NR603 Week 5 iHuman Case Study 2026 –
Dyspnea Scenario – Mock Exam
Patient Case Summary (iHuman Simulation Context):
• Patient: 65-year-old male
• Chief Complaint: Dyspnea (shortness of breath) for 3 days
• History: Hypertension, 40-pack-year smoking history, occasional cough
• Medications: Lisinopril 20 mg daily
• Vitals: BP 150/88 mmHg, HR 110 bpm, RR 28/min, SpO₂ 88% on room air, Temp 99°F
• Physical Exam: Inspiratory crackles in bilateral lower lobes, mild accessory muscle use,
mild peripheral edema
• Labs: Elevated BNP, mild leukocytosis, CXR shows bilateral infiltrates
Multiple Choice Questions
1. Which is the most appropriate initial nursing assessment for this patient?
A. Assess dietary habits
B. Assess level of consciousness, respiratory rate, SpO₂, and breath sounds
C. Assess for urinary output
D. Assess skin turgor
Answer: B – Respiratory assessment is a priority in dyspnea, including vitals, oxygen
saturation, breath sounds, and mental status.
2. The patient’s SpO₂ is 88% on room air. Which intervention should the nurse implement
first?
A. Initiate oxygen via nasal cannula
B. Encourage coughing and deep breathing
C. Call respiratory therapy for incentive spirometry
D. Place patient on bed rest
Answer: A – SpO₂ <90% indicates hypoxemia; supplemental oxygen is the priority
intervention.
3. Which laboratory result is most indicative of possible heart failure in this patient?
A. Elevated WBC
B. Elevated BNP
, C. Elevated hemoglobin
D. Low platelets
Answer: B – BNP is a biomarker for heart failure; elevated BNP with dyspnea suggests
possible acute decompensated heart failure.
4. Which of the following is the most likely differential diagnosis?
A. Asthma exacerbation
B. Pulmonary embolism
C. Acute decompensated heart failure
D. Upper respiratory infection
Answer: C – Given dyspnea, bilateral crackles, elevated BNP, and edema, acute
decompensated heart failure is the most likely.
5. The patient is started on oxygen via nasal cannula at 2 L/min. After 30 minutes, SpO₂ is
91%. What is the nurse’s next action?
A. Increase oxygen flow to 4 L/min
B. Monitor and reassess in 30 minutes
C. Call rapid response immediately
D. Remove oxygen and reassess
Answer: B – SpO₂ has improved but still needs monitoring; gradual titration is
appropriate.
6. Which nursing intervention is priority for this patient’s dyspnea?
A. Encourage ambulation
B. Position in high Fowler’s position
C. Provide oral hydration
D. Limit visitation
Answer: B – High Fowler’s position facilitates lung expansion and improves oxygenation in
patients with dyspnea.
7. Which patient education point is most important for managing chronic heart failure?
A. Avoid exercise to prevent fatigue
B. Daily weight monitoring and reporting >2 lb increase in 24 hours
Dyspnea Scenario – Mock Exam
Patient Case Summary (iHuman Simulation Context):
• Patient: 65-year-old male
• Chief Complaint: Dyspnea (shortness of breath) for 3 days
• History: Hypertension, 40-pack-year smoking history, occasional cough
• Medications: Lisinopril 20 mg daily
• Vitals: BP 150/88 mmHg, HR 110 bpm, RR 28/min, SpO₂ 88% on room air, Temp 99°F
• Physical Exam: Inspiratory crackles in bilateral lower lobes, mild accessory muscle use,
mild peripheral edema
• Labs: Elevated BNP, mild leukocytosis, CXR shows bilateral infiltrates
Multiple Choice Questions
1. Which is the most appropriate initial nursing assessment for this patient?
A. Assess dietary habits
B. Assess level of consciousness, respiratory rate, SpO₂, and breath sounds
C. Assess for urinary output
D. Assess skin turgor
Answer: B – Respiratory assessment is a priority in dyspnea, including vitals, oxygen
saturation, breath sounds, and mental status.
2. The patient’s SpO₂ is 88% on room air. Which intervention should the nurse implement
first?
A. Initiate oxygen via nasal cannula
B. Encourage coughing and deep breathing
C. Call respiratory therapy for incentive spirometry
D. Place patient on bed rest
Answer: A – SpO₂ <90% indicates hypoxemia; supplemental oxygen is the priority
intervention.
3. Which laboratory result is most indicative of possible heart failure in this patient?
A. Elevated WBC
B. Elevated BNP
, C. Elevated hemoglobin
D. Low platelets
Answer: B – BNP is a biomarker for heart failure; elevated BNP with dyspnea suggests
possible acute decompensated heart failure.
4. Which of the following is the most likely differential diagnosis?
A. Asthma exacerbation
B. Pulmonary embolism
C. Acute decompensated heart failure
D. Upper respiratory infection
Answer: C – Given dyspnea, bilateral crackles, elevated BNP, and edema, acute
decompensated heart failure is the most likely.
5. The patient is started on oxygen via nasal cannula at 2 L/min. After 30 minutes, SpO₂ is
91%. What is the nurse’s next action?
A. Increase oxygen flow to 4 L/min
B. Monitor and reassess in 30 minutes
C. Call rapid response immediately
D. Remove oxygen and reassess
Answer: B – SpO₂ has improved but still needs monitoring; gradual titration is
appropriate.
6. Which nursing intervention is priority for this patient’s dyspnea?
A. Encourage ambulation
B. Position in high Fowler’s position
C. Provide oral hydration
D. Limit visitation
Answer: B – High Fowler’s position facilitates lung expansion and improves oxygenation in
patients with dyspnea.
7. Which patient education point is most important for managing chronic heart failure?
A. Avoid exercise to prevent fatigue
B. Daily weight monitoring and reporting >2 lb increase in 24 hours
