Hyperkalemia will cause which of the following 6.

Which of the following would NOT be a sign

EKG changes? of a pulmonary embolus?

A. Depressed ST segment A. Large S wave in lead I

B. Peaked T wave B. Prolonged PR interval in lead II

C. Shortened QRS complex C. Deep Q wave in lead III

D. Presence of U wave D. Inverted T wave in lead III

2. Hypocalcemia can cause which of the 7. Which of the following dysrhythmias would
following EKG changes? be a significant indicator for a pulmonary
embolus?
A. Prolonged QT interval
A. Sinus tachycardia
B. Elevated ST segment
B. Complete heart block
C. Increased PR interval
C. Ventricular tachycardia
D. Depressed T wave
D. Wenckebach
3. Which of the following dysrhythmias would
most likely be caused by hypermagnesemia? 8. Emphysema causes several changes on the
EKG due to which of the following?
A. Premature ventricular contractions
A. Increased mucous production
B. Ventricular tachycardia
B. Loss of defense mechanisms
C. Torsades de pointes
C. Change in position of the diaphragm
D. Complete heart block
D. Increased number of alveoli
4. A J wave (Osborn wave) is associated with
which of the following processes? 9. Which of the following is a true statement
regarding cor pulmonale?
A. Subarachnoid hemorrhage
A. Cor pulmonale is a form of left-sided heart
B. Hyperkalemia
failure.
C. Hypothermia
B. Cor pulmonale is caused by gastric disease
D. Heart transplant processes.

5. Which of the following will cause deeply C. Cor pulmonale causes pulmonary edema.
inverted T waves?
D. Cor pulmonale is a consequence of
A. Subarachnoid hemorrhage pulmonary disease.

B. Hyperkalemia 10. Pericarditis will mimic signs of which of the

following on the 12-lead EKG?
C. Hypothermia
A. Massive pulmonary embolus
D. Heart transplant
B. Extended myocardial infarction
C. Advanced subarachnoid hemorrhage C. biphasic P wave.

D. Extreme hyperkalemia D. prolonged PR interval.

11. Which of the following is a known cause of Electrocardiogram is a diagnostic test that
sudden death in young athletes? checks for

A. Brugada syndrome A. fluid overload in the circulatory system.

B. Wellens syndrome B. electrical conduction problems of the heart.

C. Pericarditis C. carotid artery plaque.

D. Idiopathic hypertrophic subaortic stenosis D. heart chamber atrophy.

12. Which of the following is the cause of pacer 2. Einthoven had his participants immerse their
spikes being seen without a QRS limbs into which solution to help

complex? record the heart’s impulses?

A. Pacer failure to pace A. Hydrogen peroxide

B. Pacer failure to capture B. Betadine

C. Pacer oversensing C. Salt solution

D. Pacer undersensing D. Tap water

13. A biventricular pacemaker is used to treat 3. The letters assigned to the waves and
which of the following? segments as determined by Einthoven and

A. Heart failure still used in EKG today are

B. Ventricular tachycardia A. A, B, C, D, E

C. Torsades de pointes B. M, N, O, P, Q

D. Pulmonary hypertension C. P, Q, R, S, T

14. A patient with a heart transplant will have D. S, T, U, V, W

two:
4. The term dysrhythmia refers to
A. S waves
A. abnormal electrical impulses of the heart.
B. T waves
B. any cardiac disease or condition.
C. R waves
C. a pacemaker device.
D. P waves
D. a device that measures heart activity.
15. Digitalis toxicity will cause:
5. EKG is used to diagnose
A. peaked T waves.
A. Ludwig angina.
B. depressed ST segment.
B. Jugular venous distention.
C. Compartment syndrome. following symptoms would the physician feel
that an EKG would assist in his diagnosis?
D. Pericarditis.
A. Ringing in the ears
1. Which of the following is a correct definition
of a rhythm strip? B. Shortness of breath

A. A special test that involves 12 views of the C. One leg swelling

heart’s electrical activity
D. Increased salivation
B. A tool that can be used to definitively
6. The term pericarditis would mean that the
diagnose a myocardial infarction
patient’s heart:
C. A designated view of the heart that is used to
A. had inflammation to the sac surrounding it.
monitor rate and rhythm
B. had a lack of blood flow to the arteries
D. A translation of the contraction of each of
feeding it.
the chambers of the heart
C. was not pumping effectively to produce good
2. Einthoven assigned which of the following
cardiac output.
letters to denote each of the
D. was too thick or enlarged to beat efficiently.
waveforms found on an EKG tracing?
7. Which of the following would most likely be
A. A, B, C, D, E
able to legally interpret an EKG
B. L, M, N, O, P
tracing for diagnostic purposes?
C. U, V, W, X, Y
A. EKG technician
D. P, Q, R, S, T
B. Registered Nurse
3. An abnormal heart rhythm is known as a/an:
C. Physician
A. dysrhythmia.
D. Paramedic
B. monorhythmia.
8. The apex of the heart is located on the:
C. transrhythmia.
A. top of the heart.
D. polyrhythmia.
B. left side of the heart.
4. Tachycardia is a term that means:
C. bottom of the heart.
A. a slow heart rate.
D. right side of the heart.
B. extra beats that occur.
9. Which of the following is a true statement
C. a fast heart rate. regarding the myocardial layer of

D. the loss of beats. the heart?

5. A patient is seeing his physician for multiple A. It is the innermost layer made up of
complaints. For which of the endothelium and connective tissue.
B. The main coronary arteries are located in this A. Heart rate of 42
area.
B. Blood pressure of 140/54
C. It is continuous with the interior layer of the
C. Heart rate of 120
vessels.
D. Blood pressure of 182/112
D. It is the thick, muscular layer consisting of
cardiac muscle fiber. 15. Carotid sinus massage might be utilized in
which of the following circumstances?
10. The tricuspid valve lies between the:
A. Slow heart rates
A. right atrium and right ventricle.
B. Rapid heart rates
B. left atrium and left ventricle.
C. Increased blood pressure
C. pulmonary artery and right ventricle.
D. Decreased blood pressure
D. left ventricle and the aorta.
16. Which of the following is the correct
11. When blood flows backward due to a
sequence of the cardiac cycle?
dysfunctional heart valve, this is known as:
A. Isovolumetric ventricular contraction,
A. valvular stenosis.
ventricular ejection, ventricular filling,
B. valvular prolapse.
isovolumetric relaxation
C. valvular regurgitation.
B. Isovolumetric relaxation, ventricular filling,
D. valvular inversion. ventricular ejection, isovolumetric

12. An S3 heart sound is: ventricular contraction

A. considered to be normal in older people. C. Ventricular ejection, isovolumetric relaxation,

ventricular filling, isovolumetric
B. the normal first heart sound in the cycle.
ventricular contraction
C. occurs due to closure of the aortic valve.
D. Ventricular filling, isovolumetric ventricular
D. can be associated with heart failure.
contraction, ventricular ejection, isovolumetric
13. Which of the following would be considered relaxation
to be a positive chronotropic response?
17. Which of the following would indicate a
A. Heart rate of 42 normal ejection fraction?

B. Blood pressure of 140/54 A. 60%

C. Heart rate of 120 B. 45%

D. Blood pressure of 182/112 C. 30%

14. The parasympathetic nervous system would D. 20%

exert which of the following
18. Which of the following is the correct
responses in the heart? formula utilized for cardiac output?
A. Cardiac output = stroke volume × ejection C. extra contractions are occurring within the
fraction heart muscle.

B. Cardiac output = heart rate × blood pressure D. fewer contractions are occurring within the
heart muscle.
C. Cardiac output = stroke volume × heart rate
22. The term “refractoriness” relates to the
D. Cardiac output = blood pressure × ejection
cardiac cycle in which of the following
fraction
ways?
19. Which of the following is the correct
definition for the term “automaticity”? A. This is the same as contractility.

A. Ability of the pacemaker cells to create an B. This coincides with conductivity.

electrical impulse without nerve
C. This is related to unresponsiveness to stimuli.
stimulation
D. This is the ability to create an impulse.
B. Ability of the cardiac muscle cells to respond
23. Which of the following presents the correct
to chemical, mechanical, and
normal electrical pathway of an
electrical stimulation
electrical impulse?
C. Ability to receive an electrical impulse and
A. AV node, bundle of His, SA node, bundle
transmit it to another cardiac cell
branches, Purkinje fibers
D. Ability of the cardiac muscle to contract after
B. SA node, bundle of His, bundle branches, AV
receiving an electrical impulse
node, Purkinje fibers
20. When the movement of electrolytes across
C. Purkinje fibers, bundle branches, bundle of
cell membranes causes the inside
His, AV node, SA node
of the cell to become more positive, this
D. SA node, AV node, bundle of His, bundle
translates to:
branches, Purkinje fibers
A. an isoelectric line on the EKG.
24. Which of the following parts of the electrical
B. a spike or positive wave on the EKG. pathway is considered to be a

C. a negative deflection on the EKG. protective device during rapid atrial rates such
as atrial fibrillation?
D. a biphasic waveform on the EKG.
A. SA node
21. PEA or Pulseless Electrical Activity is seen on
the EKG recording when: B. AV node

A. only mechanical activity is occurring within C. Bundle of His

the heart muscle.
D. Purkinje fibers
B. only electrical activity occurs within the heart
25. Wolff-Parkinson-White (WPW) syndrome
muscle.
occurs due to which of the following

abnormal cardiac impulses?

A. Enhanced automaticity C. Palpating the pulse

B. Retrograde conduction D. Percussing the back

C. Escape rhythms 30. Which of the following actions should be

taken when baseline issues are seen
D. Reentry rhythms
on the EKG?
26. Which of the following would be an example
of triggered activity? A. Reposition the electrodes

A. Ventricular fibrillation B. Check for electrical interference

B. Supraventricular tachycardia C. Connect electrodes wires to appropriate

electrodes
C. Premature atrial contractions
D. Reapply disconnected electrode wires
D. Atrioventricular blocks
31. Which of the following electrolyte
27. Which of the following best describes a 12-
abnormalities might create a false alarm
lead EKG?
reading?
A. It is displayed on a cardiac monitor.
A. Hyperkalemia
B. It uses only the bipolar leads.
B. Hypermagnesemia
C. Electrodes are placed on the chest only.
C. Hypernatremia
D. It provides a complete picture of the
electrical activity. D. Hyperchloremia

28. The EASI system is a: 32. Each large box on the special EKG paper is
equal to:
A. way to remember how to attach three leads
for monitoring. A. 0.04 seconds.

B. form of the five electrode system so that 12 B. 0.20 seconds.

leads can be monitored.
C. 0.30 seconds.
C. particular form of color coding of the
D. 0.60 seconds.
electrodes.
33. Which of the following is a true statement
D. system that can be used in place of a
regarding a bipolar lead?
conventional 12-lead EKG.
A. A bipolar lead has both a negative and a
29. If a patient is exhibiting premature
positive electrode.
ventricular contractions on the EKG, which
B. Lead aVR is an example of a bipolar lead.
of the following would be an important clinical
aspect of assessing the patient? C. Lead augmented vector foot is an example of
a bipolar lead.
A. Auscultating the lungs
D. A bipolar lead uses the heart as a relative
B. Visualizing the neck area
negative electrode.
34. Einthoven’s triangle is created by the: C. fourth intercostal space to the left of the
sternum.
A. unipolar leads.
D. fifth intercostal space at the right
B. horizontal leads.
midclavicular line.
C. vertical leads.
38. Lead V8 would be placed correctly on the
D. bipolar leads. fifth intercostal space:

35. Lead II would be created by placing the A. midaxillary line.

electrodes in which of the following
B. posterior axillary line.
locations?
C. posterior scapular area.
A. Positive electrode to the right leg and
D. border of the spine.
negative electrode to the right arm
39. Which of the following might be used to
B. Positive electrode to the left leg and negative
assist in the detection of bundle
electrode to the left arm
branch blocks?
C. Positive electrode to the right leg and
negative electrode to the left arm A. Right chest leads

D. Positive electrode to the left leg and negative B. Posterior leads

electrode to the right arm
C. Modified chest leads
36. For Lead V2, the positive electrode is placed
D. Horizontal leads
at the:
40. Depolarization of the atria is seen with
A. fourth intercostal space to the right of the
which of the following?
sternum.
A. P wave
B. fourth intercostal space to the left of the
sternum. B. Q wave
C. fifth intercostal space at the midclavicular C. R wave
line.
D. T wave
D. fifth intercostal space at the anterior axillary
line. 314 EKG for Nursing Demystified

37. Proper placement of the positive electrode 41. Which of the following is a true statement
in order to view Lead V4 regarding the QRS complex?

R is: A. All three wave forms are always present in

the QRS complex.
A. fourth intercostal space to the right of the
sternum. B. A Q, R, or S wave that has an amplitude
below 5 mm is denoted with a small
B. fifth intercostal space to the right of the
sternum. case letter.
C. A notched R wave is known as an R prime and B. Rhythm regularity
is noted as a change in direction.
C. PR interval
D. The highest amplitude for the R wave should
D. QRS width
be in lead V1.
47. Using the small box method, what would
42. Which of the following might be a cause of
the heart rate be if there were 15 small squares
poor R wave progression?
in between each R wave?
A. Cholecystitis
A. 20 beats per minute
B. Fibromyalgia
B. 60 beats per minute
C. Dextrocardia
C. 80 beats per minute
D. Atrial fibrillation
D. 100 beats per minute
43. T wave inversion might be associated with
48. Which of the following would be indicative
which of the following disease
of a normal sinus rhythm?
processes?
A. Heart rate of 104
A. Hyperkalemia
B. PR interval of 0.24 seconds
B. Myocardial injury
C. QRS interval of 0.40 seconds
C. Pacemakers
D. Presence of ectopic beats
D. Cerebral hemorrhage
49. Which of the following is a true statement
44. The normal PR interval is: regarding axis?

A. 0.02 to 0.06 seconds. A. The mean electrical axis is the opposite

direction in which the electrical axis is
B. 0.04 to 0.20 seconds.
traveling.
C. 0.12 to 0.20 seconds.
B. In the hexaxial reference system, the upper
D. 0.36 to 0.44 seconds.
segments represent negative
45. A prolonged QT interval can place the
degrees.
patient at risk for which of the following?
C. Normally the mean electrical axis should fall
A. Torsades de pointes
within the scope of +180o to −90o.
B. First-degree AV block
D. In right axis deviation the axis would
C. Atrial fibrillation correspond to −90o to 0o on the reference
system.
D. Supraventricular tachycardia
50. Which of the following readings on the EKG
46. Calipers would be used to assist in would indicate a left axis deviation?
determining which of the following?
A. Lead I positive, lead aVF positive
A. Heart rate
B. Lead I negative, lead aVF positive C. The width will be greater than 0.12 seconds.

C. Lead I negative, lead aVF negative D. An S prime will occur.

D. Lead I positive, lead aVF negative 55. In which of the following leads will a left
bundle branch block be represented?
51. Which type of axis deviation might be most
commonly associated with A. Leads V1

pregnancy? and V2

A. Left axis deviation B. Leads II and III

B. Right axis deviation C. Leads I and aVR

C. Extreme right axis deviation D. Leads V5 and V6

D. No axis deviation 56. Which of the following disease processes is

most difficult to determine when a patient
52. Which of the following is a true statement
presents with a left bundle branch block?
regarding the difference between
A. Acute myocardial infarction
hypertrophy and enlargement?
B. Second-degree AV block
A. Enlargement reflects an expansion of actual
muscle mass. C. Right ventricular hypertrophy

B. Hypertrophy can be caused by hypertension. D. Hypokalemia

C. Aortic insufficiency could be a cause of 57. The Valsalva maneuver would create which
hypertrophy. of the following actions?

D. The term enlargement is most commonly A. Increase the heart rate

used to describe the ventricles.
B. Slow the heart rate
53. Right atrial enlargement would be seen in
C. Create premature beats
which parts of the following
D. Decrease premature beats
waveforms?
58. Which of the following heart rates would be
A. Downstroke of the P wave
considered to be bradycardic in
B. Height of the QRS
an infant?
C. Upswing of the P wave
A. 140 beats per minute
D. Length of the QRS
B. 120 beats per minute
54. A complete bundle branch block would have
C. 110 beats per minute
which of the following characteristics on the
QRS complex? D. 80 beats per minute
A. The Q wave will be deeper.

B. The height will be increased.

59. When a child is in a situation that is taxing to B. Noncompensatory pause
the heart, which of the following will occur in
C. Regular rhythm
order to attempt to increase cardiac output?
D. Wide QRS
A. Increase stroke volume
64. What is the term that is used when a
B. Decrease heart rate
premature ventricular contraction occurs
C. Increase heart rate
on every third beat?
D. Decrease stroke volume
A. Bigeminy
60. Which patient population would normally
B. Trigeminy
exhibit sinus arrhythmia associated with
respiratory rate? C. Quadrigeminy
A. Pregnant patients D. Coupling
B. Children 65. Which of the following is the determining
characteristic for multifocal atrial tachycardia?
C. Senior adults
A. Changing configurations of the P wave
D. Middle aged adults
B. Prolonged PR interval
61. When escape beats occur due to a
bradycardia, which of the following is the C. Widened QRS complex
best treatment? D. Rate greater than 100 beats per minute
A. Provide treatment to speed up the heart rate 66. The bundle of Kent is significant in which of
the following types of tachydysrhythmias?
B. Administer medication to eradicate the extra
beats A. Wolff-Parkinson-White (WPW) syndrome
C. No treatment is necessary at this time B. Multifocal atrial tachycardia
D. Stabilize the patient with beta blockers C. Wandering atrial pacemaker
62. Another term for sick sinus syndrome is: D. Sinus tachycardia
A. sinus arrest. 67. Which of the following are important
aspects of care with the administration
B. AV nodal dysfunction.
of adenosine (Adenocard)?
C. brady-tachy syndrome.
A. Initiate intravenous access in the right
D. sinus arrhythmia.
antecubital space.
63. Which of the following would be
B. Administer this medication slowly over at
characteristic on the EKG for a premature
least 5 minutes.
atrial contraction (PAC)?
C. Patients with Wolff-Parkinson-White (WPW)
A. No P waves present syndrome can receive this medication.
D. Watch for the development of rapid atrial D. 100 to 150 beats per minute.
fibrillation or atrial flutter.
72. The term “multifocal PVCs” means that
68. Which of the following is a correct premature ventricular contractions:
statement when administering synchronized
A. have differing configurations.
cardioversion?
B. are occurring from multiple sites.
A. Synchronized cardioversion is utilized for the
treatment of unstable ventricular tachycardia. C. have a uniform appearance.
B. When using synchronized cardioversion, D. are occurring from the same site.
press the “shock” buttons quickly.
73. Which of the following can occur with R on T
C. Medication patches on the patient’s chest are phenomenon?
a problem with this procedure.
A. Ventricular tachycardia
D. The patient should be on the main cardiac
monitor only for this procedure. B. Third-degree AV block

69. Which of the following is the best C. Atrial fibrillation

explanation for the loss of cardiac output for D. Sinus tachycardia
the patient with atrial fibrillation? 74. Which of the following provides the correct
A. Increase in stroke volume answer for the 5 H’s associated

B. Loss of atrial kick with pulseless electrical activity (PEA)?

C. Lengthened depolarization A. Hypervolemia, Hypoxia, Hypothermia,

Hypokalemia, Hydrogen ion (acidosis)
D. Prolonged T wave
B. Hypovolemia, Hypoxia, Hyperthermia,
70. Which of the following is usually seen on the Hyperkalemia, Hydrogen ion (alkalosis)
EKG for a patient with atrial
C. Hypovolemia, Hypoxia, Hyperthermia,
fibrillation? Hyperkalemia, Hydrogen ion (acidosis)
A. Sawtooth pattern D. Hypervolemia, Hyperoxia, Hyperthermia,
Hyperkalemia, Hydrogen ion (acidosis)
B. Lengthened PR interval
75. Which of the following would indicate
C. Widened QRS
mechanical capture of a pacemaker?
D. Loss of P waves
A. Palpable pulse
71. The normal rate for a junctional rhythm
B. Pacer spike
would most likely be:
C. QRS complex
A. 60 to 100 beats per minute.
D. P wave
B. 20 to 40 beats per minute.
76. Which of the following are associated with
C. 40 to 60 beats per minute.
torsades de pointes (TdP)?
A. Monomorphic morphology D. Reciprocal changes appear in the true area of
infarction.
B. Prolonged QT interval
81. Which of the following leads would indicate
C. QRS complexes with uniform height
damage to the lateral aspect of
D. Widened QRS complexes
the heart?
77. Which of the following would have a
A. Leads II, III, aVF
progressive lengthening of the PR interval with
a subsequent dropped QRS complex? B. Leads I, II, III

A. First-degree AV block C. Leads V1, V2, V3, V4

B. Mobitz type I AV block D. Leads I, aVL, V5, V6

C. Mobitz type II AV block 82. The main portion of the right coronary
artery supplies the:
D. Complete AV block
A. interventricular septum.
78. Patients with Prinzmetal’s angina will
usually have episodes: B. SA node.

A. with extreme activity or emotional upset. C. right ventricle.

B. from midnight to 8 o’clock in the morning. D. left atrium.

C. with depressed ST segments. 83. Which of the following biomarkers will stay
elevated for a longer period of time?
D. from atherosclerotic heart disease.
A. CK-MB
79. Which of the following would indicate an
injury pattern on an EKG? B. Myoglobin

A. Depressed T wave C. Troponin

B. Pathologic Q wave D. Creatinine kinase

C. Presence of a J wave 84. Which of the following electrolyte

depletions can cause a patient to be
D. Elevated ST segment
predisposed to torsades de pointes (TdP)?
80. Which of the following is a true statement
A. Phosphorus
regarding reciprocal changes?
B. Sodium
A. Reciprocal changes are a mirror image of the
injury site. C. Chloride

B. Reciprocal changes are seen as ST segment D. Magnesium

elevation.
85. A patient with a subarachnoid hemorrhage
C. Reciprocal changes are present in leads that might be most likely to present
are next to the area of infarction.
with which of the following?
A. Deeply inverted T waves

B. Prolonged PR interval

C. Very wide QRS complexes

D. Biphasic P wave