APEX EKG COMPREHENSIVE EXAM UPDATED QUESTIONS
AND ANSWERS RATED A+
✔✔3rd Degree AVB or Complete Heart Block (LETHAL) - ✔✔Regularity: atria and
ventricles are regular
Rate: atrial rate unusually 60-100; ventricular rate usually 20-40
P wave: upright, smooth, round and uniform shape, P waves may be hidden in QRS
complexes or T waves
PRI : none, because there is no association btw the P waves and QRS complexes
QRS: typically widened, but can be normal of < 0.12 seconds
T wave: usually abnormal, or within the QRS
*the ventricles and the atria are beating independent of one another
✔✔Pacemaker Failure to Fire - ✔✔the pacemaker fails to send out an electrical impulse
when it should
✔✔Pacemaker Failure to capture - ✔✔there is no P or QRS following a pacemaker
spike
✔✔Pacemaker Failure to sense - ✔✔Occurs when the pacemaker fails to sense the
patient's own intrinsic rhythm and generates a pacer spike during any part of the cardiac
cycle
✔✔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
AND ANSWERS RATED A+
✔✔3rd Degree AVB or Complete Heart Block (LETHAL) - ✔✔Regularity: atria and
ventricles are regular
Rate: atrial rate unusually 60-100; ventricular rate usually 20-40
P wave: upright, smooth, round and uniform shape, P waves may be hidden in QRS
complexes or T waves
PRI : none, because there is no association btw the P waves and QRS complexes
QRS: typically widened, but can be normal of < 0.12 seconds
T wave: usually abnormal, or within the QRS
*the ventricles and the atria are beating independent of one another
✔✔Pacemaker Failure to Fire - ✔✔the pacemaker fails to send out an electrical impulse
when it should
✔✔Pacemaker Failure to capture - ✔✔there is no P or QRS following a pacemaker
spike
✔✔Pacemaker Failure to sense - ✔✔Occurs when the pacemaker fails to sense the
patient's own intrinsic rhythm and generates a pacer spike during any part of the cardiac
cycle
✔✔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
