WGU D124 FNP OSCE Midterm SOAP Note |
Complete Patient Assessment 2026 Update with
complete solutions.
1. What does the acronym SOAP stand for in clinical documentation?
Answer: Subjective, Objective, Assessment, Plan
Rationale: SOAP is the standard format for clinical progress notes. Subjective includes
what the patient reports, Objective includes measurable findings, Assessment is the
clinical impression/diagnosis, and Plan outlines treatment and follow-up.
2. In the Subjective section of a SOAP note, which component should be
documented first?
Answer: Chief Complaint (CC)
Rationale: The chief complaint is the reason the patient is seeking care, documented in
the patient's own words. It is the starting point for the entire clinical encounter and
helps focus the history and examination.
3. Which mnemonic is used to organize the History of Present Illness (HPI) in a
SOAP note?
Answer: OLDCARTS or PQRSTU
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, Severity) or PQRSTU (Provocative/Palliative, Quality/Quantity,
Region/Radiation, Severity, Timing, Understanding) provides a systematic framework for
gathering comprehensive symptom data.
4. What is the correct order for documenting a complete physical exam in the
Objective section?
Answer: General survey, vital signs, then systems (head-to-toe)
Rationale: Documentation should follow the sequence of examination: general
appearance, vital signs, integumentary, HEENT, neck, cardiovascular, pulmonary,
abdominal, musculoskeletal, neurologic, and genitourinary.
, 5. Which two organ systems must be examined on ALL patients regardless of chief
complaint?
Answer: Heart and Lungs
Rationale: A heart and lung exam should be included on all clients regardless of the
reason for seeking care, as these systems are essential to basic health assessment.
6. In the Assessment section, how should differential diagnoses be ordered?
Answer: Most likely to least likely
Rationale: Differential diagnoses should be listed in order of probability, with the most
likely diagnosis first. Each differential should be supported by a rationale with evidence-
based citations.
7. What information should be included in the Plan section of a SOAP note?
Answer: Diagnostic testing, medications prescribed, patient education, referrals, and
follow-up plan
Rationale: The Plan must include all orders, prescriptions with dosage and duration,
health promotion education, and follow-up scheduling. Each new medication requires
indication, actions, adverse effects, and monitoring plans.
8. Which ICD-10 component is required in the Assessment section?
Answer: ICD-10 codes for each diagnosis listed
Rationale: Each diagnosis documented must include the corresponding ICD-10 code
and indicate the status (acute, chronic, stable, acute-on-chronic, improving, resolved).
9. What is the minimum number of references required for an academic SOAP
note at the graduate level?
Answer: Three primary research-based references
Rationale: Academic SOAP notes require a minimum of three primary research-based
references within the last 5 years, plus one evidence-based website. Textbooks and
UpToDate are not acceptable for graduate-level work.
10. What is an OSCE and what is the passing standard for FNP programs?
Answer: Objective Structured Clinical Examination; 80% passing standard
Rationale: An OSCE tests clinical skill performance using standardized scenarios and
patients. FNP programs require an 80% or higher to pass the OSCE and advance in the
program.
, 11. A 45-year-old female presents with new-onset fatigue, weight gain, and dry
skin. Which initial lab test is most appropriate?
Answer: TSH
Rationale: TSH is the most sensitive initial test to evaluate thyroid function and helps
differentiate between primary and secondary hypothyroidism.
12. A child presents with a barking cough and inspiratory stridor. What is the most
likely diagnosis?
Answer: Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough,
inspiratory stridor, and hoarseness. It is most common in children aged 6 months to 3
years.
13. A patient presents with red, hot, swollen joint in the big toe. What is the most
likely diagnosis?
Answer: Gout
Rationale: Gout typically presents with monoarticular inflammation, especially in the
first metatarsophalangeal joint (podagra), with sudden onset of severe pain, redness,
and swelling.
14. A 60-year-old male has a PSA of 8.5. What is the next best step?
Answer: Refer to urology
Rationale: A PSA over 4.0, especially >7.0, typically warrants urology referral for
possible biopsy. This elevated level is concerning for prostate cancer.
15. A 5-year-old has a sandpaper-like rash, fever, and sore throat. What is the
most likely diagnosis?
Answer: Scarlet fever
Rationale: Scarlet fever is a complication of strep pharyngitis caused by Group A
Streptococcus and causes a fine, sandpaper-like rash, typically accompanied by fever
and sore throat.
16. Which condition is most associated with a positive Homan's sign?
Answer: Deep vein thrombosis (DVT)
Complete Patient Assessment 2026 Update with
complete solutions.
1. What does the acronym SOAP stand for in clinical documentation?
Answer: Subjective, Objective, Assessment, Plan
Rationale: SOAP is the standard format for clinical progress notes. Subjective includes
what the patient reports, Objective includes measurable findings, Assessment is the
clinical impression/diagnosis, and Plan outlines treatment and follow-up.
2. In the Subjective section of a SOAP note, which component should be
documented first?
Answer: Chief Complaint (CC)
Rationale: The chief complaint is the reason the patient is seeking care, documented in
the patient's own words. It is the starting point for the entire clinical encounter and
helps focus the history and examination.
3. Which mnemonic is used to organize the History of Present Illness (HPI) in a
SOAP note?
Answer: OLDCARTS or PQRSTU
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, Severity) or PQRSTU (Provocative/Palliative, Quality/Quantity,
Region/Radiation, Severity, Timing, Understanding) provides a systematic framework for
gathering comprehensive symptom data.
4. What is the correct order for documenting a complete physical exam in the
Objective section?
Answer: General survey, vital signs, then systems (head-to-toe)
Rationale: Documentation should follow the sequence of examination: general
appearance, vital signs, integumentary, HEENT, neck, cardiovascular, pulmonary,
abdominal, musculoskeletal, neurologic, and genitourinary.
, 5. Which two organ systems must be examined on ALL patients regardless of chief
complaint?
Answer: Heart and Lungs
Rationale: A heart and lung exam should be included on all clients regardless of the
reason for seeking care, as these systems are essential to basic health assessment.
6. In the Assessment section, how should differential diagnoses be ordered?
Answer: Most likely to least likely
Rationale: Differential diagnoses should be listed in order of probability, with the most
likely diagnosis first. Each differential should be supported by a rationale with evidence-
based citations.
7. What information should be included in the Plan section of a SOAP note?
Answer: Diagnostic testing, medications prescribed, patient education, referrals, and
follow-up plan
Rationale: The Plan must include all orders, prescriptions with dosage and duration,
health promotion education, and follow-up scheduling. Each new medication requires
indication, actions, adverse effects, and monitoring plans.
8. Which ICD-10 component is required in the Assessment section?
Answer: ICD-10 codes for each diagnosis listed
Rationale: Each diagnosis documented must include the corresponding ICD-10 code
and indicate the status (acute, chronic, stable, acute-on-chronic, improving, resolved).
9. What is the minimum number of references required for an academic SOAP
note at the graduate level?
Answer: Three primary research-based references
Rationale: Academic SOAP notes require a minimum of three primary research-based
references within the last 5 years, plus one evidence-based website. Textbooks and
UpToDate are not acceptable for graduate-level work.
10. What is an OSCE and what is the passing standard for FNP programs?
Answer: Objective Structured Clinical Examination; 80% passing standard
Rationale: An OSCE tests clinical skill performance using standardized scenarios and
patients. FNP programs require an 80% or higher to pass the OSCE and advance in the
program.
, 11. A 45-year-old female presents with new-onset fatigue, weight gain, and dry
skin. Which initial lab test is most appropriate?
Answer: TSH
Rationale: TSH is the most sensitive initial test to evaluate thyroid function and helps
differentiate between primary and secondary hypothyroidism.
12. A child presents with a barking cough and inspiratory stridor. What is the most
likely diagnosis?
Answer: Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough,
inspiratory stridor, and hoarseness. It is most common in children aged 6 months to 3
years.
13. A patient presents with red, hot, swollen joint in the big toe. What is the most
likely diagnosis?
Answer: Gout
Rationale: Gout typically presents with monoarticular inflammation, especially in the
first metatarsophalangeal joint (podagra), with sudden onset of severe pain, redness,
and swelling.
14. A 60-year-old male has a PSA of 8.5. What is the next best step?
Answer: Refer to urology
Rationale: A PSA over 4.0, especially >7.0, typically warrants urology referral for
possible biopsy. This elevated level is concerning for prostate cancer.
15. A 5-year-old has a sandpaper-like rash, fever, and sore throat. What is the
most likely diagnosis?
Answer: Scarlet fever
Rationale: Scarlet fever is a complication of strep pharyngitis caused by Group A
Streptococcus and causes a fine, sandpaper-like rash, typically accompanied by fever
and sore throat.
16. Which condition is most associated with a positive Homan's sign?
Answer: Deep vein thrombosis (DVT)
