KAISER PERMANENTE EKG
COMPETENCY TEST – ULTIMATE
2025 STUDY GUIDE
Section 1: Systematic Analysis & Sinus Rhythms (Questions
1–25)
1.
You are reviewing a telemetry strip. The rhythm is regular with a rate of 72 bpm.
There is a P wave before every QRS complex, and the PR interval is 0.16
seconds. The QRS duration is 0.08 seconds. What is the correct interpretation?
A) Sinus Bradycardia
B) Sinus Tachycardia
C) Normal Sinus Rhythm
D) Junctional Rhythm
**Answer: C**
*Rationale: This rhythm meets all criteria for Normal Sinus Rhythm (NSR): rate
60-100 bpm, regular rhythm, P wave before every QRS, normal PR interval
(0.12-0.20 sec), and narrow QRS (<0.12 sec). Sinus Bradycardia (A) has a rate
<60 bpm; Sinus Tachycardia (B) has a rate >100 bpm; Junctional Rhythm (D)
typically has an inverted or absent P wave. NSR is the baseline for all EKG
interpretation.*
,2.
A patient’s EKG shows a regular rhythm at 54 bpm. P waves are present before
each QRS, PR interval is 0.18 seconds, and QRS is narrow. The patient is
asymptomatic and resting. What is the appropriate action per Kaiser Permanente
protocol?
A) Activate a Code Blue immediately
B) Administer atropine 0.5 mg IV
C) Monitor the patient; no intervention is needed for asymptomatic sinus
bradycardia
D) Prepare for transcutaneous pacing
**Answer: C**
*Rationale: This is Sinus Bradycardia, which is common and normal in athletes
or during sleep. Kaiser Permanente protocol emphasizes that treatment is only
indicated if the patient is symptomatic (e.g., dizziness, hypotension, chest pain).
For an asymptomatic patient, monitoring is sufficient. Code Blue (A), atropine
(B), and pacing (D) are for unstable bradycardia per ACLS guidelines, which KP
follows.*
3.
Which finding is characteristic of Sinus Arrhythmia?
A) Irregular rhythm with no P waves
B) Regular rhythm with inverted P waves
, C) Irregular rhythm that speeds up with inspiration and slows with expiration
D) Regular rhythm with a PR interval > 0.20 seconds
**Answer: C**
*Rationale: Sinus Arrhythmia is a benign, normal variant where the heart rate
varies with respiration—faster during inspiration and slower during
expiration—due to vagal tone changes. It is common in young people and
athletes. It still has a P wave before every QRS, but the R-R interval varies.
Option A describes A-fib; B describes a junctional rhythm; D describes
first-degree AV block.*
4.
A telemetry strip shows a regular rhythm at 118 bpm. P waves are present
before each narrow QRS complex, and the PR interval is 0.16 seconds. The
patient reports feeling anxious but is hemodynamically stable. What is the
correct interpretation and priority action?
A) Ventricular Tachycardia; prepare for defibrillation
B) Sinus Tachycardia; assess for underlying cause (e.g., pain, fever, anxiety,
hypovolemia)
C) Atrial Fibrillation; administer diltiazem
D) Supraventricular Tachycardia; perform vagal maneuvers
**Answer: B**
*Rationale: This rhythm is Sinus Tachycardia. The presence of a P wave before
each narrow QRS at a rate >100 bpm is diagnostic. Per Kaiser Permanente
, protocol, the priority is not to treat the rate but to identify and address the
underlying cause (e.g., pain, anxiety, fever, PE, anemia). Ventricular
Tachycardia (A) has wide QRS complexes; A-fib (C) is irregularly irregular with
no P waves; SVT (D) typically has no visible P waves or a very short RP
interval.*
5.
Using the 5-step systematic approach, which of the following is the FIRST step in
EKG interpretation?
A) Determine the PR interval
B) Assess the QRS complex morphology
C) Determine the heart rate
D) Evaluate for the presence of P waves
**Answer: C**
*Rationale: The Kaiser-recommended 5-step systematic approach is: 1) Rate, 2)
Rhythm (regular or irregular), 3) P waves, 4) PR interval, 5) QRS complex.
Determining the rate is the logical first step, as it immediately categorizes the
rhythm as bradycardic, normal, or tachycardic, guiding further analysis.*
6.
A patient’s EKG shows a heart rate of 88 bpm, regular rhythm, P wave before
every QRS, PR interval of 0.22 seconds, and narrow QRS complexes. What is the
diagnosis?
A) Normal Sinus Rhythm
COMPETENCY TEST – ULTIMATE
2025 STUDY GUIDE
Section 1: Systematic Analysis & Sinus Rhythms (Questions
1–25)
1.
You are reviewing a telemetry strip. The rhythm is regular with a rate of 72 bpm.
There is a P wave before every QRS complex, and the PR interval is 0.16
seconds. The QRS duration is 0.08 seconds. What is the correct interpretation?
A) Sinus Bradycardia
B) Sinus Tachycardia
C) Normal Sinus Rhythm
D) Junctional Rhythm
**Answer: C**
*Rationale: This rhythm meets all criteria for Normal Sinus Rhythm (NSR): rate
60-100 bpm, regular rhythm, P wave before every QRS, normal PR interval
(0.12-0.20 sec), and narrow QRS (<0.12 sec). Sinus Bradycardia (A) has a rate
<60 bpm; Sinus Tachycardia (B) has a rate >100 bpm; Junctional Rhythm (D)
typically has an inverted or absent P wave. NSR is the baseline for all EKG
interpretation.*
,2.
A patient’s EKG shows a regular rhythm at 54 bpm. P waves are present before
each QRS, PR interval is 0.18 seconds, and QRS is narrow. The patient is
asymptomatic and resting. What is the appropriate action per Kaiser Permanente
protocol?
A) Activate a Code Blue immediately
B) Administer atropine 0.5 mg IV
C) Monitor the patient; no intervention is needed for asymptomatic sinus
bradycardia
D) Prepare for transcutaneous pacing
**Answer: C**
*Rationale: This is Sinus Bradycardia, which is common and normal in athletes
or during sleep. Kaiser Permanente protocol emphasizes that treatment is only
indicated if the patient is symptomatic (e.g., dizziness, hypotension, chest pain).
For an asymptomatic patient, monitoring is sufficient. Code Blue (A), atropine
(B), and pacing (D) are for unstable bradycardia per ACLS guidelines, which KP
follows.*
3.
Which finding is characteristic of Sinus Arrhythmia?
A) Irregular rhythm with no P waves
B) Regular rhythm with inverted P waves
, C) Irregular rhythm that speeds up with inspiration and slows with expiration
D) Regular rhythm with a PR interval > 0.20 seconds
**Answer: C**
*Rationale: Sinus Arrhythmia is a benign, normal variant where the heart rate
varies with respiration—faster during inspiration and slower during
expiration—due to vagal tone changes. It is common in young people and
athletes. It still has a P wave before every QRS, but the R-R interval varies.
Option A describes A-fib; B describes a junctional rhythm; D describes
first-degree AV block.*
4.
A telemetry strip shows a regular rhythm at 118 bpm. P waves are present
before each narrow QRS complex, and the PR interval is 0.16 seconds. The
patient reports feeling anxious but is hemodynamically stable. What is the
correct interpretation and priority action?
A) Ventricular Tachycardia; prepare for defibrillation
B) Sinus Tachycardia; assess for underlying cause (e.g., pain, fever, anxiety,
hypovolemia)
C) Atrial Fibrillation; administer diltiazem
D) Supraventricular Tachycardia; perform vagal maneuvers
**Answer: B**
*Rationale: This rhythm is Sinus Tachycardia. The presence of a P wave before
each narrow QRS at a rate >100 bpm is diagnostic. Per Kaiser Permanente
, protocol, the priority is not to treat the rate but to identify and address the
underlying cause (e.g., pain, anxiety, fever, PE, anemia). Ventricular
Tachycardia (A) has wide QRS complexes; A-fib (C) is irregularly irregular with
no P waves; SVT (D) typically has no visible P waves or a very short RP
interval.*
5.
Using the 5-step systematic approach, which of the following is the FIRST step in
EKG interpretation?
A) Determine the PR interval
B) Assess the QRS complex morphology
C) Determine the heart rate
D) Evaluate for the presence of P waves
**Answer: C**
*Rationale: The Kaiser-recommended 5-step systematic approach is: 1) Rate, 2)
Rhythm (regular or irregular), 3) P waves, 4) PR interval, 5) QRS complex.
Determining the rate is the logical first step, as it immediately categorizes the
rhythm as bradycardic, normal, or tachycardic, guiding further analysis.*
6.
A patient’s EKG shows a heart rate of 88 bpm, regular rhythm, P wave before
every QRS, PR interval of 0.22 seconds, and narrow QRS complexes. What is the
diagnosis?
A) Normal Sinus Rhythm
