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SECTION 1 – Rhythm Identification & Analysis (Questions 1–25)
1. The rhythm strip shows a regular rhythm at a rate of 58 bpm. Each QRS complex
(0.08 sec) is preceded by a normal, upright P wave with a consistent PR interval
of 0.18 sec. No ectopic beats are present.
What is the correct rhythm interpretation?
A. Normal sinus rhythm
B. Sinus bradycardia
C. First-degree AV block
D. Sinus arrhythmia
Correct Answer: B
Rationale: Rate < 60 bpm with otherwise normal sinus morphology defines sinus
bradycardia; PR is constant and within normal limits, ruling out blocks.
2. The strip reveals an irregularly irregular rhythm at a ventricular rate of 110–130
bpm. No distinct P waves are seen; baseline shows fine oscillations. QRS
complexes are narrow (0.08 sec).
What is the correct rhythm interpretation?
A. Atrial flutter
B. Sinus tachycardia
C. Atrial fibrillation
D. Multifocal atrial tachycardia
Correct Answer: C
Rationale: Irregularly irregular ventricular response with absent P waves and
fibrillatory baseline is diagnostic of atrial fibrillation.
3. The rhythm is regular at 150 bpm. Saw-tooth flutter waves are seen best in lead II
at a rate of 300 bpm; QRS is narrow (0.06 sec) and 2:1 conduction is present.
What is the correct rhythm interpretation?
A. Atrial fibrillation
B. Atrial flutter
, C. SVT
D. Ventricular tachycardia
Correct Answer: B
Rationale: Classic saw-tooth flutter waves with 2:1 block producing 150 bpm
ventricular response identifies atrial flutter.
4. The strip shows a regular rhythm at 100 bpm. Each P wave is upright and
consistent with a PR interval of 0.14 sec; QRS is 0.08 sec.
What is the correct rhythm interpretation?
A. Normal sinus rhythm
B. Sinus tachycardia
C. Sinus bradycardia
D. Junctional rhythm
Correct Answer: B
Rationale: Rate 100–160 bpm with normal sinus morphology is sinus
tachycardia.
5. The rhythm is regular at 38 bpm. P waves are upright and precede each QRS; PR
0.16 sec; QRS 0.10 sec.
What is the correct rhythm interpretation?
A. Junctional bradycardia
B. Sinus bradycardia
C. Third-degree AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Sinus node origin is confirmed by upright, normal P waves and
constant PR; extreme bradycardia is still sinus bradycardia.
6. The strip shows occasional wide, bizarre QRS complexes (0.14 sec) occurring
early; no preceding P wave; compensatory pause present.
Which finding is most consistent with this dysrhythmia?
A. Premature ventricular contraction
B. Premature atrial contraction
C. Aberrantly conducted PAC
D. Ventricular escape beat
Correct Answer: A
Rationale: Early wide QRS without related P wave and full compensatory pause
defines a PVC.
7. The rhythm is essentially regular at 80 bpm; every third beat is a wide, bizarre
early QRS.
What is the correct interpretation?
A. Bigeminy of PVCs