Advanced Dysrhythmias Exam 2026/2027 – Full 75 MCQs
Advanced Cardiac Dysrhythmias Comprehensive Examination | Core Domains:
Electrocardiogram (ECG/EKG) Fundamentals & Interpretation, Sinus, Atrial, Junctional & Ventricular
Rhythms, Atrioventricular (AV) Blocks & Conduction Disorders, Pacemaker & ICD Rhythms, Acute &
Chronic Management of Dysrhythmias, Pharmacologic & Electrical Therapies (Antiarrhythmics,
Cardioversion, Defibrillation), and Clinical Correlation & Patient Assessment | Critical Care &
Cardiology Nursing Focus | Advanced Dysrhythmia Certification Exam Format
Exam Structure
The Advanced Dysrhythmias Exam for the 2026/2027 certification cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Advanced Dysrhythmias Exam guide for the 2026/2027 cycle prepares healthcare professionals for
advanced competency in cardiac rhythm analysis and management. The content focuses on the
interpretation of complex dysrhythmias, differentiation of lethal from non-lethal rhythms, and the
application of appropriate pharmacologic and interventional treatments based on current evidence-based
guidelines and ACLS protocols.
Answer Format
All correct answers and rhythm interpretations must be presented in bold and green, followed by
detailed rationales that analyze ECG components (rate, rhythm, P waves, PR interval, QRS complex),
identify key diagnostic features, explain underlying pathophysiology, and justify the corresponding
clinical management strategy.
1. ECG shows regular saw-tooth flutter waves at 300/min, 2:1 conduction, narrow QRS.
Diagnosis?
A. Atrial fibrillation
B. Atrial flutter
C. SVT
D. VT
Correct: B. Atrial flutter
Classic “saw-tooth” F waves, atrial rate 250-350/min, fixed 2:1 AV conduction.
2. Rhythm strip: ventricular rate 38, P independent of QRS, PR varies, QRS 0.08 s. Block?
,A. 1° AVB
B. 2° type I
C. 2° type II
D. 3° AVB
Correct: D. 3° AVB
AV dissociation with atrial rate > ventricular rate and narrow escape indicates complete heart block.
3. Ventricular rhythm 180, wide bizarre QRS, no P waves, concordant upward V1-V6.
Rhythm?
A. SVT with aberrancy
B. VT
C. Antidromic AVRT
D. Hyperkalemia
Correct: B. VT
Wide-complex tachycardia >150 with concordant QRS in precordial leads favors VT (Brugada sign).
4. ECG: irregularly irregular narrow QRS, no discrete P, ventricular response 130.
Management?
A. Adenosine 12 mg
B. Diltiazem bolus
C. Synchronized cardioversion
D. Amiodarone 150 mg
Correct: B. Diltiazem bolus
Hemodynamically stable AF with rapid ventricular response: rate control with CCB/BB first-line.
5. Polymorphic wide QRS alternating axis, QT 560 ms, rate 220. Immediate action?
A. Magnesium 2 g IV
B. Adenosine
C. Lidocaine
D. Procainamide
Correct: A. Magnesium 2 g IV
Torsades de pointes; prolonged QT → magnesium is ACLS drug of choice.
6. Pacemaker spikes precede each narrow QRS at 60/min; no native P waves.
Interpretation?
A. AAI pacing
B. VVI pacing
C. DDD pacing
D. Epicardial VT
Correct: B. VVI pacing
Ventricular-paced rhythm (spike → wide or narrow QRS) at set rate; no atrial activity implies
single-chamber ventricular pacing.
, 7. ECG: grouped beating, PR lengthens then dropped QRS, cycle repeats. Diagnosis?
A. 2° type I AVB
B. 2° type II AVB
C. Non-conducted PACs
D. 3° AVB
Correct: A. 2° type I AVB
Wenckebach pattern: progressive PR prolongation until a QRS is dropped; usually benign.
8. Narrow-complex tachycardia 190, regular, P visible after QRS (RP < PR). Likely
mechanism?
A. Typical AVNRT
B. Orthodromic AVRT
C. Atypical AVNRT
D. Sinus tach
Correct: A. Typical AVNRT
Short RP tachycardia with RP < PR favors typical (slow-fast) AVNRT; vagal maneuvers first.
9. ECG shows regular wide QRS 140, RBBB pattern, capture/fusion beats visible. Rhythm?
A. SVT with RBBB
B. VT
C. Antidromic AVRT
D. Aberrancy
Correct: B. VT
Capture/fusion beats are pathognomonic for VT in wide-complex tachycardia.
10. ICD interrogation: 5 episodes VF 250-260 J successfully delivered. Patient
asymptomatic. Action?
A. Replace ICD generator
B. Start amiodarone
C. Check electrolytes & meds
D. Program VT zone higher
Correct: C. Check electrolytes & meds
Rule out reversible triggers (hypokalemia, drugs, ischemia) before device or drug changes.
11. Sinus rhythm 70, PR 0.36 s, QRS 0.08 s. No symptoms. Management?
A. Permanent pacemaker
B. Atropine
C. Observation
D. Isoproterenol
Correct: C. Observation
1° AVB is benign; no therapy unless symptoms or progression.
12. ECG: irregular wide QRS 120-180, Ashman beats, underlying AF. Cause?
Advanced Cardiac Dysrhythmias Comprehensive Examination | Core Domains:
Electrocardiogram (ECG/EKG) Fundamentals & Interpretation, Sinus, Atrial, Junctional & Ventricular
Rhythms, Atrioventricular (AV) Blocks & Conduction Disorders, Pacemaker & ICD Rhythms, Acute &
Chronic Management of Dysrhythmias, Pharmacologic & Electrical Therapies (Antiarrhythmics,
Cardioversion, Defibrillation), and Clinical Correlation & Patient Assessment | Critical Care &
Cardiology Nursing Focus | Advanced Dysrhythmia Certification Exam Format
Exam Structure
The Advanced Dysrhythmias Exam for the 2026/2027 certification cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Advanced Dysrhythmias Exam guide for the 2026/2027 cycle prepares healthcare professionals for
advanced competency in cardiac rhythm analysis and management. The content focuses on the
interpretation of complex dysrhythmias, differentiation of lethal from non-lethal rhythms, and the
application of appropriate pharmacologic and interventional treatments based on current evidence-based
guidelines and ACLS protocols.
Answer Format
All correct answers and rhythm interpretations must be presented in bold and green, followed by
detailed rationales that analyze ECG components (rate, rhythm, P waves, PR interval, QRS complex),
identify key diagnostic features, explain underlying pathophysiology, and justify the corresponding
clinical management strategy.
1. ECG shows regular saw-tooth flutter waves at 300/min, 2:1 conduction, narrow QRS.
Diagnosis?
A. Atrial fibrillation
B. Atrial flutter
C. SVT
D. VT
Correct: B. Atrial flutter
Classic “saw-tooth” F waves, atrial rate 250-350/min, fixed 2:1 AV conduction.
2. Rhythm strip: ventricular rate 38, P independent of QRS, PR varies, QRS 0.08 s. Block?
,A. 1° AVB
B. 2° type I
C. 2° type II
D. 3° AVB
Correct: D. 3° AVB
AV dissociation with atrial rate > ventricular rate and narrow escape indicates complete heart block.
3. Ventricular rhythm 180, wide bizarre QRS, no P waves, concordant upward V1-V6.
Rhythm?
A. SVT with aberrancy
B. VT
C. Antidromic AVRT
D. Hyperkalemia
Correct: B. VT
Wide-complex tachycardia >150 with concordant QRS in precordial leads favors VT (Brugada sign).
4. ECG: irregularly irregular narrow QRS, no discrete P, ventricular response 130.
Management?
A. Adenosine 12 mg
B. Diltiazem bolus
C. Synchronized cardioversion
D. Amiodarone 150 mg
Correct: B. Diltiazem bolus
Hemodynamically stable AF with rapid ventricular response: rate control with CCB/BB first-line.
5. Polymorphic wide QRS alternating axis, QT 560 ms, rate 220. Immediate action?
A. Magnesium 2 g IV
B. Adenosine
C. Lidocaine
D. Procainamide
Correct: A. Magnesium 2 g IV
Torsades de pointes; prolonged QT → magnesium is ACLS drug of choice.
6. Pacemaker spikes precede each narrow QRS at 60/min; no native P waves.
Interpretation?
A. AAI pacing
B. VVI pacing
C. DDD pacing
D. Epicardial VT
Correct: B. VVI pacing
Ventricular-paced rhythm (spike → wide or narrow QRS) at set rate; no atrial activity implies
single-chamber ventricular pacing.
, 7. ECG: grouped beating, PR lengthens then dropped QRS, cycle repeats. Diagnosis?
A. 2° type I AVB
B. 2° type II AVB
C. Non-conducted PACs
D. 3° AVB
Correct: A. 2° type I AVB
Wenckebach pattern: progressive PR prolongation until a QRS is dropped; usually benign.
8. Narrow-complex tachycardia 190, regular, P visible after QRS (RP < PR). Likely
mechanism?
A. Typical AVNRT
B. Orthodromic AVRT
C. Atypical AVNRT
D. Sinus tach
Correct: A. Typical AVNRT
Short RP tachycardia with RP < PR favors typical (slow-fast) AVNRT; vagal maneuvers first.
9. ECG shows regular wide QRS 140, RBBB pattern, capture/fusion beats visible. Rhythm?
A. SVT with RBBB
B. VT
C. Antidromic AVRT
D. Aberrancy
Correct: B. VT
Capture/fusion beats are pathognomonic for VT in wide-complex tachycardia.
10. ICD interrogation: 5 episodes VF 250-260 J successfully delivered. Patient
asymptomatic. Action?
A. Replace ICD generator
B. Start amiodarone
C. Check electrolytes & meds
D. Program VT zone higher
Correct: C. Check electrolytes & meds
Rule out reversible triggers (hypokalemia, drugs, ischemia) before device or drug changes.
11. Sinus rhythm 70, PR 0.36 s, QRS 0.08 s. No symptoms. Management?
A. Permanent pacemaker
B. Atropine
C. Observation
D. Isoproterenol
Correct: C. Observation
1° AVB is benign; no therapy unless symptoms or progression.
12. ECG: irregular wide QRS 120-180, Ashman beats, underlying AF. Cause?
