2026 NRNP 6531 Week 4 Assignment i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
2026 NRNP 6531 Week 4 Assignment
i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
Instructions: Select the BEST answer for each question. Each question has four options (A–D) with one correct answer marked
[CORRECT]. A rationale with clinical reasoning follows each question.
Section 1: Clinical Assessment and Health History (Q1–Q10)
Q1: Harold Brown, a 62-year-old male, presents to the emergency department with a chief complaint of chest pain.
Using the OLDCARTS mnemonic, which of the following elements is MOST critical for the advanced practice
nurse to elicit during the history of present illness to differentiate acute coronary syndrome (ACS) from other
causes of chest pain?
A. Onset – whether the pain began suddenly or gradually during exertion [CORRECT]
B. Duration – whether the pain has been continuous for the past 6 months
C. Timing – whether the pain occurs only at night while supine
D. Severity – whether the patient rates the pain as 2 out of 10
Correct Answer: A
Rationale: In evaluating chest pain with the OLDCARTS mnemonic, onset is critical for differentiating ACS from non-cardiac etiologies.
Sudden onset of substernal pressure or tightness, especially at rest or with minimal exertion, raises suspicion for unstable angina or
myocardial infarction. Gradual onset over months suggests stable angina or non-cardiac causes. The advanced practice nurse must
characterize onset, quality, radiation, and associated symptoms (diaphoresis, nausea, dyspnea) to determine acuity and initiate
appropriate workup.
Q2: Ruby Washington, a 68-year-old female with a history of hypertension and type 2 diabetes mellitus, reports
progressive dyspnea on exertion over the past 3 months that now occurs with minimal activity. She states she now
requires three pillows to sleep comfortably and occasionally awakens gasping for air. Which symptom constellation
is MOST consistent with left-sided heart failure?
A. Bilateral lower extremity edema, jugular venous distension, and hepatomegaly
B. Orthopnea, paroxysmal nocturnal dyspnea (PND), and a chronic non-productive cardiac cough
[CORRECT]
C. Sharp pleuritic chest pain that worsens with deep inspiration
D. Postprandial fullness, early satiety, and peripheral cyanosis
Correct Answer: B
Rationale: Orthopnea, PND, and exertional dyspnea are classic manifestations of left-sided heart failure resulting from pulmonary
venous congestion. As left ventricular dysfunction progresses, increased pulmonary capillary hydrostatic pressure causes interstitial
and alveolar edema. The ‘cardiac cough’ is typically non-productive and worse when supine. Bilateral lower extremity edema and JVD
are features of right-sided heart failure, while pleuritic chest pain suggests pericarditis or pulmonary embolism.
Q3: Carlos Rodriguez, a 55-year-old male, presents with palpitations, exercise intolerance, and occasional
lightheadedness. His past medical history includes hypertension and hyperlipidemia. He reports a family history of
premature coronary artery disease in his father (MI at age 48) and sudden cardiac death in a paternal uncle. Which
statement correctly differentiates his non-modifiable from modifiable cardiovascular risk factors?
A. Family history of premature CAD is modifiable; hypertension and hyperlipidemia are non-modifiable
B. Age, male sex, and family history of premature CAD are non-modifiable; hypertension, hyperlipidemia,
and smoking are modifiable [CORRECT]
C. All risk factors in this patient are modifiable with appropriate pharmacotherapy
2026 NRNP 6531 Week 4 Assignment Page 1
, 2026 NRNP 6531 Week 4 Assignment i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
D. Only smoking and obesity are modifiable; all other factors are genetically determined
Correct Answer: B
Rationale: Non-modifiable risk factors include age, sex (male), and family history of premature coronary artery disease (first-degree
male relative with MI or sudden cardiac death before age 55). Modifiable risk factors include hypertension, hyperlipidemia, diabetes
mellitus, smoking, obesity, physical inactivity, and poor diet. The advanced practice nurse must clearly distinguish between these
categories to prioritize interventions and counsel patients effectively on risk reduction strategies.
Q4: Harold Brown is a 1.5 pack-per-day smoker for 40 years. According to the U.S. Preventive Services Task Force
(USPSTF) and evidence-based guidelines, which intervention for smoking cessation has the HIGHEST level of
evidence for long-term abstinence when combined with behavioral counseling?
A. Cold turkey self-cessation without pharmacologic support
B. Varenicline (Chantix) combined with cognitive-behavioral counseling [CORRECT]
C. Acupuncture and relaxation therapy alone
D. Nicotine replacement therapy (NRT) gum used for 2 weeks
Correct Answer: B
Rationale: Varenicline, a partial nicotinic receptor agonist, combined with behavioral counseling, yields the highest abstinence rates in
randomized controlled trials. The USPSTF recommends that all clinicians ask patients about tobacco use, advise cessation, and offer
pharmacotherapy (varenicline, NRT, or bupropion) combined with behavioral support. Cold turkey has the lowest success rate. NRT
monotherapy for only 2 weeks is insufficient duration. Complementary therapies lack robust evidence.
Q5: Ruby Washington is prescribed furosemide 40 mg PO daily for heart failure management. She reports taking it
“whenever I feel swollen.” Which teaching point is MOST important for the advanced practice nurse to address
regarding medication adherence?
A. Take furosemide every morning to prevent nocturia while maintaining consistent diuresis [CORRECT]
B. Double the dose on days when edema is visibly worse
C. Take furosemide only at bedtime to maximize absorption
D. Discontinue the medication if no symptoms are present
Correct Answer: A
Rationale: Furosemide should be taken consistently every morning to prevent nocturia and maintain steady diuresis. PRN dosing for
heart failure is inappropriate because fluid retention often precedes symptom onset. Doubling the dose risks dehydration, electrolyte
imbalance, and renal impairment. Evening dosing disrupts sleep. Adherence to scheduled daily dosing is essential for optimal volume
management, and the APN must emphasize daily weight monitoring to assess response.
Q6: Carlos Rodriguez’s evaluation reveals: fasting glucose 108 mg/dL, triglycerides 180 mg/dL, HDL 38 mg/dL,
waist circumference 44 inches, and blood pressure 148/92 mmHg. How many components of metabolic syndrome
does this patient meet, and what is the minimum number required for diagnosis?
A. He meets 3 components; minimum of 3 is required for diagnosis [CORRECT]
B. He meets 4 components; minimum of 4 is required for diagnosis
C. He meets 5 components; minimum of 2 is required for diagnosis
D. He meets 2 components; minimum of 3 is required for diagnosis
Correct Answer: A
Rationale: Carlos meets 3 of the 5 NCEP ATP III criteria for metabolic syndrome: elevated triglycerides (≥150 mg/dL), reduced HDL
(<40 mg/dL in men), and elevated blood pressure (≥130/85 mmHg or on antihypertensive treatment). His fasting glucose (108 mg/dL)
does not meet the ≥100 mg/dL impaired fasting glucose threshold by ATP III criteria, though it is elevated. Waist circumference ≥40
inches in men is the fifth criterion. Diagnosis requires at least 3 of 5 components, which Carlos fulfills.
Q7: Using the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator, Harold Brown’s 10-year risk is
calculated at 12.5%. According to the 2018 ACC/AHA Guideline on the Management of Blood Cholesterol, what is
the recommended statin therapy intensity?
2026 NRNP 6531 Week 4 Assignment Page 2
2026 NRNP 6531 Week 4 Assignment
i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
Instructions: Select the BEST answer for each question. Each question has four options (A–D) with one correct answer marked
[CORRECT]. A rationale with clinical reasoning follows each question.
Section 1: Clinical Assessment and Health History (Q1–Q10)
Q1: Harold Brown, a 62-year-old male, presents to the emergency department with a chief complaint of chest pain.
Using the OLDCARTS mnemonic, which of the following elements is MOST critical for the advanced practice
nurse to elicit during the history of present illness to differentiate acute coronary syndrome (ACS) from other
causes of chest pain?
A. Onset – whether the pain began suddenly or gradually during exertion [CORRECT]
B. Duration – whether the pain has been continuous for the past 6 months
C. Timing – whether the pain occurs only at night while supine
D. Severity – whether the patient rates the pain as 2 out of 10
Correct Answer: A
Rationale: In evaluating chest pain with the OLDCARTS mnemonic, onset is critical for differentiating ACS from non-cardiac etiologies.
Sudden onset of substernal pressure or tightness, especially at rest or with minimal exertion, raises suspicion for unstable angina or
myocardial infarction. Gradual onset over months suggests stable angina or non-cardiac causes. The advanced practice nurse must
characterize onset, quality, radiation, and associated symptoms (diaphoresis, nausea, dyspnea) to determine acuity and initiate
appropriate workup.
Q2: Ruby Washington, a 68-year-old female with a history of hypertension and type 2 diabetes mellitus, reports
progressive dyspnea on exertion over the past 3 months that now occurs with minimal activity. She states she now
requires three pillows to sleep comfortably and occasionally awakens gasping for air. Which symptom constellation
is MOST consistent with left-sided heart failure?
A. Bilateral lower extremity edema, jugular venous distension, and hepatomegaly
B. Orthopnea, paroxysmal nocturnal dyspnea (PND), and a chronic non-productive cardiac cough
[CORRECT]
C. Sharp pleuritic chest pain that worsens with deep inspiration
D. Postprandial fullness, early satiety, and peripheral cyanosis
Correct Answer: B
Rationale: Orthopnea, PND, and exertional dyspnea are classic manifestations of left-sided heart failure resulting from pulmonary
venous congestion. As left ventricular dysfunction progresses, increased pulmonary capillary hydrostatic pressure causes interstitial
and alveolar edema. The ‘cardiac cough’ is typically non-productive and worse when supine. Bilateral lower extremity edema and JVD
are features of right-sided heart failure, while pleuritic chest pain suggests pericarditis or pulmonary embolism.
Q3: Carlos Rodriguez, a 55-year-old male, presents with palpitations, exercise intolerance, and occasional
lightheadedness. His past medical history includes hypertension and hyperlipidemia. He reports a family history of
premature coronary artery disease in his father (MI at age 48) and sudden cardiac death in a paternal uncle. Which
statement correctly differentiates his non-modifiable from modifiable cardiovascular risk factors?
A. Family history of premature CAD is modifiable; hypertension and hyperlipidemia are non-modifiable
B. Age, male sex, and family history of premature CAD are non-modifiable; hypertension, hyperlipidemia,
and smoking are modifiable [CORRECT]
C. All risk factors in this patient are modifiable with appropriate pharmacotherapy
2026 NRNP 6531 Week 4 Assignment Page 1
, 2026 NRNP 6531 Week 4 Assignment i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
D. Only smoking and obesity are modifiable; all other factors are genetically determined
Correct Answer: B
Rationale: Non-modifiable risk factors include age, sex (male), and family history of premature coronary artery disease (first-degree
male relative with MI or sudden cardiac death before age 55). Modifiable risk factors include hypertension, hyperlipidemia, diabetes
mellitus, smoking, obesity, physical inactivity, and poor diet. The advanced practice nurse must clearly distinguish between these
categories to prioritize interventions and counsel patients effectively on risk reduction strategies.
Q4: Harold Brown is a 1.5 pack-per-day smoker for 40 years. According to the U.S. Preventive Services Task Force
(USPSTF) and evidence-based guidelines, which intervention for smoking cessation has the HIGHEST level of
evidence for long-term abstinence when combined with behavioral counseling?
A. Cold turkey self-cessation without pharmacologic support
B. Varenicline (Chantix) combined with cognitive-behavioral counseling [CORRECT]
C. Acupuncture and relaxation therapy alone
D. Nicotine replacement therapy (NRT) gum used for 2 weeks
Correct Answer: B
Rationale: Varenicline, a partial nicotinic receptor agonist, combined with behavioral counseling, yields the highest abstinence rates in
randomized controlled trials. The USPSTF recommends that all clinicians ask patients about tobacco use, advise cessation, and offer
pharmacotherapy (varenicline, NRT, or bupropion) combined with behavioral support. Cold turkey has the lowest success rate. NRT
monotherapy for only 2 weeks is insufficient duration. Complementary therapies lack robust evidence.
Q5: Ruby Washington is prescribed furosemide 40 mg PO daily for heart failure management. She reports taking it
“whenever I feel swollen.” Which teaching point is MOST important for the advanced practice nurse to address
regarding medication adherence?
A. Take furosemide every morning to prevent nocturia while maintaining consistent diuresis [CORRECT]
B. Double the dose on days when edema is visibly worse
C. Take furosemide only at bedtime to maximize absorption
D. Discontinue the medication if no symptoms are present
Correct Answer: A
Rationale: Furosemide should be taken consistently every morning to prevent nocturia and maintain steady diuresis. PRN dosing for
heart failure is inappropriate because fluid retention often precedes symptom onset. Doubling the dose risks dehydration, electrolyte
imbalance, and renal impairment. Evening dosing disrupts sleep. Adherence to scheduled daily dosing is essential for optimal volume
management, and the APN must emphasize daily weight monitoring to assess response.
Q6: Carlos Rodriguez’s evaluation reveals: fasting glucose 108 mg/dL, triglycerides 180 mg/dL, HDL 38 mg/dL,
waist circumference 44 inches, and blood pressure 148/92 mmHg. How many components of metabolic syndrome
does this patient meet, and what is the minimum number required for diagnosis?
A. He meets 3 components; minimum of 3 is required for diagnosis [CORRECT]
B. He meets 4 components; minimum of 4 is required for diagnosis
C. He meets 5 components; minimum of 2 is required for diagnosis
D. He meets 2 components; minimum of 3 is required for diagnosis
Correct Answer: A
Rationale: Carlos meets 3 of the 5 NCEP ATP III criteria for metabolic syndrome: elevated triglycerides (≥150 mg/dL), reduced HDL
(<40 mg/dL in men), and elevated blood pressure (≥130/85 mmHg or on antihypertensive treatment). His fasting glucose (108 mg/dL)
does not meet the ≥100 mg/dL impaired fasting glucose threshold by ATP III criteria, though it is elevated. Waist circumference ≥40
inches in men is the fifth criterion. Diagnosis requires at least 3 of 5 components, which Carlos fulfills.
Q7: Using the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator, Harold Brown’s 10-year risk is
calculated at 12.5%. According to the 2018 ACC/AHA Guideline on the Management of Blood Cholesterol, what is
the recommended statin therapy intensity?
2026 NRNP 6531 Week 4 Assignment Page 2
