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.
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:
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,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
Answer: A
Rationale: Sinus bradycardia is defined as a regular sinus rhythm with a rate below 60 bpm, with normal P waves
preceding each narrow QRS complex. A rate of 42 bpm with intact P-QRS relationship confirms sinus origin.
Q6: A telemetry strip shows an irregularly irregular rhythm with normal P waves that vary in shape from beat to
beat, and a rate of 110 bpm. Which rhythm is most likely?
A) Atrial fibrillation
B) Multifocal atrial tachycardia
C) Sinus arrhythmia
D) Premature atrial contractions
Answer: B
Rationale: Multifocal atrial tachycardia (MAT) is identified by at least three distinct P wave morphologies, varying
PR intervals, and an irregularly irregular rhythm at a rate typically above 100 bpm. It is commonly associated with
COPD.
Q7: Which rhythm characteristic distinguishes sinus arrhythmia from other irregular rhythms?
A) The irregularity correlates with the respiratory cycle
B) P waves are absent
C) The QRS complex is widened
D) The PR interval varies with each beat
Answer: A
Rationale: Sinus arrhythmia is a normal variant in which the heart rate increases with inspiration and decreases
with expiration, following the respiratory cycle. P waves remain normal and consistent in shape, and the PR interval
stays constant.
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,Q8: A nurse notes a heart rate of 55 bpm on telemetry with normal P waves, PR interval of 0.16 seconds, and narrow
QRS complexes in an asymptomatic athlete. What is the most appropriate initial action?
A) Administer atropine immediately
B) Prepare for transcutaneous pacing
C) Continue monitoring, as this may be a normal finding
D) Call a rapid response immediately
Answer: C
Rationale: Sinus bradycardia is common and often benign in well-conditioned athletes due to increased vagal tone.
In an asymptomatic patient with a normal PR interval and narrow QRS, continued monitoring without intervention
is appropriate.
Q9: A patient's telemetry shows a regular rhythm at 130 bpm, absent P waves, and a narrow QRS complex that
began and ended abruptly. Which rhythm best fits this description?
A) Sinus tachycardia
B) Paroxysmal supraventricular tachycardia
C) Atrial flutter
D) Ventricular tachycardia
Answer: B
Rationale: Paroxysmal supraventricular tachycardia (PSVT) is characterized by a sudden onset and offset, a regular
rapid rate (typically 150-250 bpm), narrow QRS complexes, and often absent or hidden P waves due to reentry
circuits above the ventricles.
Q10: What is the primary distinguishing feature of atrial flutter on an EKG?
A) A chaotic, undulating baseline
B) Sawtooth-shaped flutter waves
C) Absence of any atrial activity
D) Wide, bizarre QRS complexes
Answer: B
Rationale: Atrial flutter produces a characteristic sawtooth pattern of flutter waves, most visible in leads II, III, and
aVF, resulting from a reentrant circuit in the right atrium typically firing at 250-350 bpm.
Q11: A patient in atrial flutter has an atrial rate of 300 bpm and a ventricular rate of 75 bpm. What conduction ratio
is present?
A) 1:1 conduction
B) 2:1 conduction
C) 4:1 conduction
D) 3:1 conduction
Answer: C
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, Rationale: Dividing the atrial rate by the ventricular rate (300/75) yields a 4:1 conduction ratio, meaning only every
fourth flutter wave is conducted through the AV node to produce a QRS complex.
Q12: Which of the following best describes a normal sinus rhythm?
A) Rate 60-100 bpm, regular rhythm, one P wave before each QRS, normal intervals
B) Rate 100-150 bpm with variable P wave morphology
C) Rate less than 60 bpm with absent P waves
D) Irregularly irregular rhythm with fibrillatory waves
Answer: A
Rationale: Normal sinus rhythm is defined by a rate between 60-100 bpm, a regular rhythm, one upright P wave
preceding each QRS complex in lead II, and normal PR (0.12-0.20 sec) and QRS (less than 0.12 sec) intervals.
Q13: A premature atrial contraction (PAC) is best described as:
A) An early beat originating from an ectopic atrial focus with an abnormal P wave
B) A wide, bizarre QRS complex occurring early
C) A pause following a normal sinus beat with no P wave
D) A regular rhythm at 250 bpm with sawtooth waves
Answer: A
Rationale: A PAC arises from an ectopic focus within the atria outside the SA node, producing an early beat with a P
wave that differs in shape from the normal sinus P wave, often followed by a slight pause.
Q14: What EKG finding is most characteristic of a PAC that is not conducted to the ventricles?
A) A premature, abnormally shaped P wave not followed by a QRS complex
B) A wide QRS complex with no preceding P wave
C) Absence of any P wave activity
D) A regular sawtooth baseline
Answer: A
Rationale: A nonconducted (blocked) PAC produces an early, abnormal P wave that occurs too soon to be conducted
through the AV node, which is still refractory, resulting in no QRS complex following that P wave.
Q15: Which patient factor is a common trigger for premature atrial contractions?
A) Caffeine, stress, or electrolyte imbalance
B) Chronic beta-blocker therapy
C) Hypothyroidism only
D) Bradycardia
Answer: A
Rationale: PACs are commonly triggered by stimulants such as caffeine, nicotine, and alcohol, as well as by stress,
fatigue, and electrolyte disturbances that increase atrial irritability.
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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.
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:
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,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
Answer: A
Rationale: Sinus bradycardia is defined as a regular sinus rhythm with a rate below 60 bpm, with normal P waves
preceding each narrow QRS complex. A rate of 42 bpm with intact P-QRS relationship confirms sinus origin.
Q6: A telemetry strip shows an irregularly irregular rhythm with normal P waves that vary in shape from beat to
beat, and a rate of 110 bpm. Which rhythm is most likely?
A) Atrial fibrillation
B) Multifocal atrial tachycardia
C) Sinus arrhythmia
D) Premature atrial contractions
Answer: B
Rationale: Multifocal atrial tachycardia (MAT) is identified by at least three distinct P wave morphologies, varying
PR intervals, and an irregularly irregular rhythm at a rate typically above 100 bpm. It is commonly associated with
COPD.
Q7: Which rhythm characteristic distinguishes sinus arrhythmia from other irregular rhythms?
A) The irregularity correlates with the respiratory cycle
B) P waves are absent
C) The QRS complex is widened
D) The PR interval varies with each beat
Answer: A
Rationale: Sinus arrhythmia is a normal variant in which the heart rate increases with inspiration and decreases
with expiration, following the respiratory cycle. P waves remain normal and consistent in shape, and the PR interval
stays constant.
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,Q8: A nurse notes a heart rate of 55 bpm on telemetry with normal P waves, PR interval of 0.16 seconds, and narrow
QRS complexes in an asymptomatic athlete. What is the most appropriate initial action?
A) Administer atropine immediately
B) Prepare for transcutaneous pacing
C) Continue monitoring, as this may be a normal finding
D) Call a rapid response immediately
Answer: C
Rationale: Sinus bradycardia is common and often benign in well-conditioned athletes due to increased vagal tone.
In an asymptomatic patient with a normal PR interval and narrow QRS, continued monitoring without intervention
is appropriate.
Q9: A patient's telemetry shows a regular rhythm at 130 bpm, absent P waves, and a narrow QRS complex that
began and ended abruptly. Which rhythm best fits this description?
A) Sinus tachycardia
B) Paroxysmal supraventricular tachycardia
C) Atrial flutter
D) Ventricular tachycardia
Answer: B
Rationale: Paroxysmal supraventricular tachycardia (PSVT) is characterized by a sudden onset and offset, a regular
rapid rate (typically 150-250 bpm), narrow QRS complexes, and often absent or hidden P waves due to reentry
circuits above the ventricles.
Q10: What is the primary distinguishing feature of atrial flutter on an EKG?
A) A chaotic, undulating baseline
B) Sawtooth-shaped flutter waves
C) Absence of any atrial activity
D) Wide, bizarre QRS complexes
Answer: B
Rationale: Atrial flutter produces a characteristic sawtooth pattern of flutter waves, most visible in leads II, III, and
aVF, resulting from a reentrant circuit in the right atrium typically firing at 250-350 bpm.
Q11: A patient in atrial flutter has an atrial rate of 300 bpm and a ventricular rate of 75 bpm. What conduction ratio
is present?
A) 1:1 conduction
B) 2:1 conduction
C) 4:1 conduction
D) 3:1 conduction
Answer: C
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, Rationale: Dividing the atrial rate by the ventricular rate (300/75) yields a 4:1 conduction ratio, meaning only every
fourth flutter wave is conducted through the AV node to produce a QRS complex.
Q12: Which of the following best describes a normal sinus rhythm?
A) Rate 60-100 bpm, regular rhythm, one P wave before each QRS, normal intervals
B) Rate 100-150 bpm with variable P wave morphology
C) Rate less than 60 bpm with absent P waves
D) Irregularly irregular rhythm with fibrillatory waves
Answer: A
Rationale: Normal sinus rhythm is defined by a rate between 60-100 bpm, a regular rhythm, one upright P wave
preceding each QRS complex in lead II, and normal PR (0.12-0.20 sec) and QRS (less than 0.12 sec) intervals.
Q13: A premature atrial contraction (PAC) is best described as:
A) An early beat originating from an ectopic atrial focus with an abnormal P wave
B) A wide, bizarre QRS complex occurring early
C) A pause following a normal sinus beat with no P wave
D) A regular rhythm at 250 bpm with sawtooth waves
Answer: A
Rationale: A PAC arises from an ectopic focus within the atria outside the SA node, producing an early beat with a P
wave that differs in shape from the normal sinus P wave, often followed by a slight pause.
Q14: What EKG finding is most characteristic of a PAC that is not conducted to the ventricles?
A) A premature, abnormally shaped P wave not followed by a QRS complex
B) A wide QRS complex with no preceding P wave
C) Absence of any P wave activity
D) A regular sawtooth baseline
Answer: A
Rationale: A nonconducted (blocked) PAC produces an early, abnormal P wave that occurs too soon to be conducted
through the AV node, which is still refractory, resulting in no QRS complex following that P wave.
Q15: Which patient factor is a common trigger for premature atrial contractions?
A) Caffeine, stress, or electrolyte imbalance
B) Chronic beta-blocker therapy
C) Hypothyroidism only
D) Bradycardia
Answer: A
Rationale: PACs are commonly triggered by stimulants such as caffeine, nicotine, and alcohol, as well as by stress,
fatigue, and electrolyte disturbances that increase atrial irritability.
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