ECG WORKOUT
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1
Reference
Ch. 1 — Description & Location of the Heart — Cardiac Axis and
Lead Placement
Question Stem
A postoperative telemetry strip shows tall R waves in leads I and
aVL and deep S waves in V1. The nurse notes the precordial
leads were placed one interspace higher than usual. Which is
the MOST likely interpretation?
,A. True left ventricular hypertrophy producing left-axis
deviation.
B. Apparent ECG changes due to incorrect lead placement, not
pathological LVH.
C. Acute inferior wall myocardial infarction with reciprocal
changes.
D. Hyperkalemia causing peaked T waves and wide QRS
complex.
Correct Answer
B
Rationales
Correct (B): Incorrect precordial lead placement (too high)
commonly alters R/S transition and exaggerates R waves in
lateral limb leads; this produces pseudo-LVH patterns without
true structural change. Clinically, verify lead placement and
repeat ECG.
Incorrect (A): True LVH requires consistent voltage criteria
across correctly placed leads and clinical corroboration
(hypertension, echo). Lead misplacement can mimic but does
not confirm LVH.
Incorrect (C): Inferior MI typically produces changes in II, III,
aVF, not isolated tall R in I/aVL with deep V1 S waves.
Incorrect (D): Hyperkalemia classically shows peaked T waves
and QRS widening, not isolated tall R/ deep S due to lead
misplacement.
,Teaching Point
Always confirm correct lead placement before diagnosing
voltage-based abnormalities.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2
Reference
Ch. 2 — Function of the Heart — Stroke Volume & ECG
Correlates
Question Stem
A patient with acute decreased stroke volume becomes
hypotensive. Continuous ECG monitoring shows sinus
tachycardia at 120 bpm with normal P waves and narrow QRS
complexes. Which is the BEST clinical interpretation?
A. Sinus tachycardia compensating for reduced stroke volume to
maintain cardiac output.
B. Atrial fibrillation with rapid ventricular response causing
hypotension.
C. Ventricular tachycardia causing loss of atrial contribution to
cardiac output.
D. Third-degree AV block with junctional escape rhythm.
Correct Answer
A
, Rationales
Correct (A): Sinus tachycardia with normal P waves and narrow
QRS indicates an intact sinus mechanism increasing rate to
preserve cardiac output when stroke volume falls. Clinical
correlation with hypotension supports compensation.
Incorrect (B): Atrial fibrillation would show irregularly irregular
rhythm without discrete P waves.
Incorrect (C): Ventricular tachycardia typically has wide,
abnormal QRS complexes and no organized P–QRS relationship.
Incorrect (D): Third-degree AV block produces AV dissociation
with independent P waves and usually slower ventricular
escape rhythms.
Teaching Point
Sinus tachycardia with intact P waves is often compensatory —
treat the underlying cause first.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 2.
3
Reference
Ch. 3 — Heart Surfaces — Pericardial Effusion Effects on ECG
Question Stem
A patient with progressive dyspnea has low-voltage QRS
complexes in all leads and electrical alternans on monitoring.
EXERCISES IN ARRHYTHMIA
INTERPRETATION
8TH EDITION
• AUTHOR(S)JANE HUFF
TEST BANK
1
Reference
Ch. 1 — Description & Location of the Heart — Cardiac Axis and
Lead Placement
Question Stem
A postoperative telemetry strip shows tall R waves in leads I and
aVL and deep S waves in V1. The nurse notes the precordial
leads were placed one interspace higher than usual. Which is
the MOST likely interpretation?
,A. True left ventricular hypertrophy producing left-axis
deviation.
B. Apparent ECG changes due to incorrect lead placement, not
pathological LVH.
C. Acute inferior wall myocardial infarction with reciprocal
changes.
D. Hyperkalemia causing peaked T waves and wide QRS
complex.
Correct Answer
B
Rationales
Correct (B): Incorrect precordial lead placement (too high)
commonly alters R/S transition and exaggerates R waves in
lateral limb leads; this produces pseudo-LVH patterns without
true structural change. Clinically, verify lead placement and
repeat ECG.
Incorrect (A): True LVH requires consistent voltage criteria
across correctly placed leads and clinical corroboration
(hypertension, echo). Lead misplacement can mimic but does
not confirm LVH.
Incorrect (C): Inferior MI typically produces changes in II, III,
aVF, not isolated tall R in I/aVL with deep V1 S waves.
Incorrect (D): Hyperkalemia classically shows peaked T waves
and QRS widening, not isolated tall R/ deep S due to lead
misplacement.
,Teaching Point
Always confirm correct lead placement before diagnosing
voltage-based abnormalities.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 1.
2
Reference
Ch. 2 — Function of the Heart — Stroke Volume & ECG
Correlates
Question Stem
A patient with acute decreased stroke volume becomes
hypotensive. Continuous ECG monitoring shows sinus
tachycardia at 120 bpm with normal P waves and narrow QRS
complexes. Which is the BEST clinical interpretation?
A. Sinus tachycardia compensating for reduced stroke volume to
maintain cardiac output.
B. Atrial fibrillation with rapid ventricular response causing
hypotension.
C. Ventricular tachycardia causing loss of atrial contribution to
cardiac output.
D. Third-degree AV block with junctional escape rhythm.
Correct Answer
A
, Rationales
Correct (A): Sinus tachycardia with normal P waves and narrow
QRS indicates an intact sinus mechanism increasing rate to
preserve cardiac output when stroke volume falls. Clinical
correlation with hypotension supports compensation.
Incorrect (B): Atrial fibrillation would show irregularly irregular
rhythm without discrete P waves.
Incorrect (C): Ventricular tachycardia typically has wide,
abnormal QRS complexes and no organized P–QRS relationship.
Incorrect (D): Third-degree AV block produces AV dissociation
with independent P waves and usually slower ventricular
escape rhythms.
Teaching Point
Sinus tachycardia with intact P waves is often compensatory —
treat the underlying cause first.
Citation
Huff, J. (2022). ECG Workout: Exercises in Arrhythmia
Interpretation (8th ed.). Ch. 2.
3
Reference
Ch. 3 — Heart Surfaces — Pericardial Effusion Effects on ECG
Question Stem
A patient with progressive dyspnea has low-voltage QRS
complexes in all leads and electrical alternans on monitoring.
