,TESTBANK FOR EKGs for the Nurse Practitioner and
Physician Assistant, 4th Edition Knechtel
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
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,EKGs for the Nurse Practitioner and
Physician Assistant
Fourth Edition
MAUREEN KNECHTEL, DMSc, PA-C
Copyright © Springer Publishing Company
,Copyright © 2026 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
ISBN: 978-0-8261-4273-3
The author and the publisher of this Work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. Because medical science is continually advancing, our
knowledge base continues to expand. Therefore, as new information becomes available,
changes in procedures become necessary. We recommend that the reader always consult
current research and specific institutional policies before performing any clinical procedure or
delivering any medication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Copyright © Springer Publishing Company
,MULTIPLE-CHOICE
1. The P wave on an EKG represents:
a. Atrial repolarization
b. Ventricular repolarization
*c. Atrial depolarization
d. Ventricular depolarization
Answer: C. Atrial depolarization
Atrial depolarization is represented by the P wave. Atrial repolarization is not readily
represented on the standard EKG because it occurs at the same time as ventricular
depolarization. Ventricular depolarization is represented by the QRS complex, and the
electrical activity of the ventricles dominates the EKG. Ventricular repolarization corresponds
to the T wave.
2. The PR interval corresponds to the time of:
a. Atrial depolarization
*b. Electrical conduction from the sinus node to the atrioventricular (AV) node
c. Conduction of the impulse down the bundle branches
d. Ventricular depolarization
e. Time of repolarization of the sinoatrial node
Answer: B. Electrical conduction from the sinus node to the AV node
The PR interval depicts the time of conduction spread from the atria to the AV node. Atrial
depolarization is represented by the P wave. Conduction of impulses down the bundle
branches
is represented by the QRS complex. Atrial repolarization is not readily represented on the
standard EKG.
3. A low atrial focus is most likely to cause which of the following findings on EKG?
a. Peaked T waves
*b. Inverted P waves
c. Biphasic P waves
d. Prolonged QT interval
Answer: B. Inverted P waves
© Springer Publishing Company, LLC 1
, Inverted P waves are associated with a low atrial focus. Peaked T waves may indicate
hyperkalemia. This is due to the effect of high potassium on the cardiac action potential,
namely that it lowers the action potential and prevents repolarization. Biphasic P waves can
be a normal finding in leads V1 to V2 and are not associated with hyperkalemia. A
prolonged QT interval is more likely to be seen in hypokalemia because of the prolongation
of ventricular repolarization.
4. The inferior leads on the EKG are leads:
a. I and aVL
*b. II, III, and aVF
c. I, aVL, and V5 to V6
d. aVR and aVL
e. V1 to V2
Answer: B. II, III, and aVF
The inferior leads are leads II, III, and aVF. Leads I, aVL, V5, and V6 are the lateral leads.
Leads V1 to V4 are the anterior leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
5. The anterior leads on the EKG are:
a. Leads I and aVL
b. Leads II, III, and aVF
c. Leads V5 to V6
*d. Leads V1 to V4
Answer: D. Leads V1 to V4
Leads V1 to V4 are the anterior leads. The inferior leads are leads II, III, and aVF. Leads I,
aVL, V5, and V6 are the lateral leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
6. The lateral leads on the EKG are:
a. Leads I, II, and III
b. Leads II, III, and aVF
*c. Leads I, aVL, V5, and V6
d. Leads V1, V2, and V3
2 © Springer Publishing Company, LLC
, e. Leads V4, V5, and V6
Answer: C. Leads I, aVL, V5, and V6
Leads I, aVL, V5, and V6 are the lateral leads. The inferior leads are leads II, III, and aVF.
Leads V1 to V4 are the anterior leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
7. On an EKG, one large block corresponds to how many seconds?
a. 0.04
b. 0.1
*c. 0.2
d. 0.25
e. 0.5
Answer: C. 0.2
One large block on the EKG corresponds to 0.2 seconds, or 200 milliseconds. The other
answer options do not correspond to a measurement of a large box on EKG.
8. Hyperkalemia is most likely to cause which of the following findings on EKG?
*a. Peaked T waves
b. Inverted P waves
c. Biphasic P waves
d. Prolonged QT interval
Answer: A. Peaked T waves
Peaked T waves indicate hyperkalemia. This is due to the effect of high potassium on the
cardiac action potential, namely that it lowers the action potential and prevents
repolarization. Inverted P waves are associated with a low atrial focus. Biphasic P waves
can be a normal finding in leads V1 to V2 and are not associated with hyperkalemia. A
prolonged QT interval is more likely to be seen in hypokalemia caused by the prolongation
of ventricular repolarization.
9. Normally, the QT interval is:
*a. Half the duration of the RR interval
© Springer Publishing Company, LLC 3
, b. Double the duration of the RR interval
c. The same duration as the PR interval
d. Double the duration of the PR interval
Answer: A. Half the duration of the RR interval
At normal rates, the QT interval is approximately half the length of the RR interval, but this is
a rough guideline and not a fixed rule. The ratio of the QT interval to the RR interval is
helpful for assessing QT prolongation or QT shortening relative to heart rate. If the QT
interval is disproportionately long or short relative to the RR interval, this could suggest
electrical abnormalities, such as long QT syndrome or other arrhythmic disorders.
10. Which of the following most accurately describes preexcitation on the baseline resting EKG?
a. Long PR interval and wide QRS
*b. Short PR interval and notching in upstroke of the QRS
c. Short PR interval and normal-appearing QRS
d. Long PR interval and normal-appearing QRS
Answer: B. Short PR interval and notching in upstroke of the QRS
Explanation: Preexcitation describes an electrical impulse from the atria arriving early to the
ventricles, resulting in a shortened PR interval. The ventricles are then activated outside of
the AV node, resulting in a wide QRS with a slurring in the upstroke.
11. A ventricular escape focus will fire at a rate of:
a. 60 to 100 beats per minute (bpm)
b. 40 to 60 bpm
*c. 20 to 40 bpm
d. 100 to 120 bpm
Answer: C. 20 to 40 bpm
The ventricles can initiate a pacemaker impulse if all other areas of automaticity above it fail.
The ventricles will beat at a fixed rate of 20 to 40 bpm. Normal sinus node activity occurs at
60 to 100 bpm, an AV nodal focus initiates at 40 to 60 bpm, and there is no escape focus
that beats at 100 to 120 bpm.
12. The left bundle is composed of which type of fascicles?
4 © Springer Publishing Company, LLC
, a. Right and left
*b. Anterior and posterior
c. Lateral and inferior
d. East and west
Answer: B. Anterior and posterior
The left bundle branch is comprised of an anterior and posterior fascicle. The anterior
fascicle is located anteriorly in the left ventricle and toward the left side. The posterior
fascicle is located posteriorly and toward the right side of the left ventricle.
13. Which of the following types of heart block is most likely to be associated with structural
heart disease?
a. First-degree atrioventricular (AV) block
b. Right bundle branch block
*c. Left bundle branch block
d. Mobitz type I second-degree AV block
Answer: C. Left bundle branch block
Left bundle branch block is more likely to be associated with structural heart disease, in part
because of the size of the left ventricle as well as the left bundle branches. In general, it
would take significant disruption in this area to result in a block or delay of impulses through
it. First-degree AV block alone is usually asymptomatic and can be a result of an aging
conduction system. Right bundle branch block is often a benign finding, unless it is new in
the setting of cardiac ischemia. Mobitz type I second-degree AV block alone is often benign
as long as the patient is not having symptoms associated with it and may be reversible.
14. A 70-year-old woman presents to the emergency department with near syncope. She has a
history of sick sinus syndrome and has a dual chamber cardiac pacemaker in place. Please
identify the most likely cause of the findings on this telemetry strip.
a. Undersensing resulting in overpacing
*b. Oversensing resulting in underpacing
© Springer Publishing Company, LLC 5
, c. This represents normal device function
d. Full pacemaker battery depletion
Answer: B. Oversensing resulting in underpacing
This tracing reveals a period of normal atrioventricular sequential pacing before the
disappearance of pacing activity. The disappearance of pacing activity suggests
underpacing caused by oversensing. Overpacing would result in pacing activity in the
presence of intrinsic beats, and battery depletion would result in no pacing activity at all.
15. Which of the following conditions is typically a benign finding, requiring no intervention?
a. Atrial fibrillation
*b. Sinus arrhythmia
c. Second-degree atrioventricular (AV) block type II
d. Complete heart block
Answer: B. Sinus arrhythmia
Sinus arrhythmia is usually a normal variant typically seen in healthy, young patients and
requires no intervention. Atrial fibrillation can result in stroke if not recognized and treated.
Second-degree AV block type II and complete heart block represent an indication for cardiac
pacing, if not immediately reversible.
16. Choose the EKG findings that are most specific to pulmonary embolism.
a. ST segment elevation in leads V1 to V3
b. ST segment depression in leads V1 to V3
*c. S wave in lead I, Q wave in lead III, and T wave inversion in lead III
d. Sinus bradycardia with diffuse Q waves
Answer: C. S wave in lead I, Q wave in lead III, and T wave inversion in lead III
A significant pulmonary embolus can cause right heart strain, resulting in an S wave in lead
I, a Q wave in lead III, and T wave inversion in lead III. The other answer options are not
consistent with expected EKG findings in the presence of right heart strain.
17. The first step in diagnosing a bundle branch block is to identify:
a. RsR in leads V1 to V2
6 © Springer Publishing Company, LLC
Physician Assistant, 4th Edition Knechtel
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,EKGs for the Nurse Practitioner and
Physician Assistant
Fourth Edition
MAUREEN KNECHTEL, DMSc, PA-C
Copyright © Springer Publishing Company
,Copyright © 2026 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
ISBN: 978-0-8261-4273-3
The author and the publisher of this Work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. Because medical science is continually advancing, our
knowledge base continues to expand. Therefore, as new information becomes available,
changes in procedures become necessary. We recommend that the reader always consult
current research and specific institutional policies before performing any clinical procedure or
delivering any medication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Copyright © Springer Publishing Company
,MULTIPLE-CHOICE
1. The P wave on an EKG represents:
a. Atrial repolarization
b. Ventricular repolarization
*c. Atrial depolarization
d. Ventricular depolarization
Answer: C. Atrial depolarization
Atrial depolarization is represented by the P wave. Atrial repolarization is not readily
represented on the standard EKG because it occurs at the same time as ventricular
depolarization. Ventricular depolarization is represented by the QRS complex, and the
electrical activity of the ventricles dominates the EKG. Ventricular repolarization corresponds
to the T wave.
2. The PR interval corresponds to the time of:
a. Atrial depolarization
*b. Electrical conduction from the sinus node to the atrioventricular (AV) node
c. Conduction of the impulse down the bundle branches
d. Ventricular depolarization
e. Time of repolarization of the sinoatrial node
Answer: B. Electrical conduction from the sinus node to the AV node
The PR interval depicts the time of conduction spread from the atria to the AV node. Atrial
depolarization is represented by the P wave. Conduction of impulses down the bundle
branches
is represented by the QRS complex. Atrial repolarization is not readily represented on the
standard EKG.
3. A low atrial focus is most likely to cause which of the following findings on EKG?
a. Peaked T waves
*b. Inverted P waves
c. Biphasic P waves
d. Prolonged QT interval
Answer: B. Inverted P waves
© Springer Publishing Company, LLC 1
, Inverted P waves are associated with a low atrial focus. Peaked T waves may indicate
hyperkalemia. This is due to the effect of high potassium on the cardiac action potential,
namely that it lowers the action potential and prevents repolarization. Biphasic P waves can
be a normal finding in leads V1 to V2 and are not associated with hyperkalemia. A
prolonged QT interval is more likely to be seen in hypokalemia because of the prolongation
of ventricular repolarization.
4. The inferior leads on the EKG are leads:
a. I and aVL
*b. II, III, and aVF
c. I, aVL, and V5 to V6
d. aVR and aVL
e. V1 to V2
Answer: B. II, III, and aVF
The inferior leads are leads II, III, and aVF. Leads I, aVL, V5, and V6 are the lateral leads.
Leads V1 to V4 are the anterior leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
5. The anterior leads on the EKG are:
a. Leads I and aVL
b. Leads II, III, and aVF
c. Leads V5 to V6
*d. Leads V1 to V4
Answer: D. Leads V1 to V4
Leads V1 to V4 are the anterior leads. The inferior leads are leads II, III, and aVF. Leads I,
aVL, V5, and V6 are the lateral leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
6. The lateral leads on the EKG are:
a. Leads I, II, and III
b. Leads II, III, and aVF
*c. Leads I, aVL, V5, and V6
d. Leads V1, V2, and V3
2 © Springer Publishing Company, LLC
, e. Leads V4, V5, and V6
Answer: C. Leads I, aVL, V5, and V6
Leads I, aVL, V5, and V6 are the lateral leads. The inferior leads are leads II, III, and aVF.
Leads V1 to V4 are the anterior leads. The relationship of these lead groupings can be best
visualized on the cardiac axis wheel.
7. On an EKG, one large block corresponds to how many seconds?
a. 0.04
b. 0.1
*c. 0.2
d. 0.25
e. 0.5
Answer: C. 0.2
One large block on the EKG corresponds to 0.2 seconds, or 200 milliseconds. The other
answer options do not correspond to a measurement of a large box on EKG.
8. Hyperkalemia is most likely to cause which of the following findings on EKG?
*a. Peaked T waves
b. Inverted P waves
c. Biphasic P waves
d. Prolonged QT interval
Answer: A. Peaked T waves
Peaked T waves indicate hyperkalemia. This is due to the effect of high potassium on the
cardiac action potential, namely that it lowers the action potential and prevents
repolarization. Inverted P waves are associated with a low atrial focus. Biphasic P waves
can be a normal finding in leads V1 to V2 and are not associated with hyperkalemia. A
prolonged QT interval is more likely to be seen in hypokalemia caused by the prolongation
of ventricular repolarization.
9. Normally, the QT interval is:
*a. Half the duration of the RR interval
© Springer Publishing Company, LLC 3
, b. Double the duration of the RR interval
c. The same duration as the PR interval
d. Double the duration of the PR interval
Answer: A. Half the duration of the RR interval
At normal rates, the QT interval is approximately half the length of the RR interval, but this is
a rough guideline and not a fixed rule. The ratio of the QT interval to the RR interval is
helpful for assessing QT prolongation or QT shortening relative to heart rate. If the QT
interval is disproportionately long or short relative to the RR interval, this could suggest
electrical abnormalities, such as long QT syndrome or other arrhythmic disorders.
10. Which of the following most accurately describes preexcitation on the baseline resting EKG?
a. Long PR interval and wide QRS
*b. Short PR interval and notching in upstroke of the QRS
c. Short PR interval and normal-appearing QRS
d. Long PR interval and normal-appearing QRS
Answer: B. Short PR interval and notching in upstroke of the QRS
Explanation: Preexcitation describes an electrical impulse from the atria arriving early to the
ventricles, resulting in a shortened PR interval. The ventricles are then activated outside of
the AV node, resulting in a wide QRS with a slurring in the upstroke.
11. A ventricular escape focus will fire at a rate of:
a. 60 to 100 beats per minute (bpm)
b. 40 to 60 bpm
*c. 20 to 40 bpm
d. 100 to 120 bpm
Answer: C. 20 to 40 bpm
The ventricles can initiate a pacemaker impulse if all other areas of automaticity above it fail.
The ventricles will beat at a fixed rate of 20 to 40 bpm. Normal sinus node activity occurs at
60 to 100 bpm, an AV nodal focus initiates at 40 to 60 bpm, and there is no escape focus
that beats at 100 to 120 bpm.
12. The left bundle is composed of which type of fascicles?
4 © Springer Publishing Company, LLC
, a. Right and left
*b. Anterior and posterior
c. Lateral and inferior
d. East and west
Answer: B. Anterior and posterior
The left bundle branch is comprised of an anterior and posterior fascicle. The anterior
fascicle is located anteriorly in the left ventricle and toward the left side. The posterior
fascicle is located posteriorly and toward the right side of the left ventricle.
13. Which of the following types of heart block is most likely to be associated with structural
heart disease?
a. First-degree atrioventricular (AV) block
b. Right bundle branch block
*c. Left bundle branch block
d. Mobitz type I second-degree AV block
Answer: C. Left bundle branch block
Left bundle branch block is more likely to be associated with structural heart disease, in part
because of the size of the left ventricle as well as the left bundle branches. In general, it
would take significant disruption in this area to result in a block or delay of impulses through
it. First-degree AV block alone is usually asymptomatic and can be a result of an aging
conduction system. Right bundle branch block is often a benign finding, unless it is new in
the setting of cardiac ischemia. Mobitz type I second-degree AV block alone is often benign
as long as the patient is not having symptoms associated with it and may be reversible.
14. A 70-year-old woman presents to the emergency department with near syncope. She has a
history of sick sinus syndrome and has a dual chamber cardiac pacemaker in place. Please
identify the most likely cause of the findings on this telemetry strip.
a. Undersensing resulting in overpacing
*b. Oversensing resulting in underpacing
© Springer Publishing Company, LLC 5
, c. This represents normal device function
d. Full pacemaker battery depletion
Answer: B. Oversensing resulting in underpacing
This tracing reveals a period of normal atrioventricular sequential pacing before the
disappearance of pacing activity. The disappearance of pacing activity suggests
underpacing caused by oversensing. Overpacing would result in pacing activity in the
presence of intrinsic beats, and battery depletion would result in no pacing activity at all.
15. Which of the following conditions is typically a benign finding, requiring no intervention?
a. Atrial fibrillation
*b. Sinus arrhythmia
c. Second-degree atrioventricular (AV) block type II
d. Complete heart block
Answer: B. Sinus arrhythmia
Sinus arrhythmia is usually a normal variant typically seen in healthy, young patients and
requires no intervention. Atrial fibrillation can result in stroke if not recognized and treated.
Second-degree AV block type II and complete heart block represent an indication for cardiac
pacing, if not immediately reversible.
16. Choose the EKG findings that are most specific to pulmonary embolism.
a. ST segment elevation in leads V1 to V3
b. ST segment depression in leads V1 to V3
*c. S wave in lead I, Q wave in lead III, and T wave inversion in lead III
d. Sinus bradycardia with diffuse Q waves
Answer: C. S wave in lead I, Q wave in lead III, and T wave inversion in lead III
A significant pulmonary embolus can cause right heart strain, resulting in an S wave in lead
I, a Q wave in lead III, and T wave inversion in lead III. The other answer options are not
consistent with expected EKG findings in the presence of right heart strain.
17. The first step in diagnosing a bundle branch block is to identify:
a. RsR in leads V1 to V2
6 © Springer Publishing Company, LLC
