1
Relias Prophecy General ICU RN A V3 Actual
Exam 2026/2027 | Verified Questions with
Detailed Answers and Rationales | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Rhythm Identification
Q17: A rhythm strip shows a regular rhythm at a rate of 55 bpm. P waves are present, upright in
lead II, and have a normal shape. The PR interval is 0.16 seconds. The QRS complex is 0.08
seconds. This rhythm is:
A. Sinus arrhythmia
B. Sinus bradycardia [CORRECT]
C. Junctional rhythm
D. First-degree AV block
Correct Answer: B
Rationale: Sinus bradycardia meets all criteria for normal sinus rhythm except the rate is less
than 60 bpm. P waves are normal, distinguishing it from junctional rhythms.
Q18: A patient's rhythm strip shows a normal sinus rhythm baseline, but there is a premature beat
with a P wave that differs in shape from the sinus P waves. The QRS complex is narrow. This
premature beat is a:
A. Premature ventricular contraction (PVC)
B. Premature junctional contraction (PJC)
C. Premature atrial contraction (PAC) [CORRECT]
D. Escape beat
Correct Answer: C
,2
Rationale: PACs are characterized by a P wave that looks different from the sinus P wave (non-
conducted or conducted) and a narrow QRS. PVCs have wide QRS. PJCs have inverted or absent
P waves.
Q19: A rhythm strip demonstrates a heart rate of 88 bpm. The R-R intervals vary by more than
0.12 seconds (3 small boxes), corresponding with the patient's respiratory cycle. P waves are
normal. This is:
A. Wandering atrial pacemaker
B. Sinus arrhythmia [CORRECT]
C. Atrial fibrillation
D. Multifocal atrial tachycardia
Correct Answer: B
Rationale: Sinus arrhythmia is a normal variant where the heart rate increases with inspiration
and decreases with expiration, causing irregular R-R intervals while maintaining normal P
waves.
Q20: A rhythm strip shows a regular rhythm with a heart rate of 160 bpm. P waves are present
but difficult to distinguish as they may be hidden in the preceding T waves. The QRS is narrow
(0.08 sec). This rhythm is:
A. Sinus tachycardia
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia (PSVT) [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: PSVT (SVT) is a regular, narrow-complex tachycardia usually between 150-250 bpm.
Sinus tachycardia rarely exceeds 150 bpm in adults and has clear P waves. VT is wide complex.
,3
Q21: A rhythm strip shows P waves of varying morphologies (at least 3 distinct shapes) with
irregular R-R intervals and a heart rate of 110 bpm. This rhythm is:
A. Wandering atrial pacemaker
B. Multifocal atrial tachycardia (MAT) [CORRECT]
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: B
Rationale: MAT is characterized by discrete P waves of at least 3 different shapes, irregular
rhythm, and rate >100 bpm. Option A has rate <100. Option C has no discernible P waves.
Q22: A patient is in a rhythm with wide QRS complexes (>0.12 sec) at a rate of 30 bpm. There
are no P waves visible. The rhythm is regular. This is:
A. Junctional rhythm
B. Idioventricular rhythm [CORRECT]
C. Third-degree heart block
D. Ventricular tachycardia
Correct Answer: B
Rationale: Idioventricular rhythm is an escape rhythm originating in the ventricles, characterized
by wide QRS complexes, no P waves, and a rate typically 20-40 bpm.
Q23: A rhythm strip shows wide QRS complexes at a rate of 110 bpm. The morphology of the
QRS complexes constantly changes (twists around the baseline). This is:
A. Monomorphic ventricular tachycardia
B. Polymorphic ventricular tachycardia (Torsades de Pointes) [CORRECT]
C. Ventricular fibrillation
D. Atrial fibrillation with WPW
, 4
Correct Answer: B
Rationale: Torsades de Pointes is a specific type of polymorphic VT where the QRS complexes
appear to twist around the baseline, often associated with a prolonged QT interval.
Q24: A rhythm strip shows a regular rhythm with a rate of 75 bpm. A pacer spike is visible
before each QRS complex, and a P wave is visible before each pacer spike. The pacer spike is
followed by a wide QRS. This indicates:
A. Atrial pacing
B. Ventricular pacing
C. AV sequential pacing (Dual chamber) [CORRECT]
D. Failure to capture
Correct Answer: C
Rationale: AV sequential pacing shows spikes before the P wave (atrial spike) and before the
QRS (ventricular spike), or a P wave followed by a ventricular spike, indicating both chambers
are being paced or sensed/paced. If a P wave precedes the ventricular spike, it is often a tracked
beat (P-synchronous ventricular pacing).
Q25: A patient has a ventricular pacemaker. The rhythm strip shows pacer spikes that are not
followed by a QRS complex. This is an example of:
A. Failure to sense
B. Failure to capture [CORRECT]
C. Failure to pace
D. Undersensing
Correct Answer: B
Rationale: Failure to capture occurs when the pacemaker fires (spike visible) but the heart does
not depolarize (no QRS follows the spike).
Relias Prophecy General ICU RN A V3 Actual
Exam 2026/2027 | Verified Questions with
Detailed Answers and Rationales | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Rhythm Identification
Q17: A rhythm strip shows a regular rhythm at a rate of 55 bpm. P waves are present, upright in
lead II, and have a normal shape. The PR interval is 0.16 seconds. The QRS complex is 0.08
seconds. This rhythm is:
A. Sinus arrhythmia
B. Sinus bradycardia [CORRECT]
C. Junctional rhythm
D. First-degree AV block
Correct Answer: B
Rationale: Sinus bradycardia meets all criteria for normal sinus rhythm except the rate is less
than 60 bpm. P waves are normal, distinguishing it from junctional rhythms.
Q18: A patient's rhythm strip shows a normal sinus rhythm baseline, but there is a premature beat
with a P wave that differs in shape from the sinus P waves. The QRS complex is narrow. This
premature beat is a:
A. Premature ventricular contraction (PVC)
B. Premature junctional contraction (PJC)
C. Premature atrial contraction (PAC) [CORRECT]
D. Escape beat
Correct Answer: C
,2
Rationale: PACs are characterized by a P wave that looks different from the sinus P wave (non-
conducted or conducted) and a narrow QRS. PVCs have wide QRS. PJCs have inverted or absent
P waves.
Q19: A rhythm strip demonstrates a heart rate of 88 bpm. The R-R intervals vary by more than
0.12 seconds (3 small boxes), corresponding with the patient's respiratory cycle. P waves are
normal. This is:
A. Wandering atrial pacemaker
B. Sinus arrhythmia [CORRECT]
C. Atrial fibrillation
D. Multifocal atrial tachycardia
Correct Answer: B
Rationale: Sinus arrhythmia is a normal variant where the heart rate increases with inspiration
and decreases with expiration, causing irregular R-R intervals while maintaining normal P
waves.
Q20: A rhythm strip shows a regular rhythm with a heart rate of 160 bpm. P waves are present
but difficult to distinguish as they may be hidden in the preceding T waves. The QRS is narrow
(0.08 sec). This rhythm is:
A. Sinus tachycardia
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia (PSVT) [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: PSVT (SVT) is a regular, narrow-complex tachycardia usually between 150-250 bpm.
Sinus tachycardia rarely exceeds 150 bpm in adults and has clear P waves. VT is wide complex.
,3
Q21: A rhythm strip shows P waves of varying morphologies (at least 3 distinct shapes) with
irregular R-R intervals and a heart rate of 110 bpm. This rhythm is:
A. Wandering atrial pacemaker
B. Multifocal atrial tachycardia (MAT) [CORRECT]
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: B
Rationale: MAT is characterized by discrete P waves of at least 3 different shapes, irregular
rhythm, and rate >100 bpm. Option A has rate <100. Option C has no discernible P waves.
Q22: A patient is in a rhythm with wide QRS complexes (>0.12 sec) at a rate of 30 bpm. There
are no P waves visible. The rhythm is regular. This is:
A. Junctional rhythm
B. Idioventricular rhythm [CORRECT]
C. Third-degree heart block
D. Ventricular tachycardia
Correct Answer: B
Rationale: Idioventricular rhythm is an escape rhythm originating in the ventricles, characterized
by wide QRS complexes, no P waves, and a rate typically 20-40 bpm.
Q23: A rhythm strip shows wide QRS complexes at a rate of 110 bpm. The morphology of the
QRS complexes constantly changes (twists around the baseline). This is:
A. Monomorphic ventricular tachycardia
B. Polymorphic ventricular tachycardia (Torsades de Pointes) [CORRECT]
C. Ventricular fibrillation
D. Atrial fibrillation with WPW
, 4
Correct Answer: B
Rationale: Torsades de Pointes is a specific type of polymorphic VT where the QRS complexes
appear to twist around the baseline, often associated with a prolonged QT interval.
Q24: A rhythm strip shows a regular rhythm with a rate of 75 bpm. A pacer spike is visible
before each QRS complex, and a P wave is visible before each pacer spike. The pacer spike is
followed by a wide QRS. This indicates:
A. Atrial pacing
B. Ventricular pacing
C. AV sequential pacing (Dual chamber) [CORRECT]
D. Failure to capture
Correct Answer: C
Rationale: AV sequential pacing shows spikes before the P wave (atrial spike) and before the
QRS (ventricular spike), or a P wave followed by a ventricular spike, indicating both chambers
are being paced or sensed/paced. If a P wave precedes the ventricular spike, it is often a tracked
beat (P-synchronous ventricular pacing).
Q25: A patient has a ventricular pacemaker. The rhythm strip shows pacer spikes that are not
followed by a QRS complex. This is an example of:
A. Failure to sense
B. Failure to capture [CORRECT]
C. Failure to pace
D. Undersensing
Correct Answer: B
Rationale: Failure to capture occurs when the pacemaker fires (spike visible) but the heart does
not depolarize (no QRS follows the spike).
