| Course | NUR-3280 Health Assessment and Health Promotion |
|---|---|
| Module | Module 4 |
| Paper type | Multi-system assessment write-up |
| Length | About 1,049 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Accelerated B.S.N. Program |
| Updated | October 2026 |
Free sample paper for NUR 3280 Module 4
Six Systems, Four Abnormal Findings: A Multi-System Assessment That Keeps the Expected Apart From the Unexpected
Student Name
Accelerated B.S.N. Program, Thomas Edison State University
NUR-3280: Health Assessment and Health Promotion
Mentor Name
Month Day, Year
Six Systems, Four Abnormal Findings: A Multi-System Assessment That Keeps the Expected Apart From the Unexpected
This module widens the assessment from one system to several. For my volunteer client, the forty-nine-year-old oyster harvester assessed in earlier papers, I examined six systems guided by the health history: head and neck including hearing, respiratory, cardiovascular, peripheral vascular, musculoskeletal and a screening neurological examination. The skin was documented in full in the previous module and is summarized only where it bears on other systems. The purpose of this paper is to document the findings accurately and, above all, to separate expected findings from unexpected ones, because a multi-system examination is only useful if the abnormal findings stand out clearly enough to act on.
Head, Neck and Hearing
The head is normocephalic with no masses or tenderness. The examination sequence and documentation terms follow the course text (Jarvis & Eckhardt, 2024). Eyes show equal, round pupils reactive to light and accommodation, full extraocular movements and pink conjunctivae. The external ears show sun-related scaly lesions on both helices, documented previously; canals are clear with intact, pearly gray tympanic membranes. The nose is patent, and the oral mucosa is pink and moist, with tobacco staining of the teeth and no white or red patches on the tongue or floor of the mouth. The thyroid is not palpable, and there is no cervical lymphadenopathy.
Hearing was screened with the whispered voice test, in which the examiner stands behind the client at arm's length, masks the other ear and whispers a combination of numbers and letters. Pirozzo et al. (2003) reviewed studies of this test and concluded that it is a simple and accurate way to screen for hearing impairment when performed in a standardized way. The client repeated the whispered sequence correctly with neither ear on two attempts each but repeated a normal-voice sequence correctly. With the client's history of twenty-six years of unprotected exposure to diesel engine noise and family reports of asking for repetition, this is an unexpected finding that needs formal audiometry.
Respiratory and Cardiovascular
The chest is symmetric with an anteroposterior to lateral ratio of about one to two, and respirations are sixteen per minute, regular and unlabored. Tactile fremitus is equal bilaterally. Percussion is resonant throughout. On auscultation, breath sounds are vesicular in the peripheral fields, with scattered low-pitched rhonchi over the lower lobes that cleared after the client coughed. Given a twenty-two pack-year smoking history and a daily morning cough, these findings are noted as unexpected even though they cleared, and they support the screening discussion in the next module.
Blood pressure was measured three times after five minutes of rest using a correctly sized cuff, with readings of 146 over 94, 142 over 90 and 144 over 92 mm Hg in the right arm, and 140 over 90 in the left arm. Under the national guideline, an average reading at or above 140 over 90 falls in the stage 2 hypertension category, but the diagnosis requires elevated readings on at least two separate occasions and ideally confirmation outside the clinic (Whelton et al., 2018). The heart rate is seventy-eight and regular. The apical impulse is felt where expected, just inside the nipple line at the fifth interspace, both heart sounds are crisp, and no murmurs, rubs or gallops were heard. Carotid upstrokes are brisk without bruits.
Peripheral Vascular, Musculoskeletal and Neurological
Peripheral pulses are two plus and equal in the radial, femoral, popliteal, dorsalis pedis and posterior tibial arteries. Capillary refill is under two seconds, and there is no edema, varicosity or skin change on the legs. Musculoskeletal examination shows full range of motion in all joints except the lumbar spine, where forward flexion reproduces the client's familiar ache at about seventy degrees. There is bilateral tenderness of the paraspinal muscles from L2 to L5 without midline spinous tenderness, and straight leg raising is negative bilaterally. Hand grip is strong and equal, with mild crepitus at the base of both thumbs.
The screening neurological examination shows the client alert and oriented, with fluent speech, intact cranial nerves II through XII apart from the hearing finding, normal strength in all extremities, intact light touch and vibration in the feet, symmetric two plus reflexes at the biceps, patellar and Achilles tendons, and a steady gait and negative Romberg test.
Separating the Expected From the Unexpected
The table summarizes the examination by sorting each system's findings into expected and unexpected. Four findings require action: elevated blood pressure on repeated readings, reduced hearing on screening, lower-lobe rhonchi in a long-term smoker, and the skin lesions documented previously. The back findings are unexpected but, with no red-flag features, are consistent with the mechanical pain described in the history and are a teaching and follow-up priority rather than an urgent one.
Prioritizing them follows the usual rule of addressing what carries the greatest risk first. The blood pressure carries the highest long-term cardiovascular risk, especially with the client's family history, and needs confirmation and a primary care visit within weeks. The skin lesions and hearing need specialist evaluation. The respiratory findings feed directly into screening and tobacco cessation, which are the focus of the next two modules.
| System | Expected findings | Unexpected findings |
|---|---|---|
| Head, neck, ears | Clear canals, intact tympanic membranes, no nodes | Failed whispered voice test bilaterally |
| Respiratory | Symmetric chest, resonant percussion, equal fremitus | Lower-lobe rhonchi clearing with cough |
| Cardiovascular | Regular rhythm, no murmurs, brisk carotids | Blood pressure 142 to 146 over 90 to 94 on three readings |
| Peripheral vascular | Equal pulses, no edema, brisk refill | None |
| Musculoskeletal | Full range except lumbar flexion, strong grip | Paraspinal tenderness L2 to L5, ache at 70 degrees flexion |
| Neurological | Oriented, intact strength, sensation and reflexes | None apart from hearing |
What I Told the Client
I shared each unexpected finding in plain language: the blood pressure was high three times today and needs to be checked again soon by a doctor; the hearing test suggests some hearing loss that a hearing specialist can measure properly; the lungs had some noise that cleared with a cough, which is common in people who smoke; and the skin patches need a dermatologist's look. I gave the client a written list, because four new items at once are easy to forget, and we agreed that the blood pressure visit would come first.
References
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Pirozzo, S., Papinczak, T., & Glasziou, P. (2003). Whispered voice test for screening for hearing impairment in adults and children: Systematic review. BMJ, 327(7421), 967-970. https://doi.org/10.1136/bmj.327.7421.967
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr., . . . Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
NUR 3280 Module 4 instructions, in plain terms
In most terms Module 4 of NUR-3280 asks for a multi-system or head-to-toe assessment on a volunteer or case client. Directions usually ask you to perform the examination using correct technique, document findings for each system in professional terms, distinguish normal from abnormal findings, prioritize abnormal findings and describe follow-up or teaching. Some sections specify which systems to include, and others ask for a complete head-to-toe examination. Check the TESU course site for whether a documentation template or table is required, whether vital signs must be repeated, and how the write-up should reference earlier modules. Use measured values and objective descriptions, and avoid diagnosing findings that need a provider's evaluation.
How the NUR 3280 Module 4 example is put together
The write-up opens by explaining which systems were examined and why, linking them to the health history. Each system section documents expected findings first and then any unexpected finding with its context: the whispered voice test with a review supporting it, lung findings in light of smoking history, and three blood pressure readings with the guideline category and its diagnostic caveat. The musculoskeletal section includes the negatives that matter for back pain. A table sorts all six systems into expected and unexpected findings, followed by a paragraph ranking the abnormal findings by risk. The last section reports how the findings were explained to the client and which follow-up comes first.
Where the marks sit in the NUR 3280 Module 4 rubric
Multi-system assessments are usually graded on completeness of the examination, accuracy of technique, documentation in professional terminology, correct distinction between normal and abnormal findings, prioritization of abnormal findings, and follow-up. Mentors check for measured values, such as repeated blood pressures and graded pulses or reflexes, rather than descriptions such as normal. The prioritization row rewards a reasoned order based on risk. Follow-up should match each finding and stay within the nursing role. Clear organization, often by system with a summary table, helps the mentor confirm that every required element is present. Accurate use of guideline categories, with their caveats, demonstrates up-to-date knowledge. A brief statement of how each abnormal finding will be followed up also counts.
Common NUR 3280 Module 4 mistakes, and how to avoid them
A head-to-toe write-up often fails by recording WNL, within normal limits, for whole systems. Document what was assessed and what was found, even when normal. Another common problem is burying abnormal findings among normal ones so that the reader cannot see them; a summary table solves this. Students also label a single elevated blood pressure as hypertension, which the guideline does not support. Repeat measurements and use the correct category with its caveat. Pertinent negatives for any complaint, such as negative straight leg raising for back pain, show reasoning. If you have notes from a head-to-toe examination and need them written up properly, the desk can prepare the documentation to your directions.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 3280 and Accelerated B.S.N. Program sample papers
- NUR 3280 Module 1: Assessment Technique Paper
- NUR 3280 Module 2: Health History and Interview
- NUR 3280 Module 3: Skin Assessment Write-Up
- NUR 3280 Module 5: Health Promotion and Screening
- NUR 3280 Module 6: Health Promotion Plan
- NUR 4420 Module 3: Vulnerable Population Analysis
- NUR 4500 Module 5: First-Year Development Plan
NUR 3280 Module 4 questions, answered
Where can I find a free NUR 3280 Module 4 sample paper?
The full multi-system assessment is on this page, with its findings table, references and margin notes. It follows a volunteer oyster harvester; use its system-by-system structure and table for your own client.
Is WNL acceptable in a NUR-3280 assessment write-up?
Most mentors discourage it. Write what you assessed and what you found, such as clear breath sounds in all lobes or equal two plus radial pulses, so a reader knows the system was examined and what normal meant for this client.
How should I report blood pressure in the write-up?
Report each reading with the arm, position and rest time, use a correctly sized cuff, and repeat elevated readings. Name the guideline category for the average but note that diagnosis requires readings on separate occasions.
How do I prioritize abnormal findings?
Rank them by risk to the client, considering urgency, likelihood of serious disease and the client's history. Explain the reasoning, and say which finding should be followed up first and how soon.
What is the whispered voice test?
A simple hearing screen in which the examiner, standing behind the client and masking one ear, whispers a short sequence of numbers and letters for the client to repeat. Failing it suggests a need for formal audiometry rather than establishing a diagnosis.