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HCA Healthcare Telemetry ECG/EKG Interpretation
Exam Questions with correctanswers & Detailed
Rationales 2026 \ 2027
Part 1: HCA Telemetry Protocols & Standards of Care Question 1 What is the primary purpose of the HCA Telemetry Safety Bundle? A. To reduce the cost of cardiac monitoring equipment B. To set a standard of care for HCA facilities providing telemetry monitoring of heart rhythms for patients C. To eliminate the need for physician orders for telemetry D. To replace 12-lead ECGs with continuous monitoring ☑ correctanswer- : B Rationale: The HCA Telemetry Safety Bundle establishes a standardized approach to telemetry monitoring across all HCA facilities. This ensures consistent, evidence-based care for patients requiring cardiac rhythm monitoring. The bundle addresses initiation criteria, monitoring frequency, alarm management, and discontinuation protocols to improve patient safety and outcomes. Question 2 What is the maximum allowed time to initiate telemetry monitoring upon a patient's arrival or transfer to a unit?
A. Immediately upon arrival (0 minutes) B. Within 15 minutes C. Within 30 minutes D. Within 60 minutes ☑ correctanswer- : C Rationale: HCA protocol requires telemetry monitoring to be initiated within 30 minutes of patient arrival or transfer. This standard ensures timely cardiac monitoring for patients who need it, reducing the risk of missing critical arrhythmias during the transition of care. Question 3 A patient arrives on the unit and the nurse believes telemetry is needed, but there is no current physician order. What should the nurse do? A. Apply the telemetry immediately and obtain an order later B. Contact the provider to obtain an order before initiating monitoring C. Place the patient on a portable monitor without telemetry transmission D. Document that telemetry was not ordered and proceed without monitoring ☑ correctanswer- : B Rationale: Telemetry monitoring requires a physician/provider order before initiation. The nurse must contact the provider to obtain an order. Applying telemetry without an order violates HCA protocol and could constitute practicing beyond the nurse's scope.
interference. Electrodes should also be changed sooner if they become loose or the signal quality degrades. Question 6 The telemetry device displays a "Low Battery" warning. Approximately how much time remains before the device fails? A. 15 minutes B. 30 minutes C. 1 hour D. 2 hours ☑ correctanswer- : C Rationale: When a "Low Battery" warning appears, approximately 1 hour of battery life remains. The nurse should replace the battery or connect the device to charging promptly to prevent interruption of cardiac monitoring. Question 7 Who is responsible for ensuring telemetry boxes are cleaned and lead wires are free of damage? A. The patient's primary nurse B. The unit secretary C. Telemetry Technicians D. Environmental Services ☑ correctanswer- : C Rationale: Telemetry Technicians are responsible for routine inspection, cleaning, and maintenance of telemetry equipment,
including boxes and lead wires. This includes checking for cracks, frayed wires, and proper function. Nurses should also inspect equipment before application and report any damage. Question 8 Who is responsible for placing the telemetry unit on the patient and confirming the rhythm transmission? A. Telemetry Technician B. Registered Nurse (RN) C. Licensed Practical Nurse (LPN) D. Patient Care Technician ☑ correctanswer- : B Rationale: The Registered Nurse (RN) is responsible for applying the telemetry unit to the patient and confirming that the rhythm is transmitting properly. The RN must use two patient identifiers , document the telemetry box number, and verify transmission to the central monitoring station. Question 9 A nurse wants to adjust the alarm settings on a patient's telemetry monitor. Is this permissible? A. No, alarm settings cannot be changed under any circumstances B. Yes, any nurse can adjust alarms as needed C. Yes, but only with a specific provider order D. Only the telemetry technician can adjust alarms ☑ correctanswer- : C
A. Atrial rhythms are typically slow with rates below 60 bpm B. If consistent, non-varying P waves are easily identified, the rhythm is NOT atrial in origin C. Atrial rhythms always have wide QRS complexes D. Atrial rhythms are always regular ☑ correctanswer- : B Rationale: Atrial rhythms are characterized by the absence of classic, consistent P waves. If equal, consistent, non-varying P waves are easily identified, the rhythm originates from the SA node (sinus rhythm), not an atrial focus. Atrial rhythms are routinely fast and may be regular or irregular depending on the specific rhythm. Question 12 Which of the following atrial rhythms is ALWAYS irregular? A. Atrial Flutter B. Supraventricular Tachycardia (SVT) C. Atrial Tachycardia D. Atrial Fibrillation (A-Fib) ☑ correctanswer- : D Rationale: Atrial Fibrillation (A-Fib) , along with Wandering Atrial Pacemaker (WAP) and Multifocal Atrial Tachycardia (MAT), is ALWAYS irregular. A-Flutter can be regular or irregular depending on the conduction ratio. SVT and Atrial Tachycardia are always regular. Question 13
What is the characteristic appearance of Atrial Fibrillation (A-Fib) on ECG? A. Saw-tooth pattern with regular QRS complexes B. Wavy, chaotic baseline with overall irregularity C. Narrow QRS complexes with visible P waves D. Wide QRS complexes with a regular rhythm ☑ correctanswer- : B Rationale: Atrial Fibrillation presents with a wavy, chaotic baseline due to disorganized atrial activity (350-500 bpm). The ventricular response is irregularly irregular. QRS complexes may be narrow or wide depending on underlying conduction. Question 14 A patient's telemetry shows a "saw-tooth" appearance on the baseline. What rhythm should the nurse suspect? A. Atrial Fibrillation B. Atrial Flutter C. Sinus Tachycardia D. Ventricular Tachycardia ☑ correctanswer- : B Rationale: Atrial Flutter (A-Flutter) is characterized by consistent atrial depolarization waves creating a "flutter" or "saw-tooth" appearance on the baseline. These are often called "F waves." The rhythm may be regular or irregular depending on the AV conduction ratio (e.g., 2:1, 3:1, 4:1 block).
Question 17 A patient has a rhythm with a rate of 130 bpm, narrow QRS complexes, and three or more different P wave morphologies. The rhythm is irregular. What is the correct interpretation? A. Atrial Fibrillation B. Multifocal Atrial Tachycardia (MAT) C. Wandering Atrial Pacemaker (WAP) D. Sinus Tachycardia with PACs ☑ correctanswer- : B Rationale: Multifocal Atrial Tachycardia (MAT) is defined by three or more distinct P wave morphologies , an irregular rhythm , and a rate >100 bpm. MAT results from multiple ectopic atrial foci. If the rate is <100 bpm with similar findings, it is called Wandering Atrial Pacemaker (WAP). Question 18 What is the normal measurement for a narrow QRS complex? A. <0.10 seconds (2.5 small boxes) B. <0.12 seconds (3 small boxes) C. <0.16 seconds (4 small boxes) D. <0.20 seconds (5 small boxes) ☑ correctanswer- : B Rationale: A narrow QRS complex measures <0.12 seconds , which is less than 3 small boxes on standard ECG paper (each small box = 0. seconds). Narrow QRS indicates that ventricular depolarization is
occurring through the normal His-Purkinje pathway, suggesting a supraventricular origin. Question 19 A wide QRS complex measures greater than which value? A. >0.08 seconds (2 small boxes) B. >0.10 seconds (2.5 small boxes) C. >0.12 seconds (3 small boxes) D. >0.14 seconds (3.5 small boxes) ☑ correctanswer- : C Rationale: A wide QRS complex measures >0.12 seconds ( greater than 3 small boxes ). Wide QRS indicates that ventricular depolarization is delayed, typically due to a ventricular origin (e.g., PVC, VT) or aberrant conduction (e.g., bundle branch block). Question 20 Which of the following statements about Premature Atrial Contractions (PACs) is correct? A. PACs are a sustained rhythm, not an ectopic beat B. PACs are atrial ectopy, similar to an ill-timed hiccup within the atria C. PACs always have wide QRS complexes D. PACs originate in the ventricles ☑ correctanswer- : B Rationale: Premature Atrial Contractions (PACs) are atrial ectopy (not a sustained rhythm)—they represent single, early beats originating from an ectopic atrial focus. The description "similar to an ill-timed
Rationale: Sinus Bradycardia is defined as a sinus rhythm with a rate <60 bpm. The presence of normal P waves preceding each QRS with a normal PR interval confirms sinus origin. The rate (52 bpm) meets the criteria for bradycardia. No AV block is present. Question 23 A patient's telemetry shows a regular rhythm with a rate of 145 bpm, normal P waves, and a PR interval of 0.14 seconds. What is the correct interpretation? A. Atrial Flutter with 2:1 conduction B. Supraventricular Tachycardia C. Sinus Tachycardia D. Atrial Fibrillation ☑ correctanswer- : C Rationale: Sinus Tachycardia is a sinus rhythm with a rate > bpm (up to 150-160 bpm typically). Normal P waves preceding each QRS with a normal PR interval confirm sinus origin. The rate of 145 bpm falls within the range for sinus tachycardia, which is a physiologic response to factors like pain, fever, anxiety, or hypovolemia. Question 24 A patient's telemetry shows a regular rhythm with a rate of 42 bpm. There is no association between the P waves and the QRS complexes. The QRS complexes are narrow. What is the correct interpretation? A. Sinus Bradycardia B. First-degree AV Block
C. Second-degree AV Block Type I (Wenckebach) D. Complete Heart Block (3rd Degree AV Block) ☑ correctanswer- : D Rationale: Complete Heart Block (3rd Degree AV Block) is characterized by no association between P waves and QRS complexes (AV dissociation). The atria and ventricles beat independently. The atrial rate is typically normal, while the ventricular rate is slower (often 40-60 bpm if the escape rhythm is junctional, as indicated by narrow QRS complexes). Question 25 A patient's telemetry shows a chaotic, wavy baseline with no discernible P waves, QRS complexes, or T waves. What is the rhythm? A. Asystole B. Ventricular Fibrillation (VF) C. Ventricular Tachycardia D. Atrial Fibrillation ☑ correctanswer- : B Rationale: Ventricular Fibrillation (VF) presents as a chaotic, wavy baseline with no identifiable P waves, QRS complexes, or T waves. There is no organized electrical activity. VF is a life-threatening arrhythmia requiring immediate defibrillation and CPR. Question 26
dead battery. Always assess the patient first before treating the monitor. Question 28 The telemetry technician notes sudden, massive interference (somatic tremor) on the tracing. What is the likely cause? A. Patient movement or shivering B. Electrode gel drying out C. Interference from other equipment D. Loose electrode connection ☑ correctanswer- : A Rationale: Somatic tremor (muscle artifact) is typically caused by patient movement or shivering. Skeletal muscle activity generates electrical signals that interfere with ECG recording. The technician should check if the patient is ambulating, anxious, or experiencing rigors. Question 29 The telemetry tracing shows "wandering baseline" (the line drifts up and down). What is the likely cause? A. Patient movement B. Respiratory movement or electrodes placed over bony prominences C. 60-cycle interference from electrical equipment D. Loose electrode connection ☑ correctanswer- : B
Rationale: Wandering baseline is most commonly caused by respiratory movement or electrodes placed over bony prominences (ribs) rather than soft tissue. As the patient breathes, the chest expands and contracts, causing the baseline to drift. Proper electrode placement over soft tissue (e.g., intercostal spaces) helps minimize this artifact. Question 30 The ST segment on the monitor is elevated. The patient denies chest pain. What is the appropriate action? A. Ignore the finding since the patient is asymptomatic B. Treat the rhythm, not just the patient's complaint; obtain a 12-lead ECG immediately and notify the provider C. Wait 30 minutes and reassess the ST segment D. Document that the patient denied chest pain and continue monitoring ☑ correctanswer- : B Rationale: The appropriate action is to treat the rhythm, not just the patient's complaint. ST-segment elevation indicates possible myocardial injury, regardless of symptoms (silent ischemia is common, especially in diabetics and elderly patients). The nurse should obtain a 12 - lead ECG immediately and notify the provider. Question 31 A patient is scheduled for an MRI. What must happen to the telemetry equipment?
Question 33 Which of the following correctly describes the QRS complex characteristics in atrial rhythms? A. Atrial rhythms always have narrow QRS complexes B. Atrial rhythms always have wide QRS complexes C. Atrial rhythms can have narrow OR wide QRS complexes, depending on underlying conduction D. QRS width is not relevant in atrial rhythm interpretation ☑ correctanswer- : C Rationale: In atrial rhythms, QRS complexes can be narrow (<0.12 sec) OR wide (>0.12 sec). Narrow QRS indicates normal ventricular conduction through the His-Purkinje system. Wide QRS indicates aberrant conduction (bundle branch block, rate-related aberrancy, or pre-existing conduction disease). Question 34 A patient's telemetry shows a rhythm that starts regularly, then suddenly has a pause, followed by a P wave that looks different from the others. What is the most likely finding? A. Sinus arrest B. Premature Atrial Contraction (PAC) with compensatory pause C. Second-degree AV Block D. Junctional escape beat ☑ correctanswer- : B Rationale: This pattern describes a Premature Atrial Contraction (PAC). The early beat (PAC) has a P wave with a different morphology
because it originates from an ectopic atrial focus. The PAC is typically followed by a compensatory pause before the next sinus beat. Question 35 What is the ventricular rate range for Supraventricular Tachycardia (SVT)? A. 60-100 bpm B. 100-150 bpm C. >150-160 bpm, even upwards of 220-240 bpm D. >350-500 bpm ☑ correctanswer- : C Rationale: Supraventricular Tachycardia (SVT) is characterized by a ventricular rate >150-160 bpm, even upwards of 220-240 bpm. The ventricular rate equals the atrial rate (1:1 conduction). SVT originates at or above the AV node and typically presents with narrow QRS complexes. Question 36 A patient with a history of heart failure has a telemetry reading showing a regular rhythm with a rate of 52 bpm, no visible P waves, and narrow QRS complexes. What is the most likely rhythm? A. Sinus Bradycardia B. Junctional Rhythm C. Complete Heart Block D. Atrial Fibrillation with slow ventricular response ☑ correctanswer- : B
