1|Page
,2|Page
BASIC ARRHYTHMIA SENTARA TEST BANK
2026 | 100+ Questions with Answers &
Rationales | ECG Rhythm Recognition
Practice for Nurses
Question 1
A 68-year-old male with a history of hypertension presents to the emergency
department with palpitations and lightheadedness. His heart rate is 162 bpm, blood
pressure 108/72 mmHg. The cardiac monitor shows a regular rhythm with a rate of
162, no visible P-waves, and wide QRS complexes (>0.12 sec) that appear uniform in
morphology.
What is the most likely rhythm?
A) Atrial fibrillation with rapid ventricular response
B) Supraventricular tachycardia with aberrancy
C) Monomorphic ventricular tachycardia
D) Atrial flutter with 2:1 conduction
[CORRECT] C) Monomorphic ventricular tachycardia
Rationale: Monomorphic VT presents with a regular, wide-complex tachycardia (>100
bpm) with uniform QRS morphology. The absence of visible P-waves and the wide QRS
(>0.12 sec) distinguish it from SVT. A-fib is irregularly irregular. Atrial flutter typically
has a sawtooth baseline. SVT with aberrancy is possible but less likely in this age group
with this presentation; VT is the presumed diagnosis until proven otherwise.
Question 2
Table 1: Heart Block Comparison
,3|Page
First- Third-
Mobitz Type I
Feature Degree Mobitz Type II Degree
(Wenckebach)
AVB (Complete)
Prolonged Progressively Constant
Variable, no
PR Interval (>0.20s), lengthens until (normal or
relationship
constant a drop prolonged)
Dropped Yes (grouped Yes (sudden, Yes (AV
None
Beats beating) no warning) dissociation)
Wide (if
Narrow
QRS Width Narrow Wide (often) junctional) or
(usually)
narrow
Dangerous –
Emergency –
Clinical may progress
Benign Usually benign requires
Significance to complete
pacing
block
A 72-year-old female with a history of ischemic cardiomyopathy presents for routine
follow-up. Her ECG shows a regular atrial rate of 88 bpm and a regular ventricular
rate of 42 bpm. The P-waves have no consistent relationship to the QRS complexes.
The QRS complexes are narrow.
Based on Table 1, what is the diagnosis?
A) First-degree AV block
B) Mobitz Type I (Wenckebach)
C) Mobitz Type II
D) Third-degree AV block with junctional escape
[CORRECT] D) Third-degree AV block with junctional escape
Rationale: Complete heart block (third-degree) is characterized by AV dissociation – the
atria and ventricles beat independently. The atrial rate is faster than the ventricular
rate. The narrow QRS indicates the escape rhythm is originating from the junction (AV
node), which is a more stable escape pacemaker than a ventricular escape (which
would be wide). First-degree has no dropped beats. Mobitz I has progressively
lengthening PR intervals. Mobitz II has sudden dropped beats without PR prolongation.
, 4|Page
Question 3
Scenario: Prioritization
You are the charge nurse on a cardiac telemetry unit. You have four patients. Which
patient do you assess FIRST?
• Patient A: 55-year-old male, post-MI day 2. Telemetry shows sinus bradycardia at 52
bpm. He is asymptomatic and sleeping.
• Patient B: 68-year-old female with heart failure. Telemetry shows atrial fibrillation
with a rate of 110 bpm. She reports mild shortness of breath.
• Patient C: 74-year-old male with a history of bifascicular block. Telemetry shows a
sudden change from normal sinus to a wide-complex rhythm at 140 bpm with no
visible P-waves. He is awake but confused.
• Patient D: 62-year-old female post-cardiac surgery. Telemetry shows frequent
premature ventricular contractions (PVCs) at a rate of 8 per minute. She is
asymptomatic.
Which patient do you see first?
A) Patient A
B) Patient B
C) Patient C
D) Patient D
[CORRECT] C) Patient C
Rationale: Patient C has new-onset monomorphic ventricular tachycardia (wide-
complex, no P-waves, rate 140) with signs of hemodynamic instability (confusion). This
is a life-threatening arrhythmia requiring immediate intervention (cardioversion or
antiarrhythmic therapy). Patient B is stable with A-fib and mild symptoms. Patient A is
stable bradycardia. Patient D has PVCs which, while requiring monitoring, are not
immediately life-threatening in an asymptomatic patient.
Question 4
A 45-year-old female with no significant medical history presents with episodes of
sudden palpitations that start and stop abruptly. During an episode in the emergency
,2|Page
BASIC ARRHYTHMIA SENTARA TEST BANK
2026 | 100+ Questions with Answers &
Rationales | ECG Rhythm Recognition
Practice for Nurses
Question 1
A 68-year-old male with a history of hypertension presents to the emergency
department with palpitations and lightheadedness. His heart rate is 162 bpm, blood
pressure 108/72 mmHg. The cardiac monitor shows a regular rhythm with a rate of
162, no visible P-waves, and wide QRS complexes (>0.12 sec) that appear uniform in
morphology.
What is the most likely rhythm?
A) Atrial fibrillation with rapid ventricular response
B) Supraventricular tachycardia with aberrancy
C) Monomorphic ventricular tachycardia
D) Atrial flutter with 2:1 conduction
[CORRECT] C) Monomorphic ventricular tachycardia
Rationale: Monomorphic VT presents with a regular, wide-complex tachycardia (>100
bpm) with uniform QRS morphology. The absence of visible P-waves and the wide QRS
(>0.12 sec) distinguish it from SVT. A-fib is irregularly irregular. Atrial flutter typically
has a sawtooth baseline. SVT with aberrancy is possible but less likely in this age group
with this presentation; VT is the presumed diagnosis until proven otherwise.
Question 2
Table 1: Heart Block Comparison
,3|Page
First- Third-
Mobitz Type I
Feature Degree Mobitz Type II Degree
(Wenckebach)
AVB (Complete)
Prolonged Progressively Constant
Variable, no
PR Interval (>0.20s), lengthens until (normal or
relationship
constant a drop prolonged)
Dropped Yes (grouped Yes (sudden, Yes (AV
None
Beats beating) no warning) dissociation)
Wide (if
Narrow
QRS Width Narrow Wide (often) junctional) or
(usually)
narrow
Dangerous –
Emergency –
Clinical may progress
Benign Usually benign requires
Significance to complete
pacing
block
A 72-year-old female with a history of ischemic cardiomyopathy presents for routine
follow-up. Her ECG shows a regular atrial rate of 88 bpm and a regular ventricular
rate of 42 bpm. The P-waves have no consistent relationship to the QRS complexes.
The QRS complexes are narrow.
Based on Table 1, what is the diagnosis?
A) First-degree AV block
B) Mobitz Type I (Wenckebach)
C) Mobitz Type II
D) Third-degree AV block with junctional escape
[CORRECT] D) Third-degree AV block with junctional escape
Rationale: Complete heart block (third-degree) is characterized by AV dissociation – the
atria and ventricles beat independently. The atrial rate is faster than the ventricular
rate. The narrow QRS indicates the escape rhythm is originating from the junction (AV
node), which is a more stable escape pacemaker than a ventricular escape (which
would be wide). First-degree has no dropped beats. Mobitz I has progressively
lengthening PR intervals. Mobitz II has sudden dropped beats without PR prolongation.
, 4|Page
Question 3
Scenario: Prioritization
You are the charge nurse on a cardiac telemetry unit. You have four patients. Which
patient do you assess FIRST?
• Patient A: 55-year-old male, post-MI day 2. Telemetry shows sinus bradycardia at 52
bpm. He is asymptomatic and sleeping.
• Patient B: 68-year-old female with heart failure. Telemetry shows atrial fibrillation
with a rate of 110 bpm. She reports mild shortness of breath.
• Patient C: 74-year-old male with a history of bifascicular block. Telemetry shows a
sudden change from normal sinus to a wide-complex rhythm at 140 bpm with no
visible P-waves. He is awake but confused.
• Patient D: 62-year-old female post-cardiac surgery. Telemetry shows frequent
premature ventricular contractions (PVCs) at a rate of 8 per minute. She is
asymptomatic.
Which patient do you see first?
A) Patient A
B) Patient B
C) Patient C
D) Patient D
[CORRECT] C) Patient C
Rationale: Patient C has new-onset monomorphic ventricular tachycardia (wide-
complex, no P-waves, rate 140) with signs of hemodynamic instability (confusion). This
is a life-threatening arrhythmia requiring immediate intervention (cardioversion or
antiarrhythmic therapy). Patient B is stable with A-fib and mild symptoms. Patient A is
stable bradycardia. Patient D has PVCs which, while requiring monitoring, are not
immediately life-threatening in an asymptomatic patient.
Question 4
A 45-year-old female with no significant medical history presents with episodes of
sudden palpitations that start and stop abruptly. During an episode in the emergency
