| Course | NU 610 Advanced Health Assessment |
|---|---|
| Unit | Unit 2 |
| Paper type | Focused examination write-up |
| Length | About 1,180 words, 7 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 610 Unit 2
Focused Musculoskeletal Examination of the Right Knee After a Twisting Injury
Student Name
Department of Nursing, Herzing University
NU 610: Advanced Health Assessment
Instructor Name
February 16, 2026
Focused Musculoskeletal Examination of the Right Knee After a Twisting Injury
Reason for the Focus
A 34-year-old man presents two days after injuring his right knee while playing pickup basketball. He reports planting his right foot and pivoting to the left, hearing a pop, and being unable to continue playing. Swelling developed within about two hours. He has been walking with a limp and has not used crutches. This composite patient was built for teaching. The complaint selects the knee as the focus, and the examination below is limited to the right knee, the left knee for comparison, and the neurovascular status of both lower legs. The selection of maneuvers follows the evidence that history plus a small number of named tests gives most of the diagnostic information available at the bedside for knee ligament and meniscal injury (Solomon et al., 2001).
General Survey and Vital Signs
Alert, well-appearing adult man in mild discomfort, seated on the examination table with the right knee held in about 20 degrees of flexion. He walked into the room with a shortened stance phase on the right and did not bear full weight through the right heel. Temperature 98.4 F oral, heart rate 76 and regular, blood pressure 124/78 left arm seated, respirations 14, oxygen saturation 99 percent on room air. He rates current pain at 5 out of 10 at rest and 7 out of 10 with weight bearing.
Inspection
Patient supine, both legs exposed from mid-thigh to feet. The right knee is visibly swollen compared with the left, with loss of the normal hollows on both sides of the patellar tendon on the right; the left knee hollows are preserved. No bruising, abrasion, laceration, or erythema on either knee. Quadriceps contour is symmetric at rest. Both legs are aligned without varus or valgus deformity. The right patella sits in the midline and is not displaced laterally.
Patient standing, weight shifted mostly onto the left leg: the right knee does not fully straighten, and the patient declines to squat. Gait across the room is antalgic, with the right step shorter than the left and the right knee held stiffly through the swing phase. No locking episode occurred during the walk, and the patient reports that the knee has not locked since the injury, although it has felt as if it might give way on stairs.
Palpation
Patient supine, knees extended as far as tolerated. Skin temperature over the right knee, assessed with the back of the hand, is slightly warmer than over the left. Ballottement of the right patella with suprapatellar pressure produces a clear tap against the femur; the left patella does not ballot. A bulge sign is not reliable on the right because of the size of the effusion, and is absent on the left.
With the right knee flexed to about 90 degrees as tolerated, there is tenderness along the medial joint line, most marked at the posterior third, and no tenderness along the lateral joint line. The left medial and lateral joint lines are nontender. There is no tenderness at the right patella, the head of the fibula, or the tibial tubercle. The right medial collateral ligament is nontender along its length; the left is nontender.
Range of Motion
Active range of motion, patient supine: right knee from minus 10 degrees of extension to 95 degrees of flexion, limited by pain and a feeling of tightness at the back of the knee; left knee from 0 to 140 degrees without pain. Passive range on the right reaches minus 5 degrees of extension, with a firm but not springy end feel, and 105 degrees of flexion. The patient can perform a straight leg raise on both sides without an extension lag.
Patellar mobility, patient supine with the knee extended and the quadriceps relaxed: the right patella glides medially and laterally about one quarter of its width, limited by the effusion, and the left glides about one half of its width. The patellar apprehension test is negative on both sides, with no guarding when the patella is pushed laterally.
Special Tests
Lachman test, patient supine with the right knee at about 25 degrees of flexion, examiner stabilizing the distal femur and drawing the proximal tibia forward: increased anterior translation on the right compared with the left, with a soft end point on the right and a firm end point on the left. The Lachman test was chosen as the lead ligament maneuver because it is more sensitive for anterior cruciate ligament rupture than the anterior drawer in the acutely swollen knee (Benjaminse et al., 2006). Anterior drawer at 90 degrees of flexion could not be completed on the right because the patient could not reach 90 degrees without guarding; it was firm on the left.
Valgus stress, patient supine, at 0 and 30 degrees of flexion: no medial joint line opening on the right or left at either angle. Varus stress at 0 and 30 degrees: no lateral opening on either side. Posterior drawer at 90 degrees on the left: firm; not attempted on the right for the reason above. McMurray test, right knee, with external rotation and valgus during extension: reproduces pain at the posterior medial joint line, without a palpable click; negative on the left. The Thessaly test was not performed because the patient could not bear single-leg weight on the right.
Neurovascular Examination
Pedal pulses were palpated with the patient supine: the dorsalis pedis and the posterior tibial pulse each measure 2+ on the right and 2+ on the left, with no difference between sides. Capillary refill in the toes is under 2 seconds on both feet. Light touch sensation is intact and equal over the dorsum of the foot, the first web space, the lateral foot, and the sole bilaterally, which covers the superficial peroneal, deep peroneal, sural, and tibial nerve territories. Ankle dorsiflexion and plantar flexion strength is 5 out of 5 bilaterally. Calves are soft and nontender on both sides, and calf circumference measured 10 cm below the tibial tubercle is 38 cm on the right and 38 cm on the left.
Pertinent Negatives and Summary
No deformity, no bony point tenderness at the patella or fibular head, full ability to flex past 90 degrees passively, and the ability to take four steps into the room mean that none of the Ottawa knee rule criteria is met, so plain radiography is not indicated on that basis (Stiell et al., 1996). There is no collateral ligament laxity at either angle and no neurovascular deficit. The single interpretive statement for this record is that the combination of a pivoting mechanism with an audible pop, rapid effusion, increased Lachman translation with a soft end point, and posterior medial joint line pain on McMurray testing is consistent with an anterior cruciate ligament injury with a possible associated medial meniscal injury, to be confirmed by further evaluation.
Documentation standard applied throughout: each finding names the position and the technique that produced it, paired structures carry a side and are compared, and descriptive terms replace the words normal and unremarkable, consistent with Bickley et al. (2021).
References
Benjaminse, A., Gokeler, A., & van der Schans, C. P. (2006). Clinical diagnosis of an anterior cruciate ligament rupture: A meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 36(5), 267-288. https://doi.org/10.2519/jospt.2006.2011
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.
Solomon, D. H., Simel, D. L., Bates, D. W., Katz, J. N., & Schaffer, J. L. (2001). Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA, 286(13), 1610-1620. https://doi.org/10.1001/jama.286.13.1610
Stiell, I. G., Greenberg, G. H., Wells, G. A., McDowell, I., Cwinn, A. A., Smith, N. A., Cacciotti, T. F., & Sivilotti, M. L. (1996). Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA, 275(8), 611-615. https://doi.org/10.1001/jama.1996.03530320035031
What the NU 610 Unit 2 instructions ask for
The Unit 2 instructions ask for a focused physical examination of one body system or region chosen because of a stated complaint. You are expected to explain why the exam was limited to that region, then record findings in the order inspection, palpation, range of motion or percussion and auscultation as appropriate, and any special tests. Each finding should be an observation, not a label such as normal or within limits. Many prompts ask for both sides to be compared, and for the patient position and the technique to be named for each test. A short summary of pertinent negatives is common, along with a statement about what the findings support. Use a scenario or composite person rather than a real patient. The format is usually a written record with APA references for the techniques, and the length is set in the classroom rubric.
How this NU 610 Unit 2 example is built
The sample opens with the mechanism of injury in two sentences so the reader knows why only the knee was examined. A general survey notes the antalgic gait and the knee held in slight flexion before any vital sign is listed. Inspection compares both knees and records the lost hollows beside the patellar tendon, which points to fluid. Palpation adds warmth, a positive ballottement and tenderness along the joint line. Range of motion gives degrees for each knee, active and passive, with the reason for each limit. Special tests are written with position and technique: the Lachman shows more forward translation on the right with a soft end point. A neurovascular section grades pulses and capillary refill. The close explains why none of the Ottawa criteria is met, so plain films are not ordered, and states what the findings support.
NU 610 Unit 2 rubric: what full points look like
Points in a Herzing focused exam rubric usually sit in five places: rationale for the focus, accuracy and order of the technique, descriptive documentation, interpretation and writing. The rationale criterion rewards a clear link between the complaint and the region examined. Technique points require each step in the accepted sequence with patient position named, especially for special tests where position changes the result. Documentation is the criterion most markers read closely, and full points go to findings that are measured or described, such as degrees of motion and pulse grades, rather than called normal. Interpretation earns credit when the write-up states what the findings support and applies a decision rule correctly. Comparing the injured side with the other side is often part of this score. Writing points cover clinical terms, consistent abbreviations and citations for techniques taken from an assessment text.
NU 610 Unit 2 help: mistakes that cost points
Many students lose points by examining the whole body when the assignment asks for a focus, which buries the relevant findings. Others write "knee normal except swelling," a phrase that tells the reader nothing that can be compared later. Special tests are frequently named without the position or the end feel, so a grader cannot tell whether the test was done properly. Leaving out the uninjured side is another regular deduction, because asymmetry is the finding that matters. Some write-ups state a diagnosis such as a torn ligament as if it were confirmed, when an exam alone only supports a working impression. The neurovascular check below the injury is easy to forget and almost always on the rubric. Finally, avoid listing ranges of motion without numbers; a degree value turns an opinion into something measurable.
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NU 610 Unit 2 questions, answered
Which system should the focused write-up cover?
Whatever your instructions name. When the choice is open, pick the system your case actually points at, since a focused record is judged on the fit between the complaint and the examination performed. Cardiovascular, respiratory, abdominal and neurological all give you enough maneuvers to document properly. A system with three findings in it leaves the technique criterion with almost nothing to reward.
Is it acceptable to document a finding as normal?
In practice such shorthand survives; in this course it costs points. The record is being read for whether an examination happened, and the word normal is compatible with never having looked. Write what you saw, heard or felt, then let the closing interpretation say it was expected. If your instructions supply an approved template that uses shorthand, follow the template and describe inside it.
Do I have to examine a real person for this?
Read your instructions, since sections differ. Some supply a case, some allow a consenting volunteer, and some ask you to document practice done in lab. Any examination you perform on a real patient, together with your clinical hours and the paperwork your preceptor signs, stays yours and is never drafted for you. What sits on this page is the finished shape of the record.
Where can I find a free NU 610 Unit 2 sample paper?
You are reading it: this page shows the full NU 610 Unit 2 knee examination record, with the special tests, neurovascular check and Ottawa rule written out and margin notes beside each part. If your instructor named a different region, request a custom focused exam built on that complaint and it is delivered free within about two days.
What should a focused exam write-up include for NU 610?
It should give the reason for the focus, a brief general survey and vital signs, then inspection, palpation, range of motion and special tests for one region, both sides compared. End with pertinent negatives and a short statement of what the findings support, without claiming a confirmed diagnosis.