NR601: Primary Care of Acute and Chronic Illness
Case Study Examination
Patient Cynthia Francis, 56-year-old female
Chief Complaint Blood pressure recheck following workplace health fair
PMH Hypothyroidism (on levothyroxine 75 mcg daily),
obesity (BMI 36.2)
Format MC, SATA, Ordered Response, Matrix/Grid, Cloze (NGN
Formats)
Questions 30 with Detailed Rationales
Institution Chamberlain University College of Nursing
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Patient Case: Cynthia Francis
Chief Complaint:
Cynthia Francis is a 56-year-old obese female with a past medical history of
hypothyroidism who presents to the primary care clinic for a blood pressure recheck
after attending a workplace health fair 3 weeks ago, where her blood pressure was
found to be 158/94 mmHg.
History of Present Illness:
She reports occasional fatigue, cold intolerance, and weight gain over the past year. She
does not exercise regularly. Her diet is high in processed foods. She denies chest pain,
palpitations, headache, visual changes, or dyspnea. Her hypothyroidism was diagnosed
8 years ago and she is currently on levothyroxine 75 mcg daily. She has not had her
TSH checked in over a year.
Past Medical History:
Hypothyroidism (8 years), obesity. No known history of diabetes, cardiovascular
disease, or kidney disease. No surgeries. No known drug allergies.
Family History:
Mother: hypertension. Father: type 2 diabetes. No family history of thyroid cancer or
autoimmune disease.
Social History:
Works as an administrative assistant. Married with two adult children. Does not smoke
or use illicit drugs. Drinks alcohol occasionally (1-2 glasses of wine per week).
Sedentary lifestyle. Diet high in processed foods and fast food.
Medications:
Levothyroxine 75 mcg PO daily (takes in the morning on an empty stomach). No
OTC medications or supplements reported.
Vital Signs (Office Visit):
Vital Sign Value
Blood Pressure 154/92 mmHg (right arm, seated, repeated after 5
minutes)
Heart Rate 68 bpm, regular
2
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Respiratory Rate 16 breaths/min
Temperature 97.8 F (36.6 C)
SpO2 98% on room air
Height / Weight / BMI 5 ft 5 in (165 cm) / 215 lbs (97.5 kg) / BMI 36.2
Waist Circumference 42 inches
Physical Examination:
General: Obese female in no acute distress, alert and oriented x3. Head: Normocephalic,
atraumatic. Eyes: No papilledema, no retinopathy noted. Thyroid: Normal size, no
nodules, no tenderness. Cardiovascular: Regular rate and rhythm, no S3/S4, no
murmurs. Respiratory: Clear to auscultation bilaterally, no wheezes or crackles.
Abdomen: Obese, soft, non-tender, no organomegaly. Extremities: Warm and well-
perfused, no edema, pulses 2+ bilaterally. Neurological: Alert and oriented x3, no focal
deficits.
3
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Initial Lab Results (Pending):
The following labs have been ordered and results are pending: Comprehensive
Metabolic Panel (CMP), Complete Blood Count (CBC), Lipid Panel, TSH with reflex
Free T4, HbA1c, Urinalysis, and Urine Microalbumin-to-Creatinine Ratio.
4
Case Study Examination
Patient Cynthia Francis, 56-year-old female
Chief Complaint Blood pressure recheck following workplace health fair
PMH Hypothyroidism (on levothyroxine 75 mcg daily),
obesity (BMI 36.2)
Format MC, SATA, Ordered Response, Matrix/Grid, Cloze (NGN
Formats)
Questions 30 with Detailed Rationales
Institution Chamberlain University College of Nursing
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Patient Case: Cynthia Francis
Chief Complaint:
Cynthia Francis is a 56-year-old obese female with a past medical history of
hypothyroidism who presents to the primary care clinic for a blood pressure recheck
after attending a workplace health fair 3 weeks ago, where her blood pressure was
found to be 158/94 mmHg.
History of Present Illness:
She reports occasional fatigue, cold intolerance, and weight gain over the past year. She
does not exercise regularly. Her diet is high in processed foods. She denies chest pain,
palpitations, headache, visual changes, or dyspnea. Her hypothyroidism was diagnosed
8 years ago and she is currently on levothyroxine 75 mcg daily. She has not had her
TSH checked in over a year.
Past Medical History:
Hypothyroidism (8 years), obesity. No known history of diabetes, cardiovascular
disease, or kidney disease. No surgeries. No known drug allergies.
Family History:
Mother: hypertension. Father: type 2 diabetes. No family history of thyroid cancer or
autoimmune disease.
Social History:
Works as an administrative assistant. Married with two adult children. Does not smoke
or use illicit drugs. Drinks alcohol occasionally (1-2 glasses of wine per week).
Sedentary lifestyle. Diet high in processed foods and fast food.
Medications:
Levothyroxine 75 mcg PO daily (takes in the morning on an empty stomach). No
OTC medications or supplements reported.
Vital Signs (Office Visit):
Vital Sign Value
Blood Pressure 154/92 mmHg (right arm, seated, repeated after 5
minutes)
Heart Rate 68 bpm, regular
2
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Respiratory Rate 16 breaths/min
Temperature 97.8 F (36.6 C)
SpO2 98% on room air
Height / Weight / BMI 5 ft 5 in (165 cm) / 215 lbs (97.5 kg) / BMI 36.2
Waist Circumference 42 inches
Physical Examination:
General: Obese female in no acute distress, alert and oriented x3. Head: Normocephalic,
atraumatic. Eyes: No papilledema, no retinopathy noted. Thyroid: Normal size, no
nodules, no tenderness. Cardiovascular: Regular rate and rhythm, no S3/S4, no
murmurs. Respiratory: Clear to auscultation bilaterally, no wheezes or crackles.
Abdomen: Obese, soft, non-tender, no organomegaly. Extremities: Warm and well-
perfused, no edema, pulses 2+ bilaterally. Neurological: Alert and oriented x3, no focal
deficits.
3
, NR601 Case Study Exam | Cynthia Francis | Chamberlain University
Initial Lab Results (Pending):
The following labs have been ordered and results are pending: Comprehensive
Metabolic Panel (CMP), Complete Blood Count (CBC), Lipid Panel, TSH with reflex
Free T4, HbA1c, Urinalysis, and Urine Microalbumin-to-Creatinine Ratio.
4
