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HCA Healthcare Telemetry ECG/EKG
Interpretation Exam Questions with Correct
Answers
Question 1: A telemetry nurse is reviewing a continuous ECG strip on a post-
operative client. The rhythm shows a regular rate of 78 beats per minute,
upright P waves preceding every QRS complex with a consistent PR interval of
0.16 seconds, and a QRS duration of 0.08 seconds. Which interpretation is
most accurate?
A. Sinus bradycardia with first-degree AV block
B. Normal sinus rhythm
C. Accelerated idioventricular rhythm
D. Junctional tachycardia
CORRECT ANSWER: B. Normal sinus rhythm
Rationale: A regular rhythm between 60 and 100 beats per minute with upright P
waves before each QRS, a normal PR interval (0.12–0.20 seconds), and a narrow QRS
complex is the definition of normal sinus rhythm.
Question 2: While monitoring a client on a telemetry unit, the nurse observes
a sudden change in the ECG waveform characterized by a chaotic, irregular
baseline with no discernible P waves, QRS complexes, or T waves, and the
client is unresponsive and pulseless. What is the immediate priority action?
A. Administer adenosine 6 mg rapid IV push
B. Begin high-quality CPR and prepare for defibrillation
C. Apply transcutaneous pacing pads
D. Give atropine 1 mg IV
CORRECT ANSWER: B. Begin high-quality CPR and prepare for defibrillation
Rationale: The described rhythm is ventricular fibrillation, a pulseless arrest rhythm
that requires immediate CPR and defibrillation according to ACLS guidelines.
Question 3: A client’s telemetry strip shows a regular ventricular rate of 48
beats per minute with inverted P waves after each QRS complex and a QRS
duration of 0.10 seconds. Which rhythm is present?
A. Sinus bradycardia
B. Junctional escape rhythm
C. Complete heart block
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D. Idioventricular rhythm
CORRECT ANSWER: B. Junctional escape rhythm
Rationale: A rate of 40–60 beats per minute with inverted or absent P waves and a
narrow QRS complex originating from the AV junction is characteristic of a
junctional escape rhythm.
Question 4: The nurse notes a telemetry tracing with a heart rate of 150 beats
per minute, narrow QRS complexes, and no visible P waves. The client reports
palpitations but is hemodynamically stable. Which medication is most
appropriate as a first-line intervention if vagal maneuvers fail?
A. Amiodarone 150 mg IV over 10 minutes
B. Adenosine 6 mg rapid IV push
C. Atropine 1 mg IV
D. Dopamine infusion at 5 mcg/kg/min
CORRECT ANSWER: B. Adenosine 6 mg rapid IV push
Rationale: For stable narrow-complex tachycardia (likely SVT), adenosine is the
preferred pharmacologic agent after vagal maneuvers per ACLS protocol.
Question 5: On a continuous ECG monitor, the nurse observes progressive
lengthening of the PR interval until a QRS complex is dropped, followed by
repetition of the pattern. The client is asymptomatic. How should this rhythm
be interpreted?
A. Second-degree AV block Type I (Wenckebach)
B. Second-degree AV block Type II
C. Third-degree AV block
D. First-degree AV block
CORRECT ANSWER: A. Second-degree AV block Type I (Wenckebach)
Rationale: Progressive PR prolongation culminating in a non-conducted P wave is
the hallmark of Mobitz Type I second-degree AV block.
Question 6: A telemetry strip reveals a regular wide-complex tachycardia at
180 beats per minute with no visible P waves. The client is hypotensive and
diaphoretic. What is the most appropriate immediate intervention?
A. Administer lidocaine 1 mg/kg IV
B. Perform synchronized cardioversion
C. Give adenosine 12 mg rapid IV push
D. Start an amiodarone infusion only
CORRECT ANSWER: B. Perform synchronized cardioversion
Rationale: Unstable wide-complex tachycardia requires immediate synchronized
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cardioversion according to ACLS guidelines.
Question 7: While reviewing a client’s ECG, the nurse identifies a prolonged QT
interval of 0.52 seconds. Which medication currently prescribed places the
client at highest risk for torsades de pointes?
A. Metoprolol
B. Ondansetron
C. Lisinopril
D. Furosemide
CORRECT ANSWER: B. Ondansetron
Rationale: Ondansetron is known to prolong the QT interval and increase the risk of
torsades de pointes, especially when the QT is already prolonged.
Question 8: A client’s telemetry monitor shows an irregularly irregular rhythm
with no discernible P waves and a ventricular rate of 110 beats per minute.
Narrow QRS complexes are present. Which rhythm is displayed?
A. Atrial flutter with variable conduction
B. Atrial fibrillation with rapid ventricular response
C. Multifocal atrial tachycardia
D. Frequent premature atrial contractions
CORRECT ANSWER: B. Atrial fibrillation with rapid ventricular response
Rationale: An irregularly irregular rhythm without P waves and with a rapid
ventricular rate is diagnostic of atrial fibrillation with rapid ventricular response.
Question 9: The nurse observes a telemetry strip with a sawtooth pattern of
flutter waves at a rate of 300 per minute and a ventricular response of 150
beats per minute (2:1 conduction). The client is stable. Which interpretation is
correct?
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. Sinus tachycardia
D. Supraventricular tachycardia
CORRECT ANSWER: B. Atrial flutter with 2:1 conduction
Rationale: Classic “sawtooth” flutter waves at approximately 300/min with a fixed 2:1
ventricular response is characteristic of atrial flutter.
Question 10: A continuous ECG tracing shows a regular rhythm at 40 beats per
minute with wide QRS complexes of 0.14 seconds and no relationship between
P waves and QRS complexes. The client is hypotensive. What is the priority
intervention?
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A. Administer atropine 1 mg IV
B. Prepare for transcutaneous pacing
C. Give adenosine 6 mg rapid IV push
D. Observe and continue monitoring
CORRECT ANSWER: B. Prepare for transcutaneous pacing
Rationale: This description matches complete (third-degree) heart block with a slow
ventricular escape rhythm; unstable clients require immediate pacing.
Question 11: The nurse notes frequent premature ventricular complexes
(PVCs) on a client’s telemetry strip. Which characteristic distinguishes a PVC
from a premature atrial complex?
A. Narrow QRS complex and compensatory pause
B. Wide, bizarre QRS complex and full compensatory pause
C. Inverted P wave before the QRS
D. Shortened PR interval
CORRECT ANSWER: B. Wide, bizarre QRS complex and full compensatory
pause
Rationale: PVCs originate in the ventricles, producing a wide QRS morphology and
typically a full compensatory pause, unlike the narrow QRS of PACs.
Question 12: A client’s ECG shows ST-segment elevation of 3 mm in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
CORRECT ANSWER: B. Right coronary artery
Rationale: ST elevation in the inferior leads (II, III, aVF) most commonly indicates
occlusion of the right coronary artery.
Question 13: While monitoring a client, the nurse observes a rhythm with a
rate of 65 beats per minute, no P waves, and wide QRS complexes of 0.16
seconds that are identical in morphology. Which rhythm is present?
A. Accelerated idioventricular rhythm
B. Ventricular tachycardia
C. Junctional rhythm
D. Complete heart block
CORRECT ANSWER: A. Accelerated idioventricular rhythm
Rationale: A ventricular rhythm between 40 and 100 beats per minute with wide
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HCA Healthcare Telemetry ECG/EKG
Interpretation Exam Questions with Correct
Answers
Question 1: A telemetry nurse is reviewing a continuous ECG strip on a post-
operative client. The rhythm shows a regular rate of 78 beats per minute,
upright P waves preceding every QRS complex with a consistent PR interval of
0.16 seconds, and a QRS duration of 0.08 seconds. Which interpretation is
most accurate?
A. Sinus bradycardia with first-degree AV block
B. Normal sinus rhythm
C. Accelerated idioventricular rhythm
D. Junctional tachycardia
CORRECT ANSWER: B. Normal sinus rhythm
Rationale: A regular rhythm between 60 and 100 beats per minute with upright P
waves before each QRS, a normal PR interval (0.12–0.20 seconds), and a narrow QRS
complex is the definition of normal sinus rhythm.
Question 2: While monitoring a client on a telemetry unit, the nurse observes
a sudden change in the ECG waveform characterized by a chaotic, irregular
baseline with no discernible P waves, QRS complexes, or T waves, and the
client is unresponsive and pulseless. What is the immediate priority action?
A. Administer adenosine 6 mg rapid IV push
B. Begin high-quality CPR and prepare for defibrillation
C. Apply transcutaneous pacing pads
D. Give atropine 1 mg IV
CORRECT ANSWER: B. Begin high-quality CPR and prepare for defibrillation
Rationale: The described rhythm is ventricular fibrillation, a pulseless arrest rhythm
that requires immediate CPR and defibrillation according to ACLS guidelines.
Question 3: A client’s telemetry strip shows a regular ventricular rate of 48
beats per minute with inverted P waves after each QRS complex and a QRS
duration of 0.10 seconds. Which rhythm is present?
A. Sinus bradycardia
B. Junctional escape rhythm
C. Complete heart block
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D. Idioventricular rhythm
CORRECT ANSWER: B. Junctional escape rhythm
Rationale: A rate of 40–60 beats per minute with inverted or absent P waves and a
narrow QRS complex originating from the AV junction is characteristic of a
junctional escape rhythm.
Question 4: The nurse notes a telemetry tracing with a heart rate of 150 beats
per minute, narrow QRS complexes, and no visible P waves. The client reports
palpitations but is hemodynamically stable. Which medication is most
appropriate as a first-line intervention if vagal maneuvers fail?
A. Amiodarone 150 mg IV over 10 minutes
B. Adenosine 6 mg rapid IV push
C. Atropine 1 mg IV
D. Dopamine infusion at 5 mcg/kg/min
CORRECT ANSWER: B. Adenosine 6 mg rapid IV push
Rationale: For stable narrow-complex tachycardia (likely SVT), adenosine is the
preferred pharmacologic agent after vagal maneuvers per ACLS protocol.
Question 5: On a continuous ECG monitor, the nurse observes progressive
lengthening of the PR interval until a QRS complex is dropped, followed by
repetition of the pattern. The client is asymptomatic. How should this rhythm
be interpreted?
A. Second-degree AV block Type I (Wenckebach)
B. Second-degree AV block Type II
C. Third-degree AV block
D. First-degree AV block
CORRECT ANSWER: A. Second-degree AV block Type I (Wenckebach)
Rationale: Progressive PR prolongation culminating in a non-conducted P wave is
the hallmark of Mobitz Type I second-degree AV block.
Question 6: A telemetry strip reveals a regular wide-complex tachycardia at
180 beats per minute with no visible P waves. The client is hypotensive and
diaphoretic. What is the most appropriate immediate intervention?
A. Administer lidocaine 1 mg/kg IV
B. Perform synchronized cardioversion
C. Give adenosine 12 mg rapid IV push
D. Start an amiodarone infusion only
CORRECT ANSWER: B. Perform synchronized cardioversion
Rationale: Unstable wide-complex tachycardia requires immediate synchronized
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cardioversion according to ACLS guidelines.
Question 7: While reviewing a client’s ECG, the nurse identifies a prolonged QT
interval of 0.52 seconds. Which medication currently prescribed places the
client at highest risk for torsades de pointes?
A. Metoprolol
B. Ondansetron
C. Lisinopril
D. Furosemide
CORRECT ANSWER: B. Ondansetron
Rationale: Ondansetron is known to prolong the QT interval and increase the risk of
torsades de pointes, especially when the QT is already prolonged.
Question 8: A client’s telemetry monitor shows an irregularly irregular rhythm
with no discernible P waves and a ventricular rate of 110 beats per minute.
Narrow QRS complexes are present. Which rhythm is displayed?
A. Atrial flutter with variable conduction
B. Atrial fibrillation with rapid ventricular response
C. Multifocal atrial tachycardia
D. Frequent premature atrial contractions
CORRECT ANSWER: B. Atrial fibrillation with rapid ventricular response
Rationale: An irregularly irregular rhythm without P waves and with a rapid
ventricular rate is diagnostic of atrial fibrillation with rapid ventricular response.
Question 9: The nurse observes a telemetry strip with a sawtooth pattern of
flutter waves at a rate of 300 per minute and a ventricular response of 150
beats per minute (2:1 conduction). The client is stable. Which interpretation is
correct?
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. Sinus tachycardia
D. Supraventricular tachycardia
CORRECT ANSWER: B. Atrial flutter with 2:1 conduction
Rationale: Classic “sawtooth” flutter waves at approximately 300/min with a fixed 2:1
ventricular response is characteristic of atrial flutter.
Question 10: A continuous ECG tracing shows a regular rhythm at 40 beats per
minute with wide QRS complexes of 0.14 seconds and no relationship between
P waves and QRS complexes. The client is hypotensive. What is the priority
intervention?
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A. Administer atropine 1 mg IV
B. Prepare for transcutaneous pacing
C. Give adenosine 6 mg rapid IV push
D. Observe and continue monitoring
CORRECT ANSWER: B. Prepare for transcutaneous pacing
Rationale: This description matches complete (third-degree) heart block with a slow
ventricular escape rhythm; unstable clients require immediate pacing.
Question 11: The nurse notes frequent premature ventricular complexes
(PVCs) on a client’s telemetry strip. Which characteristic distinguishes a PVC
from a premature atrial complex?
A. Narrow QRS complex and compensatory pause
B. Wide, bizarre QRS complex and full compensatory pause
C. Inverted P wave before the QRS
D. Shortened PR interval
CORRECT ANSWER: B. Wide, bizarre QRS complex and full compensatory
pause
Rationale: PVCs originate in the ventricles, producing a wide QRS morphology and
typically a full compensatory pause, unlike the narrow QRS of PACs.
Question 12: A client’s ECG shows ST-segment elevation of 3 mm in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
CORRECT ANSWER: B. Right coronary artery
Rationale: ST elevation in the inferior leads (II, III, aVF) most commonly indicates
occlusion of the right coronary artery.
Question 13: While monitoring a client, the nurse observes a rhythm with a
rate of 65 beats per minute, no P waves, and wide QRS complexes of 0.16
seconds that are identical in morphology. Which rhythm is present?
A. Accelerated idioventricular rhythm
B. Ventricular tachycardia
C. Junctional rhythm
D. Complete heart block
CORRECT ANSWER: A. Accelerated idioventricular rhythm
Rationale: A ventricular rhythm between 40 and 100 beats per minute with wide
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