Shadow Health Cardiovascular
Assessment Practice Questions Rochelle
Joseph (DCE) | 2026 Update with complete
solutions.
Section 1: Patient Scenario & Chief Complaint
Question 1
Rochelle Joseph presents for a follow-up appointment at 32 weeks gestation. According
to the Shadow Health scenario, what is her chief complaint?
A. Chest pain and shortness of breath
B. Fatigue following a recent diagnosis of mitral valve prolapse (MVP)
C. Palpitations and dizziness
D. Leg swelling and headaches
Correct Answer: B. Fatigue following a recent diagnosis of mitral valve prolapse
(MVP)
Rationale: The scenario states that Rochelle Joseph is a 41-year-old female who presents
to the OB-GYN office for her 32-week pregnancy follow-up, complaining of fatigue
following a recent mitral valve prolapse (MVP) diagnosis. Her pregnancy and MVP are the
contextual factors that drive this focused cardiovascular assessment.
Question 2
Rochelle Joseph's current pregnancy is at how many weeks gestation?
A. 28 weeks
B. 30 weeks
C. 32 weeks
D. 34 weeks
,Correct Answer: C. 32 weeks
Rationale: According to the Shadow Health scenario, Rochelle Joseph is presenting for her
32-week pregnancy follow-up. Third-trimester pregnancy brings significant hemodynamic
changes that can influence cardiovascular symptoms such as fatigue, dyspnea, and lower
extremity edema.
Question 3
Rochelle Joseph was recently diagnosed with which cardiac condition?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Mitral valve prolapse (MVP)
D. Atrial septal defect
Correct Answer: C. Mitral valve prolapse (MVP)
Rationale: According to the Shadow Health scenario, Rochelle Joseph was recently
diagnosed with mitral valve prolapse (MVP). This valvular condition involves the
displacement of an abnormally thickened mitral valve leaflet into the left atrium during
systole, sometimes accompanied by mitral regurgitation.
Question 4
Rochelle Joseph's fatigue should be considered in the context of:
A. Normal pregnancy changes only
B. Mitral valve prolapse only
C. Both normal pregnancy changes AND her MVP diagnosis
D. Neither—fatigue is unrelated to her pregnancy or MVP
Correct Answer: C. Both normal pregnancy changes AND her MVP diagnosis
Rationale: Rochelle's fatigue has a multifactorial etiology. Pregnancy is a high-output
state that increases heart rate and blood volume, which can cause fatigue. At the same
time, the recent diagnosis of MVP means that any associated mitral regurgitation could be
,contributing to reduced cardiac efficiency. A comprehensive assessment must consider
both factors.
Question 5
What is the most important initial step when beginning the focused cardiovascular
assessment of Rochelle Joseph?
A. Auscultate the heart immediately
B. Perform a complete blood count
C. Review her medical history and establish a therapeutic dialogue
D. Order an echocardiogram
Correct Answer: C. Review her medical history and establish a therapeutic dialogue
Rationale: Before any physical examination, a thorough history is essential. The focused
cardiovascular history should include details about the MVP diagnosis (symptoms,
diagnostic testing, treatment), the course of the pregnancy, and any changes in symptoms.
Establishing a therapeutic relationship through open-ended questions is the foundation of
the DCE.
Question 6
When asking Rochelle Joseph about her fatigue, the MOST appropriate open-ended
question is:
A. "Are you tired?"
B. "Do you feel more tired than usual?"
C. "Tell me about the fatigue you've been experiencing."
D. "Does your fatigue worsen with activity?"
Correct Answer: C. "Tell me about the fatigue you've been experiencing."
Rationale: An open-ended question such as "Tell me about the fatigue you've been
experiencing" allows the patient to describe her symptoms in her own words without
leading the response. Closed-ended questions (A, B, D) restrict the patient's narrative and
might miss important details. In the Shadow Health DCE, using open-ended questions
builds rapport and elicits comprehensive information.
, Question 7
To assess the severity of fatigue, the nurse should ask:
A. "On a scale of 0 to 10, with 0 being no fatigue and 10 being the worst fatigue, how
would you rate your fatigue?"
B. "Is your fatigue mild, moderate, or severe?"
C. "Do you sleep well at night?"
D. "When did your fatigue start?"
Correct Answer: A. "On a scale of 0 to 10, with 0 being no fatigue and 10 being the
worst fatigue, how would you rate your fatigue?"
Rationale: A numeric rating scale (0-10) provides a standardized measure of symptom
severity that can be tracked over time. This allows the provider to quantify the patient's
experience and monitor for improvement or worsening. Categorical ratings
(mild/moderate/severe) are less precise, and questions about sleep do not directly assess
the fatigue itself.
Question 8
Pregnancy can exacerbate MVP symptoms. Which symptom should the nurse monitor
for as a potential complication?
A. Decreased heart rate
B. Progressive dyspnea on exertion or new-onset palpitations
C. Hypotension
D. Decreased appetite
Correct Answer: B. Progressive dyspnea on exertion or new-onset palpitations
Rationale: The increased blood volume and cardiac output of pregnancy can exacerbate
previously asymptomatic MVP. If mitral regurgitation worsens, the patient may develop
progressive dyspnea on exertion, new-onset palpitations, or other signs of heart failure.
The nurse should distinguish normal pregnancy dyspnea from pathological dyspnea.
Assessment Practice Questions Rochelle
Joseph (DCE) | 2026 Update with complete
solutions.
Section 1: Patient Scenario & Chief Complaint
Question 1
Rochelle Joseph presents for a follow-up appointment at 32 weeks gestation. According
to the Shadow Health scenario, what is her chief complaint?
A. Chest pain and shortness of breath
B. Fatigue following a recent diagnosis of mitral valve prolapse (MVP)
C. Palpitations and dizziness
D. Leg swelling and headaches
Correct Answer: B. Fatigue following a recent diagnosis of mitral valve prolapse
(MVP)
Rationale: The scenario states that Rochelle Joseph is a 41-year-old female who presents
to the OB-GYN office for her 32-week pregnancy follow-up, complaining of fatigue
following a recent mitral valve prolapse (MVP) diagnosis. Her pregnancy and MVP are the
contextual factors that drive this focused cardiovascular assessment.
Question 2
Rochelle Joseph's current pregnancy is at how many weeks gestation?
A. 28 weeks
B. 30 weeks
C. 32 weeks
D. 34 weeks
,Correct Answer: C. 32 weeks
Rationale: According to the Shadow Health scenario, Rochelle Joseph is presenting for her
32-week pregnancy follow-up. Third-trimester pregnancy brings significant hemodynamic
changes that can influence cardiovascular symptoms such as fatigue, dyspnea, and lower
extremity edema.
Question 3
Rochelle Joseph was recently diagnosed with which cardiac condition?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Mitral valve prolapse (MVP)
D. Atrial septal defect
Correct Answer: C. Mitral valve prolapse (MVP)
Rationale: According to the Shadow Health scenario, Rochelle Joseph was recently
diagnosed with mitral valve prolapse (MVP). This valvular condition involves the
displacement of an abnormally thickened mitral valve leaflet into the left atrium during
systole, sometimes accompanied by mitral regurgitation.
Question 4
Rochelle Joseph's fatigue should be considered in the context of:
A. Normal pregnancy changes only
B. Mitral valve prolapse only
C. Both normal pregnancy changes AND her MVP diagnosis
D. Neither—fatigue is unrelated to her pregnancy or MVP
Correct Answer: C. Both normal pregnancy changes AND her MVP diagnosis
Rationale: Rochelle's fatigue has a multifactorial etiology. Pregnancy is a high-output
state that increases heart rate and blood volume, which can cause fatigue. At the same
time, the recent diagnosis of MVP means that any associated mitral regurgitation could be
,contributing to reduced cardiac efficiency. A comprehensive assessment must consider
both factors.
Question 5
What is the most important initial step when beginning the focused cardiovascular
assessment of Rochelle Joseph?
A. Auscultate the heart immediately
B. Perform a complete blood count
C. Review her medical history and establish a therapeutic dialogue
D. Order an echocardiogram
Correct Answer: C. Review her medical history and establish a therapeutic dialogue
Rationale: Before any physical examination, a thorough history is essential. The focused
cardiovascular history should include details about the MVP diagnosis (symptoms,
diagnostic testing, treatment), the course of the pregnancy, and any changes in symptoms.
Establishing a therapeutic relationship through open-ended questions is the foundation of
the DCE.
Question 6
When asking Rochelle Joseph about her fatigue, the MOST appropriate open-ended
question is:
A. "Are you tired?"
B. "Do you feel more tired than usual?"
C. "Tell me about the fatigue you've been experiencing."
D. "Does your fatigue worsen with activity?"
Correct Answer: C. "Tell me about the fatigue you've been experiencing."
Rationale: An open-ended question such as "Tell me about the fatigue you've been
experiencing" allows the patient to describe her symptoms in her own words without
leading the response. Closed-ended questions (A, B, D) restrict the patient's narrative and
might miss important details. In the Shadow Health DCE, using open-ended questions
builds rapport and elicits comprehensive information.
, Question 7
To assess the severity of fatigue, the nurse should ask:
A. "On a scale of 0 to 10, with 0 being no fatigue and 10 being the worst fatigue, how
would you rate your fatigue?"
B. "Is your fatigue mild, moderate, or severe?"
C. "Do you sleep well at night?"
D. "When did your fatigue start?"
Correct Answer: A. "On a scale of 0 to 10, with 0 being no fatigue and 10 being the
worst fatigue, how would you rate your fatigue?"
Rationale: A numeric rating scale (0-10) provides a standardized measure of symptom
severity that can be tracked over time. This allows the provider to quantify the patient's
experience and monitor for improvement or worsening. Categorical ratings
(mild/moderate/severe) are less precise, and questions about sleep do not directly assess
the fatigue itself.
Question 8
Pregnancy can exacerbate MVP symptoms. Which symptom should the nurse monitor
for as a potential complication?
A. Decreased heart rate
B. Progressive dyspnea on exertion or new-onset palpitations
C. Hypotension
D. Decreased appetite
Correct Answer: B. Progressive dyspnea on exertion or new-onset palpitations
Rationale: The increased blood volume and cardiac output of pregnancy can exacerbate
previously asymptomatic MVP. If mitral regurgitation worsens, the patient may develop
progressive dyspnea on exertion, new-onset palpitations, or other signs of heart failure.
The nurse should distinguish normal pregnancy dyspnea from pathological dyspnea.
