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TL;DR

Study cardiac assessment techniques, pathophysiology, and emergency management of cardiovascular conditions. Cardiology is one of the most heavily weighted domains on the NREMT Paramedic Certification.

By Valenke Exam Prep Team·Last updated 2026-06-03

Free Cardiac Rhythms & Dysrhythmias Practice Questions

NREMT Paramedic Certification · Cardiology & Electrophysiology

This module covers Cardiac Rhythms & Dysrhythmias as part of the Cardiology & Electrophysiology section, testing your understanding of core concepts and their practical application.

ExamNREMT Paramedic Certification
Pass Rate67%
Duration150 minutes
ModuleCardiac Rhythms & Dysrhythmias

Why Cardiac Rhythms & Dysrhythmias matters

Cardiac Rhythms & Dysrhythmias is a high-weight exam domain because cardiovascular emergencies are time-critical and require immediate recognition.

Sample Practice Questions (5)

1. A patient with second-degree AV block Type II develops sudden hemodynamic instability with a ventricular rate of 30 bpm. You administer atropine 0.5 mg IV with no effect. What is the MOST appropriate next intervention?

  • Initiate transcutaneous pacing immediately
  • Administer a second dose of atropine 0.5 mg and wait
  • Administer adenosine 6 mg rapid IV push
  • Perform synchronized cardioversion at 100 joules

2. A patient's monitor shows a wide-complex tachycardia where the QRS morphology continuously changes axis, creating a "twisting" appearance around the baseline. The rate is approximately 200 bpm. This rhythm is:

  • Torsades de Pointes (polymorphic VT associated with prolonged QT)
  • Monomorphic ventricular tachycardia
  • Atrial fibrillation with WPW
  • Ventricular fibrillation

3. A cardiac arrest patient has been in asystole for the past 15 minutes despite high-quality CPR and two doses of epinephrine. The monitor appears to show very fine fibrillatory activity. What is the MOST appropriate action?

  • Confirm the rhythm in a second lead; if it remains flat or near-flat, continue treating as asystole
  • Defibrillate immediately as this is fine VF
  • Increase the monitor gain and defibrillate if the amplitude increases
  • Administer amiodarone 300 mg IV for the fibrillatory activity

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4. A patient with a history of implanted pacemaker presents with dizziness and a heart rate of 35 bpm. The monitor shows native P waves at 75 bpm with no pacemaker spikes visible. This indicates:

  • Pacemaker failure to sense and/or capture — the device is not functioning properly
  • The pacemaker is working correctly in demand mode
  • The patient's intrinsic rhythm has overridden the pacemaker
  • Normal pacemaker function with appropriate rate response

5. A patient has a wide-complex regular tachycardia at 150 bpm. You note AV dissociation with more QRS complexes than P waves, fusion beats, and capture beats on the rhythm strip. These findings confirm:

  • Ventricular tachycardia
  • SVT with aberrant conduction
  • Atrial flutter with bundle branch block
  • Accelerated idioventricular rhythm

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Frequently Asked Questions

How many Cardiac Rhythms & Dysrhythmias questions are on the NREMT Paramedic Certification?
The Cardiology & Electrophysiology section, which includes Cardiac Rhythms & Dysrhythmias, typically represents a significant portion of the exam. Focus on understanding core concepts rather than memorizing exact question counts, as the exam uses adaptive testing.
What is the best way to study Cardiac Rhythms & Dysrhythmias?
Use active recall and spaced repetition rather than passive reading. Practice with realistic exam questions, review explanations for both correct and incorrect answers, and focus on understanding the reasoning behind each concept.
Is Cardiac Rhythms & Dysrhythmias one of the harder sections on the exam?
Yes, Cardiac Rhythms & Dysrhythmias is considered one of the more challenging areas because it requires both knowledge recall and clinical reasoning. Many questions present scenarios where you must prioritize interventions, not just identify the correct treatment.