ECG WORKOUT
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1️⃣
Reference
Ch. 1 — Anatomy & Physiology of the Heart — Description and
Location of the Heart
Question Stem
A patient on the telemetry floor is alert but has a regular
rhythm at ~50 bpm. The monitor strip shows narrow QRS
complexes and either absent or retrograde (inverted after) P
waves. Considering the anatomical location of the AV node and
,surrounding tissues, which pacemaker site best explains these
findings?
Options
A. Sinoatrial (SA) node in the right atrium
B. Atrioventricular (AV) junction (AV node/ proximal bundle of
His)
C. Distal Purkinje fibers in the ventricular myocardium
D. Ectopic focus in the left atrium
Correct Answer
B
Rationales
Correct (B): Narrow QRS with absent or retrograde P waves and
a rate around 40–60 bpm indicates a junctional (AV nodal)
pacemaker; the AV junction sits anatomically near the tricuspid
annulus and can assume pacing when SA impulse fails.
Incorrect (A): SA-node origin produces upright P waves
preceding each QRS in normal lead views; absent/retrograde P
waves are inconsistent with sinus rhythm.
Incorrect (C): Ventricular (Purkinje) origin typically produces
wide QRS complexes and slower escape rates; narrow QRS here
argues against ventricular origin.
Incorrect (D): A left atrial ectopic focus would still produce P
waves preceding QRS with altered morphology, not
absent/retrograde P waves.
Teaching Point
Junctional rhythms arise from the AV junction:
,absent/retrograde P waves with narrow QRS and rate ~40–60
bpm.
2️⃣
Reference
Ch. 1 — Heart Chambers — Right Atrium vs Left Atrium
Question Stem
A long-term COPD patient’s telemetry shows peaked, tall P-
wave morphologies in leads that emphasize atrial activity.
Which chamber enlargement is most consistent with
prominent, peaked P waves and why?
Options
A. Left atrial enlargement due to mitral valve disease
B. Right atrial enlargement due to chronic pulmonary disease
C. Left ventricular enlargement due to systemic hypertension
D. Right ventricular enlargement due to pulmonary embolus
Correct Answer
B
Rationales
Correct (B): Chronic lung disease increases right atrial pressure
and size; right atrial enlargement often produces tall, peaked P
waves due to increased atrial muscle mass.
Incorrect (A): Left atrial enlargement typically causes broad,
notched or biphasic P waves, not peaked P waves.
Incorrect (C): LV enlargement primarily alters QRS amplitude
, and axis, not P-wave morphology.
Incorrect (D): Acute right ventricular strain may eventually
affect atrial size, but tall peaked P waves more classically reflect
chronic right atrial enlargement.
Teaching Point
Peaked P waves suggest right atrial enlargement (chronic lung
disease or pulmonary hypertension).
3️⃣
Reference
Ch. 1 — Heart Valves — Function and Hemodynamic Effects
Question Stem
A telemetry strip shows irregular ventricular response with
absent discrete P waves and a rapid, chaotic baseline. The
patient also has chronic mitral valve disease. Which of the
following best links the valve pathology to the rhythm
observed?
Options
A. Mitral valve disease causes increased left atrial pressure,
predisposing to atrial fibrillation.
B. Mitral valve disease directly damages the AV node, causing
complete heart block.
C. Mitral valve disease produces ectopic ventricular
pacemakers, causing ventricular tachycardia.
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1️⃣
Reference
Ch. 1 — Anatomy & Physiology of the Heart — Description and
Location of the Heart
Question Stem
A patient on the telemetry floor is alert but has a regular
rhythm at ~50 bpm. The monitor strip shows narrow QRS
complexes and either absent or retrograde (inverted after) P
waves. Considering the anatomical location of the AV node and
,surrounding tissues, which pacemaker site best explains these
findings?
Options
A. Sinoatrial (SA) node in the right atrium
B. Atrioventricular (AV) junction (AV node/ proximal bundle of
His)
C. Distal Purkinje fibers in the ventricular myocardium
D. Ectopic focus in the left atrium
Correct Answer
B
Rationales
Correct (B): Narrow QRS with absent or retrograde P waves and
a rate around 40–60 bpm indicates a junctional (AV nodal)
pacemaker; the AV junction sits anatomically near the tricuspid
annulus and can assume pacing when SA impulse fails.
Incorrect (A): SA-node origin produces upright P waves
preceding each QRS in normal lead views; absent/retrograde P
waves are inconsistent with sinus rhythm.
Incorrect (C): Ventricular (Purkinje) origin typically produces
wide QRS complexes and slower escape rates; narrow QRS here
argues against ventricular origin.
Incorrect (D): A left atrial ectopic focus would still produce P
waves preceding QRS with altered morphology, not
absent/retrograde P waves.
Teaching Point
Junctional rhythms arise from the AV junction:
,absent/retrograde P waves with narrow QRS and rate ~40–60
bpm.
2️⃣
Reference
Ch. 1 — Heart Chambers — Right Atrium vs Left Atrium
Question Stem
A long-term COPD patient’s telemetry shows peaked, tall P-
wave morphologies in leads that emphasize atrial activity.
Which chamber enlargement is most consistent with
prominent, peaked P waves and why?
Options
A. Left atrial enlargement due to mitral valve disease
B. Right atrial enlargement due to chronic pulmonary disease
C. Left ventricular enlargement due to systemic hypertension
D. Right ventricular enlargement due to pulmonary embolus
Correct Answer
B
Rationales
Correct (B): Chronic lung disease increases right atrial pressure
and size; right atrial enlargement often produces tall, peaked P
waves due to increased atrial muscle mass.
Incorrect (A): Left atrial enlargement typically causes broad,
notched or biphasic P waves, not peaked P waves.
Incorrect (C): LV enlargement primarily alters QRS amplitude
, and axis, not P-wave morphology.
Incorrect (D): Acute right ventricular strain may eventually
affect atrial size, but tall peaked P waves more classically reflect
chronic right atrial enlargement.
Teaching Point
Peaked P waves suggest right atrial enlargement (chronic lung
disease or pulmonary hypertension).
3️⃣
Reference
Ch. 1 — Heart Valves — Function and Hemodynamic Effects
Question Stem
A telemetry strip shows irregular ventricular response with
absent discrete P waves and a rapid, chaotic baseline. The
patient also has chronic mitral valve disease. Which of the
following best links the valve pathology to the rhythm
observed?
Options
A. Mitral valve disease causes increased left atrial pressure,
predisposing to atrial fibrillation.
B. Mitral valve disease directly damages the AV node, causing
complete heart block.
C. Mitral valve disease produces ectopic ventricular
pacemakers, causing ventricular tachycardia.
