One way that problem questions can be implemented is by adapting existing multiple-choice problem or scenario-based question, which are commonly used in health science assessment. The following MCQ could be easily adapted to require a written response with explanation of the reasoning and thought process of the student.

A 60-year-old man is admitted to the telemetry unit for management of new onset of paroxysmal atrial fibrillation. During the night, cardiac pauses of five to six seconds are recorded. The patient has no cardiac symptoms; heart rate is 58/min, and blood pressure is 105/60 mmHg. Results of electrocardiography are unchanged. Which of the following is the most appropriate next step?

(A) Administer atropine

(B) Initiate cardioversion using 50-J biphasic current

(C) Measure serum troponin levels

(D) Order transthoracic echocardiography

(E) Place transcutaneous pacing pads at the bedside

An adapted version of this question might read as follows:

A 60-year-old man is admitted to the telemetry unit for management of new onset of paroxysmal atrial fibrillation. During the night, cardiac pauses of five to six seconds are recorded. The patient has no cardiac symptoms; heart rate is 58/min, and blood pressure is 105/60 mmHg. Results of electrocardiography are unchanged.

Describe the correct next step in this patient’s treatment and explain the correct procedures for completing it. Explain why the step you described is correct and the expected outcome.