1
Relias Prophecy General ICU RN A V3 Exam
2026/2027 Actual Exam | Latest 100 Questions &
Correct Detailed Answers with Rationales | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Rhythm Identification
Q1: A rhythm strip shows an irregularly irregular rhythm, no discernible P waves, and a heart
rate of 110-140 bpm. This rhythm is:
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation [CORRECT]
D. Junctional tachycardia
Correct Answer: C
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm and the absence
of distinct P waves, replaced by fibrillatory waves. Option B (atrial flutter) typically has
"sawtooth" flutter waves. Option A has distinct P waves.
Q2: The nurse observes a rhythm with a regular rate of 40 bpm. The P waves are inverted in lead
II and occur after the QRS complex. This is consistent with:
A. Sinus bradycardia
B. First-degree AV block
C. Junctional rhythm [CORRECT]
D. Atrial flutter with 4:1 block
Correct Answer: C
,2
Rationale: A junctional rhythm originates in the AV node. Because the impulse travels retrograde
to the atria and antegrade to the ventricles, P waves may be inverted, absent, or follow the QRS
(retrograde conduction). Rate is typically 40-60 bpm.
Q3: A patient is unresponsive and pulseless. The cardiac monitor shows a wavy, disorganized
baseline with no identifiable QRS complexes. The nurse should initially:
A. Defibrillate immediately [CORRECT]
B. Administer Epinephrine 1 mg IV push
C. Initiate transcutaneous pacing
D. Perform synchronized cardioversion
Correct Answer: A
Rationale: The rhythm described is Ventricular Fibrillation (VF). The priority treatment for
VF/pulseless VT is immediate defibrillation. Epinephrine is given after the first shock, and
pacing is for bradycardic rhythms.
Q4: A rhythm strip shows a normal sinus rhythm baseline followed by a premature, wide, and
bizarre QRS complex without a preceding P wave. The T wave is deflected opposite the QRS.
This is:
A. Premature Atrial Contraction (PAC)
B. Premature Ventricular Contraction (PVC) [CORRECT]
C. Bundle Branch Block
D. Escape beat
Correct Answer: B
Rationale: PVCs are characterized by a premature beat, wide and bizarre QRS complex (>0.12
sec), no preceding P wave, and discordant T waves (opposite direction of QRS).
Q5: In Third-Degree AV Block (Complete Heart Block), the relationship between the P waves
and QRS complexes is:
,3
A. Consistently prolonged PR interval
B. Progressive lengthening of PR interval until a beat is dropped
C. No relationship; atria and ventricles beat independently [CORRECT]
D. P waves are absent
Correct Answer: C
Rationale: In Third-Degree Block, there is a complete block at the AV node. The atria are driven
by the SA node, and the ventricles are driven by an escape pacemaker (junctional or ventricular).
They beat independently (AV dissociation).
Q6: The patient's rhythm shows a regular rate of 150 bpm. The QRS is narrow. P waves are
difficult to distinguish but appear "sawtooth" in shape between QRS complexes. This is:
A. Sinus tachycardia
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Atrial fibrillation
Correct Answer: B
Rationale: Atrial flutter typically presents with a regular ventricular rate (if constant block) and
distinct "sawtooth" flutter (F) waves. A rate of 150 bpm is classic for Atrial Flutter with 2:1 AV
conduction (Atrial rate ~300).
Q7: The nurse notes a rhythm where the PR interval is progressively longer until a QRS complex
is dropped. This pattern repeats. This is:
A. First-degree AV block
B. Second-degree AV Block Type I (Wenckebach) [CORRECT]
C. Second-degree AV Block Type II
D. Third-degree AV block
, 4
Correct Answer: B
Rationale: Second-Degree AV Block Type I (Wenckebach) is characterized by a progressively
lengthening PR interval until a P wave is not conducted (dropped QRS). It is usually benign and
transient.
Q8: Which characteristic distinguishes Second-Degree AV Block Type II from Type I?
A. Type II has a constant PR interval [CORRECT]
B. Type II has a progressively lengthening PR interval
C. Type II is usually benign
D. Type II is treated with atropine only
Correct Answer: A
Rationale: In Type II block, the PR interval is constant for conducted beats, but beats are dropped
unexpectedly. It indicates a block below the AV node (His-Purkinje system) and carries a high
risk of progressing to complete heart block.
Q9: A patient is bradycardic with a heart rate of 45 bpm. The BP is 80/50. The rhythm is Sinus
Bradycardia. Which medication is the first-line treatment for symptomatic bradycardia?
A. Dopamine
B. Atropine [CORRECT]
C. Epinephrine
D. Isoproterenol
Correct Answer: B
Rationale: Atropine is the first-line drug for symptomatic bradycardia. If ineffective,
transcutaneous pacing or dopamine/epinephrine infusions are indicated.
Q10: A patient with a history of heart failure presents with a wide-complex tachycardia at 180
bpm. The patient is awake but dizzy with a BP of 90/60. The nurse should prepare for:
Relias Prophecy General ICU RN A V3 Exam
2026/2027 Actual Exam | Latest 100 Questions &
Correct Detailed Answers with Rationales | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Rhythm Identification
Q1: A rhythm strip shows an irregularly irregular rhythm, no discernible P waves, and a heart
rate of 110-140 bpm. This rhythm is:
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation [CORRECT]
D. Junctional tachycardia
Correct Answer: C
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm and the absence
of distinct P waves, replaced by fibrillatory waves. Option B (atrial flutter) typically has
"sawtooth" flutter waves. Option A has distinct P waves.
Q2: The nurse observes a rhythm with a regular rate of 40 bpm. The P waves are inverted in lead
II and occur after the QRS complex. This is consistent with:
A. Sinus bradycardia
B. First-degree AV block
C. Junctional rhythm [CORRECT]
D. Atrial flutter with 4:1 block
Correct Answer: C
,2
Rationale: A junctional rhythm originates in the AV node. Because the impulse travels retrograde
to the atria and antegrade to the ventricles, P waves may be inverted, absent, or follow the QRS
(retrograde conduction). Rate is typically 40-60 bpm.
Q3: A patient is unresponsive and pulseless. The cardiac monitor shows a wavy, disorganized
baseline with no identifiable QRS complexes. The nurse should initially:
A. Defibrillate immediately [CORRECT]
B. Administer Epinephrine 1 mg IV push
C. Initiate transcutaneous pacing
D. Perform synchronized cardioversion
Correct Answer: A
Rationale: The rhythm described is Ventricular Fibrillation (VF). The priority treatment for
VF/pulseless VT is immediate defibrillation. Epinephrine is given after the first shock, and
pacing is for bradycardic rhythms.
Q4: A rhythm strip shows a normal sinus rhythm baseline followed by a premature, wide, and
bizarre QRS complex without a preceding P wave. The T wave is deflected opposite the QRS.
This is:
A. Premature Atrial Contraction (PAC)
B. Premature Ventricular Contraction (PVC) [CORRECT]
C. Bundle Branch Block
D. Escape beat
Correct Answer: B
Rationale: PVCs are characterized by a premature beat, wide and bizarre QRS complex (>0.12
sec), no preceding P wave, and discordant T waves (opposite direction of QRS).
Q5: In Third-Degree AV Block (Complete Heart Block), the relationship between the P waves
and QRS complexes is:
,3
A. Consistently prolonged PR interval
B. Progressive lengthening of PR interval until a beat is dropped
C. No relationship; atria and ventricles beat independently [CORRECT]
D. P waves are absent
Correct Answer: C
Rationale: In Third-Degree Block, there is a complete block at the AV node. The atria are driven
by the SA node, and the ventricles are driven by an escape pacemaker (junctional or ventricular).
They beat independently (AV dissociation).
Q6: The patient's rhythm shows a regular rate of 150 bpm. The QRS is narrow. P waves are
difficult to distinguish but appear "sawtooth" in shape between QRS complexes. This is:
A. Sinus tachycardia
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Atrial fibrillation
Correct Answer: B
Rationale: Atrial flutter typically presents with a regular ventricular rate (if constant block) and
distinct "sawtooth" flutter (F) waves. A rate of 150 bpm is classic for Atrial Flutter with 2:1 AV
conduction (Atrial rate ~300).
Q7: The nurse notes a rhythm where the PR interval is progressively longer until a QRS complex
is dropped. This pattern repeats. This is:
A. First-degree AV block
B. Second-degree AV Block Type I (Wenckebach) [CORRECT]
C. Second-degree AV Block Type II
D. Third-degree AV block
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Correct Answer: B
Rationale: Second-Degree AV Block Type I (Wenckebach) is characterized by a progressively
lengthening PR interval until a P wave is not conducted (dropped QRS). It is usually benign and
transient.
Q8: Which characteristic distinguishes Second-Degree AV Block Type II from Type I?
A. Type II has a constant PR interval [CORRECT]
B. Type II has a progressively lengthening PR interval
C. Type II is usually benign
D. Type II is treated with atropine only
Correct Answer: A
Rationale: In Type II block, the PR interval is constant for conducted beats, but beats are dropped
unexpectedly. It indicates a block below the AV node (His-Purkinje system) and carries a high
risk of progressing to complete heart block.
Q9: A patient is bradycardic with a heart rate of 45 bpm. The BP is 80/50. The rhythm is Sinus
Bradycardia. Which medication is the first-line treatment for symptomatic bradycardia?
A. Dopamine
B. Atropine [CORRECT]
C. Epinephrine
D. Isoproterenol
Correct Answer: B
Rationale: Atropine is the first-line drug for symptomatic bradycardia. If ineffective,
transcutaneous pacing or dopamine/epinephrine infusions are indicated.
Q10: A patient with a history of heart failure presents with a wide-complex tachycardia at 180
bpm. The patient is awake but dizzy with a BP of 90/60. The nurse should prepare for:
