NR 509 ADVANCED HEALTH ASSESSMENT ABDOMINAL
PAIN DOCUMENTATION 2026 | Shadow Health Ms. Esther
Park Notes | Complete Solution | Pass Guaranteed - A+
Graded
Section 1: Subjective Data Collection - MS. ESTHER PARK's
History of Present Illness (Questions 1-12)
Question 1 In the Shadow Health simulation, Ms. Esther Park presents with
abdominal pain. When documenting the HPI using the OLDCARTS framework, which
of the following represents the correct sequence of data collection for a
comprehensive abdominal pain history?
A. Onset, Location, Duration, Characteristics, Aggravating factors, Radiation, Timing,
Severity
B. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Radiation, Timing, Severity
C. Onset, Location, Duration, Characteristics, Associated symptoms, Radiation,
Timing, Severity
D. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Relevant history, Timing, Severity
Correct Answer: B
B. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Radiation, Timing, Severity [CORRECT]
Rationale: The standard OLDCARTS mnemonic includes Alleviating factors alongside
Aggravating factors (A), not Associated symptoms or Relevant history. Option A
omits alleviating factors. Option C substitutes associated symptoms for
aggravating/alleviating. Option D incorrectly uses "Relevant history" instead of
Radiation.
,Question 2 During the Shadow Health interview, Ms. Park reports that her abdominal
pain started "about three days ago" after eating a heavy meal at a family gathering.
She rates the pain as 7/10 and describes it as "cramping and constant." Which
OLDCARTS element is MISSING from this documented statement?
A. Onset
B. Location
C. Duration
D. Severity
Correct Answer: B
B. Location [CORRECT]
Rationale: The documented statement includes onset (three days ago), duration
(constant), and severity (7/10), but fails to specify the anatomical location of the pain
(e.g., RLQ, epigastric, periumbilical). Shadow Health scoring requires location
documentation for full HPI credit. Options A, C, and D are all present in the
statement.
Question 3 Ms. Park states her abdominal pain is located in the "lower right side"
and radiates to her back. She also mentions the pain worsens with movement and
deep breathing. In Shadow Health documentation, which associated symptom would
be MOST critical to assess next given this presentation?
A. Nausea or vomiting
B. Dysuria
C. Vaginal bleeding
D. Joint pain
Correct Answer: A
A. Nausea or vomiting [CORRECT]
Rationale: Right lower quadrant pain with radiation to the back, worsened by
movement, is highly suggestive of appendicitis or renal pathology; nausea/vomiting
are key associated symptoms that support or refute these differentials. Option B
(dysuria) would suggest UTI. Option C (vaginal bleeding) suggests gynecological
, causes but is less immediately critical. Option D is unrelated to abdominal pain
assessment.
Question 4 In the Shadow Health interview, Ms. Park denies fever but reports having
"some diarrhea" since the pain started. She states she has not traveled recently and
has not eaten any unusual foods. Which documentation element represents a
pertinent NEGATIVE finding that should be recorded?
A. Denies fever
B. Reports diarrhea
C. No recent travel
D. No unusual foods
Correct Answer: A
A. Denies fever [CORRECT]
Rationale: A pertinent negative is a symptom that the patient denies but would be
expected given the clinical presentation. Fever is a key symptom of
infectious/inflammatory processes (appendicitis, diverticulitis) that is notably absent,
making it clinically significant. Options B, C, and D are either positive findings or non-
pertinent negatives in this context.
Question 5 Ms. Park is a 28-year-old female presenting with abdominal pain. During
the Shadow Health interview, which question is REQUIRED to assess pregnancy status
and must be documented for full scoring credit?
A. "Are you currently sexually active?"
B. "When was your last menstrual period?"
C. "Do you use any form of contraception?"
D. "Have you ever been pregnant before?"
Correct Answer: B
B. "When was your last menstrual period?" [CORRECT]
Rationale: LMP is the critical question for determining pregnancy status and
PAIN DOCUMENTATION 2026 | Shadow Health Ms. Esther
Park Notes | Complete Solution | Pass Guaranteed - A+
Graded
Section 1: Subjective Data Collection - MS. ESTHER PARK's
History of Present Illness (Questions 1-12)
Question 1 In the Shadow Health simulation, Ms. Esther Park presents with
abdominal pain. When documenting the HPI using the OLDCARTS framework, which
of the following represents the correct sequence of data collection for a
comprehensive abdominal pain history?
A. Onset, Location, Duration, Characteristics, Aggravating factors, Radiation, Timing,
Severity
B. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Radiation, Timing, Severity
C. Onset, Location, Duration, Characteristics, Associated symptoms, Radiation,
Timing, Severity
D. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Relevant history, Timing, Severity
Correct Answer: B
B. Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors,
Radiation, Timing, Severity [CORRECT]
Rationale: The standard OLDCARTS mnemonic includes Alleviating factors alongside
Aggravating factors (A), not Associated symptoms or Relevant history. Option A
omits alleviating factors. Option C substitutes associated symptoms for
aggravating/alleviating. Option D incorrectly uses "Relevant history" instead of
Radiation.
,Question 2 During the Shadow Health interview, Ms. Park reports that her abdominal
pain started "about three days ago" after eating a heavy meal at a family gathering.
She rates the pain as 7/10 and describes it as "cramping and constant." Which
OLDCARTS element is MISSING from this documented statement?
A. Onset
B. Location
C. Duration
D. Severity
Correct Answer: B
B. Location [CORRECT]
Rationale: The documented statement includes onset (three days ago), duration
(constant), and severity (7/10), but fails to specify the anatomical location of the pain
(e.g., RLQ, epigastric, periumbilical). Shadow Health scoring requires location
documentation for full HPI credit. Options A, C, and D are all present in the
statement.
Question 3 Ms. Park states her abdominal pain is located in the "lower right side"
and radiates to her back. She also mentions the pain worsens with movement and
deep breathing. In Shadow Health documentation, which associated symptom would
be MOST critical to assess next given this presentation?
A. Nausea or vomiting
B. Dysuria
C. Vaginal bleeding
D. Joint pain
Correct Answer: A
A. Nausea or vomiting [CORRECT]
Rationale: Right lower quadrant pain with radiation to the back, worsened by
movement, is highly suggestive of appendicitis or renal pathology; nausea/vomiting
are key associated symptoms that support or refute these differentials. Option B
(dysuria) would suggest UTI. Option C (vaginal bleeding) suggests gynecological
, causes but is less immediately critical. Option D is unrelated to abdominal pain
assessment.
Question 4 In the Shadow Health interview, Ms. Park denies fever but reports having
"some diarrhea" since the pain started. She states she has not traveled recently and
has not eaten any unusual foods. Which documentation element represents a
pertinent NEGATIVE finding that should be recorded?
A. Denies fever
B. Reports diarrhea
C. No recent travel
D. No unusual foods
Correct Answer: A
A. Denies fever [CORRECT]
Rationale: A pertinent negative is a symptom that the patient denies but would be
expected given the clinical presentation. Fever is a key symptom of
infectious/inflammatory processes (appendicitis, diverticulitis) that is notably absent,
making it clinically significant. Options B, C, and D are either positive findings or non-
pertinent negatives in this context.
Question 5 Ms. Park is a 28-year-old female presenting with abdominal pain. During
the Shadow Health interview, which question is REQUIRED to assess pregnancy status
and must be documented for full scoring credit?
A. "Are you currently sexually active?"
B. "When was your last menstrual period?"
C. "Do you use any form of contraception?"
D. "Have you ever been pregnant before?"
Correct Answer: B
B. "When was your last menstrual period?" [CORRECT]
Rationale: LMP is the critical question for determining pregnancy status and
