1
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Basic Arrhythmias With 12-Lead
EKGs– Test Bank
Edition/Reference: 9th Edition
Chapter Units
1. Electrophysiology
2. Waves and Measurements
3. Analyzing EKG Rhythm Strips
4. Sinus Rhythms
5. Atrial Rhythms
6. Junctional Rhythms
7. Heart Blocks
8. Ventricular Rhythms
9. Practice Makes Perfect
10. Final Challenge
, 3
Electrophysiology
1. What best describes cardiac automaticity? [Electrophysiology Focus 1]
A. Ability of specialized cells to initiate an impulse without outside stimulation
B. Ability of ventricles to depolarize simultaneously
C. Ability of pacemaker cells to shorten refractory period at will
D. Ability of myocardial cells to contract in response to pressure
✅ Correct Answer: Ability of specialized cells to initiate an impulse without
outside stimulation
Rationale: Automaticity allows pacemaker tissues—primarily the SA node—to
generate impulses intrinsically. This drives baseline rhythm even without neural
input. This item targets electrophysiology interpretation competency with scenario
variant 1.
DIF: Moderate
TOP: Electrophysiology - Core Concept
MSC: Cognitive
2. On ECG paper at 25 mm/sec, one small box equals: [Electrophysiology
Focus 2]
A. 0.10 sec
B. 0.20 sec
C. 0.02 sec
D. 0.04 sec
✅ Correct Answer: 0.04 sec
Rationale: At 25 mm/sec, each 1 mm small box corresponds to 0.04 seconds; one
large box equals 0.20 seconds. This item targets electrophysiology interpretation
competency with scenario variant 1.
, 4
DIF: Easy
TOP: Electrophysiology - Measurement
MSC: Cognitive
3. A systematic rhythm-strip method should begin with: [Electrophysiology
Focus 3]
A. Axis calculation only
B. ST segment analysis first
C. Rate and regularity assessment
D. QT correction before rhythm ID
✅ Correct Answer: Rate and regularity assessment
Rationale: Reliable interpretation starts with ventricular rate and rhythm regularity,
then proceeds to P waves, intervals, and QRS morphology. This item targets
electrophysiology interpretation competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Analysis Method
MSC: Application
4. Which ECG feature supports sinus rhythm? [Electrophysiology Focus 4]
A. Absent P waves
B. Every P followed by QRS with consistent PR
C. Wide QRS >0.14 sec mandatory
D. Irregularly irregular rhythm
✅ Correct Answer: Every P followed by QRS with consistent PR
, 5
Rationale: Sinus rhythm requires organized atrial depolarization from the SA node
and consistent AV conduction. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Sinus Criteria
MSC: Cognitive
5. Atrial fibrillation classically shows: [Electrophysiology Focus 5]
A. No distinct P waves and irregularly irregular R-R
B. Regular narrow-complex tachycardia
C. P before each QRS
D. Sawtooth flutter waves with fixed block
✅ Correct Answer: No distinct P waves and irregularly irregular R-R
Rationale: Chaotic atrial activity in AF prevents organized P waves and leads to
irregular ventricular response. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Atrial Rhythm
MSC: Cognitive
6. Expected intrinsic junctional escape rate is: [Electrophysiology Focus 6]
A. 60–100 bpm
B. >100 bpm
C. 20–40 bpm
D. 40–60 bpm
✅ Correct Answer: 40–60 bpm
, 6
Rationale: AV junction pacemaker cells typically discharge at 40–60 bpm when
higher pacemakers fail. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Junctional Rate
MSC: Cognitive
7. First-degree AV block is identified by: [Electrophysiology Focus 7]
A. Complete AV dissociation
B. Dropped QRS complexes
C. Progressive PR then drop
D. PR >0.20 sec with all beats conducted
✅ Correct Answer: PR >0.20 sec with all beats conducted
Rationale: First-degree block is delayed AV conduction, not intermittent or
complete non-conduction. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Heart Block
MSC: Cognitive
8. A premature ventricular complex (PVC) appears as: [Electrophysiology
Focus 8]
A. Early narrow QRS with P
B. Early wide bizarre QRS without preceding sinus P
C. Late normal QRS
D. Regular sawtooth pattern
, 7
✅ Correct Answer: Early wide bizarre QRS without preceding sinus P
Rationale: PVCs originate in ventricles, producing premature wide complexes and
altered repolarization pattern. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Ventricular Rhythm
MSC: Cognitive
9. In a six-second strip, 8 QRS complexes correspond to: [Electrophysiology
Focus 9]
A. 60 bpm
B. 72 bpm
C. 80 bpm
D. 48 bpm
✅ Correct Answer: 80 bpm
Rationale: Six-second method multiplies observed QRS count by 10; therefore 8 ×
10 = 80 bpm. This item targets electrophysiology interpretation competency with
scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Rate Calculation
MSC: Application
10. For pulseless ventricular fibrillation, immediate priority is:
[Electrophysiology Focus 10]
A. Synchronized cardioversion
B. Observation
, 8
C. Adenosine
D. Defibrillation with high-quality CPR
✅ Correct Answer: Defibrillation with high-quality CPR
Rationale: VF is a shockable cardiac arrest rhythm. Rapid defibrillation plus CPR
is essential for survival. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Moderate
TOP: Electrophysiology - Resuscitation
MSC: Application
11. What best describes cardiac automaticity? [Electrophysiology Focus 11]
A. Ability of pacemaker cells to shorten refractory period at will
B. Ability of myocardial cells to contract in response to pressure
C. Ability of specialized cells to initiate an impulse without outside stimulation
D. Ability of ventricles to depolarize simultaneously
✅ Correct Answer: Ability of specialized cells to initiate an impulse without
outside stimulation
Rationale: Automaticity allows pacemaker tissues—primarily the SA node—to
generate impulses intrinsically. This drives baseline rhythm even without neural
input. This item targets electrophysiology interpretation competency with scenario
variant 2.
DIF: Moderate
TOP: Electrophysiology - Core Concept
MSC: Cognitive
, 2
Basic Arrhythmias With 12-Lead
EKGs– Test Bank
Edition/Reference: 9th Edition
Chapter Units
1. Electrophysiology
2. Waves and Measurements
3. Analyzing EKG Rhythm Strips
4. Sinus Rhythms
5. Atrial Rhythms
6. Junctional Rhythms
7. Heart Blocks
8. Ventricular Rhythms
9. Practice Makes Perfect
10. Final Challenge
, 3
Electrophysiology
1. What best describes cardiac automaticity? [Electrophysiology Focus 1]
A. Ability of specialized cells to initiate an impulse without outside stimulation
B. Ability of ventricles to depolarize simultaneously
C. Ability of pacemaker cells to shorten refractory period at will
D. Ability of myocardial cells to contract in response to pressure
✅ Correct Answer: Ability of specialized cells to initiate an impulse without
outside stimulation
Rationale: Automaticity allows pacemaker tissues—primarily the SA node—to
generate impulses intrinsically. This drives baseline rhythm even without neural
input. This item targets electrophysiology interpretation competency with scenario
variant 1.
DIF: Moderate
TOP: Electrophysiology - Core Concept
MSC: Cognitive
2. On ECG paper at 25 mm/sec, one small box equals: [Electrophysiology
Focus 2]
A. 0.10 sec
B. 0.20 sec
C. 0.02 sec
D. 0.04 sec
✅ Correct Answer: 0.04 sec
Rationale: At 25 mm/sec, each 1 mm small box corresponds to 0.04 seconds; one
large box equals 0.20 seconds. This item targets electrophysiology interpretation
competency with scenario variant 1.
, 4
DIF: Easy
TOP: Electrophysiology - Measurement
MSC: Cognitive
3. A systematic rhythm-strip method should begin with: [Electrophysiology
Focus 3]
A. Axis calculation only
B. ST segment analysis first
C. Rate and regularity assessment
D. QT correction before rhythm ID
✅ Correct Answer: Rate and regularity assessment
Rationale: Reliable interpretation starts with ventricular rate and rhythm regularity,
then proceeds to P waves, intervals, and QRS morphology. This item targets
electrophysiology interpretation competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Analysis Method
MSC: Application
4. Which ECG feature supports sinus rhythm? [Electrophysiology Focus 4]
A. Absent P waves
B. Every P followed by QRS with consistent PR
C. Wide QRS >0.14 sec mandatory
D. Irregularly irregular rhythm
✅ Correct Answer: Every P followed by QRS with consistent PR
, 5
Rationale: Sinus rhythm requires organized atrial depolarization from the SA node
and consistent AV conduction. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Sinus Criteria
MSC: Cognitive
5. Atrial fibrillation classically shows: [Electrophysiology Focus 5]
A. No distinct P waves and irregularly irregular R-R
B. Regular narrow-complex tachycardia
C. P before each QRS
D. Sawtooth flutter waves with fixed block
✅ Correct Answer: No distinct P waves and irregularly irregular R-R
Rationale: Chaotic atrial activity in AF prevents organized P waves and leads to
irregular ventricular response. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Atrial Rhythm
MSC: Cognitive
6. Expected intrinsic junctional escape rate is: [Electrophysiology Focus 6]
A. 60–100 bpm
B. >100 bpm
C. 20–40 bpm
D. 40–60 bpm
✅ Correct Answer: 40–60 bpm
, 6
Rationale: AV junction pacemaker cells typically discharge at 40–60 bpm when
higher pacemakers fail. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Junctional Rate
MSC: Cognitive
7. First-degree AV block is identified by: [Electrophysiology Focus 7]
A. Complete AV dissociation
B. Dropped QRS complexes
C. Progressive PR then drop
D. PR >0.20 sec with all beats conducted
✅ Correct Answer: PR >0.20 sec with all beats conducted
Rationale: First-degree block is delayed AV conduction, not intermittent or
complete non-conduction. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Heart Block
MSC: Cognitive
8. A premature ventricular complex (PVC) appears as: [Electrophysiology
Focus 8]
A. Early narrow QRS with P
B. Early wide bizarre QRS without preceding sinus P
C. Late normal QRS
D. Regular sawtooth pattern
, 7
✅ Correct Answer: Early wide bizarre QRS without preceding sinus P
Rationale: PVCs originate in ventricles, producing premature wide complexes and
altered repolarization pattern. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Ventricular Rhythm
MSC: Cognitive
9. In a six-second strip, 8 QRS complexes correspond to: [Electrophysiology
Focus 9]
A. 60 bpm
B. 72 bpm
C. 80 bpm
D. 48 bpm
✅ Correct Answer: 80 bpm
Rationale: Six-second method multiplies observed QRS count by 10; therefore 8 ×
10 = 80 bpm. This item targets electrophysiology interpretation competency with
scenario variant 1.
DIF: Easy
TOP: Electrophysiology - Rate Calculation
MSC: Application
10. For pulseless ventricular fibrillation, immediate priority is:
[Electrophysiology Focus 10]
A. Synchronized cardioversion
B. Observation
, 8
C. Adenosine
D. Defibrillation with high-quality CPR
✅ Correct Answer: Defibrillation with high-quality CPR
Rationale: VF is a shockable cardiac arrest rhythm. Rapid defibrillation plus CPR
is essential for survival. This item targets electrophysiology interpretation
competency with scenario variant 1.
DIF: Moderate
TOP: Electrophysiology - Resuscitation
MSC: Application
11. What best describes cardiac automaticity? [Electrophysiology Focus 11]
A. Ability of pacemaker cells to shorten refractory period at will
B. Ability of myocardial cells to contract in response to pressure
C. Ability of specialized cells to initiate an impulse without outside stimulation
D. Ability of ventricles to depolarize simultaneously
✅ Correct Answer: Ability of specialized cells to initiate an impulse without
outside stimulation
Rationale: Automaticity allows pacemaker tissues—primarily the SA node—to
generate impulses intrinsically. This drives baseline rhythm even without neural
input. This item targets electrophysiology interpretation competency with scenario
variant 2.
DIF: Moderate
TOP: Electrophysiology - Core Concept
MSC: Cognitive
