iHUMAN CASE STUDY
60-Year-Old Female Patient with
Shortness of Breath (CHF Exacerbation)
Complete Case with Correct Answers — 2026/2027
Case Type: Virtual Patient Simulation
Patient: 60-Year-Old Female
Chief Complaint: Shortness of Breath
Diagnosis: Heart Failure Exacerbation
Grade Level: A+ | 100% Verified
Core Domains Covered:
• History Taking & Interviewing Skills
• Physical Examination (Cardiac, Respiratory, Vascular)
• Diagnostic Test Selection & Interpretation
• Differential Diagnosis Development
• Clinical Reasoning & Decision-Making
• Evidence-Based Treatment Planning
• Patient Education & Discharge Planning
• Documentation of Findings
iHuman Case Study-Aligned Format for Nursing Education
, iHuman Case Study: CHF Exacerbation | 2026/2027
TABLE OF CONTENTS
Part 1: Patient Presentation & History Taking Q1-20
Part 2: Physical Examination Q21-35
Part 3: Diagnostic Testing Q36-50
Part 4: Differential Diagnosis Q51-60
Part 5: Treatment Planning Q61-75
Part 6: Patient Education & Discharge Q76-85
Page 1
, iHuman Case Study: CHF Exacerbation | 2026/2027
PART 1: PATIENT PRESENTATION & HISTORY TAKING
Patient Scenario:
Ms. Johnson is a 60-year-old African American female presenting to the emergency department with a 3-day history
of progressive shortness of breath. She reports that her breathing has worsened, particularly when lying flat, and she
has been sleeping propped up on three pillows. She also notes bilateral lower extremity swelling that has increased
over the past week. Her past medical history is significant for heart failure with reduced ejection fraction (HFrEF),
hypertension, and type 2 diabetes mellitus.
Question 1: What is the most appropriate opening question to begin the patient interview?
A. 'What medications do you take?'
B. 'What brings you in today?'
C. 'How long have you had heart failure?'
D. 'Do you have any allergies?'
Rationale: The patient-centered interview begins with an open-ended question allowing the patient to describe their chief complaint in their
own words. 'What brings you in today?' invites the patient to share their primary concern. Closed-ended questions about medications,
diagnoses, or allergies can follow after understanding the patient's perspective on their illness.
Question 2: When obtaining the history of present illness (HPI), which characteristic of dyspnea should the
nurse assess?
A. Only the duration of symptoms
B. Onset, duration, severity, precipitating factors, and relieving factors
C. Only what makes it worse
D. Only the severity using a 1-10 scale
Rationale: A comprehensive HPI for dyspnea includes onset (when did it start), duration (how long does it last), severity (impact on
activities, orthopnea, PND), precipitating factors (exertion, lying flat, fluids), and relieving factors (medications, position changes). This
information helps differentiate heart failure exacerbation from other causes of dyspnea.
Question 3: The patient reports using three pillows to sleep. This symptom is documented as:
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Platypnea
Rationale: Orthopnea is shortness of breath when lying flat, relieved by sitting up or elevating the head. The number of pillows needed
quantifies severity (three-pillow orthopnea). This occurs in heart failure due to increased venous return and pulmonary congestion when
supine. PND is sudden onset of dyspnea awakening the patient from sleep.
Question 4: Which aspect of the patient's past medical history is most relevant to her current presentation?
A. History of childhood asthma
B. Heart failure with reduced ejection fraction
C. Appendectomy 20 years ago
D. Allergic rhinitis
Rationale: Heart failure with reduced ejection fraction is most relevant as the patient's symptoms (progressive dyspnea, orthopnea,
peripheral edema) are classic signs of HF exacerbation. The prior HF diagnosis establishes baseline cardiac dysfunction. This history
guides the differential diagnosis toward acute decompensated heart failure rather than a new primary condition.
Question 5: When reviewing the patient's medications, which medication requires clarification about
adherence?
A. Acetaminophen as needed
B. Furosemide 40 mg daily
C. Multivitamin daily
D. Calcium supplement
Rationale: Furosemide, a loop diuretic, is critical for managing heart failure by reducing fluid volume. Non-adherence or dose inadequacy
commonly precipitates HF exacerbations. The nurse should assess if the patient has been taking furosemide as prescribed, if doses have
been missed, or if symptoms suggest the dose may need adjustment. Diuretic non-adherence is a leading cause of HF hospitalization.
Question 6: The patient's social history reveals she lives alone and manages her own medications. What
additional assessment is most important?
Page 2
60-Year-Old Female Patient with
Shortness of Breath (CHF Exacerbation)
Complete Case with Correct Answers — 2026/2027
Case Type: Virtual Patient Simulation
Patient: 60-Year-Old Female
Chief Complaint: Shortness of Breath
Diagnosis: Heart Failure Exacerbation
Grade Level: A+ | 100% Verified
Core Domains Covered:
• History Taking & Interviewing Skills
• Physical Examination (Cardiac, Respiratory, Vascular)
• Diagnostic Test Selection & Interpretation
• Differential Diagnosis Development
• Clinical Reasoning & Decision-Making
• Evidence-Based Treatment Planning
• Patient Education & Discharge Planning
• Documentation of Findings
iHuman Case Study-Aligned Format for Nursing Education
, iHuman Case Study: CHF Exacerbation | 2026/2027
TABLE OF CONTENTS
Part 1: Patient Presentation & History Taking Q1-20
Part 2: Physical Examination Q21-35
Part 3: Diagnostic Testing Q36-50
Part 4: Differential Diagnosis Q51-60
Part 5: Treatment Planning Q61-75
Part 6: Patient Education & Discharge Q76-85
Page 1
, iHuman Case Study: CHF Exacerbation | 2026/2027
PART 1: PATIENT PRESENTATION & HISTORY TAKING
Patient Scenario:
Ms. Johnson is a 60-year-old African American female presenting to the emergency department with a 3-day history
of progressive shortness of breath. She reports that her breathing has worsened, particularly when lying flat, and she
has been sleeping propped up on three pillows. She also notes bilateral lower extremity swelling that has increased
over the past week. Her past medical history is significant for heart failure with reduced ejection fraction (HFrEF),
hypertension, and type 2 diabetes mellitus.
Question 1: What is the most appropriate opening question to begin the patient interview?
A. 'What medications do you take?'
B. 'What brings you in today?'
C. 'How long have you had heart failure?'
D. 'Do you have any allergies?'
Rationale: The patient-centered interview begins with an open-ended question allowing the patient to describe their chief complaint in their
own words. 'What brings you in today?' invites the patient to share their primary concern. Closed-ended questions about medications,
diagnoses, or allergies can follow after understanding the patient's perspective on their illness.
Question 2: When obtaining the history of present illness (HPI), which characteristic of dyspnea should the
nurse assess?
A. Only the duration of symptoms
B. Onset, duration, severity, precipitating factors, and relieving factors
C. Only what makes it worse
D. Only the severity using a 1-10 scale
Rationale: A comprehensive HPI for dyspnea includes onset (when did it start), duration (how long does it last), severity (impact on
activities, orthopnea, PND), precipitating factors (exertion, lying flat, fluids), and relieving factors (medications, position changes). This
information helps differentiate heart failure exacerbation from other causes of dyspnea.
Question 3: The patient reports using three pillows to sleep. This symptom is documented as:
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Platypnea
Rationale: Orthopnea is shortness of breath when lying flat, relieved by sitting up or elevating the head. The number of pillows needed
quantifies severity (three-pillow orthopnea). This occurs in heart failure due to increased venous return and pulmonary congestion when
supine. PND is sudden onset of dyspnea awakening the patient from sleep.
Question 4: Which aspect of the patient's past medical history is most relevant to her current presentation?
A. History of childhood asthma
B. Heart failure with reduced ejection fraction
C. Appendectomy 20 years ago
D. Allergic rhinitis
Rationale: Heart failure with reduced ejection fraction is most relevant as the patient's symptoms (progressive dyspnea, orthopnea,
peripheral edema) are classic signs of HF exacerbation. The prior HF diagnosis establishes baseline cardiac dysfunction. This history
guides the differential diagnosis toward acute decompensated heart failure rather than a new primary condition.
Question 5: When reviewing the patient's medications, which medication requires clarification about
adherence?
A. Acetaminophen as needed
B. Furosemide 40 mg daily
C. Multivitamin daily
D. Calcium supplement
Rationale: Furosemide, a loop diuretic, is critical for managing heart failure by reducing fluid volume. Non-adherence or dose inadequacy
commonly precipitates HF exacerbations. The nurse should assess if the patient has been taking furosemide as prescribed, if doses have
been missed, or if symptoms suggest the dose may need adjustment. Diuretic non-adherence is a leading cause of HF hospitalization.
Question 6: The patient's social history reveals she lives alone and manages her own medications. What
additional assessment is most important?
Page 2
