In an elderly patient who is confused and combative, which vital sign could be a concern?

• A. Heart rate at 164
• B. Temperature 98.6°F
• C. Respiratory rate 14
• D. Blood pressure 120/80

Answer: (A)

The main thing this item tests is recognizing that an unusually high heart rate in an elderly patient who is confused and combative is a sign of physiologic stress that needs prompt attention. A heart rate of 164 beats per minute is severe tachycardia and indicates the body is under strain—often from delirium triggered by pain, dehydration, hypoxia, infection, or other acute issues. Even though temperature, respiratory rate, and blood pressure appear normal, this marked tachycardia stands out as a potential red flag that warrants immediate assessment (oxygenation, hydration status, possible infection, chest pain, electrolyte problems, and medication effects). The other vitals are within typical ranges and do not raise the same level of concern in this scenario.