| Course | D117 Advanced Health Assessment for the Advanced Practice Nurse |
|---|---|
| Task | Task 1 |
| Paper type | Documented history and physical examination |
| Length | About 900 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D117 Task 1
Documented History and Examination: Raised Liver Enzymes Found at a Pre-Employment Physical in a 46-Year-Old Dental Laboratory Technician
Student Name
Leavitt School of Health, Western Governors University
D117: Advanced Health Assessment for the Advanced Practice Nurse, Task 1
Course Instructor
Month Day, Year
Documented History and Examination: Raised Liver Enzymes Found at a Pre-Employment Physical in a 46-Year-Old Dental Laboratory Technician
Identifying Data and Chief Complaint
A composite dental laboratory technician, age 46, presents to a primary care clinic as a new patient. He is a reliable historian and came alone. Chief complaint: "My new job's physical said my liver tests were high and I should see someone."
History of Present Illness
Three weeks ago, blood tests at a pre-employment physical showed alanine aminotransferase (ALT) 78 U/L and aspartate aminotransferase (AST) 52 U/L, with normal alkaline phosphatase and bilirubin; he brought the printed report. He feels well. He denies abdominal pain, nausea, vomiting, yellow eyes or skin, dark urine, pale stools, itching, easy bruising, swelling of the legs or abdomen, confusion, fatigue beyond usual and weight loss. He has gained about 9 kg over five years since changing from a physical job to bench work. He has never been told of abnormal liver tests before and has never had them checked. No recent illness, travel, or new medications, herbal products or supplements; he takes no acetaminophen regularly. He had a tattoo placed at age 22 in a licensed studio. No history of blood transfusion or injection drug use.
Past Medical, Family and Social History
Past medical history: told his blood pressure was 'borderline' two years ago, not treated; no diabetes diagnosis; no known lipid tests. Surgical: none. Medications: none regularly. Allergies: none known. Immunizations: completed hepatitis B series as a dental laboratory employee 15 years ago, by his report.
Family history: father with type 2 diabetes who had a myocardial infarction at 62; mother with hypothyroidism; no known liver disease, hemochromatosis or Wilson disease in the family.
Social history: married, two teenage children. Drinks two or three beers on Friday and Saturday evenings, about six drinks a week, and has not had more than four in a day in the past year; Alcohol Use Disorders Identification Test-Concise score 3. Never smoked. Eats fast food for lunch most workdays and drinks two regular sodas a day. Walks the dog 15 minutes most evenings. Occupational exposure to resin and dental acrylic vapors with ventilated work stations.
Review of Systems
General: weight gain as above; no fevers or night sweats. Skin: no jaundice, itching, spider veins or easy bruising. Eyes: no yellowing. Cardiovascular: no chest pain or leg swelling. Respiratory: no shortness of breath; wife reports loud snoring. Gastrointestinal: no abdominal pain, change in bowel habits, black stools or vomiting blood. Genitourinary: no dark urine. Endocrine: no increased thirst or urination. Musculoskeletal: no joint pain. Neurologic: no confusion or tremor.
Physical Examination
Vital signs: blood pressure 142/90 mm Hg, repeated 138/88; pulse 76 and regular; respirations 14; temperature 36.7 C; weight 104 kg, height 180 cm, body mass index 32.1; waist 111 cm.
General: well appearing, in no distress. Skin: no jaundice, spider angiomata, palmar erythema, bruising or excoriations; acanthosis nigricans at the back of the neck. Eyes: sclerae anicteric; no corneal rings on penlight examination. Head and neck: no parotid enlargement; thyroid not enlarged. Chest: clear to auscultation. Heart: regular rhythm, no murmurs.
Abdomen: protuberant, with central adiposity; bowel sounds present; soft and without tenderness; on deep inspiration a smooth, nontender liver edge descends 2 cm beneath the right costal arch; liver span 14 cm by percussion in the right midclavicular line; spleen not palpable and no dullness in Traube's space; no shifting dullness or fluid wave; no caput medusae. Extremities: no edema, no asterixis, no gynecomastia. Neurologic: alert, oriented, speech fluent, no tremor.
Assessment
Asymptomatic, mild elevation of ALT greater than AST, with normal alkaline phosphatase and bilirubin, in a 46-year-old man with class I obesity, central adiposity, acanthosis nigricans, untreated elevated blood pressure, a family history of diabetes and a smooth, enlarged liver without signs of chronic liver disease. Evaluation of raised liver enzymes should confirm the abnormality and look for common causes in a structured way (Kwo et al., 2017).
Differential diagnosis, in order: (1) metabolic dysfunction-associated steatotic liver disease, supported by obesity, central adiposity, likely insulin resistance, hypertension and hepatomegaly with an ALT-predominant pattern; this is the most common cause in this profile (Rinella et al., 2023). (2) Alcohol-related liver disease, less likely with about six drinks a week and an AST lower than ALT, but alcohol may add to injury. (3) Chronic viral hepatitis C or B, possible given a tattoo, though he reports completed hepatitis B vaccination; testing is required. (4) Hereditary hemochromatosis, possible in a middle-aged man. (5) Medication or supplement injury, unlikely with no exposures. (6) Autoimmune hepatitis, Wilson disease and celiac disease, less likely but part of a complete evaluation if the first tests are unrevealing.
Next steps recorded for the plan: repeat liver panel; hepatitis C antibody, hepatitis B surface antigen and surface antibody; iron studies with transferrin saturation and ferritin; fasting glucose or A1C and lipid panel; complete blood count with platelets; and right upper quadrant ultrasound. If steatotic liver disease is confirmed, calculate the Fibrosis-4 index from age, AST, ALT and platelet count to estimate fibrosis risk, as recommended for initial risk stratification (Rinella et al., 2023). Elevated blood pressure and snoring are recorded as additional problems, and physical examination techniques follow a standard reference (Bickley et al., 2021).
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.
Kwo, P. Y., Cohen, S. M., & Lim, J. K. (2017). ACG clinical guideline: Evaluation of abnormal liver chemistries. American Journal of Gastroenterology, 112(1), 18-35. https://doi.org/10.1038/ajg.2016.517
Rinella, M. E., Neuschwander-Tetri, B. A., Siddiqui, M. S., Abdelmalek, M. F., Caldwell, S., Barb, D., Kleiner, D. E., & Loomba, R. (2023). AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 77(5), 1797-1835. https://doi.org/10.1097/HEP.0000000000000323
What the D117 Task 1 instructions ask
The first D117 task asks you to document a comprehensive history and physical examination as an advanced practice nurse would. Most versions ask for identifying data, chief complaint, history of present illness, past medical, family and social history, review of systems, physical examination and an assessment. The patient may be a volunteer or a realistic case, depending on your instructions. Evaluators look for documentation that is complete, organized and precise, with pertinent positives and negatives, correct terminology and an assessment that follows from the findings. A write-up that records only abnormal findings, or that reaches a diagnosis the data do not support, will not meet the documentation standard this course sets.
How this D117 Task 1 example is built
The documentation follows standard order, so a clinician could find any element quickly. The history of present illness includes the laboratory values, their timing and the questions that narrow the cause, such as alcohol intake and medication use. Social history captures occupational exposures relevant to a dental laboratory. The review of systems records negatives that matter, such as no jaundice or itching. The examination documents vital signs, measurements and each system with specific findings, including signs of insulin resistance. The assessment summarizes the key data in one sentence, ranks likely causes and lists the next steps, with sources from liver enzyme guidance and current nomenclature.
Where the D117 Task 1 rubric puts the marks
D117 Task 1 aspects are scored competent, approaching competence or not evident. History aspects check for completeness and relevant detail. A review of systems aspect looks for pertinent positives and negatives. A physical examination aspect rewards specific, accurate findings documented in clinical language. An assessment aspect asks for a conclusion supported by the data, often with differential considerations. Evaluators pay attention to organization and terminology, since documentation is itself the skill being assessed, and they expect guidelines or references to support the assessment and plan. Evaluators notice when pertinent negatives appear in both the review of systems and the examination, since they narrow the differential. An assessment that states the next diagnostic steps, such as repeat enzymes and imaging, shows the documentation serves a clinical purpose.
D117 Task 1 help: what sends it back
Documentation is returned most often when normal findings are summarized as within normal limits. Record what you examined and found. Second, the history of present illness lacks the questions that matter for the complaint; for raised liver enzymes, ask about alcohol, medications, supplements and risk factors. Third, the assessment jumps to one diagnosis. Rank the possibilities and explain why one leads. Fourth, social history omits occupation and exposures that can change the differential. Finally, remove identifying details from any real volunteer and follow your program's rules about who may be examined for this task. Use one consistent format for every system.
Get a D117 Task 1 example written to your instructions
Send the D117 Task 1 instructions and the rubric aspects your course of study lists, together with any patient scenario, template or documentation format you were told to use. We write a custom example to those aspects, documented so the findings and the assessment support each other, and return it in 24-48h. The first custom sample is free.
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D117 Task 1 questions, answered
Does D117 Task 1 require a real patient?
Read your instructions, since versions differ and some pair the written work with an observed or recorded encounter. Where a written case is permitted, a composite patient is safer and usually clearer. Recorded encounters, skills check-offs and preceptor attestations belong to you and stay with you, and only a written example is ever ours to produce.
How much detail belongs in the physical examination?
Enough on the systems the complaint implicates, and honest brevity elsewhere. An evaluator reading for a focused and complete examination wants the cardiovascular and respiratory findings in detail when the complaint is chest discomfort, and does not need three lines on the integument. Document what a directed examination would cover, and describe every finding you claim to have elicited.
Can I use a documentation template from work?
Check your instructions before importing anything, and be aware that templates are the reason many submissions come back. Prefilled normals and autotext phrases read as unexamined, and an aspect asking for specific findings cannot be met by defaults. If a format is required, keep the headings and write every line underneath them yourself.
Does D117 Task 1 require a real patient?
Follow your instructions; many versions allow a volunteer or a realistic case. Whatever you use, document completely and remove identifying details, as the sample does with its composite technician.
Where can I find a free D117 Task 1 sample paper?
The full history and examination write-up is on this page with commentary. Share your D117 task and case, and the first tailored documentation example is written free.