| Course | NURS 6512 Advanced Health Assessment and Diagnostic Reasoning |
|---|---|
| Week | Week 11 |
| Paper type | Comprehensive history and physical |
| Length | About 1,800 words, 9 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NURS 6512 Week 11
Comprehensive History and Physical Examination of a 46-Year-Old Man at a Routine Visit, With Differentials for an Elevated Blood Pressure and a Thyroid Nodule
Student Name
College of Nursing, Walden University
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Instructor Name
Month Day, Year
Comprehensive History and Physical Examination of a 46-Year-Old Man at a Routine Visit, With Differentials for an Elevated Blood Pressure and a Thyroid Nodule
Identifying Data and Reason for Visit
B.W., a 46-year-old man who works as a regional sales manager, exists only on this page; every detail was composed for teaching. He is the source of the history and is judged reliable. He requests a routine physical examination because his employer's insurance now offers one without cost and because he has not seen a clinician in five years. He has no specific complaint today.
History
Present health status
He describes his health as good. He notices that he tires by mid-afternoon on days when he drives between client offices and attributes this to sleeping about six hours a night. He has gained roughly 15 lb over five years, which he connects to eating in the car and stopping regular exercise when he changed jobs.
Past medical and surgical history
Childhood illnesses include varicella. He has no chronic illnesses and has never been hospitalized. Surgical history is limited to an arthroscopic repair of a torn right meniscus at age 31. He recalls being told his blood pressure was "a little high" at an urgent care visit two years ago for a sprained wrist, with no follow-up. He has had no blood transfusions and no radiation exposure to the head or neck.
Medications, supplements, and allergies
He takes ibuprofen 400 to 600 mg two or three times a week for low back stiffness after long drives, and a daily multivitamin. He uses a decongestant nasal spray intermittently for seasonal allergies in spring. He has no known drug, food, or environmental allergies.
Family history
His father, 74, has hypertension and had a myocardial infarction at 61. His mother, 72, has hypothyroidism and osteoarthritis. A maternal aunt was treated for thyroid cancer in her fifties; he does not know the type. His paternal grandfather died of colon cancer at 78. His younger sister, 42, has no known illness. His two children, 14 and 11, are well. There is no family history of diabetes, sudden death, or endocrine tumors other than the aunt's thyroid cancer.
Social history
He is married, lives with his wife and children in a suburban house, and drives about 600 miles a week for work. He completed a bachelor's degree in business. He smoked about half a pack of cigarettes a day from age 18 to 25 and has not smoked since. He drinks two or three beers on most weekend evenings and rarely during the week, giving about eight drinks a week. He has not used recreational drugs. He drinks three large coffees a day. He does not exercise regularly. He wears a seatbelt, does not text while driving, and keeps no firearms at home. Asked about sexual health in the same matter-of-fact tone as the other questions, he reports one female partner, his wife, for 19 years, with no history of sexually transmitted infections and no concerns about sexual function. He feels safe at home.
Review of systems
General: afternoon fatigue as above; no fever, night sweats, or unintended weight loss. Skin: no new or changing moles, rashes, or itching. Head, eyes, ears, nose, throat: no headaches, vision change, hearing loss, or sinus problems outside spring allergies. Neck: no neck swelling that he has noticed, no difficulty swallowing, no hoarseness, and no pain in the front of the neck. Respiratory: no cough, wheeze, or breathlessness. Cardiovascular: no chest pain, palpitations, exertional breathlessness, orthopnea, or leg swelling. Gastrointestinal: good appetite, no heartburn, abdominal pain, change in bowel habit, or blood in the stool. Genitourinary: no dysuria, hesitancy, or nocturia. Musculoskeletal: low back stiffness after driving without radiation, numbness, or weakness. Neurological: no weakness, numbness, dizziness, or fainting. Psychiatric: mood good, no anxiety or low mood beyond ordinary work stress, and a negative response to both depression screening questions. Endocrine: no heat or cold intolerance, tremor, excessive thirst, or excessive urination. Hematologic: no easy bruising or bleeding.
Physical Examination
General survey: a well-groomed man who appears his stated age, alert and in no distress. Vital signs: blood pressure 148/94 in the right arm and 146/92 in the left, seated after five minutes of rest with an appropriately sized cuff, repeated at 144/92 after a further two minutes; heart rate 78 and regular; respirations 14; temperature 98.1 F; oxygen saturation 98 percent. Height 70 in, weight 214 lb, body mass index 30.7, waist circumference 41 in.
Skin: warm and dry, with no rashes. Scattered benign-appearing nevi on the trunk, all under 5 mm, uniform in color and border. No xanthelasma. Head: normocephalic and atraumatic. Eyes: visual acuity 20/20 in each eye; conjunctivae clear; pupils equal and reactive; fundi with sharp disc margins and no arteriovenous nicking, hemorrhages, or exudates. Ears: canals clear and tympanic membranes intact with normal landmarks; whispered voice heard bilaterally. Nose: mucosa pink with mild turbinate edema. Mouth and throat: good dentition, moist mucosa, no lesions.
Neck: supple, trachea midline. On palpation from behind with the patient swallowing, a firm, nontender, slightly irregular nodule roughly 2 cm across sits at the upper pole of the left lobe; it rises with each swallow and the skin over it moves freely. The right lobe and isthmus are not enlarged. No thyroid bruit. Lymph nodes: no cervical, supraclavicular, axillary, or inguinal lymphadenopathy.
Chest and lungs, examined in the sequence of inspection, palpation, percussion, and auscultation (Bickley et al., 2021): symmetric expansion; resonant to percussion; vesicular breath sounds without crackles or wheeze. Heart: apical impulse not displaced, felt at the fifth interspace in the midclavicular line; regular rhythm; normal S1 and S2 without S3, S4, murmur, or rub. Peripheral vascular: pulses 2+ and equal side to side at every site checked, from the radial and femoral arteries down to both arteries of the foot; no carotid, abdominal, or femoral bruits; no radiofemoral delay; no edema.
Abdomen: rounded, with central adiposity; bowel sounds normal; no bruits; tympanic to percussion with a liver span of 10 cm at the midclavicular line; soft and nontender without masses or organomegaly. Genitourinary: offered and deferred at the patient's request, with the reason recorded. Musculoskeletal: full range of motion in all joints; mild paraspinal tightness in the lumbar region without tenderness over the spine; straight leg raise negative bilaterally. Neurological: alert and oriented; cranial nerves II through XII intact; strength 5 of 5 throughout; sensation intact to light touch and vibration; reflexes 2+ and symmetric; plantar responses flexor; normal gait and Romberg.
Synthesis of Findings
Most of the examination is normal and is not repeated here. Four abnormal findings are carried forward: an elevated blood pressure on repeated measurement, a left thyroid nodule, a body mass index in the obese range with central adiposity, and daytime fatigue with short sleep. The first two receive their own differentials; the others are addressed in the problem list.
Differentials for the Abnormal Findings
Elevated blood pressure. Primary hypertension is the most likely explanation, supported by his age, a father with hypertension and early myocardial infarction, obesity, alcohol intake, and a prior elevated reading two years ago. Office readings alone cannot confirm the diagnosis, however. White coat hypertension is possible, since he is in an unfamiliar setting after five years away from clinicians, and the USPSTF recommends confirming elevated office readings with measurements outside the clinical setting before treatment (US Preventive Services Task Force [USPSTF], 2021b). Medication and substance effects are a third possibility: regular ibuprofen, a decongestant spray, and heavy caffeine intake can each raise blood pressure. Obstructive sleep apnea is a fourth, suggested by obesity, a 41-inch waist, and daytime fatigue, and it is a recognized secondary cause. Other secondary causes, such as renal artery stenosis or primary aldosteronism, are less likely given no bruits, no hypokalemia symptoms, and the gradual course, but they would be pursued if blood pressure proved resistant to treatment.
Left thyroid nodule. A benign colloid or follicular nodule is the most likely diagnosis, since the large majority of palpable thyroid nodules are benign. Differentiated thyroid carcinoma must be excluded, and several features increase concern: male sex, a firm consistency with a slightly irregular edge, and a family history of thyroid cancer, although he has no hoarseness, dysphagia, fixation, or cervical lymphadenopathy, and no childhood neck irradiation (Haugen et al., 2016). A thyroid cyst is possible and would be identified on ultrasound. A dominant nodule within an early multinodular goiter is also possible, though no other nodules were palpable. Thyroiditis is unlikely because the nodule is nontender and he has no systemic symptoms. Guidelines recommend measuring serum thyroid-stimulating hormone and obtaining a diagnostic thyroid ultrasound for any palpable nodule, with fine-needle aspiration decided by the nodule's size and sonographic pattern (Haugen et al., 2016).
Problem List
1. Left thyroid nodule, about 2 cm, firm: thyroid-stimulating hormone and diagnostic neck ultrasound ordered; further evaluation guided by results.
2. Elevated office blood pressure, hypertension not yet confirmed: home blood pressure monitoring twice daily for one week with a validated upper-arm device, or ambulatory monitoring; basic metabolic panel, lipid panel, hemoglobin A1c, urinalysis, and electrocardiogram as baseline; reduce ibuprofen use and stop the decongestant spray; review in two weeks.
3. Obesity, body mass index 30.7, with central adiposity: counseling on nutrition and activity begun; weight reduction supports blood pressure control.
4. Daytime fatigue with short sleep: STOP-BANG questionnaire and sleep history at the follow-up visit; sleep study if the score is elevated.
5. Episodic low back stiffness: mechanical, without red flags; stretching and breaks during long drives advised.
Health Maintenance
Preventive measures are organized by the history item that makes each one relevant. Because he is 46, colorectal cancer screening is due now; the USPSTF recommends screening for adults aged 45 to 75, and the options of colonoscopy or stool-based testing were discussed with him (USPSTF, 2021a). His grandfather's colon cancer at 78 does not change the starting age but was noted. His elevated blood pressure, obesity, and father's early myocardial infarction make a lipid panel and calculation of 10-year cardiovascular risk appropriate at this visit. His prior smoking history of about four pack-years does not meet the threshold for lung cancer screening. Diabetes screening with hemoglobin A1c is indicated by his weight. One-time screening for hepatitis C and HIV infection is offered, since he has no record of either. Immunizations were reviewed against the current adult schedule: he is due for a Tdap booster, the annual influenza vaccine is recommended, and COVID-19 vaccination was offered according to current guidance (Centers for Disease Control and Prevention, 2024). He was counseled on reducing alcohol intake to two drinks or fewer on any day. Skin self-examination was reviewed. A follow-up visit is scheduled in two weeks to review home blood pressure readings, laboratory results, and the thyroid ultrasound.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Centers for Disease Control and Prevention. (2024). Adult immunization schedule by age: Recommendations for ages 19 years or older, United States, 2024. U.S. Department of Health and Human Services. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., Schuff, K. G., Sherman, S. I., Sosa, J. A., Steward, D. L., Tuttle, R. M., & Wartofsky, L. (2016). 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 26(1), 1-133. https://doi.org/10.1089/thy.2015.0020
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
NURS 6512 Week 11 instructions, in plain terms
The final NURS 6512 week asks for a comprehensive history and physical on an adult. Record a complete history and review of systems, examine every region, synthesize findings, give differentials for abnormal findings and close with a problem list and health maintenance. Completeness is audited region by region, so missing the lymph node survey or skin of the back loses points. Cite assessment texts and guidelines in APA 7. This record goes beyond an undergraduate head-to-toe by adding differential reasoning and preventive care. Health maintenance belongs because a routine visit is when screening happens. Build abnormal findings into the reasoning. Use standard headings in the usual order so a reader can find any region quickly, and keep normal findings brief but specific.
How the NURS 6512 Week 11 example is put together
A long document, often eight pages or more. The history is complete: the reason for a routine visit, present health status, past medical and surgical history, medications and supplements, allergies, family history across generations, social history including occupation, substance use and sexual health, and a full review of systems. Every system is examined in turn, ending with the neurological findings, each described in the terms used in earlier weeks. Two abnormal findings emerge, an elevated blood pressure reading and a firm thyroid nodule, and each receives its own short differential. A problem list ranks active issues. The health maintenance section records which screenings and immunizations the history makes relevant, citing the USPSTF for its evidence-graded preventive recommendations. Every finding belongs to a composite.
Where the marks sit in the NURS 6512 Week 11 rubric
Final records lose points in two ways at once. Completeness is audited region by region, and leaving out the lymph node survey, the skin of the back or the peripheral pulses costs a whole criterion. At the graduate level the larger loss is a record that stops at description: abnormal findings reported without a differential, or a problem list that simply restates the findings, leave the analysis criteria unmet. Health maintenance sections listing generic screenings, unconnected to this patient's age, history or risk, score as boilerplate. Inconsistent scales between sections draw comment in a document this long. Social history that omits sexual health or substance use without explanation is marked incomplete. Preventive recommendations cited to an outdated source cost the support line.
Common NURS 6512 Week 11 mistakes, and how to avoid them
Comprehensive records score poorly when a region is skipped. Check every system. A second weakness is abnormal findings with no differential. Reason through each. Writers also skip health maintenance. Add screening by guideline. Avoid copying normal templates without checking them. Describe what you found. Keep the problem list ranked. A differential for the thyroid nodule that names the next step, an ultrasound and TSH, shows reasoning carried into action. Close with the problem that needs follow-up first. Check every region against a checklist before submitting.
Get a NURS 6512 Week 11 example written to your instructions
Along with the Week 11 prompt and rubric, include your template or required system list, and a full-system H&P is written to it on a composite adult, with differentials and health maintenance in place. The first sample costs nothing and is delivered within 24 to 48 hours. The man, his thyroid nodule and his family history are fictional.
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NURS 6512 Week 11 questions, answered
Where does this go beyond an undergraduate head-to-toe assessment?
The examination content overlaps, but the graduate record reasons about its findings. Abnormal results receive a differential, the problem list ranks issues by clinical weight, and health maintenance is tied to the patient's own risk profile. An undergraduate version typically stops at documented findings and nursing concerns, and a graduate rubric reads for the analytic sections that follow the examination.
Why include health maintenance in an assessment record?
Because graduate rubrics expect a complete visit to surface preventive needs from the history, and many score that section on its own. The example ties each item to a history detail, such as age, family history or exposure, and names its evidence source. It records what the history makes relevant, not a recommendation for any real patient.
Were the abnormal findings built in on purpose?
Yes. A record with every finding normal leaves no room to show reasoning, so the case was given two abnormal results that each call for a short differential. If your prompt supplies its own findings, the sample uses those instead, and where every finding is normal the synthesis says so and concentrates on health maintenance.
Where can I find a free NURS 6512 Week 11 sample paper?
The routine visit history and physical is reproduced here with the full history, complete exam, synthesis, differentials, problem list and health maintenance.
Which abnormal findings appear in NURS 6512 Week 11?
An elevated blood pressure and a thyroid nodule, each worked through with a differential and next steps.