PROPHECY MEDICAL SURGICAL-TELEMETRY EXAM
2026/2027 | Questions & Answers | Verified Answers | 80
Questions w/ Detailed Rationales | Comprehensive Practice |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIAC RHYTHM IDENTIFICATION (Questions 1-12)
Q1: The telemetry monitor shows a rhythm with regular R-R intervals, rate 72 bpm,
upright P waves before each QRS complex, PR interval 0.16 seconds, and narrow QRS
complexes. This rhythm is identified as:
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. First-degree AV block
D. Sinus arrhythmia
Correct Answer: B
Rationale: Normal sinus rhythm (NSR) criteria: Regular rhythm, rate 60-100 bpm, P wave
before each QRS (upright in lead II), PR interval 0.12-0.20 seconds, narrow QRS (<0.12
seconds). All criteria are met. Option A is incorrect—rate is normal, not <60. Option C
requires PR interval >0.20 seconds. Option D shows irregular R-R intervals varying with
respiration. NSR is the standard reference rhythm against which all dysrhythmias are
compared.
Q2: A patient's rhythm strip shows: Rate 52 bpm, regular rhythm, P waves present and
upright before each QRS, PR interval 0.18 seconds, QRS narrow. The nurse recognizes
this as:
,A. Junctional rhythm
B. Sinus bradycardia [CORRECT]
C. Second-degree AV block Type I
D. Idioventricular rhythm
Correct Answer: B
Rationale: Sinus bradycardia meets all NSR criteria except rate <60 bpm. The rhythm
originates from the SA node (upright P waves, normal PR interval) with 1:1 AV
conduction. Option A (junctional) would show inverted P waves, P waves after QRS, or
absent P waves. Option C would show progressive PR prolongation and dropped beats.
Option D would be wide complex, rate 20-40, no P waves. Clinical significance: Sinus
bradycardia is normal in athletes, during sleep, or with vagal stimulation; pathological if
causing hypotension, syncope, or ischemia.
Q3: The monitor shows a rhythm with rate 150 bpm, regular R-R intervals, P waves
visible and upright before each QRS, PR interval 0.14 seconds, QRS narrow. This rhythm
is:
A. Atrial flutter
B. Supraventricular tachycardia (SVT)
C. Sinus tachycardia [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: Sinus tachycardia is characterized by rate >100 bpm with maintained normal
P wave morphology and 1:1 AV conduction. At 150 bpm, P waves may be difficult to
distinguish but are present here. Option A (atrial flutter) would show sawtooth flutter
waves, not discrete P waves. Option B (SVT/AVNRT) typically has absent or retrograde
P waves (buried in QRS or shortly after). Option D would be wide complex. Causes: Pain,
,fever, hypovolemia, hypoxia, anxiety, medications, heart failure. Treatment: Address
underlying cause; beta-blockers if persistent and symptomatic.
Q4: A rhythm strip shows: No discernible P waves, irregularly irregular R-R intervals,
fibrillatory waves between QRS complexes, QRS narrow, rate approximately 110 bpm.
This is:
A. Atrial flutter with variable block
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale: Atrial fibrillation (AFib) is identified by: Irregularly irregular ventricular
response, absent P waves (replaced by chaotic fibrillatory waves), narrow QRS (unless
aberrant conduction or pre-existing BBB). Rate 110 indicates rapid ventricular response
(RVR). Option A shows regular atrial activity (sawtooth). Option C requires ≥3 distinct P
wave morphologies and rate >100. Option D has phasic variation with respiration and
visible P waves. Risk: Thromboembolism (CHA₂DS₂-VASc score), heart failure,
tachycardia-induced cardiomyopathy.
Q5: The monitor shows regular atrial activity at 300 bpm with sawtooth flutter waves,
ventricular rate 150 bpm with regular R-R intervals, QRS narrow. This represents:
A. Atrial fibrillation
B. Atrial flutter with 2:1 AV block [CORRECT]
C. Atrial tachycardia
D. Junctional tachycardia
Correct Answer: B
, Rationale: Atrial flutter demonstrates regular atrial activity (F waves) at 250-350 bpm,
typically appearing as sawtooth pattern in leads II, III, aVF. With 2:1 AV block, every
second flutter wave is conducted, producing ventricular rate ~150 bpm (300÷2). This is
the most common presentation. Option A is irregularly irregular. Option C has discrete P
waves, not sawtooth. Option D would have no atrial activity or retrograde P waves.
Treatment: Rate control (beta-blockers, calcium channel blockers, digoxin),
anticoagulation, rhythm control (synchronized cardioversion, ablation).
Q6: A rhythm strip shows: Rate 180 bpm, regular narrow QRS complexes, no visible P
waves, sudden onset and termination. This is most consistent with:
A. Sinus tachycardia
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia (PSVT/AVNRT) [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: PSVT (AVNRT or AVRT) characteristics: Sudden onset/termination
(paroxysmal), regular narrow complex tachycardia, rate 150-250 bpm, P waves often
buried in QRS or appearing as pseudo-R' in V1. Mechanism: Re-entry circuit involving AV
node. Option A has gradual onset/offset with visible P waves. Option B shows flutter
waves. Option D would be wide complex (unless SVT with aberrancy). Acute treatment:
Vagal maneuvers, adenosine 6mg rapid IV push (12mg if needed).
Q7: The monitor shows occasional early beats with: Wide, bizarre QRS (>0.12 sec), no
preceding P wave, T wave opposite direction to QRS, full compensatory pause. These
are:
A. Premature atrial contractions (PACs)
2026/2027 | Questions & Answers | Verified Answers | 80
Questions w/ Detailed Rationales | Comprehensive Practice |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIAC RHYTHM IDENTIFICATION (Questions 1-12)
Q1: The telemetry monitor shows a rhythm with regular R-R intervals, rate 72 bpm,
upright P waves before each QRS complex, PR interval 0.16 seconds, and narrow QRS
complexes. This rhythm is identified as:
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. First-degree AV block
D. Sinus arrhythmia
Correct Answer: B
Rationale: Normal sinus rhythm (NSR) criteria: Regular rhythm, rate 60-100 bpm, P wave
before each QRS (upright in lead II), PR interval 0.12-0.20 seconds, narrow QRS (<0.12
seconds). All criteria are met. Option A is incorrect—rate is normal, not <60. Option C
requires PR interval >0.20 seconds. Option D shows irregular R-R intervals varying with
respiration. NSR is the standard reference rhythm against which all dysrhythmias are
compared.
Q2: A patient's rhythm strip shows: Rate 52 bpm, regular rhythm, P waves present and
upright before each QRS, PR interval 0.18 seconds, QRS narrow. The nurse recognizes
this as:
,A. Junctional rhythm
B. Sinus bradycardia [CORRECT]
C. Second-degree AV block Type I
D. Idioventricular rhythm
Correct Answer: B
Rationale: Sinus bradycardia meets all NSR criteria except rate <60 bpm. The rhythm
originates from the SA node (upright P waves, normal PR interval) with 1:1 AV
conduction. Option A (junctional) would show inverted P waves, P waves after QRS, or
absent P waves. Option C would show progressive PR prolongation and dropped beats.
Option D would be wide complex, rate 20-40, no P waves. Clinical significance: Sinus
bradycardia is normal in athletes, during sleep, or with vagal stimulation; pathological if
causing hypotension, syncope, or ischemia.
Q3: The monitor shows a rhythm with rate 150 bpm, regular R-R intervals, P waves
visible and upright before each QRS, PR interval 0.14 seconds, QRS narrow. This rhythm
is:
A. Atrial flutter
B. Supraventricular tachycardia (SVT)
C. Sinus tachycardia [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: Sinus tachycardia is characterized by rate >100 bpm with maintained normal
P wave morphology and 1:1 AV conduction. At 150 bpm, P waves may be difficult to
distinguish but are present here. Option A (atrial flutter) would show sawtooth flutter
waves, not discrete P waves. Option B (SVT/AVNRT) typically has absent or retrograde
P waves (buried in QRS or shortly after). Option D would be wide complex. Causes: Pain,
,fever, hypovolemia, hypoxia, anxiety, medications, heart failure. Treatment: Address
underlying cause; beta-blockers if persistent and symptomatic.
Q4: A rhythm strip shows: No discernible P waves, irregularly irregular R-R intervals,
fibrillatory waves between QRS complexes, QRS narrow, rate approximately 110 bpm.
This is:
A. Atrial flutter with variable block
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale: Atrial fibrillation (AFib) is identified by: Irregularly irregular ventricular
response, absent P waves (replaced by chaotic fibrillatory waves), narrow QRS (unless
aberrant conduction or pre-existing BBB). Rate 110 indicates rapid ventricular response
(RVR). Option A shows regular atrial activity (sawtooth). Option C requires ≥3 distinct P
wave morphologies and rate >100. Option D has phasic variation with respiration and
visible P waves. Risk: Thromboembolism (CHA₂DS₂-VASc score), heart failure,
tachycardia-induced cardiomyopathy.
Q5: The monitor shows regular atrial activity at 300 bpm with sawtooth flutter waves,
ventricular rate 150 bpm with regular R-R intervals, QRS narrow. This represents:
A. Atrial fibrillation
B. Atrial flutter with 2:1 AV block [CORRECT]
C. Atrial tachycardia
D. Junctional tachycardia
Correct Answer: B
, Rationale: Atrial flutter demonstrates regular atrial activity (F waves) at 250-350 bpm,
typically appearing as sawtooth pattern in leads II, III, aVF. With 2:1 AV block, every
second flutter wave is conducted, producing ventricular rate ~150 bpm (300÷2). This is
the most common presentation. Option A is irregularly irregular. Option C has discrete P
waves, not sawtooth. Option D would have no atrial activity or retrograde P waves.
Treatment: Rate control (beta-blockers, calcium channel blockers, digoxin),
anticoagulation, rhythm control (synchronized cardioversion, ablation).
Q6: A rhythm strip shows: Rate 180 bpm, regular narrow QRS complexes, no visible P
waves, sudden onset and termination. This is most consistent with:
A. Sinus tachycardia
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia (PSVT/AVNRT) [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: PSVT (AVNRT or AVRT) characteristics: Sudden onset/termination
(paroxysmal), regular narrow complex tachycardia, rate 150-250 bpm, P waves often
buried in QRS or appearing as pseudo-R' in V1. Mechanism: Re-entry circuit involving AV
node. Option A has gradual onset/offset with visible P waves. Option B shows flutter
waves. Option D would be wide complex (unless SVT with aberrancy). Acute treatment:
Vagal maneuvers, adenosine 6mg rapid IV push (12mg if needed).
Q7: The monitor shows occasional early beats with: Wide, bizarre QRS (>0.12 sec), no
preceding P wave, T wave opposite direction to QRS, full compensatory pause. These
are:
A. Premature atrial contractions (PACs)
