Dysrhythmia NCLEX Questions 2 – Comprehensive
Cardiac Rhythm Nursing EXAM 2026/2027 LATEST
Advanced Cardiac Dysrhythmia Recognition & Management | Key Domains: ECG Waveform Analysis
& Interpretation, Atrial & Ventricular Dysrhythmias, Heart Blocks & Conduction Disturbances,
Pacemaker & ICD Rhythms, Emergency Management of Lethal Rhythms, Pharmacologic
Interventions, and Patient Education for Cardiac Monitoring | Expert-Aligned Structure | Advanced
Practice Exam Format
Introduction
This structured Comprehensive Cardiac Rhythm Nursing Exam for 2026/2027 provides an
advanced set of dysrhythmia-focused NCLEX-style questions with correct answers and rationales. It
is designed to deepen expertise in ECG interpretation, differentiate between critical and non-critical
rhythms, and guide appropriate nursing interventions and emergency responses for patients with
complex cardiac conduction issues.
Exam Structure:
• Advanced Dysrhythmia Exam: (60 COMPLEX ECG & SCENARIO QUESTIONS)
Answer Format
All correct rhythm identifications and priority interventions must appear in bold and cyan blue,
accompanied by concise rationales explaining the ECG criteria for the dysrhythmia (e.g., rate,
rhythm, P wave presence/relationship, QRS width), the associated hemodynamic stability, the
immediate emergency action for a lethal rhythm (e.g., V-Fib, Asystole), the appropriate drug therapy
(e.g., Amiodarone, Atropine), and why alternative interpretations or actions are incorrect or
dangerous.
1.
A patient’s ECG shows a regular rhythm with a rate of 48 bpm, upright P waves before every QRS, a
PR interval of 0.16 seconds, and narrow QRS complexes. This rhythm is best identified as:
● A. Sinus tachycardia
● B. First-degree AV block
● C. Sinus bradycardia
● D. Junctional rhythm
,Sinus bradycardia is defined by a rate <60 bpm, regular rhythm, normal P waves before each QRS,
normal PR interval, and narrow QRS. First-degree AV block (Option B) would have a PR >0.20 sec.
Junctional rhythm (Option D) typically lacks P waves or has inverted P waves. Sinus tachycardia
(Option A) has a rate >100 bpm.
2.
Which dysrhythmia is characterized by the absence of P waves, irregularly irregular QRS complexes,
and a ventricular rate often between 110–160 bpm?
● A. Atrial flutter
● B. Atrial fibrillation
● C. Multifocal atrial tachycardia
● D. Ventricular tachycardia
Atrial fibrillation shows no discernible P waves, an irregularly irregular rhythm, and variable
ventricular response. Atrial flutter (Option A) shows sawtooth “F” waves and often a regular
ventricular response. MAT (Option C) has ≥3 P wave morphologies. VT (Option D) has wide QRS and no
P waves but is usually regular.
3.
A patient in the ICU has an ECG showing no P waves, wide and bizarre QRS complexes occurring at a
rate of 160 bpm in a regular rhythm. The most appropriate immediate nursing intervention is to:
● A. Administer adenosine 6 mg IV push
● B. Prepare for synchronized cardioversion
● C. Assess for pulse and level of consciousness
● D. Give metoprolol 5 mg IV
The rhythm is likely ventricular tachycardia (VT). The first action is to determine if the patient is
pulseless (requiring defibrillation) or stable (may allow for medication). Pulse assessment is critical
before intervention. Adenosine (Option A) is for narrow-complex SVT. Cardioversion (Option B) is for
unstable VT—but pulse must be confirmed first. Beta-blockers (Option D) are contraindicated in
unstable VT.
4.
, An ECG shows a regular rhythm at 88 bpm, no visible P waves, and QRS complexes that are narrow
but preceded by inverted P waves in lead II. This is most consistent with:
● A. Sinus rhythm
● B. Atrial fibrillation
● C. Junctional rhythm
● D. Accelerated idioventricular rhythm
Junctional rhythms originate near the AV node. P waves may be absent, inverted (if retrograde
conduction occurs), and may appear before, during, or after the QRS. The QRS is narrow if conduction
through the bundle branches is normal. Inverted P waves in lead II support retrograde atrial
activation—classic for junctional rhythm.
5.
A patient presents with dizziness and an ECG showing P waves at 100 bpm, but QRS complexes at
only 40 bpm with no relationship between P waves and QRS complexes. This describes:
● A. First-degree AV block
● B. Mobitz Type I (Wenckebach)
● C. Mobitz Type II
● D. Third-degree (complete) heart block
Third-degree AV block shows complete dissociation between atria and ventricles—P waves and QRS
complexes occur independently. Atrial rate > ventricular rate. This is a medical emergency due to risk
of asystole or hemodynamic collapse. Mobitz types (Options B, C) show some P-QRS relationship.
6.
Which of the following is the priority intervention for a patient in ventricular fibrillation?
● A. Administer lidocaine IV
● B. Check for a pulse for 30 seconds
● C. Begin CPR and prepare for immediate defibrillation
● D. Give epinephrine 1 mg IV
Cardiac Rhythm Nursing EXAM 2026/2027 LATEST
Advanced Cardiac Dysrhythmia Recognition & Management | Key Domains: ECG Waveform Analysis
& Interpretation, Atrial & Ventricular Dysrhythmias, Heart Blocks & Conduction Disturbances,
Pacemaker & ICD Rhythms, Emergency Management of Lethal Rhythms, Pharmacologic
Interventions, and Patient Education for Cardiac Monitoring | Expert-Aligned Structure | Advanced
Practice Exam Format
Introduction
This structured Comprehensive Cardiac Rhythm Nursing Exam for 2026/2027 provides an
advanced set of dysrhythmia-focused NCLEX-style questions with correct answers and rationales. It
is designed to deepen expertise in ECG interpretation, differentiate between critical and non-critical
rhythms, and guide appropriate nursing interventions and emergency responses for patients with
complex cardiac conduction issues.
Exam Structure:
• Advanced Dysrhythmia Exam: (60 COMPLEX ECG & SCENARIO QUESTIONS)
Answer Format
All correct rhythm identifications and priority interventions must appear in bold and cyan blue,
accompanied by concise rationales explaining the ECG criteria for the dysrhythmia (e.g., rate,
rhythm, P wave presence/relationship, QRS width), the associated hemodynamic stability, the
immediate emergency action for a lethal rhythm (e.g., V-Fib, Asystole), the appropriate drug therapy
(e.g., Amiodarone, Atropine), and why alternative interpretations or actions are incorrect or
dangerous.
1.
A patient’s ECG shows a regular rhythm with a rate of 48 bpm, upright P waves before every QRS, a
PR interval of 0.16 seconds, and narrow QRS complexes. This rhythm is best identified as:
● A. Sinus tachycardia
● B. First-degree AV block
● C. Sinus bradycardia
● D. Junctional rhythm
,Sinus bradycardia is defined by a rate <60 bpm, regular rhythm, normal P waves before each QRS,
normal PR interval, and narrow QRS. First-degree AV block (Option B) would have a PR >0.20 sec.
Junctional rhythm (Option D) typically lacks P waves or has inverted P waves. Sinus tachycardia
(Option A) has a rate >100 bpm.
2.
Which dysrhythmia is characterized by the absence of P waves, irregularly irregular QRS complexes,
and a ventricular rate often between 110–160 bpm?
● A. Atrial flutter
● B. Atrial fibrillation
● C. Multifocal atrial tachycardia
● D. Ventricular tachycardia
Atrial fibrillation shows no discernible P waves, an irregularly irregular rhythm, and variable
ventricular response. Atrial flutter (Option A) shows sawtooth “F” waves and often a regular
ventricular response. MAT (Option C) has ≥3 P wave morphologies. VT (Option D) has wide QRS and no
P waves but is usually regular.
3.
A patient in the ICU has an ECG showing no P waves, wide and bizarre QRS complexes occurring at a
rate of 160 bpm in a regular rhythm. The most appropriate immediate nursing intervention is to:
● A. Administer adenosine 6 mg IV push
● B. Prepare for synchronized cardioversion
● C. Assess for pulse and level of consciousness
● D. Give metoprolol 5 mg IV
The rhythm is likely ventricular tachycardia (VT). The first action is to determine if the patient is
pulseless (requiring defibrillation) or stable (may allow for medication). Pulse assessment is critical
before intervention. Adenosine (Option A) is for narrow-complex SVT. Cardioversion (Option B) is for
unstable VT—but pulse must be confirmed first. Beta-blockers (Option D) are contraindicated in
unstable VT.
4.
, An ECG shows a regular rhythm at 88 bpm, no visible P waves, and QRS complexes that are narrow
but preceded by inverted P waves in lead II. This is most consistent with:
● A. Sinus rhythm
● B. Atrial fibrillation
● C. Junctional rhythm
● D. Accelerated idioventricular rhythm
Junctional rhythms originate near the AV node. P waves may be absent, inverted (if retrograde
conduction occurs), and may appear before, during, or after the QRS. The QRS is narrow if conduction
through the bundle branches is normal. Inverted P waves in lead II support retrograde atrial
activation—classic for junctional rhythm.
5.
A patient presents with dizziness and an ECG showing P waves at 100 bpm, but QRS complexes at
only 40 bpm with no relationship between P waves and QRS complexes. This describes:
● A. First-degree AV block
● B. Mobitz Type I (Wenckebach)
● C. Mobitz Type II
● D. Third-degree (complete) heart block
Third-degree AV block shows complete dissociation between atria and ventricles—P waves and QRS
complexes occur independently. Atrial rate > ventricular rate. This is a medical emergency due to risk
of asystole or hemodynamic collapse. Mobitz types (Options B, C) show some P-QRS relationship.
6.
Which of the following is the priority intervention for a patient in ventricular fibrillation?
● A. Administer lidocaine IV
● B. Check for a pulse for 30 seconds
● C. Begin CPR and prepare for immediate defibrillation
● D. Give epinephrine 1 mg IV
