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NUR 6111 LIAM FITZGERALD SHADOW
HEALTH: TELEHEALTH FOLLOW-UP
SICK VISIT – MANAGEMENT OF
CARDIOVASCULAR CONDITIONS 200
Questions | Answers & Rationales
Exam Blueprint: Telehealth Protocols & Legal/Ethical Considerations (10%) – 20 Qs History Taking & Assessment Findings (20%) – 40 Qs Diagnostics & Clinical Reasoning (15%) – 30 Qs Heart Failure Pathophysiology & Differential Diagnosis (20%) – 40 Qs Pharmacology & Treatment Management (20%) – 40 Qs Patient Education & Follow-Up Care (15%) – 30 Qs SECTION 1: TELEHEALTH PROTOCOLS & LEGAL/ETHICAL CONSIDERATIONS (Questions 1–20)
- Before initiating any telehealth visit, the provider must first ensure: A) The patient has eaten breakfast B) The patient is in a private location where HIPAA standards can be maintained and technology is functioning C) The patient has taken all scheduled medications D) The patient has a blood pressure cuff available Answer: B Rationale: Before initiating a telehealth visit, the provider must first ensure patient privacy and appropriate technology, including confirming the patient is in a confidential location where HIPAA standards can be maintained.
- Proper telehealth etiquette before beginning a visit includes:
A) Immediately starting the exam upon connection B) Confirming the patient can hear you and is ready for the visit C) Speaking loudly at all times D) Avoiding eye contact with the camera Answer: B Rationale: Proper telehealth etiquette requires the provider to confirm audio connectivity and ensure the patient is prepared for the visit, which establishes clear communication and sets expectations for the encounter.
- It is important to inform the patient via telehealth that the visit is protected and confidential. This statement is: A) True B) False Answer: A Rationale: Patients must be made aware of privacy protections during telehealth visits to maintain trust and comply with legal and ethical standards for remote care delivery.
- The first component of the telehealth protocol that should be documented is: A) Review of systems B) Physical assessment findings C) Confirmation that the patient is in an appropriate environment for a visit D) Medication reconciliation Answer: C Rationale: Confirming an appropriate environment ensures patient privacy and a safe space for discussion of sensitive health information.
- Before taking a history via telehealth, the provider should: A) Assume the patient knows how to use the technology B) Confirm the patient can hear the provider and is ready for the visit C) Begin asking questions immediately D) Skip the introductory protocol to save time Answer: B
B) Only open-ended questions C) A combination of open and closed questions D) Leading questions only Answer: C Rationale: Open-ended questions gather narrative information, while closed-ended questions clarify specific details; both are essential for comprehensive data collection.
- To maintain patient confidentiality during telehealth, the patient should be: A) In a public space with others present B) In a private location where others cannot overhear C) Using a shared computer in a library D) On speakerphone in a crowded room Answer: B Rationale: Confidentiality requires a private location where the patient can speak freely without risk of others overhearing protected health information. SECTION 2: HISTORY TAKING & ASSESSMENT FINDINGS (Questions 21–60)
- Mr. Fitzgerald reported taking his vital signs at home. He further reported: A) Taking them at random times of the day B) Taking them at the same time each day C) Not knowing how to take them D) Having no equipment Answer: B Rationale: Mr. Fitzgerald reported taking his vital signs daily at the same time each day, which is essential for accurate trend monitoring.
- When asked about respiratory symptoms, Mr. Fitzgerald denied all of the following EXCEPT: A) Cough B) Wheezing C) Shortness of breath
D) Denied all respiratory symptoms at this visit Answer: D Rationale: In the telehealth encounter, Mr. Fitzgerald denied shortness of breath, cough, and wheezing at this visit.
- Mr. Fitzgerald reported swelling in which location? A) Hands only B) Feet and ankles C) Abdomen D) Face only Answer: B Rationale: Mr. Fitzgerald reported swelling in his feet and ankles, with notes that socks left indentation marks.
- Mr. Fitzgerald reported noticing the swelling over what timeframe? A) Over the past day B) Over the past week C) Over the past month D) Over the past year Answer: B Rationale: Mr. Fitzgerald reported noticing swelling in his feet and ankles with recent onset.
- Regarding daily weight logs, Mr. Fitzgerald reported: A) Taking weights sporadically B) Taking daily weight at the same time each day wearing the same type of clothing C) Not weighing himself at home D) Weighing himself only at the doctor's office Answer: B Rationale: Mr. Fitzgerald reported taking daily weights at the same time each day and wearing the same type of clothing, which ensures accuracy for trending data.
- Mr. Fitzgerald reported how much weight gain? A) 1-2 pounds
- When asked about pain status, Mr. Fitzgerald reported: A) Chest pain B) Abdominal pain C) Denies pain D) Joint pain Answer: C Rationale: Mr. Fitzgerald denied pain during the telehealth encounter.
- Mr. Fitzgerald reported that socks left what on his feet/ankles? A) Red marks B) Indentation marks C) Itching D) Blisters Answer: B Rationale: Mr. Fitzgerald noted that his socks left indentation marks, indicative of pitting edema.
- Regarding his daily weight, Mr. Fitzgerald reported weighing himself at what time? A) Morning B) Afternoon C) Evening D) Different times each day Answer: A Rationale: Mr. Fitzgerald reported weighing himself at the same time each day, typically in the morning, wearing the same type of clothing.
- Mr. Fitzgerald denied which of the following cardiovascular symptoms? A) Chest pain B) Palpitations C) Both chest pain and palpitations D) Swelling Answer: C
Rationale: Mr. Fitzgerald denied chest pain and palpitations but reported swelling in his feet and ankles.
- When asked about how he was doing, Mr. Fitzgerald reported: A) Doing very poorly B) Doing well C) Not sure D) Declined to Answer Answer: B Rationale: At the beginning of the encounter, when asked how he was doing, Mr. Fitzgerald reported doing well.
- Mr. Fitzgerald's swelling was first noticed in conjunction with what? A) Chest pain B) Shortness of breath C) Weight gain D) Fatigue Answer: C Rationale: Mr. Fitzgerald reported noticing swelling in conjunction with weight gain.
- Which of the following integumentary symptoms did Mr. Fitzgerald deny? A) Itchy, dry skin B) Rash C) Bruising D) All of the above Answer: A Rationale: Mr. Fitzgerald denied itchy, dry skin when asked about integumentary symptoms.
- Regarding his daily weight logs, Mr. Fitzgerald reported taking his weight: A) Weekly B) Daily C) Monthly
SECTION 3: DIAGNOSTICS & CLINICAL REASONING (Questions 61–90)
- Which of the following evidence supports the diagnosis of fluid volume overload in Mr. Fitzgerald? (Select all that apply) A) Fatigue with activity B) Pitting edema C) Report of increased sodium consumption D) Weight gain Answer: A, B, C, D Rationale: All four findings—fatigue with activity, pitting edema, increased sodium intake, and weight gain—support the diagnosis of fluid volume overload.
- Mr. Fitzgerald's primary diagnosis according to the Shadow Health model is: A) Acute coronary syndrome B) Fluid volume overload C) Pulmonary embolism D) Myocardial infarction Answer: B Rationale: The Shadow Health model identifies fluid volume overload as the primary diagnosis, with a secondary diagnosis of acute on chronic congestive heart failure (CHF) with diastolic dysfunction.
- Mr. Fitzgerald's secondary diagnosis is: A) Hypertension B) Acute on chronic CHF with diastolic dysfunction C) Diabetes mellitus D) Chronic kidney disease Answer: B Rationale: The fluid volume overload has exacerbated his chronic condition, resulting in acute on chronic CHF with diastolic dysfunction as the secondary diagnosis.
- The evidence supporting Mr. Fitzgerald's secondary diagnosis of acute on chronic CHF includes all of the following EXCEPT:
A) Elevated diastolic pressure B) Elevated systolic pressure C) Decreased respiratory rate D) Weight gain Answer: C Rationale: Elevated diastolic and systolic pressures, along with fatigue, pitting edema, increased sodium intake, and weight gain, support the diagnosis. Decreased respiratory rate would not be expected in fluid overload.
- Mr. Fitzgerald's elevated diastolic and systolic pressures confirm what? A) A worsening cardiovascular condition B) Normal aging changes C) Medication side effects D) Dehydration Answer: A Rationale: His elevated diastolic and systolic pressures confirm a worsening condition, consistent with fluid volume overload and acute exacerbation of CHF.
- Heart failure pathophysiology is characterized by: A) Impaired atrial filling and ejection of blood B) Incomplete closure of tricuspid valve C) Near normal ventricular function D) Inadequate cardiac output to meet oxygen and metabolic demands of the body Answer: D Rationale: Heart failure is fundamentally a clinical syndrome resulting from structural or functional cardiac disorders that impair the ventricle's ability to fill with or eject blood, leading to inadequate cardiac output that cannot meet the body's metabolic demands.
- A leading cause of heart failure is: A) Hypertensive heart disease B) Atrial fibrillation C) Pulmonary embolism
C) Resting dyspnea D) Paroxysmal nocturnal dyspnea Answer: D Rationale: Paroxysmal nocturnal dyspnea (PND) is characterized by sudden awakening from sleep with severe shortness of breath, often accompanied by coughing and anxiety. It occurs due to fluid redistribution when lying down.
- Pitting edema and weight gain in a patient with heart failure indicate: A) Dehydration B) Fluid volume overload C) Malnutrition D) Renal failure Answer: B Rationale: Pitting edema and weight gain are cardinal signs of fluid volume overload, which exacerbates chronic CHF.
- A patient with fluid volume overload and heart failure would be expected to have what type of vital sign changes? A) Hypotension and bradycardia B) Hypertension and tachycardia (compensatory) C) Normal vital signs D) Hypothermia Answer: B Rationale: Fluid volume overload increases preload, often leading to hypertension, and the failing heart may compensate with tachycardia to maintain cardiac output.
- For patients with co-morbidities and chronic conditions, examining signs and symptoms at the root of the cause helps the provider: A) Ignore the chronic condition B) Determine why the chronic condition is worsening C) Discontinue all medications D) Focus only on acute symptoms Answer: B
Rationale: Examining signs and symptoms at the root of the cause helps determine why the chronic condition is worsening, allowing targeted intervention.
- The clinical finding of an S3 heart sound in a patient with heart failure is associated with: A) Decreased ventricular compliance and volume overload B) Atrial contraction C) Aortic stenosis D) Mitral regurgitation Answer: A Rationale: An S3 heart sound (ventricular gallop) occurs early in diastole and is associated with volume overload states, indicating decreased ventricular compliance.
- In patients with heart failure, the point of maximum impulse (PMI) usually: A) Remains unchanged near the fourth intercostal space B) Remains unchanged near the fifth intercostal space C) Shifts lower on the mid-clavicular line D) Shifts laterally by one or more intercostal spaces Answer: D Rationale: Cardiac enlargement in heart failure causes the PMI to shift laterally, often by one or more intercostal spaces, consistent with ventricular dilation and hypertrophy.
- In dilated cardiomyopathy and heart failure, the expected PMI location is: A) At the fifth intercostal space, mid-clavicular line B) Shifted laterally due to cardiac enlargement C) At the second intercostal space D) Non-palpable Answer: B Rationale: In dilated cardiomyopathy, the PMI typically shifts laterally due to cardiac enlargement.
- An ECG finding in a patient taking digoxin at a therapeutic dose typically includes: A) Shortened PR interval B) Slightly depressed, cupped ST segments
D) Diuretic use Answer: B Rationale: High sodium intake increases osmotic pressure, causing water retention and expanding circulating blood volume.
- Diastolic dysfunction in heart failure is characterized by: A) Impaired ability of the ventricles to relax and fill B) Impaired ability of the ventricles to contract and eject C) Normal filling with impaired ejection D) Normal contractility with valve dysfunction Answer: A Rationale: Diastolic dysfunction refers to impaired ventricular relaxation and filling, often seen with preserved ejection fraction (HFpEF).
- Mr. Fitzgerald's chronic condition is described as: A) Systolic heart failure with reduced ejection fraction B) Diastolic dysfunction (HFpEF) C) Valvular heart disease D) Congenital heart defect Answer: B Rationale: Mr. Fitzgerald's secondary diagnosis is acute on chronic CHF with diastolic dysfunction.
- According to the model Rationale, what is the relationship between fluid volume overload and Mr. Fitzgerald's CHF exacerbation? A) The fluid volume overload is independent of his CHF B) The fluid volume overload has exacerbated his chronic CHF condition C) The CHF caused the fluid volume overload to improve D) There is no relationship between the two Answer: B Rationale: The fluid volume overload has exacerbated his chronic condition, making his CHF a secondary diagnosis that is worsened by the primary fluid volume overload.
- The term "acute on chronic" in Mr. Fitzgerald's diagnosis means:
A) A new acute condition unrelated to his chronic disease B) An acute exacerbation of his underlying chronic condition C) A chronic condition with no acute component D) An acute condition that will become chronic Answer: B Rationale: "Acute on chronic" indicates an acute exacerbation (worsening) of a pre- existing chronic condition.
- A patient with heart failure asks why she needs to weigh herself daily. The nurse explains that daily weight is the best indicator of: A) Nutritional status B) Fluid retention C) Muscle mass D) Kidney function Answer: B Rationale: Daily weight monitoring is the most sensitive indicator of fluid retention; a gain of 2-3 pounds in 24 hours or 5 pounds in a week suggests worsening fluid overload.
- The presence of jugular venous distention (JVD) in a patient with heart failure indicates: A) Decreased preload B) Increased right atrial pressure (fluid overload) C) Left ventricular hypertrophy D) Aortic stenosis Answer: B Rationale: JVD reflects elevated right atrial pressure and is a sign of right-sided heart failure or fluid volume overload.
- Hepatomegaly with tenderness in a patient with heart failure is most likely due to: A) Hepatitis B) Hepatic congestion from right-sided heart failure C) Cholecystitis
D) Resting dyspnea Answer: B Rationale: PND is characterized by sudden awakening from sleep with severe shortness of breath, often occurring 2-3 hours after lying down due to fluid redistribution.
- Orthopnea is defined as: A) Shortness of breath that occurs while lying flat and improves with sitting up B) Shortness of breath that occurs with minimal activity C) Awakening from sleep with shortness of breath D) Shortness of breath that occurs only during exercise Answer: A Rationale: Orthopnea is dyspnea that occurs when the patient is supine (lying flat) and is relieved by sitting or standing. It is a classic symptom of left ventricular failure.
- The number of pillows a patient uses to sleep comfortably is an indicator of: A) Sleep apnea severity B) The degree of orthopnea C) Neck pain D) Medication effectiveness Answer: B Rationale: The number of pillows needed to sleep without shortness of breath quantifies orthopnea severity. Progressive heart failure often requires more pillows (e.g., 2-pillow, 3 - pillow orthopnea).
- A patient with chronic heart failure has a persistent cough that worsens when lying down. This cough is most likely due to: A) Gastroesophageal reflux disease (GERD) B) Post-nasal drip C) Pulmonary congestion from heart failure D) Medication side effect (ACE inhibitor) Answer: C Rationale: While ACE inhibitors can cause a dry cough, a cough that worsens when lying down is more characteristic of pulmonary congestion from heart failure.
- The New York Heart Association (NYHA) Functional Classification for a patient with heart failure who has marked limitation of physical activity and symptoms with ordinary activity is Class: A) I B) II C) III D) IV Answer: C Rationale: NYHA Class III: patients have marked limitation of physical activity; they are comfortable at rest but less than ordinary activity causes symptoms.
- Which of the following is a poor prognostic sign in heart failure? A) S3 gallop B) S4 gallop C) Mid-systolic click D) Fixed split S Answer: A Rationale: An S3 gallop indicates decreased ventricular compliance and volume overload; it is associated with poor prognosis in heart failure.
- A patient with heart failure has an echocardiogram showing a left ventricular ejection fraction (LVEF) of 35%. This is classified as: A) Heart failure with preserved ejection fraction (HFpEF) B) Heart failure with mid-range ejection fraction (HFmrEF) C) Heart failure with reduced ejection fraction (HFrEF) D) Diastolic heart failure Answer: C Rationale: HFrEF is defined as LVEF ≤40%. HFpEF is LVEF ≥50%. HFmrEF is LVEF 41 - 49%.
- The FRAME question for heart failure assessment includes asking about: A) Falls, Relaxation, Activity, Mood, Energy B) Fluid retention, Relaxation, Activity limitation, Mood, Energy level
