Dysrhythmia NCLEX Questions 2 – Comprehensive Cardiac Rhythm Nursing EXAM 2026-2027
Focused Review on ECG Interpretation, Sinus & Atrial Dysrhythmias, Junctional & Ventricular Arrhythmias, Heart
Blocks, Pacemaker Rhythms, and Nursing Interventions | Aligned with Latest NCLEX Test Plan
Introduction
This exam consists of 50 high-yield, NCLEX-style multiple-choice questions covering essential concepts in cardiac
dysrhythmias. Questions emphasize ECG recognition, clinical manifestations, priority nursing actions, and
therapeutic management. Correct answers are highlighted in bold green, followed by detailed rationales based on
current guidelines (AHA, AACN).
Questions (1–50)
1. A nurse is interpreting a rhythm strip showing regular P waves, a PR interval of 0.16 seconds, and
a QRS duration of 0.08 seconds at a rate of 88 bpm. How should the nurse interpret this rhythm?
A) Sinus bradycardia
B) Normal sinus rhythm
C) Sinus tachycardia
D) First-degree AV block
B) Normal sinus rhythm
Normal sinus rhythm is defined by: regular rhythm, rate 60–100 bpm, upright P waves before every QRS, PR
interval 0.12–0.20 seconds, and QRS < 0.12 seconds. All parameters match.
2. A client presents with sudden palpitations and dizziness. The ECG shows absent P waves and a
narrow-complex tachycardia at 160 bpm with a regular rhythm. What is the most likely dysrhythmia?
A) Atrial fibrillation
, B) Atrial flutter
C) Supraventricular tachycardia (SVT)
D) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
SVT typically presents as a sudden-onset narrow-complex tachycardia (rate 150–250 bpm) with no visible P waves
due to retrograde conduction or buried P waves. Atrial fibrillation is irregularly irregular; atrial flutter shows
sawtooth flutter waves; VT has wide QRS complexes.
3. Which finding on a 12-lead ECG is most indicative of atrial fibrillation?
A) Inverted P waves
B) Absent P waves with irregularly irregular QRS complexes
C) PR interval > 0.20 seconds
D) Wide QRS complexes
B) Absent P waves with irregularly irregular QRS complexes
Atrial fibrillation is characterized by chaotic atrial activity with no discernible P waves and an irregular
ventricular response ("irregularly irregular" rhythm). This is a hallmark ECG finding.
4. A nurse notes a heart rate of 42 bpm, dizziness, and hypotension in a client. The ECG shows
regular P waves at 80 bpm, but only some are followed by QRS complexes with a progressively
lengthening PR interval. What is the priority action?
A) Administer atropine
, B) Prepare for transcutaneous pacing
C) Monitor and document
D) Administer digoxin
A) Administer atropine
This describes second-degree AV block, Mobitz Type I (Wenckebach). Atropine is the first-line treatment for
symptomatic bradycardia. Pacing is reserved for Type II or third-degree blocks. Digoxin would worsen the block.
5. A client with a history of myocardial infarction develops a wide-complex tachycardia at 180 bpm
with no P waves and a capture beat. What is the priority nursing action?
A) Administer adenosine
B) Prepare for synchronized cardioversion
C) Check potassium level
D) Administer metoprolol
B) Prepare for synchronized cardioversion
In a client with known structural heart disease, wide-complex tachycardia should be presumed to be ventricular
tachycardia (VT) until proven otherwise. VT with a pulse but unstable (e.g., hypotension, chest pain, altered mental
status) requires immediate synchronized cardioversion.
6. Which ECG characteristic is consistent with a junctional rhythm?
A) Inverted P waves before or after the QRS
B) Absent P waves with fibrillatory baseline
Focused Review on ECG Interpretation, Sinus & Atrial Dysrhythmias, Junctional & Ventricular Arrhythmias, Heart
Blocks, Pacemaker Rhythms, and Nursing Interventions | Aligned with Latest NCLEX Test Plan
Introduction
This exam consists of 50 high-yield, NCLEX-style multiple-choice questions covering essential concepts in cardiac
dysrhythmias. Questions emphasize ECG recognition, clinical manifestations, priority nursing actions, and
therapeutic management. Correct answers are highlighted in bold green, followed by detailed rationales based on
current guidelines (AHA, AACN).
Questions (1–50)
1. A nurse is interpreting a rhythm strip showing regular P waves, a PR interval of 0.16 seconds, and
a QRS duration of 0.08 seconds at a rate of 88 bpm. How should the nurse interpret this rhythm?
A) Sinus bradycardia
B) Normal sinus rhythm
C) Sinus tachycardia
D) First-degree AV block
B) Normal sinus rhythm
Normal sinus rhythm is defined by: regular rhythm, rate 60–100 bpm, upright P waves before every QRS, PR
interval 0.12–0.20 seconds, and QRS < 0.12 seconds. All parameters match.
2. A client presents with sudden palpitations and dizziness. The ECG shows absent P waves and a
narrow-complex tachycardia at 160 bpm with a regular rhythm. What is the most likely dysrhythmia?
A) Atrial fibrillation
, B) Atrial flutter
C) Supraventricular tachycardia (SVT)
D) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
SVT typically presents as a sudden-onset narrow-complex tachycardia (rate 150–250 bpm) with no visible P waves
due to retrograde conduction or buried P waves. Atrial fibrillation is irregularly irregular; atrial flutter shows
sawtooth flutter waves; VT has wide QRS complexes.
3. Which finding on a 12-lead ECG is most indicative of atrial fibrillation?
A) Inverted P waves
B) Absent P waves with irregularly irregular QRS complexes
C) PR interval > 0.20 seconds
D) Wide QRS complexes
B) Absent P waves with irregularly irregular QRS complexes
Atrial fibrillation is characterized by chaotic atrial activity with no discernible P waves and an irregular
ventricular response ("irregularly irregular" rhythm). This is a hallmark ECG finding.
4. A nurse notes a heart rate of 42 bpm, dizziness, and hypotension in a client. The ECG shows
regular P waves at 80 bpm, but only some are followed by QRS complexes with a progressively
lengthening PR interval. What is the priority action?
A) Administer atropine
, B) Prepare for transcutaneous pacing
C) Monitor and document
D) Administer digoxin
A) Administer atropine
This describes second-degree AV block, Mobitz Type I (Wenckebach). Atropine is the first-line treatment for
symptomatic bradycardia. Pacing is reserved for Type II or third-degree blocks. Digoxin would worsen the block.
5. A client with a history of myocardial infarction develops a wide-complex tachycardia at 180 bpm
with no P waves and a capture beat. What is the priority nursing action?
A) Administer adenosine
B) Prepare for synchronized cardioversion
C) Check potassium level
D) Administer metoprolol
B) Prepare for synchronized cardioversion
In a client with known structural heart disease, wide-complex tachycardia should be presumed to be ventricular
tachycardia (VT) until proven otherwise. VT with a pulse but unstable (e.g., hypotension, chest pain, altered mental
status) requires immediate synchronized cardioversion.
6. Which ECG characteristic is consistent with a junctional rhythm?
A) Inverted P waves before or after the QRS
B) Absent P waves with fibrillatory baseline
