SHADOW HEALTH
DANNY RIVERA FOCUSED EXAM: COUGH
2026/2027
Digital Clinical Experience
Comprehensive Pediatric Respiratory Assessment Competency Assessment
Quiz Questions: 15 (Pre/Post-Simulation Combined)
Simulation: Focused Subjective & Objective Data Collection
Documentation: SOAP Note in Electronic Health Record
Total Completion Time: 60–90 Minutes | Passing Score: 80%
Platform: Shadow Health Digital Clinical Experience (DCE)
Core Domains Assessed:
Pediatric Respiratory Health History (OLDCARTS/PQRST)
Focused Physical Examination Techniques
Pediatric Respiratory Assessment Findings
Health Promotion & Risk Reduction
Documentation & Clinical Reasoning (SOAP)
Therapeutic Communication with Pediatric Patients & Families
Scenario-Based Clinical Judgment Application
, Abstract
This document presents the Shadow Health Danny Rivera Focused Exam: Cough assessment
resource for the 2026/2027 academic cycle, comprising 15 quiz questions aligned with the Digital Clinical
Experience (DCE) administered through the Shadow Health platform. The assessment evaluates
proficiency in pediatric respiratory assessment principles essential for pre-licensure nursing students.
Core domains addressed include pediatric respiratory health history collection using the OLDCARTS and
PQRST frameworks, focused physical examination techniques (inspection, palpation, percussion,
auscultation), differentiation of normal and abnormal pediatric respiratory findings (wheezes, crackles,
stridor, work of breathing indicators), health promotion strategies including asthma action plan education
and trigger avoidance, SOAP documentation standards, and therapeutic communication techniques for
pediatric patients and their families. Each question is accompanied by a detailed rationale grounded in
current pediatric assessment guidelines, nursing education standards, and evidence-based clinical
practice. The simulation component requires students to demonstrate competency in focused subjective
and objective data collection, EHR documentation, and clinical reasoning within the virtual patient
encounter.
Keywords: Shadow Health; Danny Rivera; Pediatric Cough Assessment; Focused Exam; OLDCARTS;
Wheezing; Asthma; SOAP Documentation; Pediatric Respiratory; DCE
1. Introduction
The Shadow Health Danny Rivera Focused Exam: Cough represents a standardized Digital
Clinical Experience (DCE) used in pre-licensure nursing education to evaluate students’ competency in
pediatric respiratory assessment. The virtual patient encounter with Danny Rivera, an 8-year-old
presenting with a chief complaint of cough, requires students to perform focused subjective data
collection, objective physical examination, clinical documentation, and therapeutic communication within
a simulated clinical environment.
The 2026/2027 edition integrates updated pediatric assessment guidelines from the American
Academy of Pediatrics (AAP), current asthma management recommendations from the National Heart,
Lung, and Blood Institute (NHLBI), and evidence-based nursing assessment standards. The assessment
consists of 15 quiz questions (pre- and post-simulation combined) addressing health history collection,
physical examination techniques, clinical reasoning, documentation, and health promotion, plus a
comprehensive simulation requiring demonstration of assessment competency.
Each question includes a detailed rationale providing evidence-based justification grounded in
pediatric respiratory assessment principles, nursing education standards, and clinical practice guidelines.
This document serves as both a study resource and practice assessment tool for nursing students
preparing for the Shadow Health DCE.
2. Assessment Instructions
• This assessment contains 15 quiz questions plus a comprehensive simulation component. Select the
single best answer for each quiz question.
• Total completion time: 60–90 minutes (simulation: ~45 min; quizzes: 10–15 min; documentation: 10–
15 min).
• Passing score: 80% overall (simulation performance: 70–80% minimum; documentation:
complete/accurate; quiz scores: 80% minimum).
• Domains: Health History (Q1–5), Physical Examination (Q6–9), Clinical Reasoning & Documentation
(Q10–12), Health Promotion & Communication (Q13–15).
• Correct answers are in bold green. Detailed rationales in italics follow each question.
• Simulation requires focused subjective and objective data collection, SOAP documentation, and
therapeutic communication demonstration.
DANNY RIVERA FOCUSED EXAM: COUGH
2026/2027
Digital Clinical Experience
Comprehensive Pediatric Respiratory Assessment Competency Assessment
Quiz Questions: 15 (Pre/Post-Simulation Combined)
Simulation: Focused Subjective & Objective Data Collection
Documentation: SOAP Note in Electronic Health Record
Total Completion Time: 60–90 Minutes | Passing Score: 80%
Platform: Shadow Health Digital Clinical Experience (DCE)
Core Domains Assessed:
Pediatric Respiratory Health History (OLDCARTS/PQRST)
Focused Physical Examination Techniques
Pediatric Respiratory Assessment Findings
Health Promotion & Risk Reduction
Documentation & Clinical Reasoning (SOAP)
Therapeutic Communication with Pediatric Patients & Families
Scenario-Based Clinical Judgment Application
, Abstract
This document presents the Shadow Health Danny Rivera Focused Exam: Cough assessment
resource for the 2026/2027 academic cycle, comprising 15 quiz questions aligned with the Digital Clinical
Experience (DCE) administered through the Shadow Health platform. The assessment evaluates
proficiency in pediatric respiratory assessment principles essential for pre-licensure nursing students.
Core domains addressed include pediatric respiratory health history collection using the OLDCARTS and
PQRST frameworks, focused physical examination techniques (inspection, palpation, percussion,
auscultation), differentiation of normal and abnormal pediatric respiratory findings (wheezes, crackles,
stridor, work of breathing indicators), health promotion strategies including asthma action plan education
and trigger avoidance, SOAP documentation standards, and therapeutic communication techniques for
pediatric patients and their families. Each question is accompanied by a detailed rationale grounded in
current pediatric assessment guidelines, nursing education standards, and evidence-based clinical
practice. The simulation component requires students to demonstrate competency in focused subjective
and objective data collection, EHR documentation, and clinical reasoning within the virtual patient
encounter.
Keywords: Shadow Health; Danny Rivera; Pediatric Cough Assessment; Focused Exam; OLDCARTS;
Wheezing; Asthma; SOAP Documentation; Pediatric Respiratory; DCE
1. Introduction
The Shadow Health Danny Rivera Focused Exam: Cough represents a standardized Digital
Clinical Experience (DCE) used in pre-licensure nursing education to evaluate students’ competency in
pediatric respiratory assessment. The virtual patient encounter with Danny Rivera, an 8-year-old
presenting with a chief complaint of cough, requires students to perform focused subjective data
collection, objective physical examination, clinical documentation, and therapeutic communication within
a simulated clinical environment.
The 2026/2027 edition integrates updated pediatric assessment guidelines from the American
Academy of Pediatrics (AAP), current asthma management recommendations from the National Heart,
Lung, and Blood Institute (NHLBI), and evidence-based nursing assessment standards. The assessment
consists of 15 quiz questions (pre- and post-simulation combined) addressing health history collection,
physical examination techniques, clinical reasoning, documentation, and health promotion, plus a
comprehensive simulation requiring demonstration of assessment competency.
Each question includes a detailed rationale providing evidence-based justification grounded in
pediatric respiratory assessment principles, nursing education standards, and clinical practice guidelines.
This document serves as both a study resource and practice assessment tool for nursing students
preparing for the Shadow Health DCE.
2. Assessment Instructions
• This assessment contains 15 quiz questions plus a comprehensive simulation component. Select the
single best answer for each quiz question.
• Total completion time: 60–90 minutes (simulation: ~45 min; quizzes: 10–15 min; documentation: 10–
15 min).
• Passing score: 80% overall (simulation performance: 70–80% minimum; documentation:
complete/accurate; quiz scores: 80% minimum).
• Domains: Health History (Q1–5), Physical Examination (Q6–9), Clinical Reasoning & Documentation
(Q10–12), Health Promotion & Communication (Q13–15).
• Correct answers are in bold green. Detailed rationales in italics follow each question.
• Simulation requires focused subjective and objective data collection, SOAP documentation, and
therapeutic communication demonstration.
