NUR4033 Module 4: sample paper, in real form

Reviewed by Junia Fairbank, MSN, RN · American College of Education · True APA form · Annotated

This page holds a complete NUR4033 Module 4 example in true form: a finished health assessment write-up on a composite adult client, prepared at RN to BSN level for American College of Education. The paper records a focused examination, interprets each finding instead of listing it, and closes with screening decisions that carry an eligibility rule, an interval, and a follow-up date.

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Focused Health Assessment of a 58-Year-Old Man With Uncontrolled Blood Pressure and Rising Metabolic Risk

Student Name

American College of Education

NUR4033: Health Assessment

Module 4 Assignment

Instructor Name

May 4, 2025

What this page is doingThe title sheet earns its place by naming a person, a problem, and a direction of risk instead of a course requirement. A grader can tell from the title alone that a specific scenario existed before the writing started, which is what an organization and clarity criterion rewards. American College of Education does not publish a deliverable name for this module, so the sheet carries the plain line a student would actually type, Module 4 Assignment, rather than an invented official name. The course code appears in its ACE form, with no space.
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Client Profile and Reason for the Visit

The client in this write-up is a 58-year-old man seen at a community clinic in a mid-sized Midwestern city for a follow-up visit 21 days after a blood pressure of 158/96 mm Hg was recorded at a workplace health fair. He and the clinic are composites written for teaching, so no real person, employer, or coworker is described here. He carries a diagnosis of hypertension made four years ago and takes lisinopril 10 mg once daily. He smoked about a pack a day for 24 years and quit six years ago. His father had a myocardial infarction at 61 and lived another 12 years with heart failure.

Subjective data gathered during a 20-minute interview matter as much as the readings that follow. He drives a delivery route for about 10 hours a day, eats two of three meals from fuel-stop counters, and drinks three to four beers on Friday and Saturday nights. He reports no chest pain, no shortness of breath on exertion, and no swelling, but describes a dull morning headache two or three times a month that clears without medication. He estimates missing two to three doses of lisinopril in a typical seven-day stretch. Cost is not the barrier; the bottle sits in a kitchen cabinet he passes only after he has already left for his route.

Read together, the history points at a control problem rather than a diagnostic mystery. Missed doses, a high-sodium road diet, and alcohol are three modifiable inputs sitting on top of a fixed risk profile of age, sex, family history, and a 24 pack-year smoking record. The morning headaches are nonspecific and could belong to poor sleep, caffeine, or blood pressure, so they are recorded as a symptom to track rather than a finding to explain. Naming the pattern before the examination begins keeps the physical assessment purposeful: the examination is looking for evidence of end organ damage and for anything that would change the medication plan.

What this page is doingSubjective data comes first because the examination that follows has to be aimed at something. The paragraph closing this section converts history into a working hypothesis, a control problem rather than a diagnostic mystery, and that sentence is where interpretation credit begins. Notice that the composite disclosure appears once, in plain language, and is never repeated as a disclaimer. Rubrics for a health assessment paper usually score data collection and clinical reasoning on separate rows, and this section is written to feed both.
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Objective Findings and What They Mean

Blood pressure was measured with the client seated and quiet for five minutes, feet flat, arm supported at heart level, using a cuff sized to his upper arm. The first reading in the right arm was 152/94 mm Hg, a second reading two minutes later was 148/92 mm Hg, and the left arm read 150/92 mm Hg. Heart rate was 78 and regular, respirations 16 and unlabored, temperature 36.8 degrees Celsius, and oxygen saturation 97 percent on room air. Height was 178 cm, weight 98 kg, body mass index 30.9, and waist circumference 107 cm. Averaged office readings in this range fall in the stage 2 band of the adult classification tables, and the arm-to-arm difference is inside the expected margin (Jarvis & Eckhardt, 2024).

The cardiovascular and respiratory examination was notable for what it did not show. Heart sounds were S1 and S2 without murmur, gallop, or rub; the point of maximal impulse was not displaced; jugular venous pressure was not visible with the head of the bed at 45 degrees; radial, dorsalis pedis, and posterior tibial pulses were 2+ and symmetric; and there was no pedal or pretibial edema. Lung fields were clear to auscultation in all posterior and lateral fields, with no wheeze and no prolonged expiratory phase despite the smoking history. A normal examination in a client with sustained readings this high is not a reassurance to file away. It is evidence that the pressure has not yet produced measurable damage, which changes the urgency of the plan but not its content.

Two results from the health fair were already in the record: a non-fasting A1C of 6.1 percent and a total cholesterol of 214 mg/dL with no fractionation. An A1C of 6.1 percent sits inside the 5.7 to 6.4 percent band that marks prediabetes, so it is a result that triggers a confirmatory test rather than a diagnosis. The cholesterol value cannot be read without a full lipid panel, and that gap is documented as a gap. For context, 54.5 percent of United States adults aged 40 to 59 examined in the 2017-2018 National Health and Nutrition Examination Survey had hypertension, so this client sits inside a common pattern rather than an unusual one (Ostchega et al., 2020).

What this page is doingEvery number here is measured rather than asserted, and the conditions of measurement are stated: five minutes seated, arm at heart level, cuff sized to the arm. That detail protects the reading from challenge. The section then does the thing that separates an adequate write-up from a strong one, which is to interpret an unremarkable examination instead of skipping past it. The national prevalence figure arrives with its denominator and survey period attached, so it reads as evidence rather than decoration.
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Screening Eligibility and Intervals

Screening decisions in this write-up are recorded as an eligibility rule plus an interval, because a screening name with neither is not a plan. Lung cancer screening applies to adults aged 50 to 80 who have a 20 pack-year history and who either still smoke or quit within the past 15 years, and the interval is annual low-dose computed tomography (U.S. Preventive Services Task Force, 2021b). This client is 58, carries a 24 pack-year history, and quit six years ago, so he meets all three conditions today. One low-dose scan is ordered with an annual recall, and the note records the stopping rule as well: screening ends once 15 years have passed since he quit, or once another health problem would prevent treatment.

Colorectal cancer screening applies to adults aged 45 to 75, and this client has never been screened, so he stands 13 years past the earliest age of eligibility (U.S. Preventive Services Task Force, 2021a). The interval depends on the method he chooses: colonoscopy every 10 years, a fecal immunochemical test every year, stool DNA testing every one to three years, or computed tomography colonography every five years. That choice is presented to him as a real choice, since the strategy he will actually complete matters more than the strategy with the longest interval. He selected annual fecal immunochemical testing, with the understanding that a positive result leads to a diagnostic colonoscopy rather than to a repeat stool test.

Screening for prediabetes and type 2 diabetes applies to adults aged 35 to 70 who have overweight or obesity, with repeat testing about every three years when the result is normal (U.S. Preventive Services Task Force, 2021c). With a body mass index of 30.9 and an A1C of 6.1 percent already on file, this client is past screening and into confirmation, so a fasting glucose and a repeat A1C are ordered instead of a three-year recall. One screening is deliberately not ordered: the one-time ultrasound for abdominal aortic aneurysm applies to men aged 65 to 75 who have ever smoked, and at 58 he is seven years short of that window (U.S. Preventive Services Task Force, 2019). It is written into the plan as a future item so the next nurse does not have to rediscover it.

What this page is doingEach screening is written as a rule, an interval, and a stopping point, and the client's own numbers are checked against the rule in the same sentence. That is the difference between recommending a test and applying a guideline. The screening that is deliberately not ordered does more work than the three that are, because it shows eligibility being applied rather than recited. Citations sit on the rule itself instead of being parked at the end of the paragraph, so a grader can see which claim came from where.
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Nursing Priorities, Teaching, and Follow-Up

The prioritized nursing problem is blood pressure that stays above goal because doses are missed, not because the regimen has failed, and that distinction decides the intervention. Rather than flagging the prescription for change, the plan attaches the morning dose to something already fixed in his day: the coffee he pours before he leaves, with the bottle moved to the counter beside the coffee maker. He agreed to a home monitoring protocol of two readings each morning and two each evening for seven days, discarding the first day and averaging the rest, using an upper-arm monitor he will bring to the next visit for comparison against the clinic device.

Teaching used teach-back rather than a handout. He was asked to say, in his own words, which number would prompt a call to the clinic and what he would do if he found it, and he answered correctly on the second attempt after the first answer reversed the top and bottom numbers. Diet counseling was held to two changes he named himself: packing a sandwich four days out of seven instead of buying one on the road, and moving to unsalted nuts for the afternoon stop. The clinic counseling target of under 2,300 mg of sodium per day was written on his plan in the form of foods, not milligrams.

Follow-up was set at 14 days by telephone to review the home log and at 28 days in clinic with fasting labs drawn beforehand. Two escalation rules were written into the record and read aloud: a single reading at or above 180/120 mm Hg together with chest pain, shortness of breath, weakness, or visual change means emergency care that day, and two consecutive home averages above 150/90 mm Hg means the medication conversation moves ahead of the scheduled visit. Writing the escalation threshold into the plan turns a follow-up appointment into a decision point rather than a date.

What this page is doingThe plan is specific enough to be checked: a named cue for the morning dose, a seven-day monitoring protocol with the first day discarded, two follow-up dates, and two numeric escalation thresholds. Teaching is reported honestly, including that the client answered correctly on the second attempt, which is more credible than a flat claim that education was understood. Nothing here promises an outcome and no result is claimed for the plan, which keeps the paper inside what a nurse can actually document.
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References

Jarvis, C., & Eckhardt, A. L. (2024). Physical examination and health assessment (9th ed.). Elsevier.

Ostchega, Y., Fryar, C. D., Nwankwo, T., & Nguyen, D. T. (2020). Hypertension prevalence among adults aged 18 and over: United States, 2017-2018 (NCHS Data Brief No. 364). National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db364.htm

U.S. Preventive Services Task Force. (2019). Abdominal aortic aneurysm: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening

U.S. Preventive Services Task Force. (2021a). Colorectal cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

U.S. Preventive Services Task Force. (2021b). Lung cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

U.S. Preventive Services Task Force. (2021c). Prediabetes and type 2 diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes

How this NUR 4033 Module 4 example is structured

In many sections this NUR4033 Module 4 assignment in the Health Assessment course asks for a written assessment of one adult client with the findings interpreted and a screening plan attached; your course instructions and rubric decide the exact form. The example is ordered the way a nurse actually works. It opens with the client profile and the reason for the visit, so the reader knows who is being examined before a single number appears. The second section reports objective findings and reads them against expected ranges, including the findings that are absent. The third section is the screening plan, where every recommendation carries an eligibility rule and an interval instead of a bare name. The last section sets nursing priorities, teaching, and follow-up, so the paper ends with something a nurse could do the next morning.

NUR4033 Module 4 questions, answered

What does NUR4033 Module 4 usually ask for?

American College of Education does not publish deliverable names module by module, so treat this as the common shape rather than a fixed name. In many sections a Module 4 assignment in Health Assessment asks for a written assessment of one adult client, with findings interpreted and a screening or follow-up plan attached. Your course instructions and rubric decide the exact form.

Can I write about a real patient from my own practice?

Write a composite instead. Build the client from patterns you have seen rather than from one chart, and never include a name, an employer, a specific location, or a date of service. The example here says once, in its opening paragraph, that the client and the clinic are composites. That single sentence protects privacy without turning the write-up into a disclaimer.

How do I show that findings were interpreted rather than listed?

Put the meaning next to the measurement in the same paragraph. Say what the number falls inside, what it rules out, and what it changes about the plan. Interpret the normal findings too: a clear chest and no edema in a client with sustained high readings is evidence that damage has not appeared yet, which changes urgency rather than importance.

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