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Question 1
An ECG strip shows a regular rhythm with a heart rate of 48 bpm, P waves before each
QRS, and a PR interval of 0.16 seconds. What is the rhythm?
A. Sinus tachycardia
B. Sinus bradycardia
C. Atrial fibrillation
D. First-degree AV block
E. Normal sinus rhythm
Answer: B. Sinus bradycardia
Expert Rationale: A heart rate of 48 bpm with regular P waves, normal PR interval
(0.12–0.20 s), and P before each QRS indicates sinus bradycardia.
Question 2
A client's ECG shows a heart rate of 120 bpm, regular rhythm, and P waves before each
,QRS. What is the rhythm?
A. Sinus tachycardia
B. Supraventricular tachycardia
C. Atrial flutter
D. Ventricular tachycardia
E. Junctional tachycardia
Answer: A. Sinus tachycardia
Expert Rationale: A regular rhythm with a rate of 120 bpm and P waves before
each QRS is characteristic of sinus tachycardia.
Question 3
An ECG strip shows no discernible P waves, irregular QRS complexes, and a heart rate
of 100 bpm. What is the rhythm?
A. Sinus rhythm
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular fibrillation
E. Second-degree AV block
Answer: C. Atrial fibrillation
Expert Rationale: The hallmark features of atrial fibrillation are an irregularly
irregular ventricular rhythm and the absence of distinct, organized P waves, which
are instead replaced by chaotic fibrillatory waves. A heart rate of 100 bpm under
these parameters confirms atrial fibrillation with a controlled ventricular response.
Question 4
An ECG strip reveals a regular rhythm with an atrial rate of 300 bpm showing a distinct
,saw-tooth pattern, and a ventricular rate of 75 bpm. What is the rhythm?
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular tachycardia
E. Supraventricular tachycardia
Answer: C. Atrial flutter
Expert Rationale: The defining hallmark of atrial flutter is the classic "saw-tooth"
baseline produced by rapid, regular atrial depolarization waves (flutter waves),
typically occurring at a rate of 250–350 bpm. In this case, a 4:1 AV conduction ratio
yields a regular ventricular rate of 75 bpm.
Question 5
A patient's cardiac monitor displays a rhythm that is irregular throughout. The PR
interval is progressively lengthening from beat to beat until a QRS complex is completely
dropped, after which the cycle repeats. What is the rhythm?
A. First-degree AV block
B. Second-degree AV block, Mobitz Type I (Wenckebach)
C. Second-degree AV block, Mobitz Type II
D. Third-degree AV block
E. Sinus arrhythmia
Answer: B. Second-degree AV block, Mobitz Type I (Wenckebach)
Expert Rationale: Mobitz Type I (Wenckebach) is distinguished by a progressive
prolongation of the PR interval on consecutive beats until an atrial impulse (P wave)
fails to conduct to the ventricles, resulting in a dropped QRS complex.
, Question 6
An ECG strip shows a regular atrial rhythm and a regular ventricular rhythm, but there is
absolutely no relationship between the P waves and the QRS complexes. The PR
intervals are completely variable. What is the rhythm?
A. First-degree AV block
B. Second-degree AV block, Mobitz Type I
C. Second-degree AV block, Mobitz Type II
D. Third-degree AV block (Complete Heart Block)
E. Junctional escape rhythm
Answer: D. Third-degree AV block (Complete Heart Block)
Expert Rationale: In third-degree (complete) AV block, there is a total dissociation
between the atria and the ventricles. The SA node fires independently (regular P-P
intervals) and an escape pacemaker drives the ventricles independently (regular R-
R intervals), meaning the PR interval varies randomly with no correlation.
Question 7
A monitor strip demonstrates a rhythm with a normal, upright P wave occurring early
before the next expected sinus beat. The PR interval is normal, and the QRS complex is
narrow (<0.12 seconds). What does this represent?
A. Premature Ventricular Contraction (PVC)
B. Premature Atrial Contraction (PAC)
C. Junctional Escape Beat
D. Atrial fibrillation
E. Sinus arrest
Answer: B. Premature Atrial Contraction (PAC)