ECG WORKOUT
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1️⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Description &
Location of the Heart
Question Stem (2–3 sentences)
A telemetry rhythm strip from a supine adult shows a regular
rhythm at ~60 bpm, narrow QRS complexes, visible P waves
before every QRS, and a PR interval of ~0.18 sec. The nurse
notes the precordial leads V1–V4 show normal R progression.
,Considering heart orientation in the thorax, which
interpretation best matches these ECG findings and location-
related electrode expectations?
A. Normal sinus rhythm with normal precordial R progression
consistent with a normally situated heart.
B. Sinus bradycardia with leftward heart axis due to
cardiomegaly shifting R wave progression laterally.
C. Junctional rhythm with retrograde P waves; precordial R
progression rules this out.
D. Sinus rhythm with right ventricular hypertrophy causing
abnormal R progression.
Correct Answer
A
Rationales
Correct Option: The rhythm shows sinus origin (P before each
QRS), rate ~60 bpm, and normal PR and QRS durations; normal
R progression in V1–V4 supports a normally positioned heart.
Incorrect A→B: Rate ~60 is not bradycardic clinically borderline;
leftward axis with cardiomegaly typically delays R progression
(reduced R in early precordials), which is not present.
Incorrect A→C: Junctional rhythms usually have absent or
inverted/retrograde P waves and different PR relations,
inconsistent with visible normal P waves.
Incorrect A→D: Right ventricular hypertrophy produces tall R in
V1 and exaggerated R in right precordials, inconsistent with
described normal progression.
,Teaching Point
Normal R-wave progression supports normal cardiac position
and ventricular depolarization.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Function of the
Heart
Question Stem
A patient complains of dizziness. Telemetry shows a rhythm
with absent P waves, irregularly irregular R–R intervals, and
varying R–R spacing; average ventricular rate ~110 bpm.
Considering cardiac pump function, what is the most
concerning immediate hemodynamic consequence of this
rhythm?
A. Loss of atrial contraction leading to reduced ventricular
preload and potential drop in cardiac output.
B. Increased atrial contraction causing dangerously high
ventricular filling pressures.
C. Improved cardiac output due to faster ventricular rate and
maintained atrial kick.
D. No hemodynamic effect—ventricular filling is unchanged in
this rhythm.
, Correct Answer
A
Rationales
Correct Option: The described rhythm is atrial fibrillation
(irregularly irregular, absent P waves); loss of organized atrial
contraction reduces preload (atrial kick), which can lower
cardiac output, especially in patients with stiff ventricles.
Incorrect B: Atrial fibrillation eliminates coordinated atrial
contraction, not increases it.
Incorrect C: Faster rate may temporarily increase cardiac
output, but loss of atrial contraction and irregularity often
reduce effective stroke volume—so this statement is incorrect.
Incorrect D: There is a hemodynamic effect; atrial contribution
to ventricular filling is lost.
Teaching Point
Atrial contraction contributes ~20–30% of ventricular preload;
its loss can reduce output.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
3⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Heart Surfaces
Question Stem
A lead II rhythm strip shows peaked, tall T waves in multiple
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1️⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Description &
Location of the Heart
Question Stem (2–3 sentences)
A telemetry rhythm strip from a supine adult shows a regular
rhythm at ~60 bpm, narrow QRS complexes, visible P waves
before every QRS, and a PR interval of ~0.18 sec. The nurse
notes the precordial leads V1–V4 show normal R progression.
,Considering heart orientation in the thorax, which
interpretation best matches these ECG findings and location-
related electrode expectations?
A. Normal sinus rhythm with normal precordial R progression
consistent with a normally situated heart.
B. Sinus bradycardia with leftward heart axis due to
cardiomegaly shifting R wave progression laterally.
C. Junctional rhythm with retrograde P waves; precordial R
progression rules this out.
D. Sinus rhythm with right ventricular hypertrophy causing
abnormal R progression.
Correct Answer
A
Rationales
Correct Option: The rhythm shows sinus origin (P before each
QRS), rate ~60 bpm, and normal PR and QRS durations; normal
R progression in V1–V4 supports a normally positioned heart.
Incorrect A→B: Rate ~60 is not bradycardic clinically borderline;
leftward axis with cardiomegaly typically delays R progression
(reduced R in early precordials), which is not present.
Incorrect A→C: Junctional rhythms usually have absent or
inverted/retrograde P waves and different PR relations,
inconsistent with visible normal P waves.
Incorrect A→D: Right ventricular hypertrophy produces tall R in
V1 and exaggerated R in right precordials, inconsistent with
described normal progression.
,Teaching Point
Normal R-wave progression supports normal cardiac position
and ventricular depolarization.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Function of the
Heart
Question Stem
A patient complains of dizziness. Telemetry shows a rhythm
with absent P waves, irregularly irregular R–R intervals, and
varying R–R spacing; average ventricular rate ~110 bpm.
Considering cardiac pump function, what is the most
concerning immediate hemodynamic consequence of this
rhythm?
A. Loss of atrial contraction leading to reduced ventricular
preload and potential drop in cardiac output.
B. Increased atrial contraction causing dangerously high
ventricular filling pressures.
C. Improved cardiac output due to faster ventricular rate and
maintained atrial kick.
D. No hemodynamic effect—ventricular filling is unchanged in
this rhythm.
, Correct Answer
A
Rationales
Correct Option: The described rhythm is atrial fibrillation
(irregularly irregular, absent P waves); loss of organized atrial
contraction reduces preload (atrial kick), which can lower
cardiac output, especially in patients with stiff ventricles.
Incorrect B: Atrial fibrillation eliminates coordinated atrial
contraction, not increases it.
Incorrect C: Faster rate may temporarily increase cardiac
output, but loss of atrial contraction and irregularity often
reduce effective stroke volume—so this statement is incorrect.
Incorrect D: There is a hemodynamic effect; atrial contribution
to ventricular filling is lost.
Teaching Point
Atrial contraction contributes ~20–30% of ventricular preload;
its loss can reduce output.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
3⃣ Reference
Ch. 1 — Anatomy & Physiology of the Heart — Heart Surfaces
Question Stem
A lead II rhythm strip shows peaked, tall T waves in multiple
