NR 509 Week 7 Comprehensive Physical Exam Write-Up Example

Course	NR 509 Advanced Physical Assessment
Week	7
Paper type	Comprehensive exam write-up
Length	About 1,200 words, 3 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, nurse practitioner core
Updated	October 2026

Free sample paper for NR 509 Week 7

Comprehensive Examination of the School Bus Driver From Week 1: A Firm Enlarged Thyroid, Pale Conjunctivae and Slow-Relaxing Ankle Reflexes, Recorded System by System at the Same Density From First to Last

Student Name

College of Nursing, Chamberlain University

NR 509: Advanced Physical Assessment

Instructor Name

Month Day, Year

What this page is doingThe title names the key findings and the discipline of the week, keeping the last systems as detailed as the first. Student APA 7 title page.

Context

Ms. L. R., 52, school bus driver, returned for the comprehensive examination following the health history recorded in Week 1: five months of tiredness together with feeling cold, dry skin, slower bowels, gradual weight gain and a husky voice, heavier irregular periods, a mother and sister with thyroid disease, and gestational diabetes never followed up. The examination follows the template order (Bickley et al., 2021). Each system is reported at the same level of detail, so a reader can trust that the later entries were examined as carefully as the first.

Overall Impression and Vital Signs

Overall impression: Awake, attentive and cooperative; answers questions fully but speaks slowly, with a slightly hoarse voice. Face appears puffy around the eyes. Moves without difficulty; stood from the chair without using her arms. Dressed in layers, including a cardigan, although the room is warm.

Vital signs: Seated pressures of 138/86 mm Hg on the right and 136/84 on the left, seated after 5 minutes' rest, large adult cuff; heart rate 58, regular, counted over a full minute; respiratory rate 14; temperature 36.1°C oral; pulse oximetry 98% breathing room air. She measures 165 cm and weighs 84 kg, a body mass index of 30.9 kg/m2; waist circumference 98 cm at the level of the iliac crests.

Skin, Hair and Nails

Skin of the forearms, shins and heels dry and rough, with fine scaling over the shins. Palms pale; palmar creases pale when the fingers are extended. No jaundice, rash or bruising. Mild non-pitting puffiness over the dorsum of both feet. Scalp hair coarse and dry, thinning diffusely over the crown; outer third of the eyebrows sparse on both sides. Nails brittle with longitudinal ridging; nail beds pale, refilling within 2 seconds; no spooning.

Head, Eyes, Ears, Nose and Throat

Head and face: Periorbital puffiness both sides; no tenderness over the sinuses. Eyes: Acuity 20/25 in each eye with her reading glasses at 20 feet. Palpebral conjunctivae pale on lower lid eversion, both sides; sclerae white. Pupils 3 mm, equal, brisk to light and accommodation. No lid lag or proptosis. Fundi: disc margins distinct both sides; no hemorrhages or exudates. Ears: Canals clear; drums gray and intact, both sides. Nose: Mucosa pink; septum midline. Mouth and throat: Tongue slightly enlarged, with tooth impressions along its edges. Mucosa moist. Pharynx without redness or exudate.

Neck and Lymph Nodes

Thyroid visible as a fullness in the lower anterior neck when she swallows with the head slightly extended. On palpation from behind, both lobes enlarged, about twice normal size by estimate, symmetric, firm, rubbery and slightly bosselated, without a dominant nodule; nontender; moves up with swallowing. No bruit over either lobe. Trachea midline. No cervical, supraclavicular or axillary lymph nodes palpable on either side.

Breasts

Examined seated and supine. Breasts symmetric; no skin dimpling, retraction or nipple discharge. No masses on palpation in any quadrant or the axillary tail, both sides.

Chest and Lungs

Chest expands symmetrically. Percussion resonant in all fields front and back. Breath sounds soft and vesicular throughout, both sides; no crackles or wheezes; no dullness at the bases.

Cardiovascular

Apical impulse at the fifth rib space in the left midclavicular line, small and not displaced. Rate slow and regular. First and second heart sounds of normal intensity; no extra sounds, murmurs or rub, including in the left lateral position. Neck veins not distended at 45 degrees. Carotid pulses 2+ both sides, no bruits. Pulses at the wrists, groins and both sites on each foot graded 2+ and symmetric. No pitting edema of the ankles.

Abdomen

Abdomen rounded with a healed low transverse cesarean scar and four small laparoscopic scars. Bowel sounds present but infrequent in all quadrants. Tympanic to percussion. Liver dullness measured 9 cm in the right midclavicular line; edge not felt. Spleen not felt. Soft and nontender throughout; no masses; stool palpable in the left lower quadrant. No costovertebral angle tenderness either side.

Genitourinary and Pelvic

Pelvic examination with a chaperone present, as heavy bleeding over the past year requires assessment. External genitalia normal. Vaginal mucosa pink and moist. Cervix smooth; no lesions or bleeding on contact; cervical screening sample collected. Bimanual examination: uterus anteverted, mildly enlarged and slightly irregular in contour, nontender, mobile. Adnexa without palpable masses or tenderness, both sides. Rectal examination declined by the patient; noted as not performed.

Musculoskeletal

Spine without tenderness or abnormal curvature. Knees: bony enlargement at the medial joint lines both sides, crepitus with flexion, no effusion, no warmth; full range of motion with mild discomfort. Other joints of the arms and legs with full, painless range and no swelling. Proximal strength 5/5 at the hips and shoulders both sides; able to rise from a squat.

Neurologic and Mental Status

Oriented to person, place, time and situation. Recalls three words at 5 minutes. Speech slow but fluent. Cranial nerve testing from vision through tongue movement normal. Full strength in all four limbs, symmetric. Light touch and vibration intact at the great toes, both sides; 10-g monofilament sensed at all tested sites on both feet. Reflexes 2+ and symmetric at the biceps, triceps and knees; ankle reflexes present with a visibly slow relaxation phase, both sides. Gait steady; Romberg negative. Mood described as "frustrated"; affect appropriate; no thoughts of self-harm.

What this page is doingThe last systems are recorded at the same density as the first, with side and method, which is where comprehensive write-ups usually thin out.

An Assessment That Accounts for the Whole

The examination supports three problems and one set of preventive needs, and every abnormal finding belongs to one of them. 1. Probable primary hypothyroidism, likely autoimmune: a firm, rubbery, symmetric goiter; slow heart rate; low-normal temperature; dry skin; coarse hair and thinning lateral eyebrows; periorbital and dorsal foot puffiness; enlarged tongue; hoarseness; infrequent bowel sounds with palpable stool; and slow relaxation of the ankle reflexes, all in a woman with a mother and sister with thyroid disease (McGee, 2022). 2. Suspected anemia, probably iron deficiency from heavy menstrual bleeding: pale conjunctivae, palms and nail beds, with an enlarged, irregular uterus suggesting fibroids as a cause of the bleeding. 3. Elevated blood pressure on treatment and obesity, with a history of gestational diabetes, requiring metabolic screening. 4. Knee osteoarthritis, explaining her knee pain and ibuprofen use.

Some findings cross problems. Fatigue and breathlessness on stairs could come from either hypothyroidism or anemia, or both. Hypothyroidism itself can cause heavier menstrual bleeding and can raise diastolic pressure, so treating it may improve two other problems. Plan: TSH and free T4, thyroid peroxidase antibodies, complete blood count with ferritin, hemoglobin A1c, lipid panel and basic metabolic panel; pelvic ultrasound; colorectal cancer screening and overdue vaccines; review of ibuprofen use given blood pressure; and a return appointment once results are available, within about two weeks. Her commercial driving certification makes timely treatment of fatigue a safety matter as well as a health one.

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.

McGee, S. (2022). Evidence-based physical diagnosis (5th ed.). Elsevier.

The Chamberlain NR 509 Week 7 instructions

The Week 7 assignment asks you to complete a comprehensive physical examination and document every system. You will likely need context from the history, a general survey and vital signs, every system in order, findings described objectively, an assessment that accounts for abnormal findings and APA. Link the examination to the history you took earlier. Keep the last systems as detailed as the first, with side and method throughout. Describe findings rather than labeling them. Include sensitive examinations, such as pelvic, when the history requires them, with a chaperone noted. Write an assessment that places every abnormal finding in a problem, and say which findings could belong to more than one.

How the NR 509 Week 7 example is put together

The context section recalls the Week 1 history. The overall impression records slow, slightly hoarse speech and periorbital fullness. Vital signs give pressures in both arms with a large cuff and a heart rate of 58. Skin findings include dry, rough forearms and shins and pale palms. The eyes include pale palpebral conjunctivae. The neck records a visible fullness on swallowing and both thyroid lobes enlarged and firm. Breasts, chest and heart are recorded with landmarks. The abdomen notes scars and infrequent bowel sounds. The pelvic examination, with a chaperone, addresses heavy bleeding. The knees show bony enlargement. The neurologic section records slow relaxation of the ankle reflexes. The assessment groups findings into probable hypothyroidism, possible anemia and preventive needs.

Reading the NR 509 Week 7 grading rubric

Comprehensive examination rubrics in NR 509 typically weigh completeness, consistency of detail across systems, accurate technique and terminology, objective description, an integrated assessment and APA. Detail held steady across systems is the main test, met here by recording the pelvic, musculoskeletal and neurologic sections at the same density as the skin. Completeness is credited because every system appears. Technique scores through method and side in each entry. Objective description earns points for findings rather than labels. The assessment is credited because every abnormal finding has a place and shared findings are discussed. Bates' guide and McGee support the methods. Two references complete APA.

Common NR 509 Week 7 mistakes, and how to avoid them

The signature Week 7 loss is the fading document: strong for the first several systems, then progressively thinner, ending in one-line entries. Another loss is an assessment that addresses only the most obvious problem and leaves other abnormal findings unexplained. Students also skip sensitive examinations the history requires, describe findings with labels or forget to connect the examination to the earlier history. To keep a long write-up from thinning, use the same headings and level of detail for every system. Normal systems need enough detail to show they were examined. The assessment should account for every abnormal finding. Send your history and examination notes, and an NR 509 comprehensive write-up can keep its detail to the end.

Get a NR 509 Week 7 example written to your instructions

Send the Week 7 instructions and your comprehensive template and a custom example is written into it, held at the same density from the first system to the last, inside 24 to 48 hours. The first one is free, and the examination itself stays yours to perform.

More NR 509 papers and MSN samples

NR 509 Week 7 questions, answered

How do I keep a long write-up from thinning out?

Write the systems in a different order than you will present them, starting with the ones you find tedious, then assemble. The drop in density toward the end of a comprehensive document is the most reliably marked flaw in this week, and it comes from attention rather than from knowledge.

Do normal systems need the same detail as abnormal ones?

They need enough to show they were examined, which is more than most people give them. A normal system reported in one line is indistinguishable from a system skipped. The specificity can be shorter than for an abnormal finding, but the maneuver and its result still have to be there.

Should the assessment cover every system?

It should account for the examination as a whole rather than list every system. That usually means addressing the abnormal findings in detail and acknowledging that the remaining systems were examined and unremarkable. An assessment that mentions only the abnormal reads as though the rest was never done.

Where can I find a free NR 509 Week 7 sample paper?

This page has the complete Week 7 comprehensive examination of the school bus driver, every system at full detail, the assessment of three problems and two references.

What findings support hypothyroidism in the NR 509 Week 7 examination?

A firm, enlarged thyroid, slow pulse, dry scaling skin, periorbital puffiness, slow hoarse speech and slow relaxation of the ankle reflexes, matching her history of cold intolerance and constipation.