MN552 Unit 4 Sample Paper

Focused Abdominal Assessment: Recurrent Right Upper Quadrant Pain in a 46-Year-Old Woman Seen in Primary Care

[Author Name]

School of Nursing, Purdue University Global

MN552 Advanced Health Assessment

Unit 4 Assignment

[Faculty Name]

August 11, 2026

Composite case written as a model document. No real patient, practice or clinician is described.

What this page is doingThe title names the examination, the presenting problem, the patient and the setting, so a reader knows what the paper contains before the first paragraph. Graders reward a title that could only belong to this paper. The title block carries the school, the course code with its full course name, and the unit line in the form students actually type, which keeps the document identifiable without inventing an official assignment name. The composite line at the foot settles the privacy question in one sentence.

Focused History

Chief complaint, in the patient's words: 'I get a hard ache under my right ribs after supper, and it will not let me sit still.' The patient is a 46-year-old woman seen at a suburban primary care practice at 9:15 a.m. in a same-day appointment. She describes five discrete episodes over the past two months, the most recent 36 hours ago. Each episode begins 30-60 minutes after a fatty meal, builds over roughly 20 minutes to a steady 8 out of 10 pressure in the right upper quadrant, radiates to the right scapula, and resolves on its own after 60-90 minutes. Nausea accompanies every episode and she vomited once. Walking, antacids and a heating pad change nothing. She is entirely well between episodes and has missed two days of work.

Pertinent negatives narrow the field before the examination begins. She denies fever, chills, yellowing of the eyes, dark urine, pale stools, and any episode lasting longer than six hours. She denies heartburn, dysphagia, early satiety, melena, hematochezia, unintended weight loss and change in bowel pattern. She denies chest pressure on exertion, shortness of breath, cough and back pain that wakes her at night. Her history includes two pregnancies, obesity managed with a supervised eating plan, and hyperlipidemia not currently treated with medication. Current medications are a daily multivitamin and occasional ibuprofen 400 mg taken about twice a month. She reports no known drug allergies. Her mother had a gallbladder removed at 52. She drinks alcohol twice a month, has never smoked, and takes no herbal products.

Two features of the history carry most of the diagnostic weight. The pain is episodic and self-limited rather than constant, which separates biliary colic from a gallbladder that has become and stayed inflamed, and it is postprandial and fatty-food associated, which points at gallbladder contraction rather than acid, motility or vascular causes. Risk factors line up with the same explanation: female sex, age over 40, a body mass index of 33.4, two prior pregnancies, and a first-degree relative with gallstone disease. The absence of fever, jaundice and pain beyond six hours is equally informative, because those findings would move the reasoning toward acute cholecystitis or a stone lodged in the common bile duct rather than uncomplicated colic.

What this page is doingThe history earns its marks by including what is absent. Anyone can record where the pain is; the pertinent negatives, the timing of each episode, and the trigger are what let the differential be narrowed later without new information. Notice that the third paragraph does not wait for the plan to explain the reasoning; it names the two features carrying diagnostic weight, then lists risk factors as support rather than as proof. That ordering is the difference between a data dump and a focused history.

Focused Physical Examination

Vital signs at rooming: temperature 36.8 C oral, heart rate 76 beats per minute and regular, respiratory rate 14 breaths per minute, blood pressure 132/80 mm Hg in the left arm seated, oxygen saturation 98 percent on room air, height 165 cm, weight 91 kg, body mass index 33.4. Reported pain was 0 out of 10 at the time of the visit. General appearance: well appearing and in no distress, moving onto the examination table without guarding, skin warm and dry, no scleral icterus in natural light, no sublingual yellowing, no palmar erythema, no spider angiomata and no temporal wasting.

The abdominal examination followed inspection, auscultation, percussion and palpation, so that palpation would not alter what was heard (Bickley et al., 2021). Inspection: abdomen rounded and symmetric, no surgical scars, no distension, no visible peristalsis, no dilated periumbilical veins. Auscultation: bowel sounds present and normal in pitch in all four quadrants, no bruit over the aorta or the renal arteries. Percussion: tympanic throughout, liver span 9 cm in the right midclavicular line, no shifting dullness, and fist percussion over the right costal margin produced no pain. Palpation: soft and non-distended, no guarding, no rebound, no palpable mass, and the liver edge was not felt below the costal margin. Deep palpation of the right upper quadrant produced mild discomfort that did not stop the examination.

Targeted maneuvers were negative on the day of the visit. Murphy sign was absent: deep palpation below the right costal margin during inspiration did not arrest the breath. There was no tenderness at McBurney point, no Rovsing sign, no psoas or obturator sign, and no costovertebral angle tenderness on either side (Ball et al., 2023). The epigastrium was non-tender to deep palpation. A brief cardiopulmonary screen was included because right upper quadrant pain can be referred: heart rate regular with S1 and S2 present and no murmur or rub, lungs clear to auscultation in all fields with no crackles at the right base, and no chest wall tenderness on palpation of the lower ribs.

What this page is doingTwo moves score here. First, the sequence is stated and justified: inspection, auscultation, percussion, palpation, so that palpation does not change the bowel sounds. Rubrics for advanced assessment usually check technique, not just findings. Second, the negative maneuvers are named individually rather than summarized as unremarkable. A named negative Murphy sign is usable evidence in the next section; the phrase abdomen benign is not. Regional numbers, from liver span to body mass index, keep the examination measurable.

Diagnostic Reasoning: Ruling In and Ruling Out

The history and the examination agree, and that agreement is what makes the impression defensible. Short, severe, postprandial right upper quadrant pain that radiates to the scapula and then resolves completely fits obstruction of the gallbladder outlet by a stone that falls back, and an examination performed between episodes should look close to normal, which is what it looked like. A normal temperature, an absent Murphy sign and a liver edge that is not enlarged are not evidence against gallstones; they are the expected findings in a patient who is not obstructed or infected at the moment of the visit. Reading a quiet abdomen as proof that nothing is wrong would misread the timing of the appointment rather than the patient.

Peptic ulcer disease was considered because the patient uses ibuprofen, but her pain is not relieved by food or antacids, is not epigastric and burning, and the epigastrium is non-tender; it stays on the list at low probability. Gastroesophageal reflux disease was considered and made unlikely by the absence of heartburn, regurgitation and nocturnal cough. Acute cholecystitis was considered and set aside because it produces pain that persists beyond six hours, usually with fever and a positive Murphy sign. Stone in the common bile duct and gallstone pancreatitis were considered and set aside because there is no yellowing of the eyes, no dark urine, no pale stool, and no epigastric pain boring through to the back.

Two further possibilities deserve a sentence each because missing them is costly. Right lower lobe pneumonia and inferior wall myocardial infarction can both present as upper abdominal pain, and both were addressed by the cardiopulmonary portion of the examination and by the absence of fever, cough, breathlessness, exertional symptoms and sweating. Renal colic was addressed by the absence of flank pain, hematuria and costovertebral angle tenderness. The working impression is symptomatic cholelithiasis presenting as biliary colic, held with moderate to high confidence on history and examination alone, and requiring imaging to confirm stones and to look for wall thickening or duct dilation before any surgical conversation begins.

What this page is doingThis is the sheet that separates a strong write-up from a competent one. It states the agreement between history and examination in plain terms, then defends the normal findings instead of apologizing for them. Each differential is given the specific finding that raises or lowers it, so the reader can audit the reasoning. The closing sentence sets confidence honestly, says what imaging would add, and stops short of claiming a diagnosis the data cannot yet support.

Impression and Plan

Impression: symptomatic cholelithiasis with recurrent biliary colic in a 46-year-old woman, uncomplicated at presentation. Diagnostic plan: right upper quadrant abdominal ultrasound as the first imaging study, because ultrasound is the initial study recommended for right upper quadrant pain and shows stones, wall thickening, pericholecystic fluid and duct diameter without radiation (American College of Radiology, 2022). Laboratory work was ordered the same morning: complete blood count, comprehensive metabolic panel with total and direct bilirubin, alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase, plus lipase. Normal liver chemistries and lipase alongside stones on ultrasound would support uncomplicated cholelithiasis; a rising alkaline phosphatase with a dilated common bile duct would change the referral.

Management plan: referral to general surgery for consideration of elective laparoscopic cholecystectomy is appropriate once stones are documented in a patient with typical recurrent colic, and the decision belongs to the patient and the surgeon together (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Until that appointment the plan is symptomatic: smaller meals with reduced fat, avoidance of the specific meals that have triggered episodes, and ibuprofen held because of its ulcer risk in a patient whose differential still includes peptic disease. Return precautions were written out and read back to her: pain lasting longer than six hours, temperature above 38 C, vomiting that prevents fluids, yellowing of the eyes or skin, dark urine, or pale stools.

Health maintenance was addressed at the same visit because the patient had not been seen in two years. Colorectal cancer screening was offered, since screening is recommended beginning at age 45 for adults at average risk (US Preventive Services Task Force, 2021), and she chose a stool-based test with a plan to discuss colonoscopy if it returns positive. A fasting lipid panel was added to the same draw. Follow-up was set for 7-10 days by telephone to review imaging and laboratory results, sooner if any return precaution occurs, and the surgical referral was placed the same day. Findings, differential and shared decisions were documented in the visit note.

What this page is doingThe plan is traceable line by line to the impression above it. Imaging is chosen with a reason and a citation rather than by habit, and the laboratory panel is followed by the interpretation that would change the decision, which shows anticipatory reasoning. Return precautions are specific and were read back, which is both good practice and a documentation point. Health maintenance appears because a focused visit is still a visit, and the screening offer is tied to a current recommendation.

References

American College of Radiology. (2022). ACR appropriateness criteria: Right upper quadrant pain. https://acsearch.acr.org/list

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel's guide to physical examination: An interprofessional approach (10th ed.). Elsevier.

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.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Gallstones. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones

US Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

How this MN 552 Unit 4 example is structured

In many sections this unit asks for a focused assessment write-up on a single presenting problem; your classroom's instructions and rubric decide the exact form, so read them before you use this MN552 Unit 4 example as a shape. The paper is ordered the way a clinician reasons, not the way a form is filled in. The focused history comes first, so the reader meets the complaint and the pertinent negatives that already narrow it. The examination comes second, so every finding can be checked against what the history predicted. The reasoning sheet comes third and does the work thin papers skip: it names why a quiet abdomen is consistent with the story instead of contradicting it, and it rules differentials in or out on stated evidence. The impression and plan come last, tied line by line to the two columns above. The patient is a composite.

MN552 Unit 4 questions, answered

What does an MN552 Unit 4 assignment usually ask for?

In many sections the unit that follows the systems content asks for a focused write-up on one presenting problem: a targeted history, a targeted examination, a differential with reasoning, and a plan. Your classroom's instructions and rubric decide the exact form, including whether the headings follow note format or section titles like the ones used here. Read the assignment page in your classroom first.

Can a focused assessment paper be written about a real patient?

No identifiable patient information belongs in a course paper. The safer practice, and the one used here, is a composite: a case built from typical presentations rather than from one person's chart. A composite keeps the numbers and timing clinically realistic without touching protected health information, and it lets the reasoning, rather than the source of the data, carry the grade.

Why does the example report normal findings instead of only abnormal ones?

Because pertinent negatives are evidence. An absent Murphy sign, a normal temperature and a soft epigastrium are what allow the paper to argue for uncomplicated biliary colic and against cholecystitis, ulcer disease and duct obstruction. A write-up that lists only abnormal findings gives the reader nothing to rule out, so the differential reads as asserted rather than reasoned.

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 Purdue University Global 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.

MN552 Unit 4: sample paper, in real form