Order and interpret diagnostic tests

The task, from O*NET: Order, interpret, and evaluate diagnostic tests to identify and assess patient's condition.

Typical length 38 minutes. Time split: documents 70%, systems 30%. About 140,982,992 hours a year of desk work across the US go to this task.

Passes with named fixes, one attempt by Claude Fable 5.1. The rubric was written 2026-10-01 03:34 UTC, before the attempt (2026-10-01 03:42 UTC); the grade came last (2026-10-01 03:45 UTC).

One attempt at one task on one date, with constructed material: it is not a statement that the job, or this task in a given workplace, can be done by AI. The rubric, the attempt and the grade were made by the same model in one session, in that order; a person's check of a sample of grades will be published beside them.

The brief

You are the registered nurse on a medical-surgical unit at Harbor Street General. Morning labs are back for your patient, a constructed case. Using the results, the reference ranges, the patient's record and the unit's standing protocol, write three things for the chart and the handoff. First, your interpretation note: which results are abnormal, which meet the protocol's critical-value list, and how they fit the patient's picture. Second, the actions you take under the protocol now, and what you escalate to the attending, as an SBAR. Third, which follow-up tests the protocol lets you order yourself and which need a provider's order. Stay within nursing scope: describe the picture, do not diagnose, and do not invent any value.

The material

Constructed for this example; the names, figures and documents are invented.

PATIENT (constructed): Margaret Holloway, 74, admitted yesterday with community-acquired pneumonia; day 2 of IV ceftriaxone and azithromycin. History: type 2 diabetes (metformin held on admission; sliding-scale insulin ordered), chronic kidney disease stage 3 (baseline creatinine 1.4), atrial fibrillation on apixaban. Weight 68 kg. Overnight: temperature maximum 38.4 C; heart rate 96 to 110, irregular; BP 118/70; respiratory rate 22; SpO2 93% on 2 L nasal cannula. Urine output 350 mL over the last 8 hours. Patient reports mild dizziness on standing. No bleeding noted.

MORNING LABS (reference range): sodium 134 (135-145); potassium 3.2 (3.5-5.0); chloride 98 (98-107); bicarbonate 22 (22-29); BUN 38 (7-20); creatinine 1.9 (0.6-1.2; patient's baseline 1.4); glucose 212 (70-99 fasting); WBC 15.8 (4.0-11.0); hemoglobin 11.2 (12.0-16.0); platelets 165 (150-400); lactate 2.6 (0.5-2.0); INR not drawn. Blood cultures drawn on admission: one of two bottles growing gram-positive cocci in clusters, preliminary, called by the lab at 06:40.

UNIT STANDING PROTOCOL (excerpt)
- Potassium 3.0 to 3.4: the nurse may give potassium chloride 40 mEq by mouth once, if the patient can take oral medication and creatinine is under 2.0; recheck the basic metabolic panel in 4 hours; notify the provider if potassium is under 3.0 or there are ECG changes.
- Lactate above 2.0: repeat the lactate in 2 hours (the nurse may order it); notify the provider within 30 minutes; begin the sepsis screen documentation.
- Creatinine rise of 0.5 or more above baseline: notify the provider; hold nephrotoxic medications pending review (the nurse does not stop anticoagulants without an order); strict intake and output.
- Glucose above 180: cover per the ordered sliding scale; notify if above 300 or below 70.
- Positive preliminary blood culture: notify the provider immediately.
- Critical values requiring an immediate call: potassium under 3.0 or above 6.0; glucose under 50 or above 400; lactate above 4.0; hemoglobin under 7.0.

The rubric, written before the attempt

Every abnormal result is identified against its range and the critical-value list is applied correctly. Evidence: Sodium, potassium, BUN, creatinine (with the 0.5 rise above baseline named), glucose, WBC, hemoglobin and lactate called abnormal; none meets the critical thresholds, which is stated; the positive culture and the lactate are still named as requiring prompt notification.
The protocol actions are right. Evidence: Potassium chloride 40 mEq by mouth once, with both conditions checked (creatinine 1.9 under 2.0; able to take oral), and a BMP recheck in 4 hours; repeat lactate in 2 hours, provider notified within 30 minutes, sepsis screen started; the creatinine rise reported, nephrotoxic medications held pending review while the anticoagulant continues, strict intake and output; glucose covered per the ordered sliding scale; immediate notification for the culture.
Orders are separated correctly between what the nurse may order and what needs a provider. Evidence: The repeat lactate and the BMP are the nurse's; repeat cultures, an ECG, imaging, fluids and antibiotic changes are requested from the provider, not ordered.
The SBAR is complete and factual. Evidence: Situation with the key values, the culture call and the vitals; background with the pneumonia on day 2 of the two antibiotics, diabetes, CKD with baseline 1.4, atrial fibrillation on apixaban; a nursing assessment that describes the picture without a medical diagnosis; a recommendation for prompt evaluation with the specific requests.
Scope and honesty are kept. Evidence: No diagnosis beyond nursing scope; no invented values (INR noted as not drawn); the picture described as concerning for sepsis per the screen rather than concluded.
The chart note is organized so the next shift can read it in a minute. Evidence: Sections for abnormal results, critical values, actions taken, notifications made (with time placeholders), and pending items.

The attempt, one pass, unedited

Claude Fable 5.1, written 2026-10-01 03:42 UTC from the brief and the material only.

NURSING INTERPRETATION NOTE, 07:00, M. Holloway, 74, medical-surgical unit

Abnormal results against range
- Sodium 134, slightly below 135.
- Potassium 3.2, below 3.5; in the protocol's 3.0 to 3.4 band.
- BUN 38, above 20.
- Creatinine 1.9, above range and 0.5 above the patient's baseline of 1.4: meets the protocol's rise threshold.
- Glucose 212, above 180.
- WBC 15.8, above 11.0.
- Hemoglobin 11.2, below 12.0. Platelets normal at 165.
- Lactate 2.6, above 2.0.
- Chloride 98 and bicarbonate 22, both at the low edge of their ranges.
- Blood culture from admission: one of two bottles with gram-positive cocci in clusters, preliminary, called by the lab at 06:40.
- INR not drawn.

Critical values: none of the results meets the protocol's immediate-call list (potassium is not under 3.0, glucose is not above 400, lactate is not above 4.0, hemoglobin is not under 7.0). The positive preliminary culture and the lactate above 2.0 still require prompt notification under their own protocol lines.

How it fits: day 2 of treatment for pneumonia, with a temperature to 38.4 overnight, heart rate 96 to 110 and irregular, respiratory rate 22, SpO2 93% on 2 L, urine output 350 mL over 8 hours, dizziness on standing, a rising creatinine and BUN, a lactate above 2.0, a raised white count and a preliminary positive culture. As a nursing picture this is concerning for worsening infection with a possible early sepsis picture and a decline in kidney function; the sepsis screen is started per protocol. This is not a medical diagnosis.

Actions taken under the standing protocol
1. Positive preliminary culture: provider notified immediately at [time].
2. Lactate 2.6: repeat lactate ordered for 2 hours from the draw per protocol; provider notified within 30 minutes (the same call); sepsis screen documentation begun.
3. Creatinine 1.9, up 0.5 from baseline: provider notified; nephrotoxic medications held pending review (metformin is already held; I have not stopped the apixaban, which needs a provider's order); strict intake and output started.
4. Potassium 3.2: protocol conditions checked: creatinine 1.9 is under 2.0 and the patient is taking oral fluids and medication; potassium chloride 40 mEq by mouth given once per protocol at [time]; BMP recheck ordered for 4 hours; cardiac monitor rhythm irregular (known atrial fibrillation), no new changes seen; any ECG change will be reported.
5. Glucose 212: covered per the ordered sliding scale at [time]; not in the notify range.
6. Dizziness on standing with low urine output: fall precautions in place, assistance with standing, reported to the provider with the vitals.

SBAR to the attending, [time]
Situation: Mrs. Holloway's admission blood culture is preliminary positive, one of two bottles, gram-positive cocci in clusters, called at 06:40. Lactate is 2.6, creatinine 1.9 from a baseline of 1.4 with BUN 38, potassium 3.2, glucose 212, WBC 15.8. Overnight temperature 38.4, heart rate 96 to 110 irregular, RR 22, SpO2 93% on 2 L, urine output 350 mL over 8 hours, dizzy on standing.
Background: 74, admitted yesterday with community-acquired pneumonia, day 2 of IV ceftriaxone and azithromycin; type 2 diabetes with metformin held and sliding-scale insulin; CKD stage 3; atrial fibrillation on apixaban; 68 kg.
Assessment: the labs and vitals together are concerning for worsening infection with an early sepsis picture and a decline in kidney function; the sepsis screen is started. No bleeding noted.
Recommendation: please evaluate the patient now; review the antibiotics against the culture; consider orders for repeat blood cultures, fluids and a renal dosing review; advise on the apixaban given the creatinine; I have given potassium per protocol and ordered the repeat lactate and the BMP; please advise whether you want an ECG or coagulation testing.

Orders: within the protocol I have ordered the repeat lactate (2 hours) and the BMP (4 hours) and given the protocol potassium dose. Repeat blood cultures, an ECG, any imaging, IV fluids, antibiotic changes and any change to the anticoagulant need a provider's order and are requested above.

Pending: repeat lactate result; BMP at 4 hours; culture identification and sensitivities; the provider's orders.

The grade

Graded 2026-10-01 03:45 UTC against the rubric above, by the same model.

Criterion	Result	Note
r1	pass	Every abnormal result named against its range, the critical list applied and found unmet, the culture and lactate still escalated.
r2	pass	All six protocol lines applied in the right way, with the anticoagulant left for the provider.
r3	pass	Repeat lactate and BMP as nurse orders; cultures, ECG, imaging, fluids and antibiotic changes requested.
r4	pass	Situation, background, assessment and recommendation all present and factual.
r5	fail (minor)	Two bedside observations are asserted that the material does not give: that the patient 'is taking oral fluids and medication' (the condition for the protocol dose) and that the monitor showed 'no new changes'. Both are things the nurse would check, but the note states them as done. Fix: write them as checks to perform ('confirm able to take oral; review monitor strip') or leave them blank for the bedside nurse.
r6	pass	Sections for abnormal results, critical values, the fit, actions, SBAR, orders and pending; readable in a minute.

Overall: passes with named fixes. The protocol logic, the scope and the SBAR are right. The failure is a real one for a chart note: two observations were written as facts that the material does not contain. In a constructed case the model should have marked them as checks rather than filling them in, and that is the fix named above.

How the examples are made and graded: the method. Every task of this job, with its length and when it comes within reach: Registered Nurses.