normal post-operative healing

Notify provider; assess for wound infection; obtain culture if ordered

Increase dressing changes to every 2 hours

Reassure patient and monitor only

8. A patient's white blood cell count has increased from 7.2 to 9.5 to 12.1 K/µL over 48 hours. What does this trend most likely indicate?

Immune system is functioning normally

Infection, inflammation, or stress response is present; assess for source and signs of infection

Patient is overhydrated

Leukemia is developing

9. A patient's creatinine has risen from 0.9 to 1.2 to 1.6 mg/dL over 24 hours. What is the priority nursing action?

Continue normal fluid intake

Notify provider; assess urine output, fluid status, and medication nephrotoxicity

Increase IV fluids aggressively

Restrict all fluid intake

10. A patient's albumin has declined from 3.8 to 3.5 to 3.1 g/dL over 1 week. What nursing implication does this trend suggest?

Improved nutritional status

Possible malnutrition, liver disease, or nephrotic syndrome; assess intake and collaborate on nutritional support

Acute infection resolving

No clinical significance

11. A patient's blood pressure has declined from 138/88 to 128/82 to 118/76 over 3 hours. What does this trend suggest?

Hypertensive crisis developing

Gradual hemodynamic improvement or medication effect

Acute sepsis onset

Hypervolemia resolution

12. A patient's pain score has increased from 3/10 to 5/10 to 7/10 over 2 hours despite analgesia. What should the nurse do?

Document trend and reassess cause; consider new pain source or intervention adjustment

Assume medication is not working and give maximum dose

Tell patient pain escalation is expected

Wait until next scheduled medication time

13. A patient's potassium level has declined from 4.2 to 3.8 to 3.4 mEq/L over 24 hours. What is the nurse's most appropriate response?

Continue monitoring; level is still in normal range

Notify provider; assess for dysrhythmias and muscle weakness; consider supplementation

Administer potassium-sparing diuretics

Restrict dietary potassium intake

14. A patient's respiratory rate has increased from 16 to 20 to 24 breaths/min over 3 hours. What trend pattern suggests a problem?

Gradual, sustained increase may indicate pain, anxiety, or respiratory compromise

All tachypnea is normal post-operatively

Single elevated reading indicates crisis

Respiratory rate changes are never clinically significant

15. A patient's level of consciousness has declined from alert to lethargic to drowsy over 2 hours. What is the priority assessment?

Check blood glucose, oxygen saturation, and vital signs immediately

Allow rest; lethargy is normal

Administer stimulants

Document and monitor every 4 hours

16. A patient's serum glucose has risen from 110 to 145 to 178 mg/dL over 8 hours. What action should the nurse take?

Administer insulin per protocol and reassess trending

Wait for provider order before intervention

Increase oral fluid intake

Assume stress hyperglycemia will resolve spontaneously

17. A patient's urine output has decreased from 60 mL/hr to 45 mL/hr to 25 mL/hr over 6 hours. What is the most likely concern?

Patient is well-hydrated

Renal perfusion may be compromised; assess fluid status and vital signs

Urinary retention is developing

Diuretic therapy is working effectively

18. A patient's heart rate has gradually increased from 78 to 92 to 104 bpm over 4 hours. Which trend interpretation is most concerning?

Normal response to activity or anxiety

Possible compensatory response to pain, hypovolemia, or infection

Inevitable age-related change

Expected post-operative tachycardia

19. A patient's oxygen saturation has dropped from 96% to 93% to 89% over 2 hours despite supplemental oxygen. What is the priority nursing action?

Document the trend and reassess in 1 hour

Notify the provider immediately and assess airway, breathing, circulation

Increase oxygen flow rate only

Reposition patient and recheck saturation

20. A patient's temperature has risen from 37.2°C to 37.8°C to 38.4°C over 6 hours. What action is most important?

Continue monitoring; fever is expected

Investigate source of infection; consider cultures and interventions

Administer antipyretics only

Notify provider only if temperature exceeds 40°C

NGN Trend Quiz: Can You Read the Patient's Trajectory?