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,EKGs for the Nurse Practitioner and Physician Assistant
(4th Edition, 2022) – Test Bank – Maureen Knechtel
Question 1
A 65-year-old male with a history of hypertension presents to the emergency department with substernal
chest pressure radiating to the left arm that began 45 minutes ago. His initial 12-lead EKG shows 2-mm ST-
segment elevation in leads V1 through V4. Which of the following is the most appropriate immediate next
step?
A) Order a troponin level and admit to the telemetry unit
B) Administer sublingual nitroglycerin and reassess chest pain
C) Activate the ST-segment elevation myocardial infarction (STEMI) protocol for emergent percutaneous coronary
intervention
D) Obtain a chest X-ray to rule out aortic dissection
Answer: C
ST-segment elevation in contiguous precordial leads V1–V4 indicates an anterior STEMI, which requires emergent
reperfusion therapy. The priority is to activate the STEMI protocol for immediate percutaneous coronary
intervention (PCI). Troponin levels (A) should be obtained but should not delay reperfusion. Nitroglycerin (B) may
be given but is not the definitive treatment.
Question 2
The EKG of a 72-year-old female with a history of coronary artery disease shows a regular rhythm with a
heart rate of 38 beats per minute. There is a P wave before every QRS complex, the PR interval is 0.20
seconds, and the QRS duration is 0.10 seconds. Which of the following is the most appropriate initial
management?
A) Administer atropine 0.5 mg intravenously
B) Place transcutaneous pacing pads
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,C) Obtain a serum thyroid-stimulating hormone level
D) Observe and monitor the patient with continuous telemetry
Answer: D
This EKG shows sinus bradycardia with a normal PR interval and narrow QRS complex. In a stable patient without
symptoms of hemodynamic compromise, observation and monitoring are appropriate. Atropine (A) and pacing (B)
are indicated only if the patient is symptomatic (hypotension, altered mental status, chest pain).
Question 3
A 45-year-old patient presents with palpitations and lightheadedness. The EKG shows an irregularly
irregular rhythm with no discernible P waves and a ventricular rate of 130 beats per minute. What is the
most likely diagnosis?
A) Atrial flutter with variable conduction
B) Atrial fibrillation with rapid ventricular response
C) Multifocal atrial tachycardia
D) Wandering atrial pacemaker
Answer: B
The absence of P waves with an irregularly irregular rhythm and a rate >100 bpm is classic for atrial fibrillation with
rapid ventricular response. Atrial flutter (A) typically shows sawtooth flutter waves. Multifocal atrial tachycardia
(C) has at least three different P-wave morphologies.
Question 4
On a 12-lead EKG, the presence of a Q wave greater than 0.04 seconds in duration and deeper than one-third the
height of the following R wave in leads II, III, and aVF is most consistent with:
A) Acute inferior wall ischemia
B) Previous inferior wall myocardial infarction
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, C) Acute anterior wall myocardial infarction
D) Normal variant in a healthy individual
Answer: B
Pathologic Q waves indicate transmural myocardial necrosis and are a sign of a previous (completed) myocardial
infarction. The location in leads II, III, and aVF localizes the infarct to the inferior wall. Acute ischemia (A) would
show ST-segment or T-wave changes without Q waves.
Question 5
A patient's EKG shows a regular rhythm with a rate of 45 beats per minute. The P waves are inverted in lead II, and
the PR interval is 0.12 seconds. The QRS complex is narrow at 0.08 seconds. This rhythm is most consistent with:
A) Normal sinus rhythm
B) Junctional escape rhythm
C) Idioventricular rhythm
D) Wandering atrial pacemaker
Answer: B
A junctional escape rhythm originates from the AV node and has a rate of 40–60 bpm. Retrograde atrial
depolarization produces inverted P waves in lead II (or absent P waves) with a short PR interval. Idioventricular
rhythm (C) would have wide QRS complexes (<40 bpm).
Question 6
A 58-year-old patient with a history of congestive heart failure is on digoxin therapy. Her EKG shows ST-segment
depression with a characteristic "scooped" or "sagging" morphology. This finding is most consistent with:
A) Subendocardial ischemia
B) Digoxin effect
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,EKGs for the Nurse Practitioner and Physician Assistant
(4th Edition, 2022) – Test Bank – Maureen Knechtel
Question 1
A 65-year-old male with a history of hypertension presents to the emergency department with substernal
chest pressure radiating to the left arm that began 45 minutes ago. His initial 12-lead EKG shows 2-mm ST-
segment elevation in leads V1 through V4. Which of the following is the most appropriate immediate next
step?
A) Order a troponin level and admit to the telemetry unit
B) Administer sublingual nitroglycerin and reassess chest pain
C) Activate the ST-segment elevation myocardial infarction (STEMI) protocol for emergent percutaneous coronary
intervention
D) Obtain a chest X-ray to rule out aortic dissection
Answer: C
ST-segment elevation in contiguous precordial leads V1–V4 indicates an anterior STEMI, which requires emergent
reperfusion therapy. The priority is to activate the STEMI protocol for immediate percutaneous coronary
intervention (PCI). Troponin levels (A) should be obtained but should not delay reperfusion. Nitroglycerin (B) may
be given but is not the definitive treatment.
Question 2
The EKG of a 72-year-old female with a history of coronary artery disease shows a regular rhythm with a
heart rate of 38 beats per minute. There is a P wave before every QRS complex, the PR interval is 0.20
seconds, and the QRS duration is 0.10 seconds. Which of the following is the most appropriate initial
management?
A) Administer atropine 0.5 mg intravenously
B) Place transcutaneous pacing pads
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,C) Obtain a serum thyroid-stimulating hormone level
D) Observe and monitor the patient with continuous telemetry
Answer: D
This EKG shows sinus bradycardia with a normal PR interval and narrow QRS complex. In a stable patient without
symptoms of hemodynamic compromise, observation and monitoring are appropriate. Atropine (A) and pacing (B)
are indicated only if the patient is symptomatic (hypotension, altered mental status, chest pain).
Question 3
A 45-year-old patient presents with palpitations and lightheadedness. The EKG shows an irregularly
irregular rhythm with no discernible P waves and a ventricular rate of 130 beats per minute. What is the
most likely diagnosis?
A) Atrial flutter with variable conduction
B) Atrial fibrillation with rapid ventricular response
C) Multifocal atrial tachycardia
D) Wandering atrial pacemaker
Answer: B
The absence of P waves with an irregularly irregular rhythm and a rate >100 bpm is classic for atrial fibrillation with
rapid ventricular response. Atrial flutter (A) typically shows sawtooth flutter waves. Multifocal atrial tachycardia
(C) has at least three different P-wave morphologies.
Question 4
On a 12-lead EKG, the presence of a Q wave greater than 0.04 seconds in duration and deeper than one-third the
height of the following R wave in leads II, III, and aVF is most consistent with:
A) Acute inferior wall ischemia
B) Previous inferior wall myocardial infarction
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, C) Acute anterior wall myocardial infarction
D) Normal variant in a healthy individual
Answer: B
Pathologic Q waves indicate transmural myocardial necrosis and are a sign of a previous (completed) myocardial
infarction. The location in leads II, III, and aVF localizes the infarct to the inferior wall. Acute ischemia (A) would
show ST-segment or T-wave changes without Q waves.
Question 5
A patient's EKG shows a regular rhythm with a rate of 45 beats per minute. The P waves are inverted in lead II, and
the PR interval is 0.12 seconds. The QRS complex is narrow at 0.08 seconds. This rhythm is most consistent with:
A) Normal sinus rhythm
B) Junctional escape rhythm
C) Idioventricular rhythm
D) Wandering atrial pacemaker
Answer: B
A junctional escape rhythm originates from the AV node and has a rate of 40–60 bpm. Retrograde atrial
depolarization produces inverted P waves in lead II (or absent P waves) with a short PR interval. Idioventricular
rhythm (C) would have wide QRS complexes (<40 bpm).
Question 6
A 58-year-old patient with a history of congestive heart failure is on digoxin therapy. Her EKG shows ST-segment
depression with a characteristic "scooped" or "sagging" morphology. This finding is most consistent with:
A) Subendocardial ischemia
B) Digoxin effect
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