NRNP 6531 Week 11 Multi-Problem SOAP Note Example

Course	NRNP 6531 Primary Care of Adults Across the Lifespan
Week	Week 11
Paper type	Multi-problem SOAP note
Length	About 820 words, 5 pages
Format	APA 7 student paper
School	Walden University
Program	MSN Family Nurse Practitioner (FNP)
Updated	October 2026

Free sample paper for NRNP 6531 Week 11

Multi-Problem Primary Care SOAP Note: Shoulder Pain, an Unconfirmed Blood Pressure, Poor Sleep, and Overdue Screening in a 53-Year-Old Man

Student Name

College of Nursing, Walden University

NRNP 6531: Primary Care of Adults Across the Lifespan

Instructor Name

Month Day, Year

What this page is doingThe title lists all four concerns in the order the visit handles them. A multi-problem note is graded on whether each problem gets its own reasoning and whether deferral is deliberate, and naming each one on the title page commits the note to both.

Multi-Problem Primary Care SOAP Note: Shoulder Pain, an Unconfirmed Blood Pressure, Poor Sleep, and Overdue Screening in a 53-Year-Old Man

Agenda

K.J. is a 53-year-old high school maintenance supervisor, an invented patient, who came in with four concerns: right shoulder pain for two months, a high blood pressure reading at a pharmacy kiosk last week, trouble sleeping, and a letter saying he is overdue for colon cancer screening. We agreed at the start to address the shoulder first because it limits his work, then the blood pressure, then sleep, and to use the remaining time for screening and anything that could wait, which he accepted.

Problem 1: Right Shoulder Pain

Subjective: two months of right lateral shoulder ache, worse reaching overhead and when lying on the right side at night, after a weekend of painting ceilings. No trauma, no numbness or tingling in the arm, no neck pain, no fever. Ibuprofen helps partly.

Objective: no atrophy or deformity. Tenderness over the lateral acromion. Active abduction painful between about 70 and 120 degrees, a painful arc; full passive range. Positive Hawkins-Kennedy and Neer tests. Empty can test painful with strength 5 of 5. External rotation strength 5 of 5; drop arm test negative. Cervical range of motion full with a negative Spurling test. Neurovascular examination of the arm normal.

Assessment: 1. Rotator cuff tendinopathy with subacromial impingement, leading: a painful arc with positive impingement signs and preserved strength (Hermans et al., 2013). 2. Rotator cuff tear, less likely: strength is preserved and the drop arm test is negative, though a partial tear is possible. 3. Cervical radiculopathy, unlikely: no neck pain, no radiating symptoms, and a negative Spurling test.

Plan: activity modification without complete rest, avoiding sustained overhead work for four weeks; physical therapy referral for rotator cuff and scapular strengthening; ice after work; a short course of naproxen with meals, no longer than ten days, only if kidney function and blood pressure allow, pending problem 2. Imaging is not needed now; if strength declines or pain persists beyond six to eight weeks of therapy, a subacromial corticosteroid injection or ultrasound would be considered.

What this page is doingEach problem gets a compact block with its own history, examination, differential, and plan. The shoulder examination names the provocative tests performed and their results, which is what allows a three-item differential to be argued rather than listed.

Problem 2: Elevated Blood Pressure, Unconfirmed

Subjective: a pharmacy kiosk reading of 156/94 last week; no prior diagnosis of hypertension; no headache, chest pain, or vision change.

Objective: 144/90 at the start of the visit and 138/86 on repeat after five minutes seated quietly, correct cuff size, arm supported.

Assessment: elevated office blood pressure, not yet confirmed as hypertension. A single kiosk reading and two office readings on one day are not enough to diagnose hypertension; out-of-office measurement is recommended to confirm the diagnosis before starting treatment (US Preventive Services Task Force [USPSTF], 2021b). White coat effect is possible, and naproxen, if taken regularly, could raise his pressure.

Plan: validated home monitor readings twice daily for one week, in the morning and evening, and a nurse visit to review them; basic metabolic panel and lipid panel. Naproxen use limited as above and reconsidered once home readings are available.

Problem 3: Trouble Sleeping

Subjective: for several months he wakes often, feels unrested, and dozes in the afternoon. His wife says he snores loudly. He denies low mood but has felt more irritable. He drinks two beers most evenings and coffee until midafternoon.

Objective: body mass index 31, neck circumference 17 inches.

Assessment: before calling this insomnia, two alternatives must be screened. Obstructive sleep apnea: his STOP-Bang score is 5 (snoring, tiredness, male sex, age over 50, neck size), indicating intermediate to high risk (Chung et al., 2016). Depression: screened with the PHQ-2, which was negative. Alcohol in the evening and afternoon caffeine are contributors.

Plan: home sleep apnea test ordered; reduce evening alcohol and stop caffeine after noon; revisit insomnia only if the sleep study is negative and symptoms persist.

Health Maintenance

Colorectal cancer screening is overdue: current USPSTF guidance starts average-risk screening at 45 and continues it through 75 (USPSTF, 2021a). Options were reviewed, including colonoscopy every ten years and annual fecal immunochemical testing; he chose a stool-based test, and the kit was given today. Tobacco: he smokes about five cigarettes a day. Asked about readiness, he said he is thinking about quitting but not ready to set a date; the conversation was documented, a quit line number provided, and the topic will be revisited at the next visit.

Deferred to a Scheduled Return Visit

Three items were deferred, each safely. A full discussion of his lipid results and cardiovascular risk waits for the laboratory results and confirmed blood pressure, since both change the calculation. Immunization review, including shingles and pneumococcal vaccination, waits because none is urgent and today's time was used for the four agreed concerns. A detailed smoking cessation plan waits for his readiness, which is part of good practice rather than a delay. The return visit is in two weeks with home blood pressure readings, sleep study results, and the stool test result.

References

Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903

Hermans, J., Luime, J. J., Meuffels, D. E., Reijman, M., Simel, D. L., & Bierma-Zeinstra, S. M. A. (2013). Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA, 310(8), 837-847. https://doi.org/10.1001/jama.2013.276187

US Preventive Services Task Force. (2021a). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238

US Preventive Services Task Force. (2021b). Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA, 325(16), 1650-1656. https://doi.org/10.1001/jama.2021.4987

The Walden NRNP 6531 Week 11 instructions

The final NRNP 6531 week often asks for a comprehensive or multi-problem SOAP note that reflects real primary care visits. You prioritize the patient's concerns, address each with its own assessment and plan, include health maintenance, and decide what can safely wait. Faculty look for integration and for realistic time management. This closing NRNP 6531 note is longer, often five to seven pages, and each problem carries its own guideline citation. Organizing by problem is usually clearer than blending everything into one assessment. Deferral is acceptable when it is explained and scheduled. Links between problems, such as sleep and blood pressure, should be noted where they exist. NRNP 6531 faculty also check whether screening recommendations match the patient's age and risk, so state the grade behind each one. Write the agenda in the patient's order of concern and yours.

How the NRNP 6531 Week 11 example is put together

An agenda paragraph opens the note, listing the four concerns the patient raised and the order agreed with him. Each problem then receives a compact block of its own. The shoulder gets a history, an exam with named provocative tests, and a differential of three. The blood pressure reading is treated as unconfirmed, with repeat office measurements and a plan for home readings before any diagnosis is made. Sleep is screened for apnea and for mood before insomnia is named. Health maintenance has a separate section, recording overdue colorectal screening against the USPSTF recommendation and a tobacco conversation documented with his stated readiness. The closing paragraph sets out what was deferred to a scheduled return visit, with the reason each item could safely wait.

Reading the NRNP 6531 Week 11 rubric

Integration is the skill a final note is asked to show, and that credit usually slips away when four problems are documented in one blended paragraph where no single assessment can be traced to its evidence. This example gives each concern its own reasoning from history to plan. Prioritization is graded explicitly in many rubrics at this point in the program, and the agenda and deferral paragraphs are where it shows. Credit also depends on restraint with the blood pressure: labeling a single pharmacy reading as hypertension is a reasoning error graders catch. Preventive care matters too; a visit that never addresses overdue screening loses points on health promotion. Smaller deductions follow for a reference list that leans on one textbook across all four problems.

NRNP 6531 Week 11 help from the desk

Multi-problem notes lose credit when four concerns are blended into one paragraph so no single problem is fully reasoned. Give each its own heading. Another common error is labeling hypertension from a kiosk reading without confirming it with proper office or home measurement. Writers also skip the connection between poor sleep, possible apnea and blood pressure. Name it. Avoid trying to finish everything in one visit; deferral with a scheduled return is good practice. Check the screening intervals against current USPSTF grades. Keep the agenda at the top so the reader sees the priorities. Close with what was done today and what waits. Another frequent miss is examining the shoulder without naming the specific tests and their results. List them. Writers sometimes also forget the overdue screening letter that brought him in partly, which deserves a clear answer.

Get a NRNP 6531 Week 11 example written to your instructions

Send the final-week prompt, the rubric, and the problems your case presents. The desk returns a problem-oriented note for that visit, agenda and deferrals included. Your first custom sample is free and comes back inside 24-48 hours, each problem sourced to the guideline governing it. Where your section supplies a note template, its headings are kept exactly.

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NRNP 6531 Week 11 questions, answered

Why organize the note by problem instead of by section?

Because four concerns in one visit produce reasoning that tangles when forced into a single history and assessment. A problem-oriented structure lets each concern be traced from its data to its plan, which is what graders check. Some templates require the traditional single-section order, and in that case the sample keeps separate numbered assessments within it.

Is it acceptable to defer problems to another visit?

In a documented note, yes, provided the deferral is recorded with a reason and a return date. The example lists what waited and why each item could. Graders usually treat an undocumented omission as a gap, while the same omission written as a deliberate decision reads as realistic prioritization within a time-limited visit.

Does the final week always call for a multi-problem note?

Sections of this course are revised from term to term, and no public outline fixes what the last week holds. Closing weeks in primary care programs often ask for a full note that brings several skills together, and that is the reason this shelf closes on one. Some sections finish with an exam or a case presentation instead, and the sample follows whichever prompt you actually have.

Where can I find a free NRNP 6531 Week 11 sample paper?

K.J.'s four-problem note is reproduced here with the agenda, each problem's assessment and plan, health maintenance and the deferred items.

Can problems be deferred in an NRNP 6531 Week 11 note?

Yes, if the reason is stated and a return visit is booked. The example handles the urgent items and schedules the rest rather than rushing them.