NUR417 (NUR 417) Nursing Care of the Adult 2 EKG Rhythm Interpretation Packet | Complete A+ guide | Updated 2025/26.

NUR417 Nursing Care of the Adult 2
EKG Rhythm Interpreta@on Packet


EKG Rhythm Interpreta0on Packet
Instruc0ons
Complete a review the basics of the conduc@on system and electrocardiogram (EKG) readings, then work
through the steps of systema@cally interpre@ng EKG rhythms that follow. AKer comple@ng these, you will
be presented with several opportuni@es to prac@ce your interpreta@on skills. Analyze the strips in the
Rhythm Prac@ce sec@on and enter the related data below each.

Review of the Basics
Conduc'on system
Complete the labeling for the diagram below by naming each component. Place the correct name beside
the number in the list below the diagram. Refer to your text as needed.




1. SA node 7. Purkinje Fibers
2. internodal bundles 8. Left posterior fasicle
3. Arrow showing: atrial conduction 9. Left anterior fasicle

4. AV node 10. left bundle branch
5. AV Bundle of His 11. Arrows showing: ventricular conduction

6. Right bundle branch

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, NUR417 Nursing Care of the Adult 2
EKG Rhythm Interpreta@on Packet
Electrocardiogram
The diagram that follows shows a normal sinus rhythm. Different aspects of the rhythm are labeled (progressing
from leK to right):
• The rhythm begins as straight, on the baseline.
• Next, the PR Interval is iden@fied with the upward bend of the P wave and a return to the baseline –
which is iden@fied as the PR Segment.
• The QRS Complex follows with the dip of the Q wave, followed by the spike of the R wave, and
completed with another dip – the S wave.
• Another return to baseline, following the S wave and extending to the upward bend of the T wave, is
iden@fied as the ST Segment.
• The QT Interval begins with QRS Complex and extends to the end of the T wave.
• AKer the T wave, there is a return to baseline.




Image A\ribu@on: Created by Agateller (Anthony Atkielski), converted to svg by atom., Public domain, via Wikimedia
Commons

Lead Placement




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, NUR417 Nursing Care of the Adult 2
EKG Rhythm Interpreta@on Packet
The proceeding diagram illustrates EKG lead
placement (star@ng at the top, by the shoulders,
and moving down the abdomen):
• RA – On the right, by the clavicle
• LA – On the leK, by the clavicle
• V – In the center, to the right of the sternum
• RL – On the right, below the rib cage
• LL – On the leK, below the rib cage




Systema0c Rhythm Interpreta0on
Step 1: Note the P Waves
• Is it upright in Lead II or inverted?
• Is there a P-wave in front of every QRS complex?
• Are there more P-waves than QRS complexes?
• If there are addi@onal P-waves, where are they located?
• Is there a pa\ern to the addi@onal P-waves?

Descrip(on Normal Source of Possible Varia(on
Dura(on
P wave: Represents firing of the SA node and 0.06-0.12 sec Disturbance in conduc@on
depolariza@on of the atria within atria



Step 2: Evaluate the rhythm. Is it regular or irregular?
• You can look for both atrial regularity and ventricular regularity.
o To look at atrial regularity, measure the P waves across the page or strip.
o To look at ventricular regularity, measure the R waves across the page or strip.

Step 3: Calculate Atrial Rate - Normal 60-100 bpm
There are several ways to calculate a rate. See examples below.
1. Count the number of P-waves in a 6-second strip and mul@ply by 10 (this method can be used for both
regular and irregular rhythms and is an es@mate).
2. Count using the Rule of 1500s. For this method, count the number of small boxes between one set of R
intervals and divide that number by 1500.




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