NRP 571 | Advanced Health Assessment & Diagnostic Reasoning Craig Harris | Episodic SOAP Note & Reflection
NRP 571 — Advanced Health Assessment and Diagnostic
Reasoning
Episodic SOAP Note and Reflection Assignment — Craig Harris Case
Comprehensive 100-Question Exam | 2026/2027 Latest Update | Complete Solutions with Rationales
Clinical Case Vignette — Craig Harris: Craig Harris is a 47-year-old African American male who presents to the
primary care clinic for an episodic follow-up visit. His chief complaint is: "I've been feeling tired for the past three
weeks, and my home blood pressure readings have been running high." Craig has a past medical history of hypertension
(diagnosed 5 years ago), hyperlipidemia, and obesity. Current medications include lisinopril 20 mg daily,
hydrochlorothiazide 12.5 mg daily, atorvastatin 40 mg daily, and aspirin 81 mg daily. He has no known drug allergies.
He smokes approximately one-half pack per day and works as an office manager. Vital signs: BP 154/96, HR 82, RR
16, T 98.4 °F, SpO2 99% on RA, BMI 32.4. Pertinent labs: A1c 6.2%, LDL 118 mg/dL, HDL 38 mg/dL, triglycerides
180 mg/dL. Primary assessment: uncontrolled primary hypertension (I10), hyperlipidemia (E78.5), prediabetes
(R73.03), obesity (E66.01), and tobacco use disorder (F17.210). All questions on this exam reference the Craig Harris
case unless explicitly stated.
SECTION 1: SOAP Note Structure and Documentation Standards (Subjective, Objective,
Assessment, Plan, & Formatting)
Q1: In advanced practice nursing documentation, the acronym SOAP represents which four components of
an episodic visit note?
A. Subjective, Objective, Action, Plan
B. Subjective, Objective, Assessment, Plan [CORRECT]
C. Symptoms, Observations, Assessment, Prescriptions
D. Subjective, Objective, Analysis, Procedure
Correct Answer: B
Rationale: SOAP stands for Subjective, Objective, Assessment, and Plan — the four pillars of episodic visit documentation
established by Lawrence Weed in the 1960s and still the standard for advanced practice nursing documentation in 2026/2027.
The Subjective section captures patient-reported data, Objective contains measurable findings, Assessment synthesizes clinical
reasoning, and Plan outlines management. Options A, C, and D substitute inaccurate words ("Action," "Prescriptions,"
"Analysis," "Procedure") that are not part of the SOAP framework and would misrepresent documentation structure.
Q2: Craig Harris presents for an episodic follow-up focused on uncontrolled hypertension and fatigue. Which
statement BEST distinguishes an episodic SOAP note from a comprehensive visit note?
A. Episodic notes require a complete 14-system ROS, while comprehensive visits focus only on the chief complaint
system
B. Episodic notes are problem-focused with history limited to the chief complaint and pertinent systems, whereas
comprehensive visits include a complete history and multisystem examination [CORRECT]
C. Episodic notes omit the Assessment section, while comprehensive notes require a full differential diagnosis list
D. Episodic notes are only used for acute visits, while comprehensive notes are required for every chronic disease
follow-up
Correct Answer: B
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 1
,NRP 571 | Advanced Health Assessment & Diagnostic Reasoning Craig Harris | Episodic SOAP Note & Reflection
Rationale: Episodic documentation is problem-focused: the history, exam, and MDM center on the chief complaint and
pertinent positive/negative systems, supporting lower-tier E/M codes (99212–99214). Comprehensive visits require a complete
history (HPI, PMH, PSH, meds, allergies, FH, SH, complete ROS), a comprehensive multisystem exam, and high-complexity
MDM (99215 for established patients). Option A reverses the ROS requirement; option C incorrectly removes Assessment from
episodic notes; option D conflates visit acuity with documentation type.
Q3: When documenting the Subjective section of Craig Harris's SOAP note, which information is MOST
appropriate to include?
A. Physical examination findings, vital signs, and laboratory results
B. Chief complaint, HPI, PMH, medications, allergies, family/social history, and ROS [CORRECT]
C. Primary diagnosis, ICD-10 codes, and differential diagnoses
D. Diagnostic orders, pharmacologic plan, and return precautions
Correct Answer: B
Rationale: The Subjective section captures everything the patient (or caregiver) reports: CC, HPI with OLDCARTS elements,
PMH, PSH, hospitalizations, current medications, allergies, family and social history, and review of systems. Option A belongs
in Objective; option C belongs in Assessment; option D belongs in Plan. Mixing these elements violates SOAP structure and may
result in denial of billing claims, because auditors cannot verify the level of service from properly compartmentalized
documentation.
Q4: Which entry is appropriately documented in the Objective section of Craig Harris's SOAP note?
A. "Patient reports fatigue for three weeks" (verbatim patient statement)
B. "BMI 32.4 indicating obesity based on CDC criteria" (interpretation)
C. "BP 154/96, HR 82, BMI 32.4; cardiovascular exam reveals regular rate and rhythm without murmurs"
[CORRECT]
D. "Patient likely has uncontrolled hypertension requiring medication adjustment" (assessment)
Correct Answer: C
Rationale: The Objective section contains measurable, reproducible findings: vital signs, general survey, and physical
examination data by body system, plus any diagnostic test results available at the visit. Option A is subjective patient-reported
data; option B mixes Objective with interpretive Assessment; option D is an Assessment statement. Objective data must be
factual, observable, and free of interpretation so that any clinician reviewing the note can independently verify the findings.
Q5: When writing the Assessment section of Craig Harris's SOAP note, the FNP should:
A. List only the primary diagnosis with its ICD-10 code; defer all differentials to the Plan
B. Document the primary diagnosis with clinical reasoning, list differential diagnoses with prioritization, and
reference pertinent subjective/objective findings that support each diagnosis [CORRECT]
C. Provide a narrative summary of the visit without specifying diagnoses
D. Document only the patient's self-reported symptom severity rating
Correct Answer: B
Rationale: The Assessment synthesizes subjective and objective data into diagnostic conclusions. It must include the primary
diagnosis with ICD-10 code, supporting clinical reasoning, prioritized differential diagnoses, and reference to pertinent
positives/negatives that confirm or refute each diagnosis. Option A omits differentials; option C avoids diagnostic commitment,
undermining billing; option D excludes clinical reasoning entirely. The 2026/2027 standard expects "synthesis" documentation
that explicitly links findings to conclusions for E/M audit defense.
Q6: The Plan section of Craig Harris's SOAP note should include all of the following EXCEPT:
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 2
, NRP 571 | Advanced Health Assessment & Diagnostic Reasoning Craig Harris | Episodic SOAP Note & Reflection
A. Pharmacologic management with drug name, dose, route, frequency, and duration
B. Non-pharmacologic interventions such as DASH diet counseling and exercise prescription
C. Diagnostic testing orders with rationale and follow-up timeline
D. Verbatim transcription of the entire HPI narrative for billing purposes [CORRECT]
Correct Answer: D
Rationale: The Plan documents the management strategy: prescriptions (drug, dose, route, frequency, duration),
non-pharmacologic interventions, diagnostic orders with rationale, referrals, patient education, and return precautions.
Re-transcribing the HPI (option D) is redundant, violates chart efficiency standards, and does not contribute to MDM or billing
— it may even trigger copy-paste denials. Options A, B, and C are all required Plan elements per CMS and AANP
documentation guidelines.
Q7: Which documentation element is REQUIRED to support the HPI in Craig Harris's SOAP note for an
episodic visit billed at Level 4 (99214)?
A. Four or more HPI elements (location, quality, severity, duration, timing, context, modifying factors, associated
symptoms) OR status of three chronic inactive conditions [CORRECT]
B. A complete 14-system ROS regardless of chief complaint
C. Family history dating back three generations with a detailed genogram
D. At least one paragraph describing social history from adolescence to present
Correct Answer: A
Rationale: For 99214 (established patient, moderate-complexity MDM), CMS requires a detailed history: extended HPI (4+
elements OR 3 chronic inactive conditions with status), extended ROS (2–9 systems), and pertinent PFSH. Option A correctly
identifies the HPI standard. Options B, C, and D overstate the requirement — a complete ROS, three-generation family history,
and adolescent social history are elements of comprehensive (99215) or preventive visits, not routine Level 4 follow-ups.
Q8: For Craig Harris's visit, the FNP documents ROS pertinent positives and negatives for the
cardiovascular and respiratory systems. This approach is BEST described as:
A. A complete ROS, which is required for all episodic visits
B. An extended or problem-focused ROS of pertinent systems, appropriate for a problem-focused episodic visit
when justified by the chief complaint [CORRECT]
C. An incomplete ROS that must be expanded to all 14 systems for billing compliance
D. A redundant documentation practice that can be omitted when the HPI is detailed
Correct Answer: B
Rationale: ROS may be complete (10+ systems), extended (2–9 systems), or pertinent (1 system) depending on the clinical
scenario. For Craig Harris's episodic visit, an extended ROS covering cardiovascular, respiratory, constitutional, and neurologic
systems is appropriate because these systems are relevant to hypertension and fatigue. Option A incorrectly asserts complete
ROS is mandatory for episodic visits; option C overstates the requirement; option D would jeopardize both clinical reasoning
and E/M level selection.
Q9: In Craig Harris's ROS, the FNP documents "no chest pain, no dyspnea, no palpitations, no orthopnea, no
edema." These represent:
A. Pertinent positives that support the primary diagnosis
B. Pertinent negatives that rule in competing diagnoses
C. Pertinent negatives that help rule out competing diagnoses and refine the differential [CORRECT]
D. Documentation errors because negatives should be omitted when positive findings are present
Correct Answer: C
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 3
NRP 571 — Advanced Health Assessment and Diagnostic
Reasoning
Episodic SOAP Note and Reflection Assignment — Craig Harris Case
Comprehensive 100-Question Exam | 2026/2027 Latest Update | Complete Solutions with Rationales
Clinical Case Vignette — Craig Harris: Craig Harris is a 47-year-old African American male who presents to the
primary care clinic for an episodic follow-up visit. His chief complaint is: "I've been feeling tired for the past three
weeks, and my home blood pressure readings have been running high." Craig has a past medical history of hypertension
(diagnosed 5 years ago), hyperlipidemia, and obesity. Current medications include lisinopril 20 mg daily,
hydrochlorothiazide 12.5 mg daily, atorvastatin 40 mg daily, and aspirin 81 mg daily. He has no known drug allergies.
He smokes approximately one-half pack per day and works as an office manager. Vital signs: BP 154/96, HR 82, RR
16, T 98.4 °F, SpO2 99% on RA, BMI 32.4. Pertinent labs: A1c 6.2%, LDL 118 mg/dL, HDL 38 mg/dL, triglycerides
180 mg/dL. Primary assessment: uncontrolled primary hypertension (I10), hyperlipidemia (E78.5), prediabetes
(R73.03), obesity (E66.01), and tobacco use disorder (F17.210). All questions on this exam reference the Craig Harris
case unless explicitly stated.
SECTION 1: SOAP Note Structure and Documentation Standards (Subjective, Objective,
Assessment, Plan, & Formatting)
Q1: In advanced practice nursing documentation, the acronym SOAP represents which four components of
an episodic visit note?
A. Subjective, Objective, Action, Plan
B. Subjective, Objective, Assessment, Plan [CORRECT]
C. Symptoms, Observations, Assessment, Prescriptions
D. Subjective, Objective, Analysis, Procedure
Correct Answer: B
Rationale: SOAP stands for Subjective, Objective, Assessment, and Plan — the four pillars of episodic visit documentation
established by Lawrence Weed in the 1960s and still the standard for advanced practice nursing documentation in 2026/2027.
The Subjective section captures patient-reported data, Objective contains measurable findings, Assessment synthesizes clinical
reasoning, and Plan outlines management. Options A, C, and D substitute inaccurate words ("Action," "Prescriptions,"
"Analysis," "Procedure") that are not part of the SOAP framework and would misrepresent documentation structure.
Q2: Craig Harris presents for an episodic follow-up focused on uncontrolled hypertension and fatigue. Which
statement BEST distinguishes an episodic SOAP note from a comprehensive visit note?
A. Episodic notes require a complete 14-system ROS, while comprehensive visits focus only on the chief complaint
system
B. Episodic notes are problem-focused with history limited to the chief complaint and pertinent systems, whereas
comprehensive visits include a complete history and multisystem examination [CORRECT]
C. Episodic notes omit the Assessment section, while comprehensive notes require a full differential diagnosis list
D. Episodic notes are only used for acute visits, while comprehensive notes are required for every chronic disease
follow-up
Correct Answer: B
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 1
,NRP 571 | Advanced Health Assessment & Diagnostic Reasoning Craig Harris | Episodic SOAP Note & Reflection
Rationale: Episodic documentation is problem-focused: the history, exam, and MDM center on the chief complaint and
pertinent positive/negative systems, supporting lower-tier E/M codes (99212–99214). Comprehensive visits require a complete
history (HPI, PMH, PSH, meds, allergies, FH, SH, complete ROS), a comprehensive multisystem exam, and high-complexity
MDM (99215 for established patients). Option A reverses the ROS requirement; option C incorrectly removes Assessment from
episodic notes; option D conflates visit acuity with documentation type.
Q3: When documenting the Subjective section of Craig Harris's SOAP note, which information is MOST
appropriate to include?
A. Physical examination findings, vital signs, and laboratory results
B. Chief complaint, HPI, PMH, medications, allergies, family/social history, and ROS [CORRECT]
C. Primary diagnosis, ICD-10 codes, and differential diagnoses
D. Diagnostic orders, pharmacologic plan, and return precautions
Correct Answer: B
Rationale: The Subjective section captures everything the patient (or caregiver) reports: CC, HPI with OLDCARTS elements,
PMH, PSH, hospitalizations, current medications, allergies, family and social history, and review of systems. Option A belongs
in Objective; option C belongs in Assessment; option D belongs in Plan. Mixing these elements violates SOAP structure and may
result in denial of billing claims, because auditors cannot verify the level of service from properly compartmentalized
documentation.
Q4: Which entry is appropriately documented in the Objective section of Craig Harris's SOAP note?
A. "Patient reports fatigue for three weeks" (verbatim patient statement)
B. "BMI 32.4 indicating obesity based on CDC criteria" (interpretation)
C. "BP 154/96, HR 82, BMI 32.4; cardiovascular exam reveals regular rate and rhythm without murmurs"
[CORRECT]
D. "Patient likely has uncontrolled hypertension requiring medication adjustment" (assessment)
Correct Answer: C
Rationale: The Objective section contains measurable, reproducible findings: vital signs, general survey, and physical
examination data by body system, plus any diagnostic test results available at the visit. Option A is subjective patient-reported
data; option B mixes Objective with interpretive Assessment; option D is an Assessment statement. Objective data must be
factual, observable, and free of interpretation so that any clinician reviewing the note can independently verify the findings.
Q5: When writing the Assessment section of Craig Harris's SOAP note, the FNP should:
A. List only the primary diagnosis with its ICD-10 code; defer all differentials to the Plan
B. Document the primary diagnosis with clinical reasoning, list differential diagnoses with prioritization, and
reference pertinent subjective/objective findings that support each diagnosis [CORRECT]
C. Provide a narrative summary of the visit without specifying diagnoses
D. Document only the patient's self-reported symptom severity rating
Correct Answer: B
Rationale: The Assessment synthesizes subjective and objective data into diagnostic conclusions. It must include the primary
diagnosis with ICD-10 code, supporting clinical reasoning, prioritized differential diagnoses, and reference to pertinent
positives/negatives that confirm or refute each diagnosis. Option A omits differentials; option C avoids diagnostic commitment,
undermining billing; option D excludes clinical reasoning entirely. The 2026/2027 standard expects "synthesis" documentation
that explicitly links findings to conclusions for E/M audit defense.
Q6: The Plan section of Craig Harris's SOAP note should include all of the following EXCEPT:
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 2
, NRP 571 | Advanced Health Assessment & Diagnostic Reasoning Craig Harris | Episodic SOAP Note & Reflection
A. Pharmacologic management with drug name, dose, route, frequency, and duration
B. Non-pharmacologic interventions such as DASH diet counseling and exercise prescription
C. Diagnostic testing orders with rationale and follow-up timeline
D. Verbatim transcription of the entire HPI narrative for billing purposes [CORRECT]
Correct Answer: D
Rationale: The Plan documents the management strategy: prescriptions (drug, dose, route, frequency, duration),
non-pharmacologic interventions, diagnostic orders with rationale, referrals, patient education, and return precautions.
Re-transcribing the HPI (option D) is redundant, violates chart efficiency standards, and does not contribute to MDM or billing
— it may even trigger copy-paste denials. Options A, B, and C are all required Plan elements per CMS and AANP
documentation guidelines.
Q7: Which documentation element is REQUIRED to support the HPI in Craig Harris's SOAP note for an
episodic visit billed at Level 4 (99214)?
A. Four or more HPI elements (location, quality, severity, duration, timing, context, modifying factors, associated
symptoms) OR status of three chronic inactive conditions [CORRECT]
B. A complete 14-system ROS regardless of chief complaint
C. Family history dating back three generations with a detailed genogram
D. At least one paragraph describing social history from adolescence to present
Correct Answer: A
Rationale: For 99214 (established patient, moderate-complexity MDM), CMS requires a detailed history: extended HPI (4+
elements OR 3 chronic inactive conditions with status), extended ROS (2–9 systems), and pertinent PFSH. Option A correctly
identifies the HPI standard. Options B, C, and D overstate the requirement — a complete ROS, three-generation family history,
and adolescent social history are elements of comprehensive (99215) or preventive visits, not routine Level 4 follow-ups.
Q8: For Craig Harris's visit, the FNP documents ROS pertinent positives and negatives for the
cardiovascular and respiratory systems. This approach is BEST described as:
A. A complete ROS, which is required for all episodic visits
B. An extended or problem-focused ROS of pertinent systems, appropriate for a problem-focused episodic visit
when justified by the chief complaint [CORRECT]
C. An incomplete ROS that must be expanded to all 14 systems for billing compliance
D. A redundant documentation practice that can be omitted when the HPI is detailed
Correct Answer: B
Rationale: ROS may be complete (10+ systems), extended (2–9 systems), or pertinent (1 system) depending on the clinical
scenario. For Craig Harris's episodic visit, an extended ROS covering cardiovascular, respiratory, constitutional, and neurologic
systems is appropriate because these systems are relevant to hypertension and fatigue. Option A incorrectly asserts complete
ROS is mandatory for episodic visits; option C overstates the requirement; option D would jeopardize both clinical reasoning
and E/M level selection.
Q9: In Craig Harris's ROS, the FNP documents "no chest pain, no dyspnea, no palpitations, no orthopnea, no
edema." These represent:
A. Pertinent positives that support the primary diagnosis
B. Pertinent negatives that rule in competing diagnoses
C. Pertinent negatives that help rule out competing diagnoses and refine the differential [CORRECT]
D. Documentation errors because negatives should be omitted when positive findings are present
Correct Answer: C
University of Phoenix | 2026/2027 Update | 100-Question Exam Page 3
