Cardiac Dysrhythmias NCLEX Exam
2026/2027 | 105 Questions with Answers &
Rationales | ECG Interpretation, Atrial
Fibrillation, ACLS Rhythm Recognition
Description:
Master cardiac dysrhythmias for NCLEX success. 105 evidence-based questions covering
ECG interpretation, atrial fibrillation, ventricular tachycardia, pacemakers, ACLS
medications, and case studies. Each answer includes a detailed clinical rationale updated for
2026/2027 AHA guidelines.
Download the complete examination bank now and pass your cardiac nursing certification on the
first attempt.
, Cardiac Dysrhythmias NCLEX Exam 2026
Advanced Cardiac Dysrhythmias: Nursing Assessment & Management Examination
Section 1: Electrocardiogram Interpretation
1. A nurse assesses a client’s electrocardiogram (ECG) tracing and notes that not all QRS
complexes are preceded by a P wave. How should the nurse interpret this finding?
A. The client has hyperkalemia causing irregular QRS complexes.
B. Ventricular tachycardia is overriding the normal atrial rhythm.
C. The chest leads are not making sufficient contact with the skin.
D. Ventricular and atrial depolarizations are initiated from different sites.
Answer: D
Explanation: In normal sinus rhythm, each QRS complex is preceded by a P wave, indicating
that depolarization originates from the sinoatrial node. The presence of QRS complexes without
a preceding P wave suggests that an ectopic focus (e.g., ventricular or junctional) has initiated
depolarization. This finding is not specific to hyperkalemia, ventricular tachycardia, or lead
detachment.
2. A nurse evaluates a client’s ECG strip and observes an underlying regular sinus rhythm
with occasional widened QRS complexes that lack preceding P waves. How should the
nurse document this rhythm?
A. Ventricular tachycardia
B. Ventricular fibrillation
C. Sinus rhythm with premature atrial contractions (PACs)
D. Sinus rhythm with premature ventricular contractions (PVCs)
Answer: D
Explanation: Sinus rhythm with premature ventricular contractions (PVCs) appears as an
underlying regular sinus rhythm with intermittent wide QRS complexes (>0.12 seconds) that are
, not preceded by P waves. Ventricular tachycardia would show a run of three or more PVCs
without underlying sinus beats. PACs have a normal QRS width and are preceded by an early P
wave.
Section 2: Bradycardia Management
3. A nurse cares for a client with a heart rate of 56 beats/min and no adverse symptoms.
Which activity modification should the nurse suggest to prevent further heart rate
reduction?
A. “Make sure your bath water is warm.”
B. “Avoid straining while having a bowel movement.”
C. “Limit caffeinated drinks to one per day.”
D. “Avoid strenuous exercise, such as running.”
Answer: B
Explanation: Straining during a bowel movement triggers a Valsalva maneuver, which increases
vagal tone and can further slow the heart rate. In a client with asymptomatic bradycardia, this
response is undesirable. Warm water, caffeine reduction, and avoiding strenuous exercise are not
directly related to vagal-mediated bradycardia.
4. A telemetry nurse assesses a client with a heart rate of 35 beats/min on the cardiac
monitor. Which assessment should the nurse complete next?
A. Pulmonary auscultation
B. Pulse strength and amplitude
C. Level of consciousness
D. Mobility and gait stability
Answer: C
Explanation: A heart rate of 40 beats/min or less can compromise cerebral perfusion, leading to
dizziness, confusion, or syncope. The priority assessment is level of consciousness to detect
, inadequate cerebral blood flow. Other assessments are relevant but secondary to neurologic
status in this context.
5. A nurse performs an admission assessment on a 75-year-old client with multiple chronic
diseases. Vital signs are blood pressure 135/75 mm Hg and oxygen saturation 94% on 2 L
nasal cannula. The cardiac monitor shows a regular rhythm with a heart rate of 42
beats/min. What action should the nurse take first?
A. Begin external temporary pacing.
B. Assess peripheral pulse strength.
C. Ask the client what medications he or she takes.
D. Administer 1 mg of atropine.
Answer: C
Explanation: The client is stable (asymptomatic bradycardia), so immediate intervention is not
required. Bradycardia in older adults with multiple chronic diseases is often medication-induced
(e.g., beta-blockers, calcium channel blockers, digoxin). The nurse should first obtain a
medication history. Pacing and atropine are reserved for symptomatic bradycardia.
6. A nurse cares for a client with a temporary intravenous pacemaker for bradycardia. The
ECG shows a pacing spike followed by no QRS complex. What action should the nurse
take next?
A. Administer intravenous diltiazem.
B. Assess vital signs and level of consciousness.
C. Administer sublingual nitroglycerin.
D. Assess capillary refill and temperature.
Answer: B
Explanation: A pacing spike without a subsequent QRS complex indicates loss of capture
(failure to depolarize the ventricles). The nurse must immediately assess for cardiac output by
measuring vital signs and level of consciousness. This determines if the client is
2026/2027 | 105 Questions with Answers &
Rationales | ECG Interpretation, Atrial
Fibrillation, ACLS Rhythm Recognition
Description:
Master cardiac dysrhythmias for NCLEX success. 105 evidence-based questions covering
ECG interpretation, atrial fibrillation, ventricular tachycardia, pacemakers, ACLS
medications, and case studies. Each answer includes a detailed clinical rationale updated for
2026/2027 AHA guidelines.
Download the complete examination bank now and pass your cardiac nursing certification on the
first attempt.
, Cardiac Dysrhythmias NCLEX Exam 2026
Advanced Cardiac Dysrhythmias: Nursing Assessment & Management Examination
Section 1: Electrocardiogram Interpretation
1. A nurse assesses a client’s electrocardiogram (ECG) tracing and notes that not all QRS
complexes are preceded by a P wave. How should the nurse interpret this finding?
A. The client has hyperkalemia causing irregular QRS complexes.
B. Ventricular tachycardia is overriding the normal atrial rhythm.
C. The chest leads are not making sufficient contact with the skin.
D. Ventricular and atrial depolarizations are initiated from different sites.
Answer: D
Explanation: In normal sinus rhythm, each QRS complex is preceded by a P wave, indicating
that depolarization originates from the sinoatrial node. The presence of QRS complexes without
a preceding P wave suggests that an ectopic focus (e.g., ventricular or junctional) has initiated
depolarization. This finding is not specific to hyperkalemia, ventricular tachycardia, or lead
detachment.
2. A nurse evaluates a client’s ECG strip and observes an underlying regular sinus rhythm
with occasional widened QRS complexes that lack preceding P waves. How should the
nurse document this rhythm?
A. Ventricular tachycardia
B. Ventricular fibrillation
C. Sinus rhythm with premature atrial contractions (PACs)
D. Sinus rhythm with premature ventricular contractions (PVCs)
Answer: D
Explanation: Sinus rhythm with premature ventricular contractions (PVCs) appears as an
underlying regular sinus rhythm with intermittent wide QRS complexes (>0.12 seconds) that are
, not preceded by P waves. Ventricular tachycardia would show a run of three or more PVCs
without underlying sinus beats. PACs have a normal QRS width and are preceded by an early P
wave.
Section 2: Bradycardia Management
3. A nurse cares for a client with a heart rate of 56 beats/min and no adverse symptoms.
Which activity modification should the nurse suggest to prevent further heart rate
reduction?
A. “Make sure your bath water is warm.”
B. “Avoid straining while having a bowel movement.”
C. “Limit caffeinated drinks to one per day.”
D. “Avoid strenuous exercise, such as running.”
Answer: B
Explanation: Straining during a bowel movement triggers a Valsalva maneuver, which increases
vagal tone and can further slow the heart rate. In a client with asymptomatic bradycardia, this
response is undesirable. Warm water, caffeine reduction, and avoiding strenuous exercise are not
directly related to vagal-mediated bradycardia.
4. A telemetry nurse assesses a client with a heart rate of 35 beats/min on the cardiac
monitor. Which assessment should the nurse complete next?
A. Pulmonary auscultation
B. Pulse strength and amplitude
C. Level of consciousness
D. Mobility and gait stability
Answer: C
Explanation: A heart rate of 40 beats/min or less can compromise cerebral perfusion, leading to
dizziness, confusion, or syncope. The priority assessment is level of consciousness to detect
, inadequate cerebral blood flow. Other assessments are relevant but secondary to neurologic
status in this context.
5. A nurse performs an admission assessment on a 75-year-old client with multiple chronic
diseases. Vital signs are blood pressure 135/75 mm Hg and oxygen saturation 94% on 2 L
nasal cannula. The cardiac monitor shows a regular rhythm with a heart rate of 42
beats/min. What action should the nurse take first?
A. Begin external temporary pacing.
B. Assess peripheral pulse strength.
C. Ask the client what medications he or she takes.
D. Administer 1 mg of atropine.
Answer: C
Explanation: The client is stable (asymptomatic bradycardia), so immediate intervention is not
required. Bradycardia in older adults with multiple chronic diseases is often medication-induced
(e.g., beta-blockers, calcium channel blockers, digoxin). The nurse should first obtain a
medication history. Pacing and atropine are reserved for symptomatic bradycardia.
6. A nurse cares for a client with a temporary intravenous pacemaker for bradycardia. The
ECG shows a pacing spike followed by no QRS complex. What action should the nurse
take next?
A. Administer intravenous diltiazem.
B. Assess vital signs and level of consciousness.
C. Administer sublingual nitroglycerin.
D. Assess capillary refill and temperature.
Answer: B
Explanation: A pacing spike without a subsequent QRS complex indicates loss of capture
(failure to depolarize the ventricles). The nurse must immediately assess for cardiac output by
measuring vital signs and level of consciousness. This determines if the client is
