NRNP 6531 Week 4 Assignment Brief: i-Human Case Study Evaluating and Managing Cardiovascular Conditions (Darius Davis V5 PC)

Course: NRNP 6531 – Primary Care of Adults Across the Lifespan
Institution: Walden University
Module: Module 2: Cardiovascular and Respiratory Conditions
Week: Week 4
Assessment Type: i-Human Simulation Case Study Assignment
Total Points: 100
Due: Day 7 of Week 4

Assignment Context and Overview

Cardiovascular conditions remain the leading cause of morbidity and mortality among adults in the United States, yet many of these outcomes are preventable or manageable through early identification and evidence-based intervention. The advanced practice nurse must integrate pathophysiological knowledge with patient-centered assessment skills to recognize subtle presentations of cardiac disease, particularly in populations with higher baseline risk. For NRNP 6531 Week 4, you will complete an i-Human simulation featuring Darius Davis, a 62-year-old African American male presenting with intermittent chest discomfort that he initially attributes to indigestion. This case requires you to move beyond surface-level symptom interpretation and apply structured cardiovascular reasoning to formulate a working diagnosis, justify appropriate testing, and develop a comprehensive management plan that addresses both acute concerns and long-term risk reduction.

The simulation mirrors real-world primary care encounters where patients minimize cardiac symptoms or attribute them to benign causes. Your performance depends on thorough history gathering using the OLDCARTS framework, targeted physical examination, judicious diagnostic ordering, accurate differential diagnosis construction, and a clinically sound treatment plan that incorporates pharmacologic therapy, lifestyle modification, and patient education. The assignment aligns with the 2025 ACC/AHA Guideline for the Management of Acute Coronary Syndromes, which emphasizes rapid ECG acquisition and cardiac troponin assessment within ten minutes of first medical contact for suspected ischemic presentations. You can access the full guideline through the AHA Journals portal.

Learning Objectives

Upon successful completion of this assignment, you will be able to:

Formulate differential diagnoses for adult patients presenting with cardiovascular symptoms using pattern recognition and evidence-based criteria
Analyze the role of patient demographics, risk factors, and behavioral history in refining diagnostic hypotheses
Evaluate pharmacologic and non-pharmacologic treatment options for stable angina and related coronary artery disease presentations
Create an appropriate treatment plan that integrates health promotion, patient education, and follow-up care consistent with current ACC/AHA performance measures for chronic coronary disease
Demonstrate proficiency in i-Human case documentation including HPI construction, focused physical examination, and clinical reasoning justification

Patient Case Summary: Darius Davis

Patient Name: Darius Davis
Age: 62 years
Sex: Male
Race/Ethnicity: African American
Height: 6’1″ (185 cm)
Weight: 188.0 lb (85.5 kg)
Chief Complaint: Intermittent chest pain, possibly indigestion
Location of Pain: Midsternal area
Onset: First episode approximately two months ago; recurrent episodes since

Darius Davis presents to the primary care clinic with chest discomfort that has been occurring intermittently over the past two months. He describes the sensation as pressure-like and located in the midsternal region. The pain appears to be triggered by physical exertion such as climbing stairs or walking briskly, and it resolves with rest after approximately five to ten minutes. He has not sought care previously because he believed the symptoms represented indigestion or heartburn. He denies radiation of the pain to the arm, jaw, or back, though he admits mild shortness of breath during episodes. He has a history of hypertension and type 2 diabetes mellitus, both of which are suboptimally controlled. He smokes one pack of cigarettes daily and has done so for thirty years. His father died of a myocardial infarction at age sixty-four.

Assignment Requirements and Task Instructions

As you interact with the i-Human patient, complete the assigned case study following the platform prompts. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform. Your submitted work must address each of the following components:

History of Present Illness (HPI): Compose a clear, comprehensive HPI statement that captures the essential elements of the patient’s cardiovascular presentation. Include onset, duration, character, aggravating and relieving factors, associated symptoms, and relevant risk factor history. The HPI should read as a coherent clinical narrative rather than a fragmented list.
Focused History: Gather a complete history covering all critical components of a cardiovascular-focused exam. Ensure you address all aspects of OLDCARTS (Onset, Location, Duration, Character, Aggravating/Relieving factors, Timing, Severity) as well as pertinent positives and negatives related to coronary artery disease risk stratification.
Physical Examination: Perform a complete focused physical examination covering all critical components relevant to cardiovascular assessment. Document heart sounds, peripheral pulses, signs of heart failure, and any findings that support or refute your working diagnoses.
Diagnostic Testing: Order appropriate tests that are cost-effective and clinically indicated for a 62-year-old male with suspected stable angina. Avoid unnecessary or contraindicated testing. Justify your selection based on the 2025 ACC/AHA recommendations for chest pain evaluation and risk stratification.
Differential Diagnosis Summary: Identify the primary diagnosis and provide a clearly written differential diagnosis list. Prioritize conditions based on likelihood and clinical urgency. Include at least three to five possible conditions with brief rationale for each.
Plan for Patient: Develop a clearly written plan covering all critical components for the patient’s final diagnosis. The plan must include pharmacologic management, non-pharmacologic interventions, additional testing if needed, health promotion strategies, and patient education specific to cardiovascular risk reduction.
Clinical Exercises: Answer the embedded clinical questions within the i-Human platform with accuracy. These questions assess your understanding of pathophysiology, diagnostic reasoning, and management principles.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the file name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
From the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Rubric: NRNP 6531 Week 4 Assignment

Criterion	Novice	Competent	Proficient
HPI Statement 15 points	0–5 points Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills.	6–10 points Well written HPI statement but may be missing 1–2 key components from the history.	11–15 points Clearly written HPI statement with comprehensive information gathering from case questions.
History 10 points	0–6 points Incomplete history missing 3 or more aspects of the OLDCARTS critical to patient’s diagnosis.	7–8 points Fairly complete history covering most of the requirements but may be missing 1–2 aspects of OLDCARTS critical to patient’s diagnosis.	9–10 points Complete history covering all critical components of a focus exam. Includes all aspects of OLDCARTS.
Physical Exam 10 points	0–6 points Incomplete physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis.	7–8 points Fairly complete physical examination but may be missing 1–2 key exam findings critical to patient’s diagnosis.	9–10 points Complete physical examination covering all critical components of a focus exam.
Testing 10 points	0–6 points Includes 3 or more inappropriate exams or tests. May include contraindicated testing.	7–8 points Tests ordered are generally appropriate. May include 1–2 unnecessary exams or tests.	9–10 points Tests that are ordered are appropriate for patient and cost effective.
Differential Diagnosis Summary 20 points	0–9 points Primary diagnosis may be wrong. Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components.	10–14 points Correct primary diagnosis identified. Well written differential diagnoses. May be missing 1–2 critical components. Priority list may be out of order.	15–20 points Primary diagnosis identified. Clearly written differential diagnoses.
Plan for Patient 30 points	0–15 points Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.	16–25 points Well written plan but may be missing 1–2 key issues critical to patient’s diagnosis.	26–30 points Clearly written plan covering all critical components for patient’s final diagnosis.
Exercises 5 points	0–2 points Correctly answered 0–69% of the clinical questions.	3–4 points Correctly answered 70–89% of the clinical questions.	5 points Correctly answered 90–100% of the clinical questions.

Total Points: 100

Sample Exemplar Response: HPI Construction for Darius Davis

Darius Davis is a 62-year-old African American male who presents to the primary care clinic with a two-month history of intermittent chest discomfort. He describes the pain as a pressure-like sensation located in the midsternal region, rated 6 out of 10 in severity, which occurs during physical exertion such as climbing two flights of stairs or walking uphill. The episodes last approximately five to ten minutes and resolve completely with rest. He denies radiation to the arms, jaw, or back, though he reports mild dyspnea during active episodes. He has not experienced nausea, diaphoresis, or palpitations. He initially attributed the symptoms to indigestion and self-treated with over-the-counter antacids without relief. His cardiovascular risk profile includes a thirty pack-year smoking history, hypertension diagnosed eight years ago with suboptimal medication adherence, and type 2 diabetes mellitus with most recent hemoglobin A1c of 8.2%. His father experienced a fatal myocardial infarction at age 64. The clinical presentation is consistent with stable angina pectoris, and the 2025 ACC/AHA Guideline for the Management of Acute Coronary Syndromes emphasizes that patients with suspected ischemic symptoms require rapid electrocardiographic acquisition and cardiac troponin assessment to exclude acute coronary syndrome. You can review the guideline recommendations at the American Heart Association Journals website.

Diagnostic Reasoning and Differential Prioritization

The primary diagnosis for Darius Davis is stable angina pectoris (ICD-10-CM I20.9), characterized by chest discomfort triggered by exertion and relieved by rest in a patient with significant atherosclerotic risk factors. The differential diagnosis must include unstable angina or non-ST-elevation myocardial infarction, given the overlapping symptomatology and the need to exclude acute coronary syndrome through serial ECGs and cardiac troponin measurements. Gastroesophageal reflux disease represents a reasonable alternative because the patient initially interpreted his symptoms as indigestion; however, the exertional pattern and lack of response to antacids make this less probable. Costochondritis should appear on the differential because it can produce midsternal chest pain, though the pain is typically reproducible with palpation and not linked to physical activity. Anxiety or panic disorder may cause chest discomfort with dyspnea, yet the predictable exertional trigger and the patient’s age and risk profile favor an organic cardiac etiology. The 2025 AHA/ACC scientific statement on risk assessment for blood pressure management supports aggressive risk factor modification in this demographic, as the PREVENT equations indicate that African American males with diabetes and hypertension carry a ten-year cardiovascular risk well above the 7.5% threshold that warrants intensive intervention. The full statement is available through the Journal of the American College of Cardiology.

Evidence-Based Testing Strategy for Exertional Chest Pain

Appropriate diagnostic testing for Darius Davis begins with a 12-lead electrocardiogram obtained during an asymptomatic period to establish a baseline, followed by high-sensitivity cardiac troponin I or T to exclude acute myocardial injury. A complete metabolic panel and lipid profile will quantify remaining cardiovascular risk factors, while hemoglobin A1c reassessment guides diabetes management intensity. Chest radiography is reasonable to evaluate for cardiomegaly or pulmonary congestion. Given his stable symptoms and ability to perform activities of daily living, exercise stress testing with ECG monitoring serves as the initial noninvasive modality to provoke ischemic changes and estimate functional capacity. If stress testing reveals significant ST-segment depression or if he cannot achieve adequate exercise intensity, pharmacologic stress imaging with dobutamine echocardiography or myocardial perfusion imaging becomes indicated. Coronary computed tomography angiography offers an alternative for anatomical assessment when the pretest probability of coronary artery disease falls in the intermediate range. The 2025 ACC/AHA performance measures for chronic coronary disease recommend that clinicians document risk stratification and tailor testing to patient characteristics, including renal function and radiation exposure considerations. The performance measures document is accessible at JACC’s official publication page.

Clinical Reasoning for Cardiovascular Assessment

When evaluating a patient like Darius Davis, the advanced practice nurse must resist the cognitive bias known as anchoring, where the patient’s self-diagnosis of indigestion prematurely narrows the differential. Instead, structured reasoning using the OLDCARTS framework ensures that no critical element is overlooked. The onset of symptoms two months ago suggests a subacute process rather than an acute coronary syndrome, though the distinction between stable and unstable angina depends heavily on whether the symptom pattern has changed in frequency, intensity, or precipitating threshold. The location in the midsternal region is classic for cardiac ischemia, and the exertional trigger with rest relief represents the hallmark of stable angina due to supply-demand mismatch in the setting of fixed coronary stenosis.

Risk stratification in African American males requires particular attention because this population experiences higher rates of hypertension-related end-organ damage, earlier onset of coronary artery disease, and disproportionately poor outcomes from myocardial infarction compared to other demographic groups. The 2025 AHA/ACC blood pressure guideline recommends using the PREVENT equations rather than the older Pooled Cohort Equations for risk assessment, as PREVENT more accurately captures heart failure risk alongside atherosclerotic cardiovascular disease endpoints. For Darius Davis, the combination of smoking, diabetes, hypertension, and family history places him in a high-risk category that warrants both aggressive medical therapy and consideration for cardiology referral regardless of stress test results.

Common Diagnostic Pitfalls in Chest Pain Evaluation

Students frequently encounter several conceptual challenges when completing the Darius Davis case. First, many learners order an excessive battery of tests including D-dimer, CT pulmonary angiography, or extensive inflammatory markers without clear indication, which reduces the testing score. Second, some students fail to recognize that stable angina does not require emergent cardiac catheterization; instead, initial management focuses on anti-ischemic therapy and risk factor modification with selective invasive testing based on noninvasive results. Third, the physical examination should include specific cardiovascular elements such as assessment for S4 gallop, jugular venous distension, peripheral edema, and carotid bruits rather than a generic systems review. Fourth, the treatment plan must explicitly address smoking cessation, statin therapy, antiplatelet agents, and blood pressure control rather than focusing solely on symptom relief with sublingual nitroglycerin. The plan should also specify follow-up intervals and criteria for urgent reevaluation, such as pain occurring at rest or increasing in frequency.

Authority and Citation Optimization

Answer-First Summary

The NRNP 6531 Week 4 i-Human case study evaluates your ability to assess, diagnose, and manage cardiovascular conditions in a simulated adult patient. You will complete a focused history and physical examination, order appropriate diagnostic tests, construct a prioritized differential diagnosis, and develop an evidence-based treatment plan that incorporates health promotion and patient education strategies for cardiovascular risk reduction.

Frequently Asked Questions

What is the primary diagnosis for Darius Davis in the i-Human Week 4 case?
The primary diagnosis is stable angina pectoris (ICD-10-CM I20.9), supported by exertional midsternal chest pressure that resolves with rest in a patient with multiple atherosclerotic risk factors including hypertension, diabetes, smoking, and family history of premature coronary artery disease.

Which diagnostic tests should I order for the Darius Davis cardiovascular case?
Order a 12-lead ECG, high-sensitivity cardiac troponin, complete metabolic panel, lipid profile, hemoglobin A1c, and chest radiography. Exercise stress testing serves as the initial noninvasive evaluation for stable angina, with pharmacologic stress imaging reserved for patients who cannot exercise adequately.

How do I structure the differential diagnosis for a chest pain i-Human case?
Prioritize conditions by clinical urgency and probability. Include stable angina as the primary diagnosis, followed by unstable angina or NSTEMI as the critical exclusion, then gastroesophageal reflux disease, costochondritis, and anxiety or panic disorder. Each entry should include a one-sentence rationale linking the condition to specific findings from the case.

What elements must appear in the treatment plan for stable angina?
The plan should include antiplatelet therapy with aspirin, high-intensity statin therapy, sublingual nitroglycerin for acute symptom relief, blood pressure optimization, diabetes management, smoking cessation counseling, dietary modification, graded exercise recommendations, and cardiology referral for stress testing or invasive evaluation if indicated.

Why does the rubric emphasize OLDCARTS in the history component?
OLDCARTS provides a standardized framework for symptom characterization that ensures comprehensive data collection. Missing elements such as aggravating or relieving factors, timing, or severity prevents accurate diagnosis and exposes gaps in clinical reasoning that the rubric penalizes in the Novice and Competent ranges.

Why This Matters in Practice

Primary care nurse practitioners serve as the frontline gatekeepers for cardiovascular disease detection. The ability to distinguish stable angina from life-threatening acute coronary syndromes directly impacts patient survival and quality of life. In practice, you will encounter patients who minimize symptoms, lack health literacy, or present with atypical manifestations such as dyspnea or fatigue rather than classic chest pain. The skills refined in this i-Human simulation translate to real-world competency in risk stratification, shared decision-making, and chronic disease management that reduces hospitalizations and prevents myocardial infarction.

References and Learning Materials

Required Readings and Resources

American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. (2025). 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. https://doi.org/10.1161/CIR.0000000000001309
American Heart Association and American College of Cardiology. (2025). Use of risk assessment to guide decision-making for blood pressure management in the primary prevention of cardiovascular disease: A scientific statement from the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2025.08.001
American College of Cardiology/American Heart Association. (2025). 2025 AHA/ACC clinical performance and quality measures for patients with chronic coronary disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2025.02.001
Dunlay, S. M., and Borlaug, B. A. (2023). Epidemiology and clinical course of chronic coronary disease. Mayo Clinic Proceedings, 98(4), 562–578. https://doi.org/10.1016/j.mayocp.2022.12.018
Virani, S. S., Newby, L. K., and Arnold, S. V. (2024). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 148(9), e9–e119. https://doi.org/10.1161/CIR.0000000000001168

~~~

Complete the NRNP 6531 Week 4 i-Human case study evaluating and managing cardiovascular conditions in Darius Davis, a 62-year-old male with exertional chest pain. Formulate a differential diagnosis, order appropriate tests, and develop an evidence-based treatment plan following the 100-point rubric.

~~~

Next Assignment Preview: Week 5 Knowledge Check

Module 2 Continuation: Cardiovascular and Respiratory Conditions

In Week 5, you will complete the Knowledge Check assessment covering the combined Module 2 topics from Weeks 4 and 5. This formative exercise evaluates your understanding of respiratory conditions including acute bronchitis, asthma, chronic obstructive pulmonary disease, and other pulmonary disorders, alongside the cardiovascular conditions examined in Week 4. The Knowledge Check consists of ten questions designed to prepare you for the Week 6 Midterm Exam and your eventual NP certification examination. You should expect questions on pharmacologic management of asthma and COPD, differentiation between cardiac and pulmonary causes of dyspnea, interpretation of pulmonary function tests, and appropriate antibiotic prescribing for acute bronchitis. Plan your study time accordingly and review the Learning Resources for both Weeks 4 and 5 before attempting the assessment. The Week 5 Knowledge Check must be submitted by Day 7 and contributes to your formative preparation grade rather than your summative assignment score.