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Sentara Basic Arrhythmia Exam Study
Guide | 150 Multiple-Choice Q&A with
Clinical Scenarios | Pass Your
Telemetry Certification 2026
QUESTION 1
A 62-year-old male with a history of hypertension presents with palpitations. His ECG
shows a regular rhythm at 76 bpm. There are upright P-waves before every QRS
complex. The PR interval is 0.18 seconds. The QRS duration is 0.10 seconds.
What is the rhythm?
A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) First-degree AV block
[CORRECT] A) Normal sinus rhythm
Rationale: Normal sinus rhythm is defined by a rate of 60–100 bpm, upright P-waves
preceding each QRS, a PR interval of 0.12–0.20 seconds, and a QRS duration <0.12
seconds. This rhythm meets all criteria. Sinus bradycardia would have a rate <60. Sinus
tachycardia would have a rate >100. First-degree AV block would have a PR interval
>0.20 seconds.
QUESTION 2
A 58-year-old female presents with dizziness and fatigue. Her heart rate is 42 bpm.
The ECG shows a regular rhythm with upright P-waves before each QRS. The PR
interval is 0.16 seconds. The QRS is narrow.
What is the rhythm and what is the appropriate initial management?
A) Normal sinus rhythm – no treatment
B) Sinus bradycardia – atropine if symptomatic
C) First-degree AV block – pacemaker
D) Junctional bradycardia – epinephrine
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[CORRECT] B) Sinus bradycardia – atropine if symptomatic
Rationale: Sinus bradycardia is a sinus rhythm with a rate <60 bpm. This patient is
symptomatic (dizziness, fatigue). The initial treatment is atropine 0.5 mg IV if
symptoms are present. Junctional bradycardia would have no P-waves or inverted P-
waves. First-degree AV block would have a prolonged PR interval. Normal sinus rhythm
would have a rate >60.
QUESTION 3
A 45-year-old male with no cardiac history presents with palpitations that started
suddenly while he was resting. His ECG shows a regular, narrow-complex tachycardia
at 180 bpm. No P-waves are visible. His blood pressure is 115/72 mmHg.
What is the most likely rhythm and what is the first-line treatment?
A) Sinus tachycardia – treat underlying anxiety
B) Atrial flutter – start diltiazem
C) AV nodal reentrant tachycardia (AVNRT) – adenosine 6 mg IV push
D) Ventricular tachycardia – amiodarone
[CORRECT] C) AV nodal reentrant tachycardia (AVNRT) – adenosine 6 mg IV
push
Rationale: AVNRT presents with sudden-onset, regular, narrow-complex tachycardia
without visible P-waves. The patient is hemodynamically stable, so adenosine is the
first-line treatment. Sinus tachycardia has a gradual onset and visible P-waves. Atrial
flutter has sawtooth waves. Ventricular tachycardia has wide QRS complexes.
QUESTION 4
Table 1: AV Block Comparison
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Mobitz I Third-
Feature First-Degree Mobitz II
(Wenckebach) Degree
Prolonged, Progressively No
PR Interval Constant
constant lengthens relationship
Dropped Yes Yes (AV
None Yes (grouped)
Beats (sudden) dissociation)
QRS Width Narrow Narrow Often wide Variable
Clinical
Benign Usually benign Dangerous Emergency
Significance
A 70-year-old male presents with "skipped beats." His ECG shows a regular atrial rate
of 80 bpm. The PR interval is 0.18 seconds and constant. Every 4th P-wave is not
followed by a QRS complex. The QRS complexes are wide (0.14 sec).
Based on Table 1, what is the rhythm?
A) First-degree AV block
B) Mobitz Type I (Wenckebach)
C) Mobitz Type II
D) Third-degree AV block
[CORRECT] C) Mobitz Type II
Rationale: Mobitz Type II is characterized by sudden, unexpected dropped QRS
complexes without PR prolongation before the dropped beat. The PR intervals of
conducted beats are constant. The wide QRS suggests the block is infranodal. Mobitz I
would have progressive PR prolongation. Third-degree would have no relationship
between P and QRS.
QUESTION 5
Scenario: Prioritization
You are the charge nurse on a cardiac step-down unit. Which patient do you assess
FIRST?
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Sentara Basic Arrhythmia Exam Study
Guide | 150 Multiple-Choice Q&A with
Clinical Scenarios | Pass Your
Telemetry Certification 2026
QUESTION 1
A 62-year-old male with a history of hypertension presents with palpitations. His ECG
shows a regular rhythm at 76 bpm. There are upright P-waves before every QRS
complex. The PR interval is 0.18 seconds. The QRS duration is 0.10 seconds.
What is the rhythm?
A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) First-degree AV block
[CORRECT] A) Normal sinus rhythm
Rationale: Normal sinus rhythm is defined by a rate of 60–100 bpm, upright P-waves
preceding each QRS, a PR interval of 0.12–0.20 seconds, and a QRS duration <0.12
seconds. This rhythm meets all criteria. Sinus bradycardia would have a rate <60. Sinus
tachycardia would have a rate >100. First-degree AV block would have a PR interval
>0.20 seconds.
QUESTION 2
A 58-year-old female presents with dizziness and fatigue. Her heart rate is 42 bpm.
The ECG shows a regular rhythm with upright P-waves before each QRS. The PR
interval is 0.16 seconds. The QRS is narrow.
What is the rhythm and what is the appropriate initial management?
A) Normal sinus rhythm – no treatment
B) Sinus bradycardia – atropine if symptomatic
C) First-degree AV block – pacemaker
D) Junctional bradycardia – epinephrine
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[CORRECT] B) Sinus bradycardia – atropine if symptomatic
Rationale: Sinus bradycardia is a sinus rhythm with a rate <60 bpm. This patient is
symptomatic (dizziness, fatigue). The initial treatment is atropine 0.5 mg IV if
symptoms are present. Junctional bradycardia would have no P-waves or inverted P-
waves. First-degree AV block would have a prolonged PR interval. Normal sinus rhythm
would have a rate >60.
QUESTION 3
A 45-year-old male with no cardiac history presents with palpitations that started
suddenly while he was resting. His ECG shows a regular, narrow-complex tachycardia
at 180 bpm. No P-waves are visible. His blood pressure is 115/72 mmHg.
What is the most likely rhythm and what is the first-line treatment?
A) Sinus tachycardia – treat underlying anxiety
B) Atrial flutter – start diltiazem
C) AV nodal reentrant tachycardia (AVNRT) – adenosine 6 mg IV push
D) Ventricular tachycardia – amiodarone
[CORRECT] C) AV nodal reentrant tachycardia (AVNRT) – adenosine 6 mg IV
push
Rationale: AVNRT presents with sudden-onset, regular, narrow-complex tachycardia
without visible P-waves. The patient is hemodynamically stable, so adenosine is the
first-line treatment. Sinus tachycardia has a gradual onset and visible P-waves. Atrial
flutter has sawtooth waves. Ventricular tachycardia has wide QRS complexes.
QUESTION 4
Table 1: AV Block Comparison
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Mobitz I Third-
Feature First-Degree Mobitz II
(Wenckebach) Degree
Prolonged, Progressively No
PR Interval Constant
constant lengthens relationship
Dropped Yes Yes (AV
None Yes (grouped)
Beats (sudden) dissociation)
QRS Width Narrow Narrow Often wide Variable
Clinical
Benign Usually benign Dangerous Emergency
Significance
A 70-year-old male presents with "skipped beats." His ECG shows a regular atrial rate
of 80 bpm. The PR interval is 0.18 seconds and constant. Every 4th P-wave is not
followed by a QRS complex. The QRS complexes are wide (0.14 sec).
Based on Table 1, what is the rhythm?
A) First-degree AV block
B) Mobitz Type I (Wenckebach)
C) Mobitz Type II
D) Third-degree AV block
[CORRECT] C) Mobitz Type II
Rationale: Mobitz Type II is characterized by sudden, unexpected dropped QRS
complexes without PR prolongation before the dropped beat. The PR intervals of
conducted beats are constant. The wide QRS suggests the block is infranodal. Mobitz I
would have progressive PR prolongation. Third-degree would have no relationship
between P and QRS.
QUESTION 5
Scenario: Prioritization
You are the charge nurse on a cardiac step-down unit. Which patient do you assess
FIRST?
