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HCA HEALTHCARE TELEMETRY EKG EXAM RHYTHM INTERPRETATION FINAL TEST
100 PRACTICE QUESTIONS WITH VERIFIED CORRECT ANSWERS
SECTION 1: ATRIAL RHYTHMS (Questions 1-25) Q001. A patient's telemetry strip shows a wavy, chaotic baseline with no identifiable P waves and an irregularly irregular ventricular response. What rhythm is this? a) Atrial Flutter b) Atrial Fibrillation c) Multifocal Atrial Tachycardia d) Wandering Atrial Pacemaker Answer: b Rationale: Atrial Fibrillation (A-Fib) is characterized by a wavy, chaotic baseline with no discernible P waves and an irregularly irregular ventricular response. The atrial rate is typically >350-500 bpm. Q002. The telemetry technician notes a "sawtooth" pattern on the baseline of a patient's EKG strip. The ventricular rate is regular at 150 bpm. This rhythm is most consistent with: a) Atrial Fibrillation b) Atrial Flutter with 2:1 conduction c) Supraventricular Tachycardia d) Sinus Tachycardia Answer: b Rationale: Atrial Flutter is characterized by a "sawtooth" or "flutter" wave appearance. When the AV node conducts every other atrial beat, it results in 2:1 conduction and a regular ventricular rate typically around 150 bpm (atrial rate ~300 bpm).
Q003. Which of the following atrial rhythms is ALWAYS irregular? a) Atrial Flutter b) Atrial Fibrillation c) Atrial Tachycardia d) Supraventricular Tachycardia Answer: b Rationale: Atrial Fibrillation is ALWAYS irregularly irregular. Atrial Flutter can be regular or irregular depending on the conduction ratio. Atrial Tachycardia and SVT are always regular. Q004. A patient's EKG shows a fast, regular rhythm with narrow QRS complexes and no discernible P waves. The heart rate is 180 bpm. This is most likely: a) Atrial Fibrillation b) Atrial Flutter c) Supraventricular Tachycardia (SVT) d) Ventricular Tachycardia Answer: c Rationale: Supraventricular Tachycardia (SVT) is characterized by a fast (150-250 bpm), regular rhythm with narrow QRS complexes and no visible P waves. It originates at or above the AV node. Q005. A rhythm strip demonstrates three or more different P-wave morphologies, an irregular ventricular response, and a rate of 120 bpm. This rhythm is: a) Wandering Atrial Pacemaker b) Multifocal Atrial Tachycardia (MAT) c) Atrial Fibrillation d) Sinus Arrhythmia
c) Atrial rhythms always have wide QRS complexes d) Atrial rhythms always have a regular ventricular response Answer: b Rationale: Atrial rhythms are routinely fast. If equal, consistent P waves are easily identified, the rhythm is NOT atrial in origin—it is likely a sinus rhythm. Q009. A telemetry strip shows a regular rhythm with "teeny-tiny" P waves, a fast rate, and narrow QRS complexes. This is characteristic of: a) Atrial Fibrillation b) Atrial Tachycardia c) Junctional Rhythm d) Wandering Atrial Pacemaker Answer: b Rationale: Atrial Tachycardia is described as having "teeny-tiny" P waves, a fast rate, narrow QRS complexes, and is always regular. Q010. What is the atrial rate in atrial flutter? a) 150-250 bpm b) 250 - 450 bpm c) 350-500 bpm d) 60-100 bpm Answer: b Rationale: Atrial flutter typically has an atrial rate of 250-450 bpm. Q011. A patient's EKG shows an irregular rhythm with a rate of 80 bpm and at least three different P-wave morphologies. This is most consistent with: a) Multifocal Atrial Tachycardia
b) Wandering Atrial Pacemaker (WAP) c) Atrial Fibrillation d) Sinus Arrhythmia Answer: b Rationale: Wandering Atrial Pacemaker is characterized by at least three different P-wave morphologies, an irregular rhythm, and a ventricular rate <100 bpm. Q012. What is the primary risk associated with uncontrolled atrial fibrillation? a) Hypotension b) Thrombus formation and stroke c) Heart block d) Ventricular tachycardia Answer: b Rationale: Atrial fibrillation impairs atrial contraction, leading to blood stasis and thrombus formation, which significantly increases the risk of stroke. Q013. In atrial flutter, the "flutter" waves are caused by: a) A re-entrant circuit in the right atrium b) Multiple ectopic foci in the atria c) AV node dysfunction d) Ventricular ectopy Answer: a Rationale: Atrial flutter is typically caused by a macro-re-entrant circuit in the right atrium, resulting in the characteristic sawtooth pattern. Q014. Which of the following statements regarding Premature Atrial Contractions (PACs) is correct?
b) 250-450 bpm c) 350 - 500 bpm d) >500 bpm Answer: c Rationale: Atrial fibrillation typically has an atrial rate of 350-500 bpm. Q018. Which atrial rhythm is characterized by a 1:1 ratio between atrial and ventricular rates? a) Atrial Fibrillation b) Atrial Flutter c) Atrial Tachycardia d) Wandering Atrial Pacemaker Answer: c Rationale: In atrial tachycardia, the ventricular rate equals the atrial rate with a 1:1 conduction ratio. Q019. A patient's EKG shows an irregular rhythm with no identifiable P waves and a chaotic baseline. The QRS complexes are narrow. This is: a) Atrial Flutter b) Atrial Fibrillation c) Multifocal Atrial Tachycardia d) Junctional Rhythm Answer: b Rationale: The absence of P waves with a chaotic baseline and irregular narrow QRS complexes is diagnostic of atrial fibrillation. Q020. What is the initial management priority for a patient with uncontrolled atrial fibrillation and signs of decreased cardiac output?
a) Anticoagulation b) Rate control with beta-blockers or calcium channel blockers c) Immediate defibrillation d) Atropine administration Answer: b Rationale: Rate control is the priority for unstable patients with atrial fibrillation. Beta-blockers and calcium channel blockers are used to control ventricular rate. Q021. In atrial flutter, the characteristic "flutter" waves are best seen in which leads? a) I, aVL b) V1-V c) II, III, aVF d) V5, V Answer: c Rationale: Flutter waves are typically best visualized in the inferior leads (II, III, aVF) due to the direction of the re-entrant circuit. Q022. A patient's telemetry shows a rhythm with a rate of 110 bpm, an irregular rhythm, and three different P-wave morphologies. This is: a) Wandering Atrial Pacemaker b) Multifocal Atrial Tachycardia c) Atrial Fibrillation d) Sinus Tachycardia with PACs Answer: b Rationale: The presence of three or more P-wave morphologies with a rate >100 bpm defines Multifocal Atrial Tachycardia.
SECTION 2: SINUS RHYTHMS (Questions 26-45) Q026. What is the normal heart rate range for normal sinus rhythm? a) 40-60 bpm b) 50-80 bpm c) 60 - 100 bpm d) 80-120 bpm Answer: c Rationale: Normal sinus rhythm (NSR) has a heart rate of 60-100 beats per minute. Q027. A patient presents with a heart rate of 45 bpm, regular rhythm, and normal P waves and QRS complexes. This rhythm is: a) Normal Sinus Rhythm b) Sinus Bradycardia c) Sinus Tachycardia d) Junctional Rhythm Answer: b Rationale: Sinus bradycardia is defined as a sinus rhythm with a rate less than 60 bpm. Q028. Which of the following can cause sinus tachycardia? a) Fever b) Anxiety c) Hypovolemia d) All of the above
Answer: d Rationale: Sinus tachycardia can be caused by fever, anxiety, exercise, pain, hypovolemia, shock, anemia, and stimulants. Q029. A patient's EKG shows a regular rhythm at 130 bpm with normal P waves and narrow QRS complexes. What is the most likely rhythm? a) Atrial Fibrillation b) Atrial Flutter c) Sinus Tachycardia d) Supraventricular Tachycardia Answer: c Rationale: Sinus tachycardia is characterized by a regular rhythm with normal P waves and a rate >100 bpm. Q030. What is the first-line treatment for symptomatic sinus bradycardia? a) Epinephrine b) Atropine 0.5 mg IV push c) Transcutaneous pacing d) Dopamine Answer: b Rationale: Atropine 0.5 mg IV push is the first-line medication for symptomatic sinus bradycardia. It can be repeated up to 3 mg total. Q031. A patient with sinus bradycardia is asymptomatic. What is the appropriate management? a) Administer atropine b) Monitor and observe c) Start transcutaneous pacing
c) 60 - 100 bpm d) >100 bpm Answer: c Rationale: The normal intrinsic firing rate of the SA node is 60-100 beats per minute. Q035. A patient's EKG shows a regular rhythm with a rate of 110 bpm. P waves are present and normal, and the PR interval is 0.16 seconds. What is the rhythm? a) Sinus Bradycardia b) Sinus Tachycardia c) Atrial Tachycardia d) Normal Sinus Rhythm Answer: b Rationale: The presence of normal P waves and a rate >100 bpm indicates sinus tachycardia. Q036. Which of the following medications can cause sinus bradycardia? a) Beta-blockers b) Antipyretics c) Antibiotics d) Antihistamines Answer: a Rationale: Beta-blockers and calcium-channel blockers can cause sinus bradycardia. Q037. A patient with sinus tachycardia has a heart rate of 140 bpm. Which of the following findings would suggest a non-physiologic cause? a) The patient is anxious b) The patient has a fever of 102°F c) The heart rate does not vary with activity
d) The patient is in pain Answer: c Rationale: Inappropriate sinus tachycardia may be suspected when the heart rate does not vary appropriately with activity or stimulation. Q038. What is the correct sequence for interpreting an EKG rhythm? a) Rate, Rhythm, P waves, PR interval, QRS duration b) Rhythm, P waves, Rate, PR interval, QRS duration c) Rhythm, Rate, P waves, PR interval, QRS duration d) P waves, Rate, Rhythm, QRS duration, PR interval Answer: c Rationale: The correct sequence for EKG interpretation is: 1) Rhythm (regular or irregular), 2) Rate, 3) Identify P waves, 4) Measure PR interval, 5) Measure QRS duration. Q039. A patient's EKG shows a regular rhythm at 55 bpm with normal P waves. The patient is a marathon runner and is asymptomatic. This is: a) Pathologic sinus bradycardia b) Physiologic sinus bradycardia c) Sinus arrest d) First-degree heart block Answer: b Rationale: Sinus bradycardia is common in well-trained athletes and is a normal physiologic finding due to increased vagal tone. Q040. What is the maximum recommended total dose of atropine for symptomatic bradycardia? a) 1 mg
a) 0.04-0.08 seconds b) 0.08-0.12 seconds c) 0.12-0.20 seconds d) 0.20-0.24 seconds Answer: c Rationale: The normal PR interval is 0.12 to 0.20 seconds (3 to 5 small boxes). Q044. A patient with sinus bradycardia develops hypotension and dizziness. What is the appropriate next step? a) Administer atropine b) Start transcutaneous pacing c) Administer dopamine d) Observe and monitor Answer: a Rationale: Symptomatic sinus bradycardia with hypotension and altered mental status should be treated with atropine. Q045. What is the normal duration of the QRS complex? a) <0.04 seconds b) <0.12 seconds c) <0.20 seconds d) <0.24 seconds Answer: b Rationale: The normal QRS duration is less than 0.12 seconds (less than 3 small boxes).
SECTION 3: VENTRICULAR RHYTHMS (Questions 46-70) Q046. A patient's telemetry shows a run of three or more wide, bizarre QRS complexes at a rate of 180 bpm. This is: a) Atrial Fibrillation b) Ventricular Tachycardia (V-Tach) c) Supraventricular Tachycardia d) Junctional Tachycardia Answer: b Rationale: Ventricular tachycardia is defined as three or more consecutive PVCs at a rate > bpm. The QRS complexes are wide and bizarre. Q047. What is the minimum heart rate for ventricular tachycardia? a) 60 bpm b) 80 bpm c) 100 bpm d) 120 bpm Answer: c Rationale: Ventricular tachycardia is defined as a rate greater than 100 bpm. Q048. A patient's EKG shows a chaotic, disorganized waveform with no identifiable QRS complexes. The patient is unresponsive and pulseless. This rhythm is: a) Asystole b) Ventricular Fibrillation (V-Fib) c) Torsades de Pointes d) Ventricular Tachycardia Answer: b
Answer: c Rationale: Two PVCs in a row are called a couplet. Three or more PVCs in a row constitute ventricular tachycardia. Q052. A patient's EKG shows PVCs occurring every other beat. This is called: a) Bigeminy b) Trigeminy c) Quadrigeminy d) Couplets Answer: a Rationale: Bigeminy is the pattern of PVCs occurring every other beat (alternating with a normal beat). Q053. Which electrolyte imbalance can lead to torsades de pointes? a) Hyperkalemia b) Hypercalcemia c) Hypomagnesemia d) Hyponatremia Answer: c Rationale: Hypomagnesemia can cause torsades de pointes and prolongation of the QT interval. Q054. A patient's EKG shows a complete absence of electrical activity with a flatline tracing. This is: a) Ventricular Fibrillation b) Pulseless Electrical Activity c) Asystole d) Sinus Arrest
Answer: c Rationale: Asystole is characterized by a complete absence of electrical activity, appearing as a flatline on the EKG. Q055. What is the primary treatment for asystole? a) Defibrillation b) High-quality CPR and epinephrine c) Synchronized cardioversion d) Transcutaneous pacing Answer: b Rationale: Asystole is treated with high-quality CPR and epinephrine. Defibrillation is not indicated. Q056. A patient's EKG shows a slow, wide QRS rhythm at a rate of 30 bpm with no P waves. This is: a) Junctional Rhythm b) Idioventricular Rhythm c) Sinus Bradycardia d) Third-Degree Heart Block Answer: b Rationale: Idioventricular rhythm is a ventricular escape rhythm with a rate of 20-40 bpm, wide QRS complexes, and no P waves. Q057. Which of the following is a common cause of PVCs? a) Caffeine b) Nicotine c) Myocardial ischemia
