AdventHealth EKG Exam 2026 Actual Exam
Questions and Verified Answers
Comprehensive ECG Interpretation
Certification Prep
ADVENTHEALTH EKG EXAM 2026 - ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS Comprehensive ECG Interpretation Certification Prep
• This exam contains verified questions covering all major EKG interpretation topics
with detailed EXPERT RATIONALE to reinforce learning and clinical application
• Study this material by reviewing questions systematically, focusing on EXPERT
RATIONALE, comparing similar patterns, and correlating findings with clinical
scenarios to build interpretation confidence
QUESTION 1
A 58-year-old male presents with chest pain. The EKG shows ST elevation in
leads II, III, and aVF with reciprocal ST depression in I and aVL. What is the
most likely diagnosis?
A) Anterior wall myocardial infarction
B) Lateral wall myocardial infarction
C) Inferior wall myocardial infarction
D) Posterior wall myocardial infarction
E) Right ventricular infarction
CORRECT ANSWER: C) Inferior wall myocardial infarction
EXPERT RATIONALE: ST elevation in the inferior leads (II, III, aVF) with reciprocal ST
depression in the lateral leads (I and aVL) is the classic presentation of acute
inferior wall MI. The inferior wall is supplied primarily by the right coronary artery
(RCA) in approximately 80% of the population. The reciprocal changes help confirm
the diagnosis by showing the opposite electrical activity in the opposite wall.
,QUESTION 2
Which lead should be monitored to detect right ventricular involvement in an
inferior wall MI?
A) V4R
B) V1
C) V5
D) aVL
E) II
CORRECT ANSWER: A) V4R
EXPERT RATIONALE: The right-sided chest lead V4R (placed at the same level as V4
but on the right side of the chest) is used specifically to assess right ventricular
involvement in inferior MIs. ST elevation in V4R indicates RV infarction, which
requires cautious fluid management as the RV is preload-dependent. This is crucial
clinical information because standard 12-lead EKGs do not include right-sided
leads.
QUESTION 3
A patient's EKG shows a PR interval of 0.28 seconds. What conduction
abnormality is present?
A) Normal variant
B) First-degree AV block
C) Second-degree AV block type I
D) Second-degree AV block type II
E) Third-degree AV block
CORRECT ANSWER: B) First-degree AV block
,EXPERT RATIONALE: A PR interval greater than 0.20 seconds (one small box)
represents a delay in AV conduction. First-degree AV block is defined as a
prolonged PR interval (>0.20 seconds) with a constant relationship between P
waves and QRS complexes, meaning every P wave is followed by a QRS. This is a
benign finding in most cases and may be seen in athletes or with certain
medications like digitalis or beta-blockers.
QUESTION 4
What is the normal duration of the QRS complex?
A) Less than 0.08 seconds
B) 0.08 to 0.12 seconds
C) 0.12 to 0.16 seconds
D) 0.16 to 0.20 seconds
E) Greater than 0.20 seconds
CORRECT ANSWER: B) 0.08 to 0.12 seconds
EXPERT RATIONALE: The normal QRS duration is 0.08 to 0.12 seconds (2 to 3 small
boxes on EKG paper running at 25 mm/second). A QRS duration of 0.12 seconds or
greater indicates a wide complex rhythm or bundle branch block. This
measurement is critical for distinguishing between narrow complex and wide
complex arrhythmias and for identifying conduction abnormalities.
QUESTION 5
An EKG shows a regular rhythm with a rate of 180 bpm, narrow QRS
complexes, and no visible P waves. What is the most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter with RVR
C) Supraventricular tachycardia
, D) Sinus tachycardia
E) Ventricular tachycardia
CORRECT ANSWER: C) Supraventricular tachycardia
EXPERT RATIONALE: SVT presents with a regular, narrow-complex rhythm at rates
typically between 150-250 bpm with absent or buried P waves (often in the ST
segment or T wave due to the rapid rate). The regularity and narrow QRS complex
rule out atrial fibrillation and ventricular tachycardia. SVT at 180 bpm is too fast for
typical sinus tachycardia and lacks the sawtooth pattern of atrial flutter.
QUESTION 6
Which of the following is the most common type of atrial flutter?
A) Type I (typical) atrial flutter
B) Type II (atypical) atrial flutter
C) Atrial fibrillation with flutter waves
D) Reverse typical atrial flutter
E) Chaotic atrial flutter
CORRECT ANSWER: A) Type I (typical) atrial flutter
EXPERT RATIONALE: Type I (typical) atrial flutter, also called cavotricuspid isthmus-
dependent flutter, accounts for approximately 90% of cases. It has a slower rate
(240-350 bpm) and produces characteristic sawtooth or picket fence flutter waves
best seen in leads II, III, and aVF. The mechanism involves reentry in the right
atrium. Type II atrial flutter is less common and faster (350-430 bpm) with less
distinctive flutter waves.
QUESTION 7
A patient in atrial fibrillation has a ventricular response of 120 bpm with an
irregular rhythm. What is the significance of this finding?
Questions and Verified Answers
Comprehensive ECG Interpretation
Certification Prep
ADVENTHEALTH EKG EXAM 2026 - ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS Comprehensive ECG Interpretation Certification Prep
• This exam contains verified questions covering all major EKG interpretation topics
with detailed EXPERT RATIONALE to reinforce learning and clinical application
• Study this material by reviewing questions systematically, focusing on EXPERT
RATIONALE, comparing similar patterns, and correlating findings with clinical
scenarios to build interpretation confidence
QUESTION 1
A 58-year-old male presents with chest pain. The EKG shows ST elevation in
leads II, III, and aVF with reciprocal ST depression in I and aVL. What is the
most likely diagnosis?
A) Anterior wall myocardial infarction
B) Lateral wall myocardial infarction
C) Inferior wall myocardial infarction
D) Posterior wall myocardial infarction
E) Right ventricular infarction
CORRECT ANSWER: C) Inferior wall myocardial infarction
EXPERT RATIONALE: ST elevation in the inferior leads (II, III, aVF) with reciprocal ST
depression in the lateral leads (I and aVL) is the classic presentation of acute
inferior wall MI. The inferior wall is supplied primarily by the right coronary artery
(RCA) in approximately 80% of the population. The reciprocal changes help confirm
the diagnosis by showing the opposite electrical activity in the opposite wall.
,QUESTION 2
Which lead should be monitored to detect right ventricular involvement in an
inferior wall MI?
A) V4R
B) V1
C) V5
D) aVL
E) II
CORRECT ANSWER: A) V4R
EXPERT RATIONALE: The right-sided chest lead V4R (placed at the same level as V4
but on the right side of the chest) is used specifically to assess right ventricular
involvement in inferior MIs. ST elevation in V4R indicates RV infarction, which
requires cautious fluid management as the RV is preload-dependent. This is crucial
clinical information because standard 12-lead EKGs do not include right-sided
leads.
QUESTION 3
A patient's EKG shows a PR interval of 0.28 seconds. What conduction
abnormality is present?
A) Normal variant
B) First-degree AV block
C) Second-degree AV block type I
D) Second-degree AV block type II
E) Third-degree AV block
CORRECT ANSWER: B) First-degree AV block
,EXPERT RATIONALE: A PR interval greater than 0.20 seconds (one small box)
represents a delay in AV conduction. First-degree AV block is defined as a
prolonged PR interval (>0.20 seconds) with a constant relationship between P
waves and QRS complexes, meaning every P wave is followed by a QRS. This is a
benign finding in most cases and may be seen in athletes or with certain
medications like digitalis or beta-blockers.
QUESTION 4
What is the normal duration of the QRS complex?
A) Less than 0.08 seconds
B) 0.08 to 0.12 seconds
C) 0.12 to 0.16 seconds
D) 0.16 to 0.20 seconds
E) Greater than 0.20 seconds
CORRECT ANSWER: B) 0.08 to 0.12 seconds
EXPERT RATIONALE: The normal QRS duration is 0.08 to 0.12 seconds (2 to 3 small
boxes on EKG paper running at 25 mm/second). A QRS duration of 0.12 seconds or
greater indicates a wide complex rhythm or bundle branch block. This
measurement is critical for distinguishing between narrow complex and wide
complex arrhythmias and for identifying conduction abnormalities.
QUESTION 5
An EKG shows a regular rhythm with a rate of 180 bpm, narrow QRS
complexes, and no visible P waves. What is the most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter with RVR
C) Supraventricular tachycardia
, D) Sinus tachycardia
E) Ventricular tachycardia
CORRECT ANSWER: C) Supraventricular tachycardia
EXPERT RATIONALE: SVT presents with a regular, narrow-complex rhythm at rates
typically between 150-250 bpm with absent or buried P waves (often in the ST
segment or T wave due to the rapid rate). The regularity and narrow QRS complex
rule out atrial fibrillation and ventricular tachycardia. SVT at 180 bpm is too fast for
typical sinus tachycardia and lacks the sawtooth pattern of atrial flutter.
QUESTION 6
Which of the following is the most common type of atrial flutter?
A) Type I (typical) atrial flutter
B) Type II (atypical) atrial flutter
C) Atrial fibrillation with flutter waves
D) Reverse typical atrial flutter
E) Chaotic atrial flutter
CORRECT ANSWER: A) Type I (typical) atrial flutter
EXPERT RATIONALE: Type I (typical) atrial flutter, also called cavotricuspid isthmus-
dependent flutter, accounts for approximately 90% of cases. It has a slower rate
(240-350 bpm) and produces characteristic sawtooth or picket fence flutter waves
best seen in leads II, III, and aVF. The mechanism involves reentry in the right
atrium. Type II atrial flutter is less common and faster (350-430 bpm) with less
distinctive flutter waves.
QUESTION 7
A patient in atrial fibrillation has a ventricular response of 120 bpm with an
irregular rhythm. What is the significance of this finding?
