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ECG examination

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1. You initiate cardiac monitoring in a patient admitted with an exacerbation of chronic obstructive pulmonary disease. At the beginning of your shift, you print out the rhythm strip above. What's your interpretation of this rhythm?



2. A 68-year-old patient with a history of heart failure is receiving digoxin. At the beginning of your shift, you record the patient's rhythm strip shown above. You interpret this rhythm as

a. junctional tachycardia.

b. wandering pacemaker.

c. sinus tachycardia.


3. A 54-year-old patient is admitted to your unit with an acute MI. While you're assessing him, he tells you that his heart keeps skipping a beat. You record the strip above from his cardiac monitor. What's your interpretation of the rhythm?



4. Following a patient's cardiac catheterization, his cardiac monitor displays the rhythm strip above. How would you interpret the rhythm?



5. A 78-year-old patient is admitted to your unit with dehydration after dosing herself with extra furosemide. Her admission potassium level is 2.5 mEq/liter. You're administering I.V. potassium chloride when you notice the rhythm above on her cardiac monitor. What's your interpretation of this rhythm?



6. You perform synchronized electrical cardioversion on a conscious patient with unstable monomorphic ventricular tachycardia. The monitor suddenly displays the rhythm above. What's your interpretation of this rhythm?



7. The patient recently had a transvenous ventricular pacemaker inserted. You notice this rhythm on the monitor. What does it show?

a. failure to sense

b. oversensing

c. pacemaker-mediated tachycardia


8. A patient returns to your unit from the postanesthesia care unit after undergoing a right lower lobectomy. When you begin cardiac monitoring, you note the rhythm strip above. What's your interpretation of this rhythm?

a. sinus arrhythmia

c. atrial fibrillation

b. atrial flutter

9. A 32-year-old patient with a history of Wolff-Parkinson-White (WPW) syndrome is admitted to your unit following gallbladder surgery. Which of the following ECG characteristics are typical in a patient with WPW syndrome?

a. prolonged PR interval and narrow QRS complex

b. prolonged PR interval and presence of a delta wave

c. widened QRS complex and presence of a delta wave

10. After a patient receives procainamide, his QT interval is prolonged on his rhythm strip. You notify his health care provider immediately because you know that prolongation of the QT interval places the patient at risk for what?

a. atrial fibrillation

b. junctional tachycardia

c. ventricular tachycardia

11. A 36-year-old patient with a history of heart transplantation is admitted to your unit for observation after an appendectomy. If she develops symptomatic bradycardia, which drug is indicated?

a. atropine

b. isoproterenol

c. dobutamine

12. A patient who sustained an acute MI is undergoing a signal-averaged ECG. Why is this test typically ordered?

a. to locate posterior-wall damage

b. to identify whether the patient is at risk for sudden death from sustained ventricular tachycardia

c. to identify whether the patient has suffered damage to his right ventricle

13. You're caring for a 72-year-old patient admitted with unstable angina. He calls you into his room and complains of chest pain that he rates as 8 on a scale of 0 to 10 (10 being the worst). You immediately obtain a 12-lead ECG. Which ECG change would you expect with angina?

a. pathologic Q wave

b. T-wave inversion

c. widened QRS complex

14. A patient's 12-lead ECG reveals left axis deviation, which is considered normal in

a. infants.

b. young adults.

c. pregnant women.

15. A patient comes to the ED after experiencing substernal chest pain for about 4 hours. Which change on the 12-lead ECG is associated with myocardial necrosis?

a. pathologic Q waves

b. T-wave inversion

c. ST-segment elevation

16. When examining your patient's 12-lead ECG, you notice a bundle-branch block. Which leads should you check to determine whether the block is in the right or left bundle?

a. V1 and V6

b. II and aVF

c. V4 and V5


  • 1. The rhythm strip shows atrial flutter (4:1 block).
  • 2. a. The rhythm strip reveals junctional tachycardia.
  • 3. The rhythm strip shows sinus tachycardia with premature ventricular contractions.
  • 4. The rhythm strip shows type I (Mobitz I or Wenckebach) second-degree AV block.
  • 5. The rhythm strip shows ventricular tachycardia (monomorphic).
  • 6. The rhythm strip shows ventricular fibrillation.
  • 7. a. The ECG pacemaker spikes fall where they shouldn't, indicating a failure to sense.
  • 8. c. This rhythm strip reveals atrial fibrillation.
  • 9. c. Wolff-Parkinson-White syndrome causes a shortened PR interval (less than 0.12 second) and a widened QRS complex (greater than 0.12 second). The beginning of the QRS complex may appear slurred. This hallmark sign is called a delta wave.
  • 10. c. Prolongation of the QT interval is a sign that the patient is predisposed to developing ventricular tachycardia.
  • 11. b. Isoproterenol is the drug of choice for treating symptomatic bradycardia in patients who've undergone heart transplantation. The vagal nerve dissection that occurs during heart transplantation surgery renders atropine ineffective in these patients.
  • 12. b. Signal-averaged ECG helps identify patients at risk for sudden death from sustained ventricular tachycardia. The test uses a computer to identify late electrical potentials that can't be detected by a 12-lead ECG.
  • 13. b. Classic ECG changes associated with angina include T-wave inversion, flattened T wave, and ST-segment depression.
  • 14. c. Left axis deviation is a normal finding in pregnant women because the enlarging uterus displaces the diaphragm upward, causing the heart to shift to the left and anteriorly. Right axis deviation may occur as a normal variant in children and young adults.
  • 15. a. The ECG change associated with a necrotic area is a pathologic Q wave. The area of myocardial necrosis is called the zone of infarction. The zone of injury shows up on an ECG as an elevated ST segment. The zone of ischemia is represented by T-wave inversion.
  • 16. a. After you identify a bundle-branch block, examine lead V1, which lies to the right of the heart, and lead V6, which lies to the left of the heart. These leads will tell you if the block is in the right or left bundle.


ECG Interpretation Made Incredibly Easy!, 3rd edition, Springhouse Corp., 2004.
    © 2006 Lippincott Williams & Wilkins, Inc.