ADVENT HEALTH EKG 2026 COMPLETE
QUESTIONS AND ANSWERS GRADED A+
◉ Junctional Rhythm. Answer: Impulse starts in the AV junction
• P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
◉ Accelerated Junctional Rhythm. Answer: Accelerated Junctional
Same criteria as Junctional Rhythm, except the Ventricular rate is 60-
100
For stable patients: IV access, vagal maneuvers, adenosine, O2, Beta
blockers, calcium channel blockers
◉ Idioventricular Rhythm (IVR). Answer: Impulse originates in the
ventricles
▪ Rhythm: Ventricular is usually regular
▪ Rate: Ventricular between 20-40
▪ QRS: ≥ 0.12
▪ Atrial rate, rhythm, and PRI: N/A
,- Treatment: assess pt, check for DNR in chart, transcutaneous
pacing, atropine. NEVER GIVE ANTI-ARRYTHMICS MEDICATIONS
◉ Accelerated Idioventricular Rhythm. Answer: Follows the same
criteria as IVR, except Ventricular rate is 40-100.
• If no intervention happens, the patient will deteriorate.
- Treatment: assess pt, atropine, transcutaneous pacing. NEVER
GIVE ANTI-ARRHYTHMIC MEDICATIONS
◉ Ventricular Pacing. Answer: • The pacemaker lead is placed in to
right ventricle.
• The pacemaker generator fires an impulse Initiating ventricular
activity.
• The right ventricle will contract first followed by the left ventricle.
This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm, rate,
and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from pacer
spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured from
pacer spike to end
of QRS
, ◉ Atrial-ventricular Pacing. Answer: One pacemaker lead is placed
into the right atria and another is placed into the right
ventricle.
• The pacemaker generator fires an impulse to the atria and then to
the ventricle sequentially
causing atrial then ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P waves
may or may not be seen
(lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
◉ Failure to capture. Answer: A pacer spike note followed by the
appropriate atrial or ventricular response
• Can be a potentially lethal situation!
◉ Failure to pace. Answer: Absence of pacer activity (spikes) when
the pacemaker generator should have fired an impulse.
• Typically seen when the patient's intrinsic heart rate falls less than
the pacemaker's low HR limit and
the pacer fails to fire.
QUESTIONS AND ANSWERS GRADED A+
◉ Junctional Rhythm. Answer: Impulse starts in the AV junction
• P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
◉ Accelerated Junctional Rhythm. Answer: Accelerated Junctional
Same criteria as Junctional Rhythm, except the Ventricular rate is 60-
100
For stable patients: IV access, vagal maneuvers, adenosine, O2, Beta
blockers, calcium channel blockers
◉ Idioventricular Rhythm (IVR). Answer: Impulse originates in the
ventricles
▪ Rhythm: Ventricular is usually regular
▪ Rate: Ventricular between 20-40
▪ QRS: ≥ 0.12
▪ Atrial rate, rhythm, and PRI: N/A
,- Treatment: assess pt, check for DNR in chart, transcutaneous
pacing, atropine. NEVER GIVE ANTI-ARRYTHMICS MEDICATIONS
◉ Accelerated Idioventricular Rhythm. Answer: Follows the same
criteria as IVR, except Ventricular rate is 40-100.
• If no intervention happens, the patient will deteriorate.
- Treatment: assess pt, atropine, transcutaneous pacing. NEVER
GIVE ANTI-ARRHYTHMIC MEDICATIONS
◉ Ventricular Pacing. Answer: • The pacemaker lead is placed in to
right ventricle.
• The pacemaker generator fires an impulse Initiating ventricular
activity.
• The right ventricle will contract first followed by the left ventricle.
This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm, rate,
and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from pacer
spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured from
pacer spike to end
of QRS
, ◉ Atrial-ventricular Pacing. Answer: One pacemaker lead is placed
into the right atria and another is placed into the right
ventricle.
• The pacemaker generator fires an impulse to the atria and then to
the ventricle sequentially
causing atrial then ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P waves
may or may not be seen
(lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
◉ Failure to capture. Answer: A pacer spike note followed by the
appropriate atrial or ventricular response
• Can be a potentially lethal situation!
◉ Failure to pace. Answer: Absence of pacer activity (spikes) when
the pacemaker generator should have fired an impulse.
• Typically seen when the patient's intrinsic heart rate falls less than
the pacemaker's low HR limit and
the pacer fails to fire.
