🎯 Next Gen Item Types · Lesson 4 of 5 · 6 min
Highlight Items and Reading a Trend Over Time
🖍️ 'Highlight the findings that require follow-up.' The nurse's note is two paragraphs long. Some sentences are bait. The trick is to read every sentence as a lab value with a normal range.
💡 Key idea
Highlight only what is abnormal for this client at this moment. In trend tables, direction beats the single number; a 'normal' value reached by a steep change is the finding.
🧠 Why it matters
HIGHLIGHT items present text (a nurse's note, a history, a table) and ask you to select the words or sentences that answer a question, most often the findings that are ABNORMAL, concerning or require follow-up. Read each sentence and ask whether it is expected for this client's age, condition and stage of care; expected findings are the bait, and highlighting them costs points under plus/minus scoring. Highlight the phrase that carries the abnormality, not the whole paragraph. TREND items, which can use any of the response formats, show vital signs or labs at several times and ask which trend is most concerning: compare each value to its earlier values, not only to the normal range. A blood pressure of 110/70 is normal, but a fall from 150/90 to 110/70 in an hour in a post-op client is bleeding until proven otherwise; a heart rate climbing from 70 to 98 is compensation even though 98 is still 'normal'. Look for pairs that move in opposite directions, such as a rising heart rate with a falling blood pressure or a rising temperature with a falling white count, and for a value that was improving and has reversed. Case studies unfold, updating the record from screen to screen, so recognizing cues often depends on direction, not snapshots.
🏥 In the real world
📊 A trend table: 0800 HR 78, BP 132/80; 1000 HR 96, BP 118/74; 1200 HR 118, BP 98/60. Every 1000 value is inside the normal range. A candidate reading snapshots sees nothing until noon. A candidate reading direction sees compensation at 1000 and acts two hours earlier. The exam rewards the second candidate because real units do too.
📌 Takeaways
- Expected findings are bait; highlight the abnormality
- Compare each value to its own earlier values
- Opposite movements (HR up, BP down) and reversals are the concerning trends
✅ Test yourself
A highlight item asks for findings that require follow-up in a client 1 day after abdominal surgery. Which phrase should the candidate NOT highlight?
- 'Absent bowel sounds with abdominal distention'
- 'Oxygen saturation 90% on room air'
- 'Incisional pain 3/10 after medication'
- 'Temperature 38.9 °C'
Answer: C · 'Incisional pain 3/10 after medication'
Controlled incisional pain is an expected post-operative finding; the others are abnormal and need follow-up.
A trend table shows a post-operative client's heart rate rising from 72 to 98 over three hours while blood pressure falls from 128/82 to 108/68. All values are within normal limits. How should the candidate interpret this?
- An expected response to pain medication
- No concern, because every value is within normal limits
- Improvement in the client's condition
- A concerning trend suggesting early hypovolemia
Answer: D · A concerning trend suggesting early hypovolemia
Opposite movement of heart rate and blood pressure signals compensation for volume loss or bleeding; the direction matters more than the normal ranges.
Under plus/minus scoring on a highlight item, what is the consequence of highlighting an expected, normal finding?
- The candidate must restart
- No effect on the score
- A point is subtracted
- The item is automatically correct
Answer: C · A point is subtracted
Incorrect highlights subtract points, so selectivity matters.
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