ANDRES BONIFACIO COLLEGE

School of Nursing
College Park, Dipolog City, 7100
Tel. No. (065) 212-9776/ Fax No. (065) 212-9178
web-site: www.abcollege.edu.ph

PRACTICE EXAMINATION
NCM 422 – ALL ABOUT ECG
Prepared by: jeanmayRN😊

Name: __________________________________________________ Date: ________________

Year and Section: __________________

_____ 1. Select the options below that best describe a sinus rhythm.
a. Regular atrial rhythm c. Equal atrial and ventricular rate
b. Irregular ventricular rhythm d. PR Interval < 0.20 seconds

_____ 2. What should the PR Interval measure for Normal Sinus Rhythm?
a. 0.35 – 0.44 sec c. 0.12-0.20 seconds
b. > 0.12 seconds d. > 0.20 seconds

_____ 3. TRUE or FALSE: Both the atrial and ventricular rate is the same for Normal Sinus Rhythm.
a. TRUE b. FALSE

_____ 4. Which statement below is FALSE regarding Normal Sinus Rhythm?

a. The QRS complex should measure <0.12 seconds. c. The ventricular rate should be 40-60 bpm.
b. The atrial rate should be 60-100 bpm. d. A p wave should accompany every QRS complex.

_____ 5. The nurse notes the rhythm above on the cardiac monitor. The nurse does a pulse check, and a pulse is present. What next
action by the nurse is most appropriate?
a. Continue to monitor. c. Start chest compressions.
b. Prepare for the administration of Atropine d. Activate the emergency response system

_____ 6 Sinus tachycardia originates from what part of the electrical conduction system?
a. Bundle of His c. AV Node
b. Bundle Branches d. SA Node

_____ 7. You're analyzing an ECG strip. For the rhythm to be identified as Sinus Tachycardia, what must be present in the rhythm?
(Select all that apply)
a. One p wave present in front of every QRS complex e. Regular atrial and ventricular rate
b. Atrial rate >100 bpm f. Atrial rate <60 bpm
c. Ventricular rate >100 bpm g. QRS complex <0.12 seconds
d. Regular atrial rate and irregular ventricular rate h. PR interval 0.12-0.20 seconds

_____ 8. You're providing care to a 55-year-old male. You note on the bedside monitor the patient has a heart rate of 116 bpm. You
obtain an ECG and discover the patient rhythm is Sinus Tachycardia. You assess probable causes of this rhythm. Which finding below
could be a cause of this patient's heart rhythm?
a. Digoxin therapy c. Temperature 103.6'F
b. Pain rating of 2 on 1-10 scale d. Blood glucose of 86 mg/dL

_____ 9. Your patient is experiencing Sinus Tachycardia with a rate of 160 bpm. Which findings below demonstrate the patient is
experiencing a decrease in cardiac output? Select all that apply.
a. Blood pressure 220/120 mmHg c. Crackles throughout the lung fields
b. Blood pressure 70/42 mmHg d. Cool extremities
_____ 10. What are possible causes of Sinus Tachycardia? Select all that apply.
a. Exercise d. Sick Sinus Syndrome
b. Atropine e. Cardiogenic shock
c. Pain f. Hypothyroidism

_____ 11. Your patient develops Sinus Tachycardia with a heart rate of 136 bpm. The patient is post-op from hip surgery. The patient
reports chest pain that is worst with each breath in and has shortness of breath. These findings can correlate with what serious
condition?
a. Cardiogenic shock c. Sick Sinus Syndrome
b. Pulmonary embolism d. Hypovolemic shock

_____ 12. Which statement below best describes why Sinus Tachycardia could lead to decreased cardiac output?
a. "The atrial kick is decreased leading to inadequate atria emptying."
b. "The ventricles don't have enough time to fill completely so less blood is pumped out of the heart."
c. "The rapid firing of the SA node leads to rapid atrial contraction and causes blood to pool in the atria."
d. "The ventricles are unable to properly contract and push blood forward so less blood is pumped out of the heart.”

_____ 13. What medication below is NOT a treatment for Sinus Tachycardia?
a. Verapamil c. Metoprolol
b. Antipyretics d Dopamine.

_____ 14. Use the figure above to answer the next 4 questions: What is the rate of the rhythm above?
a. 110 bpm b. 120 bpm c. 130 bpm d. 140 bpm

_____ 15. What is the PR Interval?

a. 0.06 seconds b. 0.12 seconds c. 0.16 seconds d. 0.20 seconds

_____ 16. What is the atrial rate?

a. 100 bpm b. 110 bpm c. 120 bpm d. 130 bpm

_____ 17. True or False: The rhythm above is Sinus Tachycardia.

a. TRUE b. FALSE
_____ 18. Sinus bradycardia originates in what part of the electrical conduction system?
a. AV node c. Bundle Branches
b. SA node d. Bundle of His

_____ 19. You're analyzing a patient's ECG reading. What should be found in the rhythm for it to be considered Sinus Bradycardia
(select all that apply)
a. One p wave present in front of every QRS complex d. Atrial rate 40 and ventricular rate of 40
b. QRS interval 0.08 seconds e. PR interval 0.14 seconds
c. Regular atrial and ventricular rate f. PR interval 0.36 seconds

_____ 20. You obtain an ECG on a patient and the rhythm is sinus bradycardia with a rate of 52 bpm. Your NEXT nursing action is to?
a. Prepare to administer Atropine IV push c. Assess the patient
b. Set-up for transcutaneous pacing d. Call a rapid response

_____ 21. Your patient is experiencing extreme fatigue, hypotension, palpations, and shortness of breath. You obtain an ECG and
discover a rhythm of sinus bradycardia with a rate of 40 bpm. What finding below could be causing this condition?
a. Potassium level of 3.9 meq/L c. Blood glucose 84
b. Lisinopril 10 mg BID PO d. Digoxin 0.125 mg PO daily
_____ 22. Which of the following is NOT a treatment for symptomatic sinus bradycardia?
a. Dopamine c. Synchronized cardioversion
b. Atropine d. Transcutaneous pacing

______ 23. A patient is experiencing sinus bradycardia with a rate of 34 bpm and blood pressure of 78/42. The patient reports
symptoms of chest pain, has cool and clammy skin, dyspnea, and feels like they may faint. The nurse prepares to administer
Atropine per a standing physician's order for the patient's symptomatic bradycardia. How will the nurse administer this medication?
a. 3 mg IV push every 3-5 minutes, max dose of 5 mg c. 3-5 mg IV push every 1 minute, max dose 10 mg
b. 2 mg IV push every 1-2 minutes, max dose of 3 mg d. 1 mg IV push every 3-5 minutes, max dose of 3 mg

_____ 24. Referring to the previous question (23), Atropine was ineffective for treating the bradycardia. The patient is still
symptomatic with a rate 35 bpm. What other options could be considered for the patient? Select all that apply:
a. Transcutaneous pacing c. Dopamine Infusion
b. Amiodarone Infusion d. Epinephrine Infusion

_____ 25. Which medication below should not be used for the treatment of sinus bradycardia in a patient with a transplanted heart?
a. Isoproterenol c. Epinephrine
b. Atropine d. Glucagon

_____ 26. Select the options below that describe the rhythm above:
a. Atrial rate <60 bpm e. QRS complex absent
b. Regular atrial rate f. Fibrillary waves present
c. Irregular ventricular rate g. Atrial Flutter
d. Ventricular rate >100 bpm h. Atrial Fibrillation

_____ 27. The nurse is assessing an ECG strip. Which finding on the ECG strip is NOT a characteristic present in atrial fibrillation (a-
fib)?
a. fibrillary waves c. saw-tooth waves
b. unmeasurable atrial rate d. irregular ventricular rate

_____ 28. The patient is symptomatic and experiencing shortness of breath and chest pain. The patient's blood pressure in 80/44
with the heart rate fluctuating between 130-150s. The nurse calls a rapid response and prepares the patient for.
a. Ablation c. Defibrillation
b. Synchronized cardioversion. d. Pacemaker implantation

_____ 29. Which statements below best described a transesophageal echocardiogram (TEE) used in the treatment of atrial
fibrillation? Select all that apply:
a. It can be performed before a cardioversion to assess for blood clots in the heart.
b. This procedure destroys electrical pathways in the heart to help return a patient’s heart rhythm to normal.
c. During this procedure, an ultrasound probe is inserted in the patient’s mouth down through the esophagus where it takes
ultrasound pictures of the heart.
d. During the procedure, a transducer is placed on the chest that sends ultrasound waves through the skin so pictures can
be obtained of the heart’s blood flow.

_____ 30. What complications can develop from uncontrolled atrial fibrillation that the nurse should monitor for? Select all that
apply:
a. Hypertension c. Heart failure
b. Stroke d. Hyperglycemia

_____ 31. True or False: If a patient has been in atrial fibrillation for more than 48 hours, anticoagulation is needed prior to a
cardioversion due to blood clot risks.
a. TRUE b. FALSE
_____ 32. Select the options below that describe the rhythm above:
a. P-waves present d. QRS complex less than 0.12 seconds
b. Fibrillary waves present e. Atrial flutter
c. Flutter waves present f. Atrial Fibrillation

_____ 33. Which statement is correct about atrial flutter?

a. The ventricular rate will always be irregular. c. This rhythm has a saw-tooth appearance.
b. P-waves will be present. d. The PR interval will be >0.20 seconds.

_____ 34. True or False: Atropine is the first-line treatment to help control the rate in a patient with atrial flutter.
a. TRUE b. FALSE

_____ 35. Your patient's ECG shows atrial flutter. What complication can arise from this type of rhythm?
a. Pericarditis c. Hypoglycemia
b. Stroke d. Endocarditi
_____ 36. True or False: Treatment for unstable atrial flutter is synchronized cardioversion.
a. TRUE b. FALSE

_____ 37. Fill-in-the-blank: Rhythm 1 is _________________ , and Rhythm 2 is _____________.

a. atrial fibrillation; atrial flutter c. atrial flutter; atrial fibrillation
b. first-degree heart block; atrial flutter d. atrial flutter; sinus bradycardia

_____ 38. 1. Select the options below that describe the rhythm above:
a. Monomorphic e. Ventricular fibrillation
b. Regular atrial rhythm f. Ventricular rate >100 bpm
c. QRS complex >0.12 seconds g. Atrial rate >80 bpm
d. Irregular ventricular rhythm h. Ventricular tachycardia

_____ 39. TRUE or FALSE: Torsade’s de pointes is known as a type of monomorphic ventricular tachycardia.
a. TRUE b. FALSE

_____ 40. Your patient is unresponsive and the cardiac monitor shows Torsade’s de Pointes as the patient's rhythm. As the code
team is attempting to resuscitate the patient, you look through the patient's electronic health record to try to determine a potential
cause for this rhythm. What found in the patient's record is a cause of this rhythm?
a. Magnesium level 2 mg/dL c. Potassium 5 mEq/L
b. Amiodarone d. Glyburide

_____ 41. The patient is experiencing ventricular tachycardia. You assess the patient and find the patient is having no symptoms and
a pulse is present. What type of treatment do you anticipate will be ordered for this patient?
 a. CPR c. Amiodarone IV
b. Defibrillation d. Digoxin IV

_____ 42. The patient is experiencing the rhythm above. The patient is presenting with a blood pressure of 70/42, mental status
changes, and is clammy and pale. A pulse is present. The nurse preps the patient for.
a. CPR c. Defibrillation
b. Synchronized cardioversion d. Atropine IV

_____ 43. A patient is experiencing ventricular tachycardia and is unresponsive with no pulse. After activating the emergency
response system, the nurse would immediately….
a. Prep the patient for defibrillation c. Secure the airway
b. Administer IV epinephrine d. Start chest compressions

_____ 44. The following rhythm is noted in your patient. The patient is unresponsive and has no pulse. What order below would the
nurse ask for clarification if received?
a. IV Amiodarone c. Defibrillation
b. IV Magnesium Sulfate d. IV epinephrine

_____ 45. Select the options below that describe the rhythm above:
a. Coarse fibrillatory waves c. Ventricular fibrillation
b. Fine fibrillatory waves d. Ventricular tachycardia
_____ 46. TRUE or FALSE: Ventricular fibrillation (V-fib) is a lethal rhythm that results in the quivering of the ventricles which leads to
a rapid fall in cardiac output.
a. TRUE b. FALSE

_____ 47. TRUE or FALSE: A patient experiencing fine ventricular fibrillation has a better chance of being revived than a patient in
coarse ventricular fibrillation.
a. TRUE b. FALSE

_____ 48. The nurse sees the rhythm above on the ECG. The patient is unresponsive and has no pulse. The nurse calls a code blue
and takes what step next?
a. Prepare for defibrillation c. Start high-quality CPR
b. Administer Epinephrine d. Notify the physician

_____ 49. What other medications can be administered to a patient experiencing Ventricular fibrillation (V-fib) during a code
resuscitation attempt? Select all that apply:
a. Atropine b. Epinephrine c. Amiodarone d. Lidocaine

_____ 50. Your patient is in ventricular fibrillation (v-fib). You’ve started CPR and the airway is supported. A rhythm checked in
performed and shows the patient is still in ventricular fibrillation. The NEXT action the code team will take in addition to performing
high-quality CPR is to?
a. Administer Atropine b. Defibrillate c. Administer Epinephrine d. Synchronized cardiovert.

_____ 51. Select the options below that describe asystole.

a. Absent of P-wave, QRS complex, T-wave c. Erratic, unorganized ECG wave form
b. Flatline d. Pulseless
_____ 52. TRUE or FALSE: Asystole requires immediate defibrillation to increase the patient's chances of survival.
a. TRUE b. FALSE
_____ 53. The cardiac monitor is showing asystole for the patient's rhythm. However, the patient is alert and oriented with a strong
pulse when palpated. The nurse should perform what action next?
a. Press the code blue button c. Check the monitor's cable and electrode connection
b. Start CPR d. Continue to monitor

_____ 54. The patient has the rhythm above displaying on the cardiac monitor. The patient is unresponsive, and no pulse is present.
The nurse calls a code blue and then should do what next?
a. Prepare the patient for defibrillation c. Administer Atropine
b. Check the main cause d. Start CPR

_____ 55. What medication can be administered during resuscitation to a patient who is in asystole?
a. Amiodarone b. Epinephrine c. Atropine d. Adenosine

_____ 56. Which rhythm cannot be treated with defibrillation? Select all that apply:
a. Pulseless V-Tach c. Pulseless Electrical Activity
b. Asystole d. V-Fib

_____ 57. Which of the following is NOT found in the rhythm Pulseless Electrical Activity (PEA)?
a. Organization c. P waves
b. Pulse d. QRS complexes

_____ 58. The nurse observes the rhythm above on the cardiac monitor. The nurse assesses the patient and finds that the patient is
unresponsive and has no pulse. The nurse calls a code blue and starts CPR. A rhythm checked is performed and the same rhythm is
noted with no pulse. What is an INCORRECT action by the code team for treatment of this rhythm?
a. Continue CPR c. Administer Epinephrine
b. Defibrillation d. Support the airway

_____ 59. True or False: PEA (Pulseless Electrical Activity) can have many presentations on the ECG and can sometimes appear as a
complete flat line.
a. TRUE b. FALSE

_____ 60. Which medication below can be used during a code to treat PEA (Pulseless Electrical Activity)?
a. Atropine b. Amiodarone c. Lidocaine d. Epinephrine

_____ 61. True or False: In a First-Degree Heart Block, the atrial rhythm is regular and the QRS complex will measure less than 0.12
seconds.
a. TRUE b. FALSE

_____ 62. Your patient is found to have a First-Degree Heart Block after obtaining an ECG. The patient is asymptomatic. The nurse
prepares to? Select all that apply:
a. Assess the patient's current medications c. Continue to monitor
b. Activate the emergency response team d. Obtain atropine and temporary pacing pads

_____ 63. What medication below could cause a First-Degree Heart Block?
a. Lisinopril b. Dilitiazem c. Furosemide d. Clopidogrel

_____ 64. A hallmark finding in a First-Degree Heart Block is?

a. a gradually lengthening PR interval with a random dropped QRS complex
b. a PR interval >0.20 seconds
c. a constant PR interval with random dropped QRS complexes
d. independent p waves and QRS complexes

_____ 65. Which statement below best describes why a First-Degree Heart Block occurs?
a. The SA node is firing too rapidly to the AV node.
b. The signal traveling from the AV node to the Purkinje fibers is blocked in the right and left bundle branches
c. The electrical signal is moving slowly through the AV node.
d. The AV node is completely unable to fire during the electrical conduction cycle which create a delay in ventricular
contraction.
_____ 66. True or False: A hallmark finding in a Second-Degree type I (Mobitz I or Wenckebach) heart block is that the PR interval
will remain constant throughout the rhythm but there will be a dropped QRS complex after a p wave.
a. TRUE b. FALSE

_____ 67. In Second-Degree type I (Mobitz I or Wenckebach) heart block why is the ventricular rate slower than the atrial rate?
a. The atrial rate is faster than the ventricular rate because of the shorten PR intervals.
b. The constant PR intervals decrease the rate of conduction to the AV node which slows down the ventricular rate.
c. The ventricular rate is slower than the atrial rate because at times the electrical signal isn’t able to travel down from the
atria to the ventricles, which leads to a dropped QRS complex.
d. The SA node is firing too slowly and this affects how the AV node stimulates the ventricles to contract.
The answer is C. The ventricular rate is slower than the atrial rate because at times the electrical signal isn’t able to travel down from
the atria to the ventricles, which leads to a dropped QRS complex.

_____ 68. Your patient reports they do not feel well and feels very weak. You assess the patient’s vital signs. The patient’s blood
pressure is 78/52 and heart rate is irregular and weak. The patient appears clammy and pale. You note a Second-Degree type I heart
block on the ECG. What steps should the nurse take? Select all that apply:
a. Activate the emergency response system d. Prepare temporary pacing pads and monitor
b. Prepare Atropine e. Assess patient’s current medications
c. Prepare for Synchronized Conversion f. Start chest compressions

_____ 69. What are potential causes of a Second-Degree Type I (Mobitz I or Wenckebach) Heart Block? Select all that apply:
a. An anterior wall myocardial infarction c. Rheumatic fever
b. Calcium channel d. blockers Beta Blockers

_____ 70. Which of the following is NOT a finding in a Second-Degree Type II heart block (Mobitz II) ECG reading?
a. Normal p waves with constant PR intervals c. Progressively prolonged PR intervals
b. Missing QRS complexes d. Regular atrial rhythm

_____ 71. TRUE or FALSE: A Second-Degree Type II heart block (Mobitz II) is the most serious type of heart block among all the types
of AV heart blocks.
a. TRUE b. FALSE

_____ 72. You see the rhythm above on the ECG. The patient is experiencing hypotension, weak pulse, and mental status changes.
The nurse knows to prep the patient for the following procedure:
a. Synchronized cardioversion c. Temporary pacing
b. Defibrillation. d. Ablation

_____ 73. Your patient has a Second-Degree Type II (Mobitz II) heart block. What information found in the patient’s health history is
NOT associated with causing this type of rhythm?
a. Anterior wall myocardial infarction c. Diltiazem
b. Heart valve damage d. Glyburide

_____ 74. Select all the options below that describe a Third-Degree Heart Block heart rhythm:
a.PR Interval progressively prolonged d. Regular atrial rhythm
b. Ventricular rhythm regular e. Slower ventricular rate than atrial rate
c. Independent P waves and QRS complexes f. Equal atrial and ventricular rate

_____ 75. TRUE or FALSE: A Third-Degree Heart Block is unlikely to cause symptoms in a patient and usually requires no treatment.
a. TRUE b. FALSE

_____ 76. Which option below best describes the findings a nurse would find in a Third-Degree Heart Block (complete heart block)?
a. Normal p waves with progressively prolonged PR interval and missing QRS complexes
b. Normal p waves with constant PR intervals and intermittent missing QRS complexes
c. Normal p waves each with a QRS complex but prolonged PR intervals regularly throughout the rhythm
d. Normal p waves and QRS complexes that are independent of each other but has regular atrial and ventricular rhythm
_____ 77. Your patient is experiencing a blood pressure of 70/42, weak pulse, chest pain, and is pale. The patient is confused and
anxious. An ECG is obtained, and a Third-Degree Heart Block is noted. What treatment should the nurse be prepping for?
a. Amiodarone IV b. Defibrillation c. Temporary pacing d. Synchronized Defibrillation

_____ 78. Select below all the causes of a Third-Degree Heart block:
a. Congenital heart disease c. Heart valve damage
b. Digoxin Toxicity d. Blood Glucose 50 mg/dL

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