APEX EKG COMPREHENSIVE EXAM UPDATED
QUESTIONS AND ANSWERS SURE A+
✔✔Wandering Atrial Pacemaker - ✔✔If you have three or more different looking P
waves but the strip meets the rest of sinus criteria it is call Wandering Atrial Pacemaker
(WAP)
Less than 100
Irregular
✔✔ST Elevation - ✔✔
✔✔ST Depression - ✔✔
✔✔ EKG Grid - ✔✔Each small square (the smaller lighter boxes within the big bold
boxes) represents 0.04 seconds
Each larger square (the boxes within the bold lines) represents 0.2 seconds.
Each large square has 5 small squares across SO 0.04 X 5 = 0.2 seconds
✔✔The 6 Second Strip Method - ✔✔Least accurate, but quickest way to estimate rate
especially in irregular rhythms
✔✔EKG - ✔✔
✔✔EKG intervals - ✔✔
✔✔P Wave - ✔✔Atrial depolarization
✔✔PR Interval - ✔✔Normal is 0.12 to 0.20 seconds
Corresponds to the delay the AV node provides to allow for ventricular filling
✔✔QRS Complex - ✔✔Normal is <0.12 seconds usually between 0.06 to 0.10 seconds
Ventricular depolarization
✔✔QT Interval - ✔✔Normal 0.36-0.46
✔✔6 Steps for Rhythm Interpretation - ✔✔Determine Regularity
Calculate the Rate
Evaluate the P wave
Measure the PRI
Evaluate the QRS Width
Evaluate the T wave and Calculate the QTI
✔✔Normal Sinus Rhythm - ✔✔Regularity: atrial and ventricular rate are regular
Rate: 60 to 100 beats per minute
, P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Bradycardia - ✔✔Regularity: atrial and ventricular rate are regular
Rate: < 60 beats per minute
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Tachycardia - ✔✔Regularity: atrial and ventricular rate are regular
Rate: >100 beats per minute
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Arrhythmia - ✔✔Regularity: atrial and ventricular rate are the same but the
rhythm will be slightly irregular
Rate: variable, can be bradycardia to normal
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Arrest and Sinus Pause - ✔✔Regularity: Regular but interrupted (by a pause)
Rate: can occur at any heart rate
P wave: normal sinus P waves before the pause
PRI: 0.12 to 0.20 seconds before the pause, may be shorter or absent after the pause
QRS: 0.06 to 0.10 seconds on the sinus beats, on the escape beats the QRS may be
narrow or wide depending on which pacemaker of the heart resumes after the pause
QTI: 0.36 to 0.46 seconds for the sinus beats
✔✔Premature Atrial Contractions
PACs - ✔✔Regularity: underlying atrial rate is regular except for early beat, ventricular
rate is regular
Rate: determined by the underlying rhythm
P wave: upright, smooth, round and uniform shape, EXCEPT for the premature beat, it
will shaped differently
PRI : 0.12 to 0.20 seconds except for early beat
QUESTIONS AND ANSWERS SURE A+
✔✔Wandering Atrial Pacemaker - ✔✔If you have three or more different looking P
waves but the strip meets the rest of sinus criteria it is call Wandering Atrial Pacemaker
(WAP)
Less than 100
Irregular
✔✔ST Elevation - ✔✔
✔✔ST Depression - ✔✔
✔✔ EKG Grid - ✔✔Each small square (the smaller lighter boxes within the big bold
boxes) represents 0.04 seconds
Each larger square (the boxes within the bold lines) represents 0.2 seconds.
Each large square has 5 small squares across SO 0.04 X 5 = 0.2 seconds
✔✔The 6 Second Strip Method - ✔✔Least accurate, but quickest way to estimate rate
especially in irregular rhythms
✔✔EKG - ✔✔
✔✔EKG intervals - ✔✔
✔✔P Wave - ✔✔Atrial depolarization
✔✔PR Interval - ✔✔Normal is 0.12 to 0.20 seconds
Corresponds to the delay the AV node provides to allow for ventricular filling
✔✔QRS Complex - ✔✔Normal is <0.12 seconds usually between 0.06 to 0.10 seconds
Ventricular depolarization
✔✔QT Interval - ✔✔Normal 0.36-0.46
✔✔6 Steps for Rhythm Interpretation - ✔✔Determine Regularity
Calculate the Rate
Evaluate the P wave
Measure the PRI
Evaluate the QRS Width
Evaluate the T wave and Calculate the QTI
✔✔Normal Sinus Rhythm - ✔✔Regularity: atrial and ventricular rate are regular
Rate: 60 to 100 beats per minute
, P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Bradycardia - ✔✔Regularity: atrial and ventricular rate are regular
Rate: < 60 beats per minute
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Tachycardia - ✔✔Regularity: atrial and ventricular rate are regular
Rate: >100 beats per minute
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Arrhythmia - ✔✔Regularity: atrial and ventricular rate are the same but the
rhythm will be slightly irregular
Rate: variable, can be bradycardia to normal
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : 0.12 to 0.20 seconds
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape
✔✔Sinus Arrest and Sinus Pause - ✔✔Regularity: Regular but interrupted (by a pause)
Rate: can occur at any heart rate
P wave: normal sinus P waves before the pause
PRI: 0.12 to 0.20 seconds before the pause, may be shorter or absent after the pause
QRS: 0.06 to 0.10 seconds on the sinus beats, on the escape beats the QRS may be
narrow or wide depending on which pacemaker of the heart resumes after the pause
QTI: 0.36 to 0.46 seconds for the sinus beats
✔✔Premature Atrial Contractions
PACs - ✔✔Regularity: underlying atrial rate is regular except for early beat, ventricular
rate is regular
Rate: determined by the underlying rhythm
P wave: upright, smooth, round and uniform shape, EXCEPT for the premature beat, it
will shaped differently
PRI : 0.12 to 0.20 seconds except for early beat
