Question 1
A 25-year-old patient presents to the emergency department with palpitations, anxiety, and a feeling of being lightheaded. The patient’s heart rate is recorded at 120 beats per minute, blood pressure is 130/85 mmHg, and respiratory rate is 18 breaths per minute. The patient denies any chest pain. An EKG confirms sinus tachycardia.
Which of the following interventions should the nurse prioritize?
A. Administer high-flow oxygen.
B. Prepare for immediate cardioversion.
C. Administer intravenous beta-blockers.
D. Encourage deep breathing and relaxation techniques.
E. Start an intravenous fluid bolus.
Rationale: In a patient with sinus tachycardia without evidence of acute distress or instability (as indicated by the absence of chest pain and normal blood pressure), non-pharmacological interventions such as encouraging deep breathing and relaxation techniques can be beneficial. These interventions help in reducing sympathetic stimulation, which can decrease heart rate and relieve symptoms associated with anxiety and palpitations. Administration of medications or more invasive procedures should be considered based on further assessment and persistence of symptoms. Encouraging non-pharmacological interventions is a safe initial approach while preparing for further assessment or interventions if needed.
Question 2
A 58-year-old patient with a history of hypertension and diabetes mellitus type 2 presents to the clinic complaining of fatigue and episodes of rapid heartbeat lasting for minutes over the past week. The patient’s current medications include metformin, lisinopril, and aspirin. A physical examination reveals a heart rate of 110 beats per minute. An EKG confirms sinus tachycardia.
Which of the following actions is most appropriate for the nurse to take next?
A. Advise the patient to stop taking lisinopril immediately.
B. Instruct the patient to increase their fluid and salt intake.
C. Arrange for a thyroid function test.
D. Recommend starting an anticoagulant therapy.
E. Schedule a cardiac catheterization.
Rationale: In patients presenting with sinus tachycardia, especially those with risk factors such as hypertension and diabetes, it is essential to consider and rule out secondary causes such as hyperthyroidism. Thyroid function tests can help identify if the thyroid is overactive, which could explain the symptoms of rapid heartbeat and fatigue. Lisinopril, a medication for hypertension, is not directly related to the onset of sinus tachycardia and should not be stopped abruptly without medical advice. Fluid and salt intake modifications, anticoagulant therapy, and cardiac catheterization are not indicated based on the information provided, making the thyroid function test the most appropriate next step.
Question 3
A 25-year-old patient presents to the emergency department with palpitations, anxiety, and a feeling of being lightheaded. The patient’s heart rate is recorded at 120 beats per minute, blood pressure is 130/85 mmHg, and respiratory rate is 18 breaths per minute. The patient denies any chest pain. An EKG confirms sinus tachycardia.
Which of the following interventions should the nurse prioritize?
A. Administer high-flow oxygen.
B. Prepare for immediate cardioversion.
C. Administer intravenous beta-blockers.
D. Encourage deep breathing and relaxation techniques.
E. Start an intravenous fluid bolus.
Rationale: In a patient with sinus tachycardia without evidence of acute distress or instability (as indicated by the absence of chest pain and normal blood pressure), non-pharmacological interventions such as encouraging deep breathing and relaxation techniques can be beneficial. These interventions help in reducing sympathetic stimulation, which can decrease heart rate and relieve symptoms associated with anxiety and palpitations. Administration of medications or more invasive procedures should be considered based on further assessment and persistence of symptoms. Encouraging non-pharmacological interventions is a safe initial approach while preparing for further assessment or interventions if needed.
Question 4
A 58-year-old patient with a history of hypertension and diabetes mellitus type 2 presents to the clinic complaining of fatigue and episodes of rapid heartbeat lasting for minutes over the past week. The patient’s current medications include metformin, lisinopril, and aspirin. A physical examination reveals a heart rate of 110 beats per minute. An EKG confirms sinus tachycardia.
Which of the following actions is most appropriate for the nurse to take next?
A. Advise the patient to stop taking lisinopril immediately.
B. Instruct the patient to increase their fluid and salt intake.
C. Arrange for a thyroid function test.
D. Recommend starting an anticoagulant therapy.
E. Schedule a cardiac catheterization.
Rationale: In patients presenting with sinus tachycardia, especially those with risk factors such as hypertension and diabetes, it is essential to consider and rule out secondary causes such as hyperthyroidism. Thyroid function tests can help identify if the thyroid is overactive, which could explain the symptoms of rapid heartbeat and fatigue. Lisinopril, a medication for hypertension, is not directly related to the onset of sinus tachycardia and should not be stopped abruptly without medical advice. Fluid and salt intake modifications, anticoagulant therapy, and cardiac catheterization are not indicated based on the information provided, making the thyroid function test the most appropriate next step.
Question 5
A 34-year-old patient presents to the clinic for a routine check-up. The patient reports occasional palpitations but no other symptoms. The physical examination reveals a heart rate of 100 beats per minute. The patient has no history of cardiovascular diseases and leads a moderately active lifestyle. An EKG confirms sinus tachycardia.
Which of the following is the most likely cause of the patient’s sinus tachycardia?
A. Dehydration
B. Acute myocardial infarction
C. Pulmonary embolism
D. Physical inactivity
E. Anxiety
Rationale: Sinus tachycardia in a young, otherwise healthy patient with occasional palpitations and no history of cardiovascular diseases is most likely due to a non-cardiac cause such as anxiety. Anxiety can increase sympathetic nervous system activity, leading to an elevated heart rate. Dehydration could be a cause but is less likely in the absence of other symptoms such as dry mucous membranes or decreased urine output. Acute myocardial infarction and pulmonary embolism are serious conditions that typically present with additional symptoms beyond palpitations and elevated heart rate. Physical inactivity is not directly associated with acute episodes of sinus tachycardia.
Question 6
A 45-year-old patient with a known history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with difficulty breathing, a productive cough, and a heart rate of 130 beats per minute. The patient appears to be in distress and is using accessory muscles to breathe. Oxygen saturation on room air is 88%. An EKG confirms sinus tachycardia.
Which of the following interventions is most appropriate to address the patient’s sinus tachycardia?
A. Administer a nebulized bronchodilator.
B. Start an anticoagulant immediately.
C. Give oral beta-blockers.
D. Perform endotracheal intubation.
E. Prescribe antibiotics.
Rationale: For a patient with COPD exacerbation presenting with difficulty breathing, productive cough, and sinus tachycardia, administering a nebulized bronchodilator is the most appropriate initial intervention. The bronchodilator will help relieve bronchospasm, improve airflow, reduce work of breathing, and subsequently may help in reducing the heart rate caused by the respiratory distress. Anticoagulants and beta-blockers are not first-line treatments for acute respiratory distress in COPD exacerbations. Endotracheal intubation may be necessary for respiratory failure, but initial management should focus on bronchodilation and oxygen supplementation. Antibiotics may be considered if there’s a bacterial infection, but the immediate concern is to address the breathing difficulty and tachycardia.
Question 7
Vignette: A 22-year-old athlete presents to the clinic with a complaint of sudden onset palpitations after a vigorous training session. The patient has no significant medical history and takes no medications. Vital signs show a heart rate of 115 beats per minute, blood pressure 125/75 mmHg, and respiratory rate of 16 breaths per minute. An EKG confirms sinus tachycardia.
What is the most appropriate initial management for this patient?
A. Immediate cardioversion.
B. Administer intravenous fluids.
C. Observation and rest.
D. Start beta-blocker therapy.
E. Prescribe anti-anxiety medication.
Rationale: For a young athlete with sinus tachycardia following vigorous exercise, the most appropriate initial management is observation and rest. Sinus tachycardia is a normal physiological response to exercise due to increased demand for oxygen and nutrients by the muscles. It usually resolves with rest as the body returns to its baseline state. Immediate cardioversion and starting pharmacological treatments such as beta-blockers or anti-anxiety medication are not indicated in this scenario without evidence of underlying pathology. Intravenous fluids are not necessary unless there is evidence of dehydration or volume depletion.
Question 8
Vignette: A 34-year-old patient presents to the clinic for a routine check-up. The patient reports occasional palpitations but no other symptoms. The physical examination reveals a heart rate of 100 beats per minute. The patient has no history of cardiovascular diseases and leads a moderately active lifestyle. An EKG confirms sinus tachycardia.
Which of the following is the most likely cause of the patient’s sinus tachycardia?
A. Dehydration
B. Acute myocardial infarction
C. Pulmonary embolism
D. Physical inactivity
E. Anxiety
Rationale: Sinus tachycardia in a young, otherwise healthy patient with occasional palpitations and no history of cardiovascular diseases is most likely due to a non-cardiac cause such as anxiety. Anxiety can increase sympathetic nervous system activity, leading to an elevated heart rate. Dehydration could be a cause but is less likely in the absence of other symptoms such as dry mucous membranes or decreased urine output. Acute myocardial infarction and pulmonary embolism are serious conditions that typically present with additional symptoms beyond palpitations and elevated heart rate. Physical inactivity is not directly associated with acute episodes of sinus tachycardia.
Question 9
Vignette: A 45-year-old patient with a known history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with difficulty breathing, a productive cough, and a heart rate of 130 beats per minute. The patient appears to be in distress and is using accessory muscles to breathe. Oxygen saturation on room air is 88%. An EKG confirms sinus tachycardia.
Which of the following interventions is most appropriate to address the patient’s sinus tachycardia?
A. Administer a nebulized bronchodilator.
B. Start an anticoagulant immediately.
C. Give oral beta-blockers.
D. Perform endotracheal intubation.
E. Prescribe antibiotics.
Rationale: For a patient with COPD exacerbation presenting with difficulty breathing, productive cough, and sinus tachycardia, administering a nebulized bronchodilator is the most appropriate initial intervention. The bronchodilator will help relieve bronchospasm, improve airflow, reduce work of breathing, and subsequently may help in reducing the heart rate caused by the respiratory distress. Anticoagulants and beta-blockers are not first-line treatments for acute respiratory distress in COPD exacerbations. Endotracheal intubation may be necessary for respiratory failure, but initial management should focus on bronchodilation and oxygen supplementation. Antibiotics may be considered if there’s a bacterial infection, but the immediate concern is to address the breathing difficulty and tachycardia.
Question 10
Vignette: A 22-year-old athlete presents to the clinic with a complaint of sudden onset palpitations after a vigorous training session. The patient has no significant medical history and takes no medications. Vital signs show a heart rate of 115 beats per minute, blood pressure 125/75 mmHg, and respiratory rate of 16 breaths per minute. An EKG confirms sinus tachycardia.
What is the most appropriate initial management for this patient?
A. Immediate cardioversion.
B. Administer intravenous fluids.
C. Observation and rest.
D. Start beta-blocker therapy.
E. Prescribe anti-anxiety medication.
Rationale: For a young athlete with sinus tachycardia following vigorous exercise, the most appropriate initial management is observation and rest. Sinus tachycardia is a normal physiological response to exercise due to increased demand for oxygen and nutrients by the muscles. It usually resolves with rest as the body returns to its baseline state. Immediate cardioversion and starting pharmacological treatments such as beta-blockers or anti-anxiety medication are not indicated in this scenario without evidence of underlying pathology. Intravenous fluids are not necessary unless there is evidence of dehydration or volume depletion.