Monday, May 18, 2015

Practice EKG Strips 441

Identify the following rhythms

1.











a. Sinus rhythm with PACs
b. Sinus arrhythmia
c. Atrial fibrillation
d. 2nd degree heart block type II


2.












a. Ventricular tachycardia
b. Junctional tachycardia
c. Sinus tachycardia
d. Supraventricular tachycardia


3













a. Atrial paced
b. Failure to pace
c. Failure to capture
d. Ventricular paced

4.












a. Sinus rhythm with frequent multifocal PVCs
b. Sinus rhythm with trigeminal PVCs
c. Sinus rhythm with uniform PVCs
d. Sinus rhythm with bigeminal PVCs 

5.











a. 1st degree block
b. 2nd degree heart block type I
c. 2nd degree heart block type II
d. 3rd degree block


Answers

1. The answer is: b. Sinus arrhythmia.  The rhythm is irregular.  The rate is 80 bpm.  The P waves are uniform and upright and paired with a QRS complex.  The QRS complexes are narrow.  No ectopic beats are seen.  PR: .12 sec.  QRS: .08 sec. QT: .36 sec. Answer A is incorrect because no early are seen and the P waves are uniform.  Answer C is not correct because there are very distinguishable P waves.  Answer D isn’t right either.  All the P waves are associated with a QRS complex.  There are no dropped beats.

2. The answer is: c. Sinus tachycardia.  The rhythm is regular.  The rate is 150 bpm.   P waves are seen but they are somewhat buried in the T waves of the preceding beats.  The P waves are associated with a QRS complex.  The QRS complexes are narrow. There is some ST depression.  No ectopic beats are seen. PR: .12 sec, QRS: .08 sec.  QT: .28 sec.   Answer D is not correct because there are P waves and the QRS complexes are narrow.  Answer B is incorrect because the P waves are upright or positive.  They are absent or inverted in junctional rhythms. Answer D is wrong because there are P waves present.  These are not seen in SVT.

3. The answer is: a. Atrial paced. The rhythm is regular.  The heart rate is 60 bpm.  Some flattened P waves are present and they are preceded by an atrial pacer spike.  There is a 1:1 relationship between the P waves and the QRS complexes.  The QRS complexes are a little wide.  No early beats are seen.   PR: .24 sec, QRS: .10 sec, QT: .44 sec.   Answer B is not right because the pacemaker fires appropriately.  Answer C is incorrect because a complex follows each electronic pacemaker spike.  Answer D is not correct because the pacemaker spikes are seen before the P waves, not the QRS complexes.

4. The answer is: d. Sinus rhythm with bigeminal PVCs.   The rhythm is irregular due to the PVCs.  The rate is 70 bpm.  There are upright P waves and they have a corresponding QRS complex.  The QRS complexes are narrow.  Unifocal PVCs are seen every other beat.  A compensatory pause follows each PVC.  PR: .16 sec, QRS: .08 sec, QT: .40 sec.  Answer A is not correct because the PVCs look alike.  Answer B is incorrect because the PVCs are seen every other beat, not every third beat.  Answer C is correct but not the best nursing school answer.  The PVCs are uniform but it does not taken into account the pattern associated with the PVCs, namely that they occur every other beat.

5. The answer is: b. 2nd degree heart block type I. The rhythm is irregular.  The heart rate is: 50 bpm.  The P waves are uniform and have a positive axis.  Not all P waves are paired up with a QRS complexes.  The unpaired or dropped P waves are seen after the 2nd and 4th complexes.  The PR interval gets longer over successive beats until a beat is dropped.  The QRS complexes are narrow.  No premature beats are seen.  PR: .28/.40 sec.  QRS: .08 sec, QT: .40 sec.  Answer A is not correct because with a 1st degree block the PR interval is uniform, not progressively increasing in duration.  Answer C is not correct because the PR intervals are not uniform.  With a type II block all the PR intervals on the conducted beats are the same. Answer D is not correct because, except the dropped P waves, most other P waves are associated with a QRS complexes.  In a CHB there is no association between the atrial impulses and the ventricular impulses.



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