Cardiac HealthStream Telemetry Practice Exam

The main concept is that a junctional rhythm is paced by tissue in the AV junction, which has its own intrinsic firing rate of about 40–60 beats per minute. When the SA node slows or its signal doesn’t reach the ventricles, the AV junction takes over and sets a rhythm in that 40–60 bpm range. On the ECG, P waves may be absent or appear after the QRS, and the QRS is usually narrow because ventricular conduction is intact, reflecting the junctional origin.

That’s why 40–60 bpm is the best answer. A rate of 60–100 bpm is typical for normal sinus rhythm driven by the SA node. A rate of 20–40 bpm points to a slower ventricular escape rhythm, not a junctional rhythm. A rate of 100–150 bpm would indicate accelerated junctional activity or junctional tachycardia, not the standard junctional rhythm.