Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
GEORGETTE MODULE 1 & 2 QUESTIONS WITH
COMPLETE SOLUTIONS 2026/2027
Comprehensive Clinical Reasoning Examination • i-Human Patients Case Study Standards • Advanced
Practice Nursing Clinical Reasoning Competencies • Evidence-Based Diagnostic & Management
Guidelines (2026/2027 Edition)
Examination Overview: This 100-item examination evaluates clinical reasoning competencies across ten domains
aligned with i-Human Patients Virtual Patient Case Study standards and the 2026/2027 ACC/AHA/HFSA Heart
Failure Guidelines. Cognitive level distribution: 20% recall, 50% application, 30% analysis. Item format: 80%
scenario-based clinical reasoning anchored to the Georgette Williams virtual patient case (58-year-old African
American female with hypertension, type 2 diabetes, and former smoking history presenting with progressive dyspnea,
orthopnea, and edema), and 20% direct knowledge. Each item includes a fully annotated rationale explaining why the
correct option is best and why the distractors are incorrect, with explicit reference to evidence-based clinical practice
and i-Human case standards.
Section 1: Patient History & Interviewing – Module 1
Q1: Georgette Williams, a 58-year-old African American woman, presents to the primary care clinic with
progressive dyspnea on exertion and bilateral leg swelling over the past three weeks. When initiating the
i-Human interview, which opening statement best exemplifies patient-centered interviewing and
establishes a therapeutic alliance?
A. Mrs. Williams, I need to ask you a series of questions about your symptoms so I can complete your chart.
B. Mrs. Williams, thank you for coming in today. Please tell me in your own words what has been
bringing you in and how it has affected your daily life. *[CORRECT]*
C. Mrs. Williams, I understand you have shortness of breath and leg swelling - how long has this been
going on?
D. Mrs. Williams, before we begin I want to confirm your medications and allergies so we don't miss
anything important.
Correct Answer: B
Rationale: Patient-centered interviewing begins with an open-ended invitation that empowers the patient to tell her
story in her own words, fostering rapport and uncovering information the clinician might not anticipate. Option A
is provider-centered and task-driven; Option C is a closed-ended question that narrows the history prematurely;
Option D skips the patient's narrative entirely. i-Human history-taking rubrics reward opening the encounter with
a broad, patient-focused prompt before progressing to focused questioning.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 1
,Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q2: During the history of present illness (HPI), you apply the OLDCARTS framework to structure
Georgette's symptom exploration. Which component of OLDCARTS is most critical to capture when
characterizing her dyspnea?
A. Onset, including whether the dyspnea began abruptly or insidiously and any relation to a
triggering event. *[CORRECT]*
B. Treatment, listing every over-the-counter remedy she has tried at home.
C. Severity on a 0-10 numeric scale identical to a pain rating.
D. Radiation of dyspnea to other body regions such as the back or jaw.
Correct Answer: A
Rationale: Onset distinguishes acute processes (pulmonary embolism, pneumothorax, acute decompensated heart
failure) from chronic progressive conditions (COPD, chronic HF, interstitial lung disease), fundamentally shaping
the differential. Treatment and severity are useful but secondary; 'radiation' applies to pain, not dyspnea. The
i-Human HPI rubric requires explicit documentation of onset, location, duration, character, aggravating/relieving
factors, radiation, associated symptoms, and timing for full credit.
Q3: Georgette describes her breathing as worse with exertion and when lying flat at night, requiring three
pillows to sleep. Which historical element should you elicit next to clarify the orthopnea?
A. Whether she has noticed any wheezing or whistling sounds when breathing.
B. The exact number of flights of stairs she could climb six months ago versus today.
C. Whether the breathlessness improves when she sits upright or stands. *[CORRECT]*
D. Whether anyone in her family has ever had similar breathing problems.
Correct Answer: C
Rationale: Orthopnea that improves with sitting upright is pathognomonic for venous return redistribution in heart
failure; confirming positional relief validates the symptom's cardiogenic origin and supports the differential of
decompensated HF. Wheezing and stair tolerance are useful but do not confirm orthopnea. Family history is part
of the family history section, not the HPI clarification of orthopnea. i-Human rubrics require the student to verify
the positional nature of orthopnea before scoring the symptom as present.
Q4: Which of the following questions is the best example of a closed-ended question appropriate for
narrowing Georgette's medication history?
A. Tell me everything you take for your health, including herbs and vitamins.
B. How does taking your blood pressure medicine make you feel?
C. Do you take your lisinopril every morning as prescribed? *[CORRECT]*
D. What concerns do you have about the medicines you are currently taking?
Correct Answer: C
Rationale: Closed-ended questions elicit specific, verifiable facts and are ideal for confirming medication
adherence, dose, and timing. Option A is broad and open-ended (best for the initial medication list). Option B
explores feelings (open-ended). Option D invites concerns (open-ended). i-Human interviewing standards require
a deliberate mix: open-ended prompts to build the narrative, then closed-ended prompts to verify specific data
points such as doses, frequencies, and adherence.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 2
,Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q5: When taking Georgette's past medical history (PMH), which chronic condition in her history most
directly contributes to her current presentation of dyspnea and edema and must be documented in the
i-Human PMH field?
A. Hypertension diagnosed 10 years ago, currently treated with lisinopril 20 mg daily.
*[CORRECT]*
B. Cholecystectomy in 2008 with no postoperative complications.
C. Seasonal allergic rhinitis controlled with over-the-counter loratadine.
D. Remote history of childhood varicella infection without sequelae.
Correct Answer: A
Rationale: Long-standing hypertension is a leading cause of heart failure with preserved or reduced ejection
fraction and is the most clinically relevant PMH item for Georgette's dyspnea and edema. Cholecystectomy and
remote varicella are surgical and pediatric history items with no bearing on the current presentation. Allergic
rhinitis is minor. i-Human PMH documentation prioritizes chronic conditions that influence the active problem list,
with surgical history captured in a separate Past Surgical History field.
Q6: Georgette's family history reveals her father died of a myocardial infarction at age 62 and her mother
has type 2 diabetes. According to evidence-based cardiovascular risk stratification, which additional
family-history element most increases her pretest probability of ischemic cardiomyopathy?
A. A paternal uncle diagnosed with gout at age 55.
B. A sister diagnosed with hypertension at age 48. *[CORRECT]*
C. A maternal aunt with hypothyroidism diagnosed at age 60.
D. A paternal cousin with exercise-induced asthma.
Correct Answer: B
Rationale: Premature cardiovascular disease in a first-degree relative (sister with hypertension before age 55)
substantially increases Georgette's cardiovascular risk and supports an ischemic etiology for her heart failure. The
ACC/AHA 2026 cardiovascular risk guidelines emphasize first-degree family history of premature CVD (men <55,
women <65) as a major risk-enhancing factor. Gout, hypothyroidism, and asthma in second-degree relatives are
not primary cardiovascular risk enhancers.
Q7: When eliciting Georgette's social history, which approach best demonstrates motivational interviewing
technique for her former smoking status?
A. You should never smoke again because it caused your heart disease.
B. Why did you smoke for so many years if you knew it was bad for you?
C. You quit smoking five years ago - what helped you succeed, and what concerns do you have now?
*[CORRECT]*
D. I'm going to refer you to a smoking cessation program just in case.
Correct Answer: C
Rationale: Motivational interviewing uses open-ended questions, affirmations, reflective listening, and
summarizing (OARS) to elicit and strengthen patient motivation. Option C affirms her success and invites her
perspective, exemplifying MI. Options A and B are judgmental and confrontational, undermining rapport. Option
D assumes the patient needs intervention without exploring her current status, violating MI principles and
i-Human communication rubrics.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 3
, Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q8: Georgette reveals she works as an office manager, lives with her husband, and has two adult children
living nearby. She drinks one to two glasses of wine on weekends and denies illicit drug use. Which element
of her social history is most important to assess next given her presentation?
A. Her dietary sodium and fluid intake patterns. *[CORRECT]*
B. Her preferred brand of wine and where she purchases it.
C. Whether she enjoys her job as an office manager.
D. Whether her adult children attended college.
Correct Answer: A
Rationale: Dietary sodium and fluid intake directly modulate heart failure exacerbations; assessing these is
essential for both diagnostic understanding and management planning. The brand of wine, job satisfaction, and
children's education are social context but have minimal bearing on her volume overload. i-Human social history
rubrics require eliciting lifestyle factors that influence the presenting complaint, including diet, exercise, substance
use, and adherence barriers.
Q9: Which documentation entry best meets i-Human standards for recording Georgette's allergy history?
A. Allergies: NKDA.
B. Allergies: No known drug allergies; tolerates lisinopril, metformin, atorvastatin, and aspirin
without adverse effects. *[CORRECT]*
C. Allergies: Patient states she is allergic to something but cannot recall what.
D. Allergies: No allergies reported; patient has never been hospitalized.
Correct Answer: B
Rationale: i-Human allergy documentation should explicitly state NKDA and note tolerance of current
medications, ensuring downstream providers have actionable information. A bare 'NKDA' without context is less
complete. Option C indicates incomplete data and requires further clarification. Option D conflates allergy history
with hospitalization history. Complete allergy documentation includes drug, environmental, food, and latex
allergies plus reaction severity.
Q10: When conducting the review of systems (ROS) for Georgette, which positive ROS finding would be
most consistent with her suspected diagnosis of decompensated heart failure?
A. Nocturia of four times per night for the past two weeks. *[CORRECT]*
B. Polyuria of clear urine up to ten times daily for the past month.
C. Hemoptysis of bright red blood approximately one tablespoon daily.
D. Dysuria and suprapubic pressure for the past three days.
Correct Answer: A
Rationale: Nocturia is a classic ROS finding in heart failure: supine posture at night mobilizes peripheral edema,
increasing renal perfusion and urine output. Polyuria with clear urine suggests diabetes insipidus or uncontrolled
diabetes mellitus. Hemoptysis suggests malignancy, TB, or pulmonary embolism. Dysuria and suprapubic pressure
suggest UTI. i-Human ROS rubrics require students to identify cardiac, respiratory, renal, and constitutional
symptoms that align with the suspected diagnosis.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 4
GEORGETTE MODULE 1 & 2 QUESTIONS WITH
COMPLETE SOLUTIONS 2026/2027
Comprehensive Clinical Reasoning Examination • i-Human Patients Case Study Standards • Advanced
Practice Nursing Clinical Reasoning Competencies • Evidence-Based Diagnostic & Management
Guidelines (2026/2027 Edition)
Examination Overview: This 100-item examination evaluates clinical reasoning competencies across ten domains
aligned with i-Human Patients Virtual Patient Case Study standards and the 2026/2027 ACC/AHA/HFSA Heart
Failure Guidelines. Cognitive level distribution: 20% recall, 50% application, 30% analysis. Item format: 80%
scenario-based clinical reasoning anchored to the Georgette Williams virtual patient case (58-year-old African
American female with hypertension, type 2 diabetes, and former smoking history presenting with progressive dyspnea,
orthopnea, and edema), and 20% direct knowledge. Each item includes a fully annotated rationale explaining why the
correct option is best and why the distractors are incorrect, with explicit reference to evidence-based clinical practice
and i-Human case standards.
Section 1: Patient History & Interviewing – Module 1
Q1: Georgette Williams, a 58-year-old African American woman, presents to the primary care clinic with
progressive dyspnea on exertion and bilateral leg swelling over the past three weeks. When initiating the
i-Human interview, which opening statement best exemplifies patient-centered interviewing and
establishes a therapeutic alliance?
A. Mrs. Williams, I need to ask you a series of questions about your symptoms so I can complete your chart.
B. Mrs. Williams, thank you for coming in today. Please tell me in your own words what has been
bringing you in and how it has affected your daily life. *[CORRECT]*
C. Mrs. Williams, I understand you have shortness of breath and leg swelling - how long has this been
going on?
D. Mrs. Williams, before we begin I want to confirm your medications and allergies so we don't miss
anything important.
Correct Answer: B
Rationale: Patient-centered interviewing begins with an open-ended invitation that empowers the patient to tell her
story in her own words, fostering rapport and uncovering information the clinician might not anticipate. Option A
is provider-centered and task-driven; Option C is a closed-ended question that narrows the history prematurely;
Option D skips the patient's narrative entirely. i-Human history-taking rubrics reward opening the encounter with
a broad, patient-focused prompt before progressing to focused questioning.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 1
,Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q2: During the history of present illness (HPI), you apply the OLDCARTS framework to structure
Georgette's symptom exploration. Which component of OLDCARTS is most critical to capture when
characterizing her dyspnea?
A. Onset, including whether the dyspnea began abruptly or insidiously and any relation to a
triggering event. *[CORRECT]*
B. Treatment, listing every over-the-counter remedy she has tried at home.
C. Severity on a 0-10 numeric scale identical to a pain rating.
D. Radiation of dyspnea to other body regions such as the back or jaw.
Correct Answer: A
Rationale: Onset distinguishes acute processes (pulmonary embolism, pneumothorax, acute decompensated heart
failure) from chronic progressive conditions (COPD, chronic HF, interstitial lung disease), fundamentally shaping
the differential. Treatment and severity are useful but secondary; 'radiation' applies to pain, not dyspnea. The
i-Human HPI rubric requires explicit documentation of onset, location, duration, character, aggravating/relieving
factors, radiation, associated symptoms, and timing for full credit.
Q3: Georgette describes her breathing as worse with exertion and when lying flat at night, requiring three
pillows to sleep. Which historical element should you elicit next to clarify the orthopnea?
A. Whether she has noticed any wheezing or whistling sounds when breathing.
B. The exact number of flights of stairs she could climb six months ago versus today.
C. Whether the breathlessness improves when she sits upright or stands. *[CORRECT]*
D. Whether anyone in her family has ever had similar breathing problems.
Correct Answer: C
Rationale: Orthopnea that improves with sitting upright is pathognomonic for venous return redistribution in heart
failure; confirming positional relief validates the symptom's cardiogenic origin and supports the differential of
decompensated HF. Wheezing and stair tolerance are useful but do not confirm orthopnea. Family history is part
of the family history section, not the HPI clarification of orthopnea. i-Human rubrics require the student to verify
the positional nature of orthopnea before scoring the symptom as present.
Q4: Which of the following questions is the best example of a closed-ended question appropriate for
narrowing Georgette's medication history?
A. Tell me everything you take for your health, including herbs and vitamins.
B. How does taking your blood pressure medicine make you feel?
C. Do you take your lisinopril every morning as prescribed? *[CORRECT]*
D. What concerns do you have about the medicines you are currently taking?
Correct Answer: C
Rationale: Closed-ended questions elicit specific, verifiable facts and are ideal for confirming medication
adherence, dose, and timing. Option A is broad and open-ended (best for the initial medication list). Option B
explores feelings (open-ended). Option D invites concerns (open-ended). i-Human interviewing standards require
a deliberate mix: open-ended prompts to build the narrative, then closed-ended prompts to verify specific data
points such as doses, frequencies, and adherence.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 2
,Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q5: When taking Georgette's past medical history (PMH), which chronic condition in her history most
directly contributes to her current presentation of dyspnea and edema and must be documented in the
i-Human PMH field?
A. Hypertension diagnosed 10 years ago, currently treated with lisinopril 20 mg daily.
*[CORRECT]*
B. Cholecystectomy in 2008 with no postoperative complications.
C. Seasonal allergic rhinitis controlled with over-the-counter loratadine.
D. Remote history of childhood varicella infection without sequelae.
Correct Answer: A
Rationale: Long-standing hypertension is a leading cause of heart failure with preserved or reduced ejection
fraction and is the most clinically relevant PMH item for Georgette's dyspnea and edema. Cholecystectomy and
remote varicella are surgical and pediatric history items with no bearing on the current presentation. Allergic
rhinitis is minor. i-Human PMH documentation prioritizes chronic conditions that influence the active problem list,
with surgical history captured in a separate Past Surgical History field.
Q6: Georgette's family history reveals her father died of a myocardial infarction at age 62 and her mother
has type 2 diabetes. According to evidence-based cardiovascular risk stratification, which additional
family-history element most increases her pretest probability of ischemic cardiomyopathy?
A. A paternal uncle diagnosed with gout at age 55.
B. A sister diagnosed with hypertension at age 48. *[CORRECT]*
C. A maternal aunt with hypothyroidism diagnosed at age 60.
D. A paternal cousin with exercise-induced asthma.
Correct Answer: B
Rationale: Premature cardiovascular disease in a first-degree relative (sister with hypertension before age 55)
substantially increases Georgette's cardiovascular risk and supports an ischemic etiology for her heart failure. The
ACC/AHA 2026 cardiovascular risk guidelines emphasize first-degree family history of premature CVD (men <55,
women <65) as a major risk-enhancing factor. Gout, hypothyroidism, and asthma in second-degree relatives are
not primary cardiovascular risk enhancers.
Q7: When eliciting Georgette's social history, which approach best demonstrates motivational interviewing
technique for her former smoking status?
A. You should never smoke again because it caused your heart disease.
B. Why did you smoke for so many years if you knew it was bad for you?
C. You quit smoking five years ago - what helped you succeed, and what concerns do you have now?
*[CORRECT]*
D. I'm going to refer you to a smoking cessation program just in case.
Correct Answer: C
Rationale: Motivational interviewing uses open-ended questions, affirmations, reflective listening, and
summarizing (OARS) to elicit and strengthen patient motivation. Option C affirms her success and invites her
perspective, exemplifying MI. Options A and B are judgmental and confrontational, undermining rapport. Option
D assumes the patient needs intervention without exploring her current status, violating MI principles and
i-Human communication rubrics.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 3
, Georgette Module 1 & 2 - Comprehensive Clinical Reasoning Examination - 2026/2027 i-Human Patients Case Study Standards
Q8: Georgette reveals she works as an office manager, lives with her husband, and has two adult children
living nearby. She drinks one to two glasses of wine on weekends and denies illicit drug use. Which element
of her social history is most important to assess next given her presentation?
A. Her dietary sodium and fluid intake patterns. *[CORRECT]*
B. Her preferred brand of wine and where she purchases it.
C. Whether she enjoys her job as an office manager.
D. Whether her adult children attended college.
Correct Answer: A
Rationale: Dietary sodium and fluid intake directly modulate heart failure exacerbations; assessing these is
essential for both diagnostic understanding and management planning. The brand of wine, job satisfaction, and
children's education are social context but have minimal bearing on her volume overload. i-Human social history
rubrics require eliciting lifestyle factors that influence the presenting complaint, including diet, exercise, substance
use, and adherence barriers.
Q9: Which documentation entry best meets i-Human standards for recording Georgette's allergy history?
A. Allergies: NKDA.
B. Allergies: No known drug allergies; tolerates lisinopril, metformin, atorvastatin, and aspirin
without adverse effects. *[CORRECT]*
C. Allergies: Patient states she is allergic to something but cannot recall what.
D. Allergies: No allergies reported; patient has never been hospitalized.
Correct Answer: B
Rationale: i-Human allergy documentation should explicitly state NKDA and note tolerance of current
medications, ensuring downstream providers have actionable information. A bare 'NKDA' without context is less
complete. Option C indicates incomplete data and requires further clarification. Option D conflates allergy history
with hospitalization history. Complete allergy documentation includes drug, environmental, food, and latex
allergies plus reaction severity.
Q10: When conducting the review of systems (ROS) for Georgette, which positive ROS finding would be
most consistent with her suspected diagnosis of decompensated heart failure?
A. Nocturia of four times per night for the past two weeks. *[CORRECT]*
B. Polyuria of clear urine up to ten times daily for the past month.
C. Hemoptysis of bright red blood approximately one tablespoon daily.
D. Dysuria and suprapubic pressure for the past three days.
Correct Answer: A
Rationale: Nocturia is a classic ROS finding in heart failure: supine posture at night mobilizes peripheral edema,
increasing renal perfusion and urine output. Polyuria with clear urine suggests diabetes insipidus or uncontrolled
diabetes mellitus. Hemoptysis suggests malignancy, TB, or pulmonary embolism. Dysuria and suprapubic pressure
suggest UTI. i-Human ROS rubrics require students to identify cardiac, respiratory, renal, and constitutional
symptoms that align with the suspected diagnosis.
Advanced Practice Nursing - Clinical Reasoning Competencies Page 4
