Kingdom of Saudi Arabia Ministry of Education University of Hail College of Nursing المملكة العربية السعودية وزارة التعليم جامـعـة حـائل كلية التمريض Master of Science in Nursing / Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book Exam Second Semester 2019-2020 Questions Sheet Dear Student, find the attached case study, read it carefully and answer related questions using attached “Students Answer Sheet” and upload completed answer sheet on blackboard, you have 48 hours to complete this exam and submit your answers. Case Study Henry Brusca is a 68-year-old, married father of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the emergency room with the complaint of “just not feeling right.” His BP on admission was 170/118, so he was admitted to the coronary care unit with the diagnosis of uncontrolled HTN. His BP was controlled with medication, and he was discharged several days later. He is now being seen for follow-up care and management of HTN. Because Mr. Brusca is newly diagnosed with HTN, you will need to complete a history and thorough cardiovascular examination. Case Study Findings Biographical data: · 68-year-old white male. · Married, father of seven grown children. · Self-employed entrepreneur; BS degree in engineering. · Born and raised in the United States, Italian descent, Catholic religion. · Blue Cross/Blue Shield medical insurance plan. · Referral: Follow-up by primary care physician. · Source: Self, reliable. Current health status: · No chest pain, dyspnea, palpitations, or edema. · Complains of fatigue, loss of energy, and occasional dizzy spells. Past health history: · No rheumatic fever or heart murmurs. · No history of injuries. · Inguinal hernia repair. · Left ventricular hypertrophy revealed by electrocardiogram (ECG). · Hospitalized 3 weeks ago for HTN. · No known food, drug, or environmental allergies. · No other previous medical problems. · Immunizations up to date. · No prescribed medications except Vasotec 5 mg bid and weekly use of antacid for indigestion. Family history: · Positive family history of HTN and stroke. · Mother had HTN and died at age 78 of a stroke. · Paternal uncle died at age 79 of MI. Review of systems: · General Health Survey: Fatigue, weight gain of 60 lb over past 3 years. · Integumentary: Feet cold, thick nails, tight shoes. · Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy spells over past 6 months. · Eyes: Wears glasses, no visual complaints, yearly eye examination. · Respiratory: “Short winded” with activity. · Gastrointestinal: Indigestion on weekly basis. · Genitourinary: Awakens at least once a night to go to bathroom. · Musculoskeletal/Neurological: General weakness, cramps in legs with walking. · Lymphatic: No reported problems. · Endocrine: No reported problems. Psychosocial profile: · States that he does not have time for routine checkups. “I only go to the doctor’s when I’m sick. “Typical day consists of arising at 7 A.M. ...

1. Kingdom of Saudi Arabia
Ministry of Education
University of Hail
College of Nursing
‫ة‬ ‫عودي‬ ‫س‬ ‫ال‬ ‫ية‬ ‫عرب‬ ‫ال‬ ‫كة‬ ‫ل‬ ‫مم‬ ‫ال‬
‫يم‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫وزارة‬
‫ل‬ ‫ـائ‬ ‫ح‬ ‫عـة‬ ‫امـ‬ ‫ج‬
‫ض‬ ‫تمري‬ ‫ال‬ ‫ية‬ ‫ل‬ ‫ك‬
Master of Science in Nursing / Emergency
Advanced Health Assessment Theory (NURS 511)
Final Open Book Exam
Second Semester 2019-2020
Questions Sheet
Dear Student, find the attached case study, read it carefully and
answer related questions using attached “Students Answer
Sheet” and upload completed answer sheet on blackboard, you
have 48 hours to complete this exam and submit your answers.
Case Study
Henry Brusca is a 68-year-old, married father of 7 who was in
relatively good health until 3 weeks ago. At that time, he visited
the emergency room with the complaint of “just not feeling
right.” His BP on admission was 170/118, so he was admitted to
the coronary care unit with the diagnosis of uncontrolled HTN.
His BP was controlled with medication, and he was discharged
several days later. He is now being seen for follow-up care and
management of HTN. Because Mr. Brusca is newly diagnosed
with HTN, you will need to complete a history and thorough
cardiovascular examination.
Case Study Findings
Biographical data:
· 68-year-old white male.

2. · Married, father of seven grown children.
· Self-employed entrepreneur; BS degree in engineering.
· Born and raised in the United States, Italian descent, Catholic
religion.
· Blue Cross/Blue Shield medical insurance plan.
· Referral: Follow-up by primary care physician.
· Source: Self, reliable.
Current health status:
· No chest pain, dyspnea, palpitations, or edema.
· Complains of fatigue, loss of energy, and occasional dizzy
spells.
Past health history:
· No rheumatic fever or heart murmurs.
· No history of injuries.
· Inguinal hernia repair.
· Left ventricular hypertrophy revealed by electrocardiogram
(ECG).
· Hospitalized 3 weeks ago for HTN.
· No known food, drug, or environmental allergies.
· No other previous medical problems.
· Immunizations up to date.
· No prescribed medications except Vasotec 5 mg bid and
weekly use of antacid for indigestion.
Family history:
· Positive family history of HTN and stroke.
· Mother had HTN and died at age 78 of a stroke.
· Paternal uncle died at age 79 of MI.
Review of systems:
· General Health Survey: Fatigue, weight gain of 60 lb over past
3 years.
· Integumentary: Feet cold, thick nails, tight shoes.
· Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy
spells over past 6 months.
· Eyes: Wears glasses, no visual complaints, yearly eye
examination.
· Respiratory: “Short winded” with activity.

3. · Gastrointestinal: Indigestion on weekly basis.
· Genitourinary: Awakens at least once a night to go to
bathroom.
· Musculoskeletal/Neurological: General weakness, cramps in
legs with walking.
· Lymphatic: No reported problems.
· Endocrine: No reported problems.
Psychosocial profile:
· States that he does not have time for routine checkups. “I only
go to the doctor’s when I’m sick. “Typical day consists of
arising at 7 A.M., showering, having breakfast, and then going
to work. Returns home by 6 P.M., eats dinner, watches TV till
11:30 P.M., but usually falls asleep before news is over.
Usually in bed by 12 midnight.
· 24-hour recall reveals a diet high in carbohydrates and fats
and lacking in fruits and vegetables. Heavy-handed with salt
shaker; salts everything. Admits that he has gained weight over
the years and is 60 lb overweight.
· No regular exercise program. States: “I’m too busy running
my business.”
· Hobbies include reading, crossword puzzles, and antique
collecting.
· Sleeps about 7 hours a night, but usually feels he is not getting
enough sleep. Lately is more and more tired. Wife states that he
snores.
· Never smoked. Has a bottle of wine every night with dinner.
· Works at sedentary job, usually 7 days a week. No
environmental hazards in workplace.
· Lives with wife of 45 years in a two-story, single home in the
suburbs with ample living space.
· Has a large, close, caring family.
· Admits that running his own business is very stressful, but
feels he can handle it alone and doesn’t need anyone to help
him.
General Health Survey findings:
· Well-developed, well-groomed 68-year-old white male,

4. appears younger than stated age.
· Sits upright and relaxed during interview, answers questions
appropriately.
· Alert and responsive without complaint, oriented x 4 (time,
place, situation, and person).
· Affect pleasant and appropriate.
· Head-to-toe scan reveals positive arcus senilis, positive AV
nicking and cotton wool, extremity changes including thin,
shiny skin, thick nails, and edema.
Vital Signs
· Temperature, 36.6 °C.
· Pulse, 86 BPM, strong and regular.
· Respirations, 18/min, unlabored.
· BP: 150/90 mmHg.
Height: 180 CM. Weight: 124
KG.
Cardiovascular assessment findings include:
· Neck Vessels
· Positive large carotid pulsation, +3, symmetrical with smooth,
sharp upstroke and rapid descent, artery stiff, negative for
thrills and bruits.
· JVP at 30 degrees <3 cm, negative abdominojugular reflux.
· Precordium
· Positive sustained pulsations displaced lateral to apex, PMI 3
cm with increased amplitude.
· Slight pulsations also appreciated at LLSB and base, but not
as pronounced.
· Negative thrills; cardiac borders percussed third, fourth, and
fifth intercostal spaces to the left of the midclavicular line.
· Heart sounds appreciated with regular rate and rhythm at apex
S1 > S2 and +S4,at LLSB S1 > S2.
· S2 negative split, at base left S1 < 2 negative split, at base
right S1 < 2 with an accentuated
· S2, negative for murmurs and rubs.
Questions:
1. What questions might be useful to elicit further details

5. surrounding the Chest pain, using one of the common acronyms
in this regard? (5 Marks)
2. From the subjective information you have obtained from Mr.
Brusca’s history, what are his identifiable risk factors for heart
disease? Which risk factors are modifiable and which are
unmodifiable? (5 Marks)
3. List three priority nursing diagnosis for Mr. Brusca’s case,
and cluster subjective and objective data that support each
diagnosis. (3 Marks)
4. From the previous data, discuss the main issues of health
promotion and disease prevention should the nurse discussed
during health history and physical examination? (4 Marks).
5. Considering the relationship of the cardiovascular system to
the respiratory system, what respiratory problems might Mr.
Brusca have as a result of his cardiovascular disease? (3 Marks)
Page 4 of 4
Accredited University by the ASIC on March 27, 2017
Accredited BSN Program by AHPGS on February 15, 2018
Kingdom of Saudi Arabia
Ministry of Education
University of Hail
College of Nursing
‫ة‬ ‫عودي‬ ‫س‬ ‫ال‬ ‫ية‬ ‫عرب‬ ‫ال‬ ‫كة‬ ‫ل‬ ‫مم‬ ‫ال‬
‫يم‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫وزارة‬
‫ل‬ ‫ـائ‬ ‫ح‬ ‫عـة‬ ‫امـ‬ ‫ج‬
‫ض‬ ‫تمري‬ ‫ال‬ ‫ية‬ ‫ل‬ ‫ك‬
Master of Science in Nursing / Emergency
Advanced Health Assessment Theory (NURS 511)
Final Open Book Exam
Second Semester 2019-2020
Students Answer Sheet

6. Student Name:
Student ID:
Overall Given Mark:
/ 20
Instructions:
Based on the given case study of Mr. Brusca, write your
answers on the giving space using this answer sheet and upload
it on Blackboard before the 48 hours since begging of the exam.
Your exam begins on Friday 01/05/2020 at 10:00 pm and end on
Sunday 03/05/2020 at 10:00 pm.
1. Question Number 1: What questions might be useful to elicit
further details surrounding the Chest pain, using one of the
common acronyms in this regard? (5 Marks)
Answer:

7. 2. Question Number 2: From the subjective information you
have obtained from Mr. Brusca’s history, what are his
identifiable risk factors for heart disease? Which risk factors are
modifiable and which are unmodifiable?
(5 Marks)
Answer:
3. Question Number 3: List three priority nursing diagnosis for
Mr. Brusca’s case, and cluster subjective and objective data that

8. support each diagnosis. (3 Marks)
Answer:
#
Nursing Diagnosis
Subjective Data
Objective Data
1
2
3

9. 4. Question Number 4: From the previous data, discuss the main
issues of health promotion and disease prevention should the
nurse discussed during health history and physical examination?
(4 Marks)
Answer:

10. 5. Question Number 5: Considering the relationship of the
cardiovascular system to the respiratory system, what
respiratory problems might Mr. Brusca have as a result of his
cardiovascular disease? And what are respiratory clinical signs
associated with the respiratory problem(s)? (3 Marks)
Answer:
Page 5 of 5
Accredited University by the ASIC on March 27, 2017
Accredited BSN Program by AHPGS on February 15, 2018