Nick Item-Writing Academy
About 40 minutes · Academy module: Trend Workshop.
The NGN trend item presents client data across time — vital-signs tabs, laboratory flowsheets, intake-and-output records — and asks the examinee to interpret the direction of change. The tested skill is analyzing cues over time: is the client improving, deteriorating, or stable, and what does the trajectory demand next? The data must unfold across at least three time points; two points is a comparison, not a trend.
The giveaway trend is a straight line in one direction — every value worsening, every tab screaming the same message. An examinee can answer without reading carefully. Build trends with texture: most values stable, one parameter drifting; an early improvement followed by a late decline; a value that looks alarming in isolation but is stable in context. The examinee should have to read the trend, not just notice its slope.
Include at least one distractor reading of the data — the conclusion a hasty reader draws from the most dramatic single value while missing the overall trajectory. That is the trend-format near-miss.
Every value in the table must be readable at a glance: consistent units, aligned time points, no more data than the decision requires. The uninterpretable table — six tabs, fourteen rows, mixed units — tests working memory, not clinical judgment. Our read: if you need a second read to find the value the item turns on, cut the table in half. The trend should be visible in one careful pass.
Normal values are not free: each normal row is an invitation to chase a wrong branch. Include the values the decision needs and the near-miss values that rule out alternatives — nothing else.
(intended key: B)
Stem: A nurse reviews the client's vital-signs trend:
| Time | 0800 | 1200 | 1600 |
| Blood pressure | 128/78 | 124/76 | 82/54 |
| Heart rate | 88 | 92 | 124 |
| Respiratory rate | 18 | 20 | 28 |
| Temperature | 98.6°F | 99.1°F | 101.4°F |
Which action should the nurse take first?
A. Encourage oral fluids and recheck vital signs in 4 hours B. Notify the provider of the client's deteriorating condition C. Administer the prescribed antipyretic D. Document the findings and continue to monitor
single-point decision — the trend is decorative.
Only the 1600 column matters; the 0800 and 1200 columns could be deleted without changing the answer. A trend item whose data collapses to one time point is a traditional item wearing a table costume — and an expensive one, since the examinee paid reading time for nothing. The rewrite makes the trajectory the decision: the client's pressure is falling across all three points while the provider has already been notified once, so the tested judgment is recognizing a trend that demands escalation, not a single bad value.
— cold-solve verified: 2/2 (solvers chose B, B)
Stem: A nurse reviews the client's vital-signs trend:
| Time | 0800 | 1200 | 1600 |
| Blood pressure | 118/74 | 102/66 | 88/58 |
| Heart rate | 92 | 104 | 118 |
| Respiratory rate | 18 | 22 | 26 |
| Temperature | 99.0°F | 100.2°F | 101.6°F |
The provider was notified at 1200 and prescribed an antipyretic and a fluid bolus, both administered. Which action should the nurse take now?
A. Continue the current plan and recheck vital signs in 4 hours B. Notify the provider that the client is not responding to treatment C. Administer another dose of the prescribed antipyretic D. Encourage oral fluids and continue to monitor
Key: B
Every parameter is worsening despite the 1200 interventions — the trend, not any single value, is the finding. Continuing the plan (A) or repeating the antipyretic (C) ignores the trajectory; the correct judgment is escalation. Both independent cold solvers selected B and named no other defensible option.
Recording it adds the module to your Academy completion record on this device — module, track, level, and date, ready to download from your account page for faculty-development documentation.