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EXAM 1: DYSRHYTHMIAS (NCLEX) EXAM
COMPREHENSIVE QUESTIONS WITH MULTIPLE
CHOICES |VERIFIED & REVISED ANSWERS (NEW) 2025-
2026, ALREADY GRADED A+
1. A client’s ECG shows a heart rate of 48 bpm, regular rhythm, P wave
before each QRS, PR interval normal, QRS normal. Which
dysrhythmia does this represent?
a) Atrial fibrillation
b) Normal sinus rhythm
c) Sinus bradycardia
d) Junctional rhythm
Answer: c) Sinus bradycardia
Rationale: Sinus bradycardia = HR <60 bpm, normal rhythm, normal
intervals. Seen in athletes, vagal stimulation, or beta-blocker use.
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2. A patient presents with irregularly irregular rhythm, no visible P
waves, and narrow QRS complexes. What is the most likely rhythm?
a) Atrial flutter
b) Atrial fibrillation
c) Ventricular tachycardia
d) Sinus tachycardia
Answer: b) Atrial fibrillation
Rationale: A-fib is characterized by absent P waves and irregularly irregular
ventricular response. Risk: stroke → anticoagulation therapy.
3. Which ECG finding is typical of atrial flutter?
a) Wide QRS with no P waves
b) Sawtooth flutter waves
c) Irregularly irregular baseline
d) ST segment elevation
Answer: b) Sawtooth flutter waves
Rationale: Atrial flutter produces sawtooth F-waves, usually at a 2:1 or 3:1
conduction ratio to ventricles.
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4. A patient in the ICU has ventricular tachycardia without a pulse.
What is the nurse’s priority action?
a) Administer amiodarone IV
b) Defibrillate immediately
c) Start CPR and give atropine
d) Give supplemental oxygen and monitor
Answer: b) Defibrillate immediately
Rationale: Pulseless VT = treat as cardiac arrest → CPR + rapid
defibrillation.
5. A patient with third-degree (complete) heart block will typically
require which intervention?
a) Beta-blocker
b) Pacemaker insertion
c) IV magnesium
d) Defibrillation
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Answer: b) Pacemaker insertion
Rationale: In complete heart block, atria and ventricles beat independently.
Definitive treatment = permanent pacemaker.
6. Which medication is most commonly used to treat supraventricular
tachycardia (SVT) acutely?
a) Amiodarone
b) Adenosine
c) Epinephrine
d) Digoxin
Answer: b) Adenosine
Rationale: Adenosine briefly blocks AV node conduction → can terminate
SVT. Rapid IV push followed by saline flush.
7. Which ECG characteristic defines ventricular fibrillation (V-fib)?
a) Regular narrow QRS
b) Sawtooth flutter waves
c) Chaotic, wavy baseline with no QRS
d) ST segment depression
EXAM 1: DYSRHYTHMIAS (NCLEX) EXAM
COMPREHENSIVE QUESTIONS WITH MULTIPLE
CHOICES |VERIFIED & REVISED ANSWERS (NEW) 2025-
2026, ALREADY GRADED A+
1. A client’s ECG shows a heart rate of 48 bpm, regular rhythm, P wave
before each QRS, PR interval normal, QRS normal. Which
dysrhythmia does this represent?
a) Atrial fibrillation
b) Normal sinus rhythm
c) Sinus bradycardia
d) Junctional rhythm
Answer: c) Sinus bradycardia
Rationale: Sinus bradycardia = HR <60 bpm, normal rhythm, normal
intervals. Seen in athletes, vagal stimulation, or beta-blocker use.
,2|Page
2. A patient presents with irregularly irregular rhythm, no visible P
waves, and narrow QRS complexes. What is the most likely rhythm?
a) Atrial flutter
b) Atrial fibrillation
c) Ventricular tachycardia
d) Sinus tachycardia
Answer: b) Atrial fibrillation
Rationale: A-fib is characterized by absent P waves and irregularly irregular
ventricular response. Risk: stroke → anticoagulation therapy.
3. Which ECG finding is typical of atrial flutter?
a) Wide QRS with no P waves
b) Sawtooth flutter waves
c) Irregularly irregular baseline
d) ST segment elevation
Answer: b) Sawtooth flutter waves
Rationale: Atrial flutter produces sawtooth F-waves, usually at a 2:1 or 3:1
conduction ratio to ventricles.
,3|Page
4. A patient in the ICU has ventricular tachycardia without a pulse.
What is the nurse’s priority action?
a) Administer amiodarone IV
b) Defibrillate immediately
c) Start CPR and give atropine
d) Give supplemental oxygen and monitor
Answer: b) Defibrillate immediately
Rationale: Pulseless VT = treat as cardiac arrest → CPR + rapid
defibrillation.
5. A patient with third-degree (complete) heart block will typically
require which intervention?
a) Beta-blocker
b) Pacemaker insertion
c) IV magnesium
d) Defibrillation
, 4|Page
Answer: b) Pacemaker insertion
Rationale: In complete heart block, atria and ventricles beat independently.
Definitive treatment = permanent pacemaker.
6. Which medication is most commonly used to treat supraventricular
tachycardia (SVT) acutely?
a) Amiodarone
b) Adenosine
c) Epinephrine
d) Digoxin
Answer: b) Adenosine
Rationale: Adenosine briefly blocks AV node conduction → can terminate
SVT. Rapid IV push followed by saline flush.
7. Which ECG characteristic defines ventricular fibrillation (V-fib)?
a) Regular narrow QRS
b) Sawtooth flutter waves
c) Chaotic, wavy baseline with no QRS
d) ST segment depression
