HCA Healthcare Telemetry ECG/EKG Interpretation
Exam Questions with Correct Answers & Detailed
Rationales 2026/2027
Q1: A patient's telemetry strip shows a wavy, chaotic baseline with no identifiable P waves and irregular
ventricular response. What rhythm is most likely?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular tachycardia
D) Sinus arrhythmia
Answer: B
Rationale: Atrial fibrillation is characterized by a chaotic, wavy baseline with no discernible P waves and an
irregularly irregular ventricular response. The atria quiver rather than contract effectively, producing the
characteristic fibrillatory waves.
Q2: A patient presents with a heart rate of 150 bpm, narrow QRS complex, and regular rhythm with visible P
waves preceding each QRS. Which rhythm is most likely?
A) Sinus tachycardia
B) Atrial flutter with 2:1 conduction
C) Supraventricular tachycardia
D) Ventricular tachycardia
Answer: A
Rationale: Sinus tachycardia is a regular rhythm with a rate greater than 100 bpm, narrow QRS complexes, and
normal P waves preceding each QRS. The rate of 150 bpm with visible P waves indicates sinus origin with rapid
conduction.
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,Q3: An EKG technician observes pacing spikes on a patient's EKG with no electrical activity following the spikes.
This finding indicates:
A) Failure to sense
B) Failure to capture
C) Normal pacemaker function
D) Oversensing
Answer: B
Rationale: Failure to capture occurs when a pacing spike is not followed by a corresponding P wave or QRS
complex, indicating that the electrical stimulus is not depolarizing the myocardium. This requires prompt
evaluation and potential pacemaker reprogramming.
Q4: The normal intrinsic rate of the sinoatrial (SA) node is:
A) 20-40 beats per minute
B) 40-60 beats per minute
C) 60-100 beats per minute
D) 100-150 beats per minute
Answer: C
Rationale: The sinoatrial node normally generates impulses at a rate of 60-100 beats per minute. The
atrioventricular node has an intrinsic rate of 40-60 bpm, and the Purkinje fibers have a rate of 20-40 bpm.
Q5: A patient's rhythm strip shows a regular rhythm with a rate of 42 bpm, narrow QRS complexes, and normal
P waves. Which rhythm is most likely?
A) Sinus bradycardia
B) First-degree AV block
C) Junctional rhythm
D) Atrial fibrillation
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,Answer: A
Rationale: Sinus bradycardia is defined as a sinus rhythm with a rate less than 60 bpm. The presence of normal P
waves preceding each QRS confirms sinus origin, and the narrow QRS indicates normal ventricular conduction.
Q6: What is the normal duration of the PR interval?
A) 0.04-0.08 seconds
B) 0.08-0.12 seconds
C) 0.12-0.20 seconds
D) 0.20-0.28 seconds
Answer: C
Rationale: The normal PR interval, measured from the beginning of the P wave to the beginning of the QRS
complex, is 0.12-0.20 seconds (3-5 small boxes). Prolonged PR intervals indicate first-degree AV block, while
shortened intervals may indicate pre-excitation syndromes.
Q7: A patient's telemetry strip reveals a regular rhythm with a rate of 38 bpm, widened QRS complexes (>0.12
seconds), and no P waves. Which rhythm is most likely?
A) Sinus bradycardia with bundle branch block
B) Junctional escape rhythm
C) Ventricular escape rhythm
D) Idioventricular rhythm
Answer: D
Rationale: Idioventricular rhythm is a ventricular escape rhythm with a rate of 20-40 bpm, wide QRS complexes
(≥0.12 seconds), and absent P waves. This rhythm indicates failure of higher pacemakers and requires
immediate evaluation.
Q8: On a standard EKG strip, one small box represents how many seconds?
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, A) 0.01 seconds
B) 0.02 seconds
C) 0.04 seconds
D) 0.10 seconds
Answer: C
Rationale: On standard EKG paper running at 25 mm/second, each small box is 1 mm and represents 0.04
seconds. Each large box (5 small boxes) represents 0.20 seconds.
Q9: A patient presents with a sudden onset of palpitations and a heart rate of 180 bpm. The EKG shows a regular
rhythm with narrow QRS complexes and no visible P waves. What is the most likely rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Supraventricular tachycardia (SVT)
D) Ventricular tachycardia
Answer: C
Rationale: Supraventricular tachycardia is characterized by a rapid, regular rhythm (typically 150-250 bpm),
narrow QRS complexes, and absent or abnormal P waves. The sudden onset and absence of P waves distinguish
it from sinus tachycardia.
Q10: The EKG technician must NOT share their interpretation of the EKG with the patient under which
circumstance?
A) When the patient asks about the results
B) When the interpretation is normal
C) Under any circumstances without provider authorization
D) When the patient appears anxious
Answer: C
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Exam Questions with Correct Answers & Detailed
Rationales 2026/2027
Q1: A patient's telemetry strip shows a wavy, chaotic baseline with no identifiable P waves and irregular
ventricular response. What rhythm is most likely?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular tachycardia
D) Sinus arrhythmia
Answer: B
Rationale: Atrial fibrillation is characterized by a chaotic, wavy baseline with no discernible P waves and an
irregularly irregular ventricular response. The atria quiver rather than contract effectively, producing the
characteristic fibrillatory waves.
Q2: A patient presents with a heart rate of 150 bpm, narrow QRS complex, and regular rhythm with visible P
waves preceding each QRS. Which rhythm is most likely?
A) Sinus tachycardia
B) Atrial flutter with 2:1 conduction
C) Supraventricular tachycardia
D) Ventricular tachycardia
Answer: A
Rationale: Sinus tachycardia is a regular rhythm with a rate greater than 100 bpm, narrow QRS complexes, and
normal P waves preceding each QRS. The rate of 150 bpm with visible P waves indicates sinus origin with rapid
conduction.
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,Q3: An EKG technician observes pacing spikes on a patient's EKG with no electrical activity following the spikes.
This finding indicates:
A) Failure to sense
B) Failure to capture
C) Normal pacemaker function
D) Oversensing
Answer: B
Rationale: Failure to capture occurs when a pacing spike is not followed by a corresponding P wave or QRS
complex, indicating that the electrical stimulus is not depolarizing the myocardium. This requires prompt
evaluation and potential pacemaker reprogramming.
Q4: The normal intrinsic rate of the sinoatrial (SA) node is:
A) 20-40 beats per minute
B) 40-60 beats per minute
C) 60-100 beats per minute
D) 100-150 beats per minute
Answer: C
Rationale: The sinoatrial node normally generates impulses at a rate of 60-100 beats per minute. The
atrioventricular node has an intrinsic rate of 40-60 bpm, and the Purkinje fibers have a rate of 20-40 bpm.
Q5: A patient's rhythm strip shows a regular rhythm with a rate of 42 bpm, narrow QRS complexes, and normal
P waves. Which rhythm is most likely?
A) Sinus bradycardia
B) First-degree AV block
C) Junctional rhythm
D) Atrial fibrillation
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,Answer: A
Rationale: Sinus bradycardia is defined as a sinus rhythm with a rate less than 60 bpm. The presence of normal P
waves preceding each QRS confirms sinus origin, and the narrow QRS indicates normal ventricular conduction.
Q6: What is the normal duration of the PR interval?
A) 0.04-0.08 seconds
B) 0.08-0.12 seconds
C) 0.12-0.20 seconds
D) 0.20-0.28 seconds
Answer: C
Rationale: The normal PR interval, measured from the beginning of the P wave to the beginning of the QRS
complex, is 0.12-0.20 seconds (3-5 small boxes). Prolonged PR intervals indicate first-degree AV block, while
shortened intervals may indicate pre-excitation syndromes.
Q7: A patient's telemetry strip reveals a regular rhythm with a rate of 38 bpm, widened QRS complexes (>0.12
seconds), and no P waves. Which rhythm is most likely?
A) Sinus bradycardia with bundle branch block
B) Junctional escape rhythm
C) Ventricular escape rhythm
D) Idioventricular rhythm
Answer: D
Rationale: Idioventricular rhythm is a ventricular escape rhythm with a rate of 20-40 bpm, wide QRS complexes
(≥0.12 seconds), and absent P waves. This rhythm indicates failure of higher pacemakers and requires
immediate evaluation.
Q8: On a standard EKG strip, one small box represents how many seconds?
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, A) 0.01 seconds
B) 0.02 seconds
C) 0.04 seconds
D) 0.10 seconds
Answer: C
Rationale: On standard EKG paper running at 25 mm/second, each small box is 1 mm and represents 0.04
seconds. Each large box (5 small boxes) represents 0.20 seconds.
Q9: A patient presents with a sudden onset of palpitations and a heart rate of 180 bpm. The EKG shows a regular
rhythm with narrow QRS complexes and no visible P waves. What is the most likely rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Supraventricular tachycardia (SVT)
D) Ventricular tachycardia
Answer: C
Rationale: Supraventricular tachycardia is characterized by a rapid, regular rhythm (typically 150-250 bpm),
narrow QRS complexes, and absent or abnormal P waves. The sudden onset and absence of P waves distinguish
it from sinus tachycardia.
Q10: The EKG technician must NOT share their interpretation of the EKG with the patient under which
circumstance?
A) When the patient asks about the results
B) When the interpretation is normal
C) Under any circumstances without provider authorization
D) When the patient appears anxious
Answer: C
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