NUR 6111: Liam Fitzgerald Shadow Health Telehealth
Follow-Up Sick Visit Management of Cardiovascular
Conditions — Comprehensive Assessment Exam 2026
Update with Complete Solutions.
Patient Context: Liam Fitzgerald is a 52-year-old male presenting for a telehealth follow-up after
being started on Lisinopril 10 mg for hypertension 8 weeks ago. He reports a dry, persistent
cough that started 3 weeks after initiating the medication.
DOMAIN 1: TELEHEALTH ASSESSMENT & PATIENT COMMUNICATION (8 Questions)
Sub-Domain 1A: Adapting Physical Assessment for Telehealth (3 Questions)
Question 1 — Multiple Choice
During the telehealth visit with Liam Fitzgerald, which physical assessment technique is MOST
appropriate to evaluate his reported lower extremity edema?
A. Direct palpation of the ankles by the nurse practitioner through the video screen
B. Instructing Liam to position his camera to visualize both ankles and coaching him to press his
finger into the medial malleolus for 5 seconds to assess for pitting
C. Scheduling an in-person appointment immediately because edema cannot be assessed via
telehealth
D. Asking Liam to describe the edema using a 1-10 pain scale without visual confirmation
[CORRECT: B]
Rationale: In telehealth, the provider must adapt physical assessment by coaching the patient
through self-examination techniques. Visual inspection via video combined with patient-guided
palpation (pressing over the medial malleolus/bony prominence for 1-2 seconds) allows the
provider to observe for pitting and assess severity. This mirrors the validated Shadow Health
approach where the student instructs the patient to move the camera and perform the pitting
edema test. Direct palpation through video is impossible, immediate in-person scheduling is
unnecessary for stable edema, and pain scales do not assess pitting edema.
,Question 2 — Multiple Choice
Which piece of home monitoring equipment is MOST essential for Liam Fitzgerald to have
available during this telehealth follow-up visit for hypertension management?
A. Pulse oximeter
B. Home blood pressure cuff (automatic upper-arm monitor)
C. Peak flow meter
D. Glucometer
[CORRECT: B]
Rationale: Home blood pressure monitoring is the cornerstone of telehealth hypertension
management. It provides objective data that replaces in-clinic manual readings and allows the
provider to evaluate the effectiveness of Lisinopril 10 mg. JNC 8 guidelines emphasize the
importance of accurate BP measurement for treatment decisions. While pulse oximetry and
peak flow meters have roles in respiratory assessment, they are not primary for hypertension
follow-up. A glucometer is irrelevant unless the patient has diabetes.
Question 3 — Select-All-That-Apply (SATA)
Which visual cues should the telehealth nurse practitioner prioritize when assessing Liam
Fitzgerald's cardiovascular status through video? (Select all that apply.)
A. Respiratory rate and effort (work of breathing)
B. Skin color and presence of diaphoresis
C. Jugular venous distension (if camera angle permits neck visualization)
D. Capillary refill time (coaching patient to press and release fingernail)
E. Clubbing of the fingernails
F. Presence of peripheral cyanosis
[CORRECT: A, B, C, D, F]
Rationale: In telehealth, visual inspection becomes paramount. The provider should assess
respiratory effort (A) for signs of fluid overload/heart failure, skin color and diaphoresis (B) for
distress, JVD (C) for volume status if the patient can position the camera, capillary refill (D) as a
coached self-assessment for perfusion, and peripheral cyanosis (F) for oxygenation status.
Clubbing (E) is a chronic physical finding unrelated to acute cardiovascular assessment and is
difficult to reliably assess via video.
, Sub-Domain 1B: Reviewing Social History & Modifiable Risk Factors (2 Questions)
Question 4 — Multiple Choice
When reviewing modifiable cardiovascular risk factors via telehealth with Liam Fitzgerald, which
finding requires the MOST immediate nursing intervention and education?
A. Occasional alcohol consumption on special occasions (reduced from 1-2 beers nightly)
B. History of smoking cessation 5 years ago with current nicotine gum use
C. Dietary sodium intake averaging 3,000 mg/day despite reporting a "low-sodium diet"
D. Sedentary lifestyle with no regular physical activity
[CORRECT: C]
Rationale: Excessive sodium intake (3,000 mg/day) directly contradicts the DASH diet
recommendations (<2,300 mg/day, ideally <1,500 mg/day) and undermines antihypertensive
therapy. This requires immediate education on reading food labels, identifying hidden sodium
sources, and adhering to fluid restrictions if applicable. While alcohol (A) and smoking history
(B) are relevant, Liam has already made positive changes. Sedentary lifestyle (D) is important
but sodium reduction has a more immediate impact on BP control and fluid volume status.
Question 5 — Select-All-That-Apply (SATA)
Which social history findings from Liam Fitzgerald's telehealth interview are considered NON-
modifiable cardiovascular risk factors? (Select all that apply.)
A. Family history of hypertension and hyperlipidemia (mother living; father deceased at 75 from
cardiac causes)
B. History of smoking (quit after myocardial infarction 5 years ago)
C. Age 52 years at time of presentation
D. Male gender
E. Occupation as a retired postal service truck driver (sedentary work history)
F. Family history of early coronary artery disease
[CORRECT: A, C, D, F]
Rationale: Non-modifiable risk factors include family history (A, F), age (C), and male gender (D).
Smoking history (B) is modifiable (he already quit). Occupation (E) is modifiable through
retirement and lifestyle changes. Understanding this distinction is critical for patient
Follow-Up Sick Visit Management of Cardiovascular
Conditions — Comprehensive Assessment Exam 2026
Update with Complete Solutions.
Patient Context: Liam Fitzgerald is a 52-year-old male presenting for a telehealth follow-up after
being started on Lisinopril 10 mg for hypertension 8 weeks ago. He reports a dry, persistent
cough that started 3 weeks after initiating the medication.
DOMAIN 1: TELEHEALTH ASSESSMENT & PATIENT COMMUNICATION (8 Questions)
Sub-Domain 1A: Adapting Physical Assessment for Telehealth (3 Questions)
Question 1 — Multiple Choice
During the telehealth visit with Liam Fitzgerald, which physical assessment technique is MOST
appropriate to evaluate his reported lower extremity edema?
A. Direct palpation of the ankles by the nurse practitioner through the video screen
B. Instructing Liam to position his camera to visualize both ankles and coaching him to press his
finger into the medial malleolus for 5 seconds to assess for pitting
C. Scheduling an in-person appointment immediately because edema cannot be assessed via
telehealth
D. Asking Liam to describe the edema using a 1-10 pain scale without visual confirmation
[CORRECT: B]
Rationale: In telehealth, the provider must adapt physical assessment by coaching the patient
through self-examination techniques. Visual inspection via video combined with patient-guided
palpation (pressing over the medial malleolus/bony prominence for 1-2 seconds) allows the
provider to observe for pitting and assess severity. This mirrors the validated Shadow Health
approach where the student instructs the patient to move the camera and perform the pitting
edema test. Direct palpation through video is impossible, immediate in-person scheduling is
unnecessary for stable edema, and pain scales do not assess pitting edema.
,Question 2 — Multiple Choice
Which piece of home monitoring equipment is MOST essential for Liam Fitzgerald to have
available during this telehealth follow-up visit for hypertension management?
A. Pulse oximeter
B. Home blood pressure cuff (automatic upper-arm monitor)
C. Peak flow meter
D. Glucometer
[CORRECT: B]
Rationale: Home blood pressure monitoring is the cornerstone of telehealth hypertension
management. It provides objective data that replaces in-clinic manual readings and allows the
provider to evaluate the effectiveness of Lisinopril 10 mg. JNC 8 guidelines emphasize the
importance of accurate BP measurement for treatment decisions. While pulse oximetry and
peak flow meters have roles in respiratory assessment, they are not primary for hypertension
follow-up. A glucometer is irrelevant unless the patient has diabetes.
Question 3 — Select-All-That-Apply (SATA)
Which visual cues should the telehealth nurse practitioner prioritize when assessing Liam
Fitzgerald's cardiovascular status through video? (Select all that apply.)
A. Respiratory rate and effort (work of breathing)
B. Skin color and presence of diaphoresis
C. Jugular venous distension (if camera angle permits neck visualization)
D. Capillary refill time (coaching patient to press and release fingernail)
E. Clubbing of the fingernails
F. Presence of peripheral cyanosis
[CORRECT: A, B, C, D, F]
Rationale: In telehealth, visual inspection becomes paramount. The provider should assess
respiratory effort (A) for signs of fluid overload/heart failure, skin color and diaphoresis (B) for
distress, JVD (C) for volume status if the patient can position the camera, capillary refill (D) as a
coached self-assessment for perfusion, and peripheral cyanosis (F) for oxygenation status.
Clubbing (E) is a chronic physical finding unrelated to acute cardiovascular assessment and is
difficult to reliably assess via video.
, Sub-Domain 1B: Reviewing Social History & Modifiable Risk Factors (2 Questions)
Question 4 — Multiple Choice
When reviewing modifiable cardiovascular risk factors via telehealth with Liam Fitzgerald, which
finding requires the MOST immediate nursing intervention and education?
A. Occasional alcohol consumption on special occasions (reduced from 1-2 beers nightly)
B. History of smoking cessation 5 years ago with current nicotine gum use
C. Dietary sodium intake averaging 3,000 mg/day despite reporting a "low-sodium diet"
D. Sedentary lifestyle with no regular physical activity
[CORRECT: C]
Rationale: Excessive sodium intake (3,000 mg/day) directly contradicts the DASH diet
recommendations (<2,300 mg/day, ideally <1,500 mg/day) and undermines antihypertensive
therapy. This requires immediate education on reading food labels, identifying hidden sodium
sources, and adhering to fluid restrictions if applicable. While alcohol (A) and smoking history
(B) are relevant, Liam has already made positive changes. Sedentary lifestyle (D) is important
but sodium reduction has a more immediate impact on BP control and fluid volume status.
Question 5 — Select-All-That-Apply (SATA)
Which social history findings from Liam Fitzgerald's telehealth interview are considered NON-
modifiable cardiovascular risk factors? (Select all that apply.)
A. Family history of hypertension and hyperlipidemia (mother living; father deceased at 75 from
cardiac causes)
B. History of smoking (quit after myocardial infarction 5 years ago)
C. Age 52 years at time of presentation
D. Male gender
E. Occupation as a retired postal service truck driver (sedentary work history)
F. Family history of early coronary artery disease
[CORRECT: A, C, D, F]
Rationale: Non-modifiable risk factors include family history (A, F), age (C), and male gender (D).
Smoking history (B) is modifiable (he already quit). Occupation (E) is modifiable through
retirement and lifestyle changes. Understanding this distinction is critical for patient
