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Page 1 of 176 HCA HEALTHCARE TELEMETRY EKG RHYTHM INTERPRETATION FINAL EXAM 2026 AND STUDY GUIDE ALL COMPLETE ACCURATE QUESTIONS WITH WELL ELABORATED ANSWERS PLUS RATIONALES (100% CORRECT VERIFIED SOLUTIONS) CURRENTLY UPDATED VERSION 2026 EDITION | ALREADY GRADED A+ (BR 1. A 45-year-old male with no cardiac history has a heart rate of 72 bpm, regular rhythm, P wave before every QRS, Page 2 of 176 PR interval 0.16 sec, QRS 0.08 sec. What is the rhythm? A) Sinus bradycardia B) Normal sinus rhythm C) Sinus tachycardia D) Atrial fibrillation Answer: B Rationale: All criteria for normal sinus rhythm (NSR) are met: rate 60-100, regular, P wave positive in lead II before each QRS, PR 0.12-0.20 sec, QRS <0.12 sec. 2. Which statement best describes sinus arrhythmia? A) Irregular rhythm with absent P waves B) Regular rhythm with rate <60 C) Irregular rhythm with P-P interval varying >0.12 sec, P before each QRS D) Irregular rhythm with no relationship between P and QRS Page 4 of 176 4. Sinus tachycardia is defined as: A) HR >100, irregular, no P waves B) HR >100, regular, P before each QRS, normal PR C) HR >100, wide QRS, P after QRS D) HR 60-100, regular, inverted P waves Answer: B Rationale: Sinus tachycardia originates from SA node; rate >100, regular, normal P wave axis, PR normal. 5. A 30-year-old with anxiety and palpitations has HR 118, regular, P before QRS, PR 0.14 sec. What is the rhythm? A) Atrial flutter B) Sinus tachycardia C) Junctional tachycardia D) Ventricular tachycardia Page 5 of 176 Answer: B Rationale: Rate >100 with normal P wave morphology and PR interval indicates sinus tachycardia, often physiologic. 6. Which of the following can cause sinus tachycardia? A) Fever B) Hypothyroidism C) Beta-blocker overdose D) Hyperkalemia Answer: A Rationale: Fever, pain, anxiety, dehydration, hyperthyroidism, and stimulants cause sinus tachycardia. Hypothyroidism and beta-blockers cause bradycardia. 7. A 55-year-old with chest pain has HR 150, regular, P waves buried in T waves. What is the most likely rhythm? A) Atrial fibrillation Page 7 of 176 9. A 70-year-old with syncope has a 3.5-second pause on telemetry with no escape beat. What is the rhythm? A) Sinus arrhythmia B) Sinus arrest C) Atrial fibrillation D) Second-degree AV block Answer: B Rationale: Sinus arrest = prolonged pause without P waves; if no escape rhythm, can cause syncope. 10. Which medication is most likely to cause symptomatic sinus bradycardia? A) Digoxin B) Metoprolol C) Amiodarone D) Furosemide Page 8 of 176 Answer: B Rationale: Beta-blockers (metoprolol) decrease SA node automaticity. Digoxin causes AV block more than sinus bradycardia. 11. A healthy 22-year-old athlete has HR 48 at rest, regular, normal P waves. This is most likely: A) Sinus bradycardia — normal variant B) Sick sinus syndrome C) Junctional rhythm D) First-degree AV block Answer: A Rationale: Athletes often have resting HR 40-50 due to high vagal tone; asymptomatic requires no intervention. 12. Which finding is NOT consistent with normal sinus rhythm? Page 10 of 176 14. Sinus tachycardia in a hospitalized patient should prompt evaluation for: A) Pain, fever, hypovolemia B) Myocardial infarction only C) Hyperkalemia D) Pacemaker malfunction Answer: A Rationale: Common causes: pain, fever, dehydration, anemia, infection, PE. 15. A 60-year-old post-op day 1 has HR 115, BP 90/60, P waves normal. Next step? A) Give metoprolol B) Give IV fluids C) Start amiodarone D) Cardiovert Page 11 of 176 Answer: B Rationale: Tachycardia with hypotension suggests hypovolemia; treat cause, not rate. 16. Which rhythm has a rate of 40-60 bpm, regular, normal P waves? A) Junctional rhythm B) Sinus bradycardia C) Idioventricular rhythm D) Atrial fibrillation Answer: B Rationale: Sinus bradycardia = SA node firing at 40-60 bpm with normal conduction. 17. A 75-year-old with dizziness has HR 38, regular, P before QRS. What is first-line treatment if symptomatic? A) Epinephrine Page 13 of 176 19. A patient’s telemetry shows HR 92, regular, P before QRS, PR 0.14 sec, QRS 0.08 sec. This is: A) NSR B) Sinus tachycardia C) Atrial flutter 2:1 D) Junctional rhythm Answer: A Rationale: Rate within 60-100 = NSR, not sinus tachycardia. 20. Which electrolyte disturbance can cause sinus bradycardia? A) Hypokalemia B) Hyperkalemia C) Hyponatremia D) Hypocalcemia Page 14 of 176 Answer: B Rationale: Severe hyperkalemia depresses SA node; hypokalemia causes U waves and arrhythmias. 21. A 50-year-old with panic attack has HR 130, regular, P before QRS. After 10 minutes, rate returns to 80 with rest. Rhythm? A) Paroxysmal SVT B) Sinus tachycardia C) Atrial flutter D) MAT Answer: B Rationale: Sinus tachycardia gradually slows with resolution of cause; SVT stops abruptly. 22. Which finding differentiates sinus arrhythmia from atrial fibrillation? Page 16 of 176 24. Sinus pause with escape rhythm indicates: A) Normal variant B) SA node failure with backup pacemaker C) Atrial fibrillation D) AV block Answer: B Rationale: Escape beat (junctional or ventricular) indicates lower pacemaker takes over during pause. 25. A 40-year-old with fatigue has HR 52, regular, P before QRS, PR 0.20 sec. What is the rhythm? A) First-degree AV block with sinus bradycardia B) Normal sinus rhythm C) Junctional rhythm D) Second-degree AV block Page 17 of 176 Answer: A Rationale: Rate <60 = sinus bradycardia; PR >0.20 = first- degree AV block. Both can coexist. 26. Which is a normal response to inspiration in sinus arrhythmia? A) Heart rate increases B) Heart rate decreases C) P waves disappear D) PR interval prolongs Answer: A Rationale: Inspiration — decreased vagal tone — increased HR. 27. A 28-year-old pregnant woman has HR 105 at rest, regular, P waves normal. This is: A) Sinus tachycardia — physiologic Page 19 of 176 29. A 55-year-old with chest pressure has HR 120, BP 100/70, P waves normal. Next step? A) Adenosine B) Evaluate for ischemia C) Cardiovert D) Metoprolol IV Answer: B Rationale: Sinus tachycardia can be compensatory in Ml; treat underlying ischemia. 30. Which is true about sinus arrest vs. sinus pause? A) Sinus arrest is longer than 3 seconds without escape B) Sinus pause is always pathological C) Sinus arrest has P waves but no QRS D) Sinus pause requires pacing Page 20 of 176 Answer: A Rationale: Sinus arrest = prolonged pause (>3 sec) without escape; sinus pause = shorter, often benign. SECTION 2: ATRIAL RHYTHMS (Questions 31-80) 31. A patient has a chaotic baseline with no identifiable P waves, irregularly irregular ventricular response at 110 bpm, QRS narrow. What is the rhythm? A) Atrial flutter B) Atrial fibrillation C) Multifocal atrial tachycardia D) Wandering atrial pacemaker Answer: B Rationale: Atrial fibrillation hallmark: no P waves, fibrillatory waves, irregularly irregular R-R intervals. 
