| Course | NSG 521 Fundamental Concepts and Health Assessment |
|---|---|
| Unit | Unit 3 |
| Paper type | Review of systems record |
| Length | About 840 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NSG 521 Unit 3
Review of Systems for a Man Admitted With Pneumonia: What He Confirmed, What He Denied, and Why the Denials Matter
Student Name
Department of Nursing, Herzing University
NSG 521: Fundamental Concepts and Health Assessment
Instructor Name
February 5, 2026
Review of Systems for a Man Admitted With Pneumonia: What He Confirmed, What He Denied, and Why the Denials Matter
Patient and Method
Mr. Walker, the composite 64-year-old man admitted with community-acquired pneumonia, was asked about each body system in the order taught in the course, on his second hospital day. His answers are recorded in reported speech, as he gave them, with his wife's additions marked. Questions were asked about the past month unless stated. After each system, a sentence notes which answers matter most for his care and why. A review of systems is a list of what the patient reports, not of what the examiner finds; findings are recorded separately (Bickley et al., 2021).
General
Confirms fever up to 101 at home, chills, and fatigue for about a week. Confirms about 5 pounds lost in the past week, which he attributes to not eating. Denies night sweats. Denies unplanned weight loss before this illness.
Why it matters: the absence of night sweats and of weight loss before the illness makes a slower process, such as tuberculosis or cancer, less likely in a former heavy smoker, though the chest imaging follow-up will address this further.
Skin
Denies rashes, new lesions, or itching. Denies easy bruising.
Head, Eyes, Ears, Nose, and Throat
Confirms a runny nose and sore throat at the start of the illness, now resolved. Denies ear pain, vision changes, or headache.
Respiratory
Confirms cough for eight days, producing rust-colored sputum. Confirms sharp right-sided chest pain with deep breaths. Confirms breathlessness when walking to the bathroom now. Confirms, before this illness, three months of breathlessness climbing one flight of stairs, which he had not mentioned before being asked. Denies coughing up bright red blood. Denies wheezing.
Why it matters: pleuritic pain and rust-colored sputum fit the current pneumonia (Metlay et al., 2019). The three months of exertional breathlessness before the illness is not explained by pneumonia and needs follow-up after recovery.
Cardiovascular
Denies chest pressure or pain with exertion before this illness. Denies waking at night short of breath. Denies needing extra pillows to breathe at night; sleeps on one pillow. Denies swelling of the ankles. Denies palpitations. His wife adds that he has been "slowing down on the stairs" since the fall.
Why it matters: the three months of exertional breathlessness raise the possibility of heart disease, but the denials of orthopnea, waking at night breathless, and ankle swelling make heart failure less likely. These denials do not exclude it, and they will be weighed with the examination and later tests.
Gastrointestinal
Confirms poor appetite and mild nausea this week. Denies vomiting. Denies black or tarry stools. Denies blood in the stool. Denies abdominal pain.
Why it matters: a week of ibuprofen, four doses daily, raises the question of bleeding. The denial of black stools and abdominal pain makes a bleeding ulcer less likely, which is important because nonsteroidal drugs can cause gastrointestinal bleeding.
Genitourinary
Confirms urinating less than usual in the last few days. Denies pain on urination. Denies blood in the urine.
Why it matters: reduced urination with poor intake, ibuprofen, and lisinopril together raises concern for kidney injury, which his laboratory results will show.
Musculoskeletal and Neurological
Confirms generalized aches with the fever. Denies calf pain or swelling. Denies weakness on one side, numbness, or confusion; his wife agrees he has not been confused.
Why it matters: the denial of calf pain and swelling makes a blood clot less likely as a cause of chest pain and breathlessness, though his risk is raised by bed rest; his mobility is being encouraged.
Endocrine, Hematologic, and Psychological
Denies excessive thirst or urination. Denies history of anemia or bleeding problems. Confirms worry about "being stuck in the hospital"; denies low mood before the illness; sleeping poorly because of cough.
How the Questions Were Asked
Two techniques shaped the answers. First, each symptom was asked about in plain words rather than clinical terms: "Do you wake up at night gasping for air?" rather than asking about paroxysmal nocturnal dyspnea, and "Have your stools been black, like tar?" rather than asking about melena. Second, where a denial would change the plan, it was confirmed with a follow-up: when he said his ankles did not swell, he was asked whether his shoes or socks had felt tight by evening, and he again said no. His wife was invited to add anything she had noticed at the end of each system, which produced the one addition about the stairs. The whole review took about 12 minutes, paused once for a coughing spell.
Summary of the Pertinent Findings
Pertinent positives: productive cough with rust-colored sputum, pleuritic right chest pain, fever, reduced intake and urination, and three months of exertional breathlessness before the illness. Pertinent negatives: no night sweats or prior weight loss, no orthopnea or ankle swelling, no black stools despite daily ibuprofen, no calf pain, no confusion. Each negative narrows a different possibility, and each was asked on purpose because of something in his history (Jarvis, 2020).
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.
Jarvis, C. (2020). Physical examination & health assessment (8th ed.). Elsevier.
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581ST
Reading the NSG 521 Unit 3 instructions
Unit 3 asks you to record a review of systems for one patient. You will describe the patient and method, record what was confirmed and denied for each system, explain how questions were asked and summarize pertinent positives and negatives. Students often ask how many systems to cover and why denials matter. Cover every system, even briefly. Denials matter because they rule out alternative diagnoses or complications, such as no calf pain making a clot less likely in a breathless patient. Ask about one symptom at a time in plain words. Record the patient's own descriptions where useful. The summary should show which positives and negatives shape care.
Inside the NSG 521 Unit 3 example
The record opens with the patient and how the review was conducted: at the bedside, after the history, with his wife present for part of it. Each system has a short entry beginning with confirms or denies, so the reader can scan quickly. The respiratory entry describes cough, rust-colored sputum and pleuritic pain on the right. The cardiovascular entry records denials that lower concern for heart disease as the cause of his breathlessness. The genitourinary entry notes less urine, which links to his fluid status. The method section explains asking one symptom at a time in plain words. The summary lists pertinent positives and negatives with a sentence on why each matters, which turns a long list into clinical reasoning.
NSG 521 Unit 3 rubric: what full points look like
Herzing's rubric for a review of systems record usually covers completeness, accuracy of terms, the method of questioning, pertinent positives and negatives and their clinical meaning. The summary of pertinent negatives is where graders look hardest, because it shows the student knows why a denial earns a place in the record. Completeness points reward every system, even when brief. Term criteria look for accurate words, such as pleuritic or hemoptysis, used only when they fit. Method points go to plain-language questions asked one symptom at a time. Clinical meaning earns credit when each pertinent finding is linked to a diagnosis or complication. A consistent confirms and denies format helps. The IDSA community-acquired pneumonia guideline supports the reasoning.
NSG 521 Unit 3 help before you submit
Review of systems records in Unit 3 often slip by listing only positive findings, which hides what was ruled out. Another frequent problem is asking several symptoms in one question, which yields a single no that covers too much. Students often skip systems that seem unrelated, such as skin or psychological. Pertinent negatives are recorded but not explained. The patient's own words are lost. The summary is missing. Clinical terms are applied without checking, such as calling any sputum purulent. Duration of symptoms is left out. Weight loss is not quantified. Finally, explain why each denial matters, because graders reward a record that uses negatives to narrow the diagnosis.
Get a NSG 521 Unit 3 example written to your instructions
Send the Unit 3 instructions and the rubric from your NSG 521 classroom, together with the presenting complaint the record should sit under. We write a custom example that restates the complaint first, groups the pertinent denials beside it, keeps reported speech throughout and marks the unasked systems as unasked. First custom sample free, returned inside 24 to 48 hours.
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NSG 521 Unit 3 questions, answered
What makes a negative pertinent?
Its capacity to change the reading of something already in the record. A denial matters when a yes would have moved the interpretation of the complaint, and a good test is whether you could say in one sentence what the no rules out or makes less likely. Denials failing that test still belong under coverage, but they do not earn a place beside the presenting problem.
Should every system be included?
Follow the instructions, which in many sections ask for a full pass in an early unit and a focused one later. Where the instructions leave it open, cover what the complaint touches thoroughly and mark the rest honestly as not asked. Instructors generally read a truthful gap as better control of the record than a complete-looking file nobody could have gathered in the time available.
Can findings from an examination go in the same document?
Only in a separate, clearly labeled section, and many sections keep them in different deliverables entirely. The distinction is the point of the unit: one column holds what a person reports about themselves and the other holds what somebody else observed, and readers who cannot tell which is which stop trusting either. Keep the boundary visible even when the assignment combines them.
Where can I find a free NSG 521 Unit 3 sample paper?
The full NSG 521 Unit 3 review of systems record is free on this page, confirmed and denied symptoms with pertinent findings summarized. Send your interview notes for a custom systems review.
What is a pertinent negative in nursing assessment?
A symptom the patient denies that matters because it makes another diagnosis less likely, such as no calf pain in a breathless patient lowering concern for a blood clot. This sample summarizes pertinent negatives for a man with pneumonia.