| Course | D117 Advanced Health Assessment for the Advanced Practice Nurse |
|---|---|
| Task | Task 2 |
| Paper type | Focused assessment write-up |
| Length | About 1,300 words, 5 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D117 Task 2
Focused Musculoskeletal and Neurologic Assessment: Right Lower Extremity Radicular Pain in a 47-Year-Old Warehouse Order Picker
[Author Name]
Leavitt School of Health, Western Governors University
D117 Advanced Health Assessment for the Advanced Practice Nurse
Task 2
[Course Instructor]
August 11, 2026
Composite case written as a model document. No real patient, employer or clinician is described.
Subjective
Chief complaint, in the patient's own words: 'My back grabbed when I lifted a case eleven days ago, and now the pain runs down my right leg into my foot.' The patient is a 47-year-old man who works as an order picker in a distribution warehouse and lifts cartons of 15 to 20 kg for most of an eight hour shift. The pain began suddenly as he lifted a carton from floor level with a twist to the right. It sits in the right lower back and buttock at rest and travels down the posterior thigh, along the lateral calf, and into the space between the first and second toes. He rates it 4 out of 10 at rest and 8 out of 10 on standing from a chair or on coughing.
Sitting for more than twenty minutes, coughing, sneezing and forward bending make the leg pain worse; lying supine with the hips and knees flexed and walking short distances make it better. He has taken ibuprofen 400 mg three times daily for nine days with partial relief and has missed four shifts. He describes numbness along the outer right calf and the top of the foot, and says his right foot has slapped the floor twice on stairs. He denies bowel or bladder incontinence, urinary retention, saddle numbness, weakness in both legs, fever, chills, night sweats, unexplained weight loss, any history of cancer, injected drug use, recent spinal procedure, and pain that wakes him from sleep or is unrelieved by any position.
History includes obesity with a stable weight of 104 kg, hypertension treated with lisinopril 10 mg daily, and one earlier episode of back pain without leg symptoms six years ago that resolved in ten days. He takes no anticoagulant and no corticosteroid, has no known drug allergies, has never smoked, drinks alcohol twice a month, and has had no surgery. Family history includes hypertension in both parents and no inflammatory arthritis. Pertinent review of systems: constitutional negative for fever and weight change; musculoskeletal positive for right leg pain and negative for morning stiffness beyond an hour, joint swelling and groin pain; neurologic positive for numbness and a sense of weakness in the right foot and negative for falls and bladder change; vascular negative for calf cramping that comes on with walking and eases on standing still.
Objective
Vital signs: temperature 36.8 C oral, blood pressure 138/84 mm Hg, heart rate 78 beats per minute and regular, respiratory rate 16 breaths per minute, oxygen saturation 98 percent on room air, height 178 cm, weight 104 kg, body mass index 32.8. General appearance: alert and in no distress at rest, shifting weight off the right leg when standing, and rising from the chair with both hands on the armrests. Inspection of the back shows loss of the normal lumbar lordosis and a list away from the right side, with no midline step off, no skin lesion, no scar and no swelling. Palpation reproduces tenderness over the right paraspinal muscles from L4 through S1, without midline vertebral tenderness and without sacroiliac tenderness.
Lumbar range of motion: flexion to 40 degrees limited by right leg pain, extension to 15 degrees with local back pain only, and lateral bending to 20 degrees on each side. Motor testing: right great toe extension 4/5, right ankle dorsiflexion 4/5, right ankle plantar flexion 5/5, right knee extension 5/5, hip flexion 5/5, and all left lower extremity groups 5/5. He cannot hold a heel walk on the right beyond three steps, while toe walking is intact on both sides. Sensation to light touch and pinprick is reduced over the right lateral calf and dorsal foot including the first web space, and is intact elsewhere. Deep tendon reflexes are 2+ at both patellae and 2+ at both Achilles tendons, with no clonus and downgoing plantar responses.
Provocative maneuvers: passive straight leg raise on the right reproduces the radiating leg pain at 40 degrees and is relieved by knee flexion, and ankle dorsiflexion at 35 degrees reproduces it again. Left straight leg raise at 70 degrees reproduces pain in the right leg, a positive crossed straight leg raise. Slump testing on the right reproduces the same radiation and eases when the neck is extended. Hip examination is unremarkable, with full internal rotation, a negative FABER maneuver on both sides and no groin pain on any hip movement. Sacroiliac compression and distraction are negative. Dorsalis pedis and posterior tibial pulses are 2+ on both sides, capillary refill is under two seconds, and both calves are soft, symmetric and nontender. Abdominal examination shows no pulsatile mass and no bruit.
Impression and Diagnostic Reasoning
Working impression: acute right L5 radiculopathy, most consistent with a lateral disc herniation at L4-L5, of eleven days duration and without red flag features. Every element of that statement rests on data already on the page. The reported pain follows the L5 dermatome from buttock to lateral calf to first web space, and sensory testing is reduced over exactly that strip. The reported foot slap matches measured dorsiflexion and great toe extension of 4/5, while plantar flexion and the Achilles reflex remain normal, which places the lesion at L5 rather than S1. Symptoms worsen with sitting, coughing and flexion, all of which raise intradiscal and intrathecal pressure, and ease with hip and knee flexion, which slackens the nerve root.
The provocative maneuvers were chosen to test that impression rather than to fill a template. A straight leg raise that reproduces radiating pain between 30 and 70 degrees is sensitive for root tension but not specific, so a positive result on its own would not carry the conclusion. The crossed straight leg raise does the heavy work here: it is considerably more specific for a herniated disc compressing a nerve root, and a left sided lift that reproduces right sided symptoms is difficult to explain by muscular strain. Slump testing agrees with both, and the fact that it eases when cervical extension reduces neural tension gives a third independent read on the same structure.
The alternatives are dismissed by named findings rather than by assertion. Lumbar muscle strain would explain paraspinal tenderness and reduced flexion, but not dermatomal sensory loss, a myotomal motor deficit or a positive crossed straight leg raise. Hip osteoarthritis is excluded by full internal rotation, a negative FABER maneuver and the absence of groin pain. Sacroiliac dysfunction is excluded by negative compression and distraction with no sacroiliac tenderness. Peripheral arterial disease is unlikely with 2+ distal pulses, warm feet and pain that is worse with sitting rather than with walking. Neurogenic claudication from spinal stenosis stays on the list but sits lower, since stenosis pain usually builds with extension and walking and eases with flexion, and this pattern is the reverse.
Cauda equina syndrome is the one diagnosis that would change everything within hours, and it is answered directly: no saddle anesthesia, no urinary retention or incontinence, no fecal incontinence, no weakness in both legs, and normal reflexes with downgoing plantar responses. Fracture, infection and malignancy are equally unsupported by the history and by the examination. Because no red flag is present, routine imaging in the first 42 days would not change this impression, while a rapidly progressive motor deficit, a new bladder change or a fever would each move the case to same day imaging. The single number worth tracking is the right dorsiflexion grade, since a fall from 4/5 toward 3/5 turns a conservative course into a surgical conversation.
References
Agency for Healthcare Research and Quality. (2020). Noninvasive nonpharmacological treatment for chronic pain: A systematic review update (Comparative Effectiveness Review No. 227). U.S. Department of Health and Human Services. https://effectivehealthcare.ahrq.gov/
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 Neurological Disorders and Stroke. (2023). Low back pain. U.S. Department of Health and Human Services, National Institutes of Health. https://www.ninds.nih.gov/health-information/disorders/back-pain
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530. https://doi.org/10.7326/M16-2367
What the D117 Task 2 instructions ask
The second D117 task asks you to perform and document a focused assessment for a specific complaint. Most versions ask for subjective data, objective findings from the relevant systems, and an impression with diagnostic reasoning. The examination should be focused but thorough within its scope, using special tests appropriate to the complaint. Evaluators look for subjective and objective sections that agree with each other, findings documented precisely enough to localize the problem, and reasoning that explains why the leading diagnosis fits and why serious alternatives are less likely. A focused write-up that omits red flag screening for back pain would miss a safety element the course expects. Most versions expect the reasoning to be written out, not implied.
How this D117 Task 2 example is built
The write-up opens with the chief complaint in quotation marks, then a history organized around onset, location, radiation, severity and modifying factors. Red flags are addressed explicitly, from bowel and bladder symptoms to fever and weight loss. The objective section begins with vital signs, then documents inspection, palpation, range of motion, straight leg raise, sensation by dermatome, reflexes and strength by myotome. The impression names the level and side and explains which findings point to L5. A short differential explains why other causes, such as hip pathology or cauda equina syndrome, are unlikely, and the reasoning cites current guidance on low back pain with radicular symptoms.
Where the D117 Task 2 rubric puts the marks
D117 Task 2 aspects are rated competent, approaching competence or not evident. A subjective aspect checks for a focused, relevant history with red flag screening. An objective aspect looks for appropriate examination techniques and precise documentation. An impression aspect wants a working diagnosis supported by the findings. A reasoning aspect rewards explanation of how the data point to the diagnosis and away from alternatives. Evaluators check that subjective and objective data are consistent and that special tests are named and interpreted correctly, and they expect current clinical sources for the reasoning. Evaluators also check that each special test is named correctly, performed on the right side and interpreted, since a positive or negative result without meaning adds nothing. Localization to a nerve root level earns credit when several findings agree.
D117 Task 2 help: what sends it back
Focused write-ups come back most often when the subjective and objective sections contradict each other, such as a history of numbness with normal sensation recorded without comment. Reconcile them or explain the difference. Second, special tests are listed without results or interpretation. Third, red flags are omitted; for back pain, document their absence explicitly. Fourth, the impression lacks localization. Name the level and side and the findings that support it. Finally, keep the examination focused. Documenting every body system is not required, but the systems that bear on the complaint must be complete. Keep a dermatome chart beside you while writing.
Get a D117 Task 2 example written to your instructions
This paper is an original model document written by our desk, not a submitted student paper and not an official Western Governors University 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.
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D117 Task 2 questions, answered
What does D117 Task 2 usually ask for?
In many versions this task asks for a focused history and physical write-up on one presenting problem, documented in a standard clinical format and closed with an impression the data support. Some versions supply the patient scenario and some ask you to build one. Read your own task instructions and rubric aspects, since required sections and documentation style vary by version.
How do I keep the subjective and objective sections from contradicting each other?
Write the objective section against the subjective section, item by item. Every symptom reported should have a maneuver, a measurement or a documented negative that answers it, and no finding should appear that the encounter did not produce. If a reported numbness has no sensory testing behind it, an evaluator sees a gap, and the impression built on it cannot hold.
Can I submit this write-up as my own work?
No. This is an original model document written by our desk to show what a finished focused write-up looks like. It was never submitted and it received no score. Use it to see how the three sections lock together, then document your own encounter in your own words against the rubric aspects your evaluator will use.
What does D117 Task 2 usually ask for?
A focused history and examination for one complaint, documented with an impression and diagnostic reasoning. The sample assesses radicular leg pain after a lifting injury in a warehouse worker.
Where can I find a free D117 Task 2 sample paper?
The focused assessment is reproduced above in full with notes. For a write-up on your own complaint, send the D117 instructions and your first custom version costs nothing.