**The Telemetry & ECG Mastery: Rhythm
Recognition and Critical Action**
1. A patient's cardiac monitor shows a regular rhythm with a rate of 42 bpm, no visible P waves, and
wide QRS complexes (>0.12 seconds). What is the most appropriate first action?
A) Administer atropine 0.5 mg IV push
B) Prepare for transcutaneous pacing
C) Assess the patient's level of consciousness and blood pressure
D) Document the rhythm as sinus bradycardia
💫RATIONALE✔️✔️: The rhythm is likely junctional or idioventricular bradycardia. The first action is
always to assess the patient (ABCs). If the patient is symptomatic (hypotension, altered mental status),
then treat.
💫ANSWER✔️✔️: C) Assess the patient's level of consciousness and blood pressure
---
2. A patient with a history of heart failure is on telemetry. The nurse notes a rhythm with a rate of 150
bpm, regular R-R intervals, narrow QRS complexes, and no visible P waves. What is the most likely
rhythm?
A) Atrial fibrillation
B) Atrial flutter (with 2:1 block)
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
💫RATIONALE✔️✔️: SVT (reentrant tachycardia) typically presents with narrow QRS, regular rate 150-250,
and no visible P waves. Atrial flutter with 2:1 block has flutter waves (sawtooth) at 300/min. Atrial
fibrillation is irregularly irregular.
💫ANSWER✔️✔️: C) Supraventricular tachycardia (SVT)
,---
3. A patient's cardiac monitor shows a rhythm with a rate of 180 bpm, narrow QRS, regular rhythm, and
a P wave before each QRS. The patient is hypotensive and confused. What is the priority action?
A) Administer adenosine 6 mg IV push
B) Perform synchronized cardioversion
C) Administer amiodarone 150 mg IV
D) Have the patient perform a Valsalva maneuver
💫RATIONALE✔️✔️: Unstable tachycardia (hypotension, altered mental status) requires immediate
synchronized cardioversion. Do not delay for vagal maneuvers or medications.
💫ANSWER✔️✔️: B) Perform synchronized cardioversion
---
4. A patient's telemetry shows a rhythm with a rate of 220 bpm, regular, narrow QRS, and no visible P
waves. The patient is asymptomatic. What is the priority action?
A) Administer adenosine 6 mg IV push
B) Perform vagal maneuvers (Valsalva, carotid massage)
C) Prepare for synchronized cardioversion
D) Administer metoprolol 5 mg IV
💫RATIONALE✔️✔️: Stable SVT (asymptomatic) is initially treated with vagal maneuvers (Valsalva, carotid
massage), then adenosine. Cardioversion is for unstable patients.
💫ANSWER✔️✔️: B) Perform vagal maneuvers (Valsalva, carotid massage)
---
5. A patient's cardiac monitor shows a rhythm with a rate of 300 bpm, chaotic baseline, no discernible P
waves, and irregularly irregular QRS complexes. What is the most likely rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Ventricular fibrillation
D) Multifocal atrial tachycardia
💫RATIONALE✔️✔️: Atrial fibrillation is characterized by an irregularly irregular rhythm with no P waves
and a chaotic baseline. Atrial flutter has sawtooth waves.
, 💫ANSWER✔️✔️: A) Atrial fibrillation
---
6. A patient with atrial fibrillation is on a continuous heparin drip. The nurse notes that the patient's
ventricular rate is 140 bpm. Which medication should the nurse anticipate administering to control the
rate?
A) Adenosine
B) Metoprolol or diltiazem
C) Amiodarone
D) Atropine
💫RATIONALE✔️✔️: Rate control in atrial fibrillation is achieved with beta-blockers (metoprolol) or non-
dihydropyridine calcium channel blockers (diltiazem, verapamil). Adenosine is for SVT.
💫ANSWER✔️✔️: B) Metoprolol or diltiazem
---
7. A patient's cardiac monitor shows a regular rhythm with a rate of 42 bpm, a P wave before each QRS,
and a normal PR interval. What is the rhythm?
A) Sinus bradycardia
B) Junctional rhythm
C) First-degree AV block
D) Second-degree AV block type I
💫RATIONALE✔️✔️: Sinus bradycardia: regular rhythm, rate <60, P wave before each QRS, normal PR
interval. Junctional rhythm has no P waves or inverted P waves.
💫ANSWER✔️✔️: A) Sinus bradycardia
---
8. A patient's telemetry shows a rhythm with a prolonged PR interval (>0.20 seconds) but every P wave
is followed by a QRS complex. What is the rhythm?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II
Recognition and Critical Action**
1. A patient's cardiac monitor shows a regular rhythm with a rate of 42 bpm, no visible P waves, and
wide QRS complexes (>0.12 seconds). What is the most appropriate first action?
A) Administer atropine 0.5 mg IV push
B) Prepare for transcutaneous pacing
C) Assess the patient's level of consciousness and blood pressure
D) Document the rhythm as sinus bradycardia
💫RATIONALE✔️✔️: The rhythm is likely junctional or idioventricular bradycardia. The first action is
always to assess the patient (ABCs). If the patient is symptomatic (hypotension, altered mental status),
then treat.
💫ANSWER✔️✔️: C) Assess the patient's level of consciousness and blood pressure
---
2. A patient with a history of heart failure is on telemetry. The nurse notes a rhythm with a rate of 150
bpm, regular R-R intervals, narrow QRS complexes, and no visible P waves. What is the most likely
rhythm?
A) Atrial fibrillation
B) Atrial flutter (with 2:1 block)
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
💫RATIONALE✔️✔️: SVT (reentrant tachycardia) typically presents with narrow QRS, regular rate 150-250,
and no visible P waves. Atrial flutter with 2:1 block has flutter waves (sawtooth) at 300/min. Atrial
fibrillation is irregularly irregular.
💫ANSWER✔️✔️: C) Supraventricular tachycardia (SVT)
,---
3. A patient's cardiac monitor shows a rhythm with a rate of 180 bpm, narrow QRS, regular rhythm, and
a P wave before each QRS. The patient is hypotensive and confused. What is the priority action?
A) Administer adenosine 6 mg IV push
B) Perform synchronized cardioversion
C) Administer amiodarone 150 mg IV
D) Have the patient perform a Valsalva maneuver
💫RATIONALE✔️✔️: Unstable tachycardia (hypotension, altered mental status) requires immediate
synchronized cardioversion. Do not delay for vagal maneuvers or medications.
💫ANSWER✔️✔️: B) Perform synchronized cardioversion
---
4. A patient's telemetry shows a rhythm with a rate of 220 bpm, regular, narrow QRS, and no visible P
waves. The patient is asymptomatic. What is the priority action?
A) Administer adenosine 6 mg IV push
B) Perform vagal maneuvers (Valsalva, carotid massage)
C) Prepare for synchronized cardioversion
D) Administer metoprolol 5 mg IV
💫RATIONALE✔️✔️: Stable SVT (asymptomatic) is initially treated with vagal maneuvers (Valsalva, carotid
massage), then adenosine. Cardioversion is for unstable patients.
💫ANSWER✔️✔️: B) Perform vagal maneuvers (Valsalva, carotid massage)
---
5. A patient's cardiac monitor shows a rhythm with a rate of 300 bpm, chaotic baseline, no discernible P
waves, and irregularly irregular QRS complexes. What is the most likely rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Ventricular fibrillation
D) Multifocal atrial tachycardia
💫RATIONALE✔️✔️: Atrial fibrillation is characterized by an irregularly irregular rhythm with no P waves
and a chaotic baseline. Atrial flutter has sawtooth waves.
, 💫ANSWER✔️✔️: A) Atrial fibrillation
---
6. A patient with atrial fibrillation is on a continuous heparin drip. The nurse notes that the patient's
ventricular rate is 140 bpm. Which medication should the nurse anticipate administering to control the
rate?
A) Adenosine
B) Metoprolol or diltiazem
C) Amiodarone
D) Atropine
💫RATIONALE✔️✔️: Rate control in atrial fibrillation is achieved with beta-blockers (metoprolol) or non-
dihydropyridine calcium channel blockers (diltiazem, verapamil). Adenosine is for SVT.
💫ANSWER✔️✔️: B) Metoprolol or diltiazem
---
7. A patient's cardiac monitor shows a regular rhythm with a rate of 42 bpm, a P wave before each QRS,
and a normal PR interval. What is the rhythm?
A) Sinus bradycardia
B) Junctional rhythm
C) First-degree AV block
D) Second-degree AV block type I
💫RATIONALE✔️✔️: Sinus bradycardia: regular rhythm, rate <60, P wave before each QRS, normal PR
interval. Junctional rhythm has no P waves or inverted P waves.
💫ANSWER✔️✔️: A) Sinus bradycardia
---
8. A patient's telemetry shows a rhythm with a prolonged PR interval (>0.20 seconds) but every P wave
is followed by a QRS complex. What is the rhythm?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II
