EKG Practice Test for the Nurse Practitioner and Physician Assistant

Last Updated on March 28, 2025

EKG Practice Test for the Nurse Practitioner and Physician Assistant. There are 30 multiple-choice questions on EKG. Each question has four choices. Select one correct choice. You can check your score at the end of the quiz.

It is imperative to implement a systematic approach to EKG interpretation. There are five main areas to master. They are rate, rhythm, axis, block, and infarction. If you review each EKG and identify and appropriately interpret these five areas, you will know everything you need to know about that EKG.

The next critical point to master after calculating the heart rate is the evaluation of the rhythm. This can be done by establishing the presence or absence of regularly occurring QRS complexes. Simply put, evaluate if the rhythm is regular or irregular. Using calipers, march from R wave to R wave across the EKG. If the QRS complexes march out at even intervals across the page, the rhythm is regular (EKG 5.1).

A rhythm is irregular if it has a variation (EKG 5.2). An irregular rhythm is not necessarily pathologic. This chapter focuses on identifying and classifying irregular rhythms as normal or abnormal. If a rhythm is identified as irregular, it must be further classified as regularly irregular or irregularly irregular. These points are accomplished by adequately identifying the presence or absence of patterns and evaluating the P wave.

EKG Practice Test for the Nurse Practitioner and Physician Assistant

EKG Practice Test

EKG Practice Test
For the Nurse Practitioner and Physician Assistant Exam
Total Items: 30
Time Limit: N/A

1) What is the effect of increased vagal tone on heart rate?

A) Increase the heart rate

B) Cause an unpredictable fluctuation

C) No significant change

D) Decrease the heart rate

2) An EKG is described as having a right axis if the mean QRS vector lies between ______ and ______ degrees.

A) –180 and –90 degrees

B) –90 and 0 degrees

C) 0 and +90 degrees

D) +90 and +180 degrees

3) Which type of second-degree AV block carries more immediate concern due to a higher risk of progression to complete heart block?

A) Mobitz type II second-degree AV block

B) Mobitz type I second-degree AV block

C) First-degree AV block

D) Third-degree AV block

4) Left posterior fascicular block (LPFB) causes which type of axis deviation?

A) Right axis deviation

B) Extreme axis deviation

C) Normal axis

D) Left axis deviation

5) Assuming a 10-second rhythm strip, a calculated heart rate of 36 bpm most likely indicates a rhythm originating from:

A) Atrial tissue

B) The ventricles

C) The AV node

D) The sinus node

6) Determine the heart rate of the patient in this rhythm strip, assuming it is a 10-second recording.

A) 50 bpm

B) 60 bpm

C) 90 bpm

D) 70 bpm

7) An EKG is described as having a normal axis if the mean QRS vector lies between ______ and ______ degrees.

A) 0 and –90 degrees

B) 0 and +90 degrees

C) +90 and +180 degrees

D) –90 and –180 degrees

8) In which direction does the normal axis vector point?

A) Directly leftward

B) Up and to the patient’s right

C) Down and to the patient’s left

D) Directly upward

9) An EKG is described as having a left axis if the mean QRS vector lies between ______ and ______ degrees.

A) +90 and +180 degrees

B) 0 and –90 degrees

C) 0 and +90 degrees

D) –90 and –180 degrees

10) Define the type of conduction delay present in this EKG.

A) First-degree AV block

B) Left anterior fascicular block

C) Right bundle branch block

D) Left bundle branch block

11) Regarding a given rhythm strip, is a

A) Regular

B) Consistently variable

C) Irregularly irregular

D) Slightly irregular

12) A first-degree AV block is defined by a PR interval that is greater than:

A) 180 ms

B) 200 ms

C) 220 ms

D) 160 ms

13) Calculate the heart rate of the patient in this rhythm strip utilizing the 300-150-100-75-60-50 method for determining heart rate. Is it originating from the sinus node, AV node, or in the ventricles?

A) 60 bpm, AV node

B) 50 bpm, sinus node

C) 75 bpm, Ventricles

D) 40 bpm, Atrial ectopic focus

14) Which type of complete bundle branch block is more likely to be seen in the setting of advanced pulmonary disease?

A) First-degree AV block

B) Right bundle branch block

C) Left bundle branch block

D) Left anterior fascicular block

15) Regarding a given rhythm strip, is a

A) Variable

B) Irregular

C) Irregularly irregular

D) Regular

16) Left anterior fascicular block (LAFB) causes which type of axis deviation?

A) No axis deviation

B) Left axis deviation

C) Right axis deviation

D) Extreme axis deviation

17) Normal sinus activity occurs at a rate between:

A) 100 and 140 bpm

B) 20 and 40 bpm

C) 60 and 100 bpm

D) 40 and 60 bpm

18) A gradually lengthening PR interval followed by a dropped QRS complex and a subsequent shorter PR interval is diagnostic of which type of heart block?

A) First-degree AV block

B) Mobitz type II second-degree AV block

C) Third-degree AV block

D) Mobitz type I second-degree AV block

19) A ventricular escape focus typically fires at a rate between:

A) 60 and 100 bpm

B) 100 and 140 bpm

C) 40 and 60 bpm

D) 20 and 40 bpm

20) An interventricular conduction delay is defined by a QRS duration greater than _______ milliseconds and less than _______ milliseconds.

A) 140 and 160 ms

B) 80 and 100 ms

C) 120 and 140 ms

D) 100 and 120 ms

21) Which type of complete bundle branch block is more likely to be associated with structural heart disease?

A) Left bundle branch block

B) Left anterior fascicular block

C) Incomplete bundle branch block

D) Right bundle branch block

22) Atrial fibrillation typically produces an _____ rhythm with a lack of clear ______.

A) Regular rhythm with absent T waves

B) Irregular rhythm with absence of QRS complexes

C) Irregular rhythm with lack of clear P waves

D) Regular rhythm with clear P waves

23) The four axis quadrants are created by the intersection of which two leads?

A) Lead I and aVF

B) Lead III and aVR

C) Lead II and aVF

D) Lead I and aVL

24) Dissociation of regular P waves from regular QRS complexes defines which type of heart block?

A) Incomplete bundle branch block

B) First-degree AV block

C) Third-degree (complete) AV block

D) Second-degree AV block (Mobitz type I)

25) Define the type of conduction delay present in this EKG.

A) Left bundle branch block

B) Left anterior fascicular block

C) Right bundle branch block

D) First-degree AV block

26) Which of the following results in more frequent premature atrial contractions (PACs)?

A) Atrial trigeminy

B) Neither produces PACs

C) Both produce an equal frequency of PACs

D) Atrial bigeminy

27) AV dissociation is diagnostic of which type of premature beat?

A) Premature sinus beat

B) Premature junctional contraction

C) Premature ventricular contraction

D) Premature atrial contraction

28) An AV nodal junctional focus typically fires at a rate between:

A) 20 and 40 bpm

B) 40 and 60 bpm

C) 100 and 120 bpm

D) 60 and 100 bpm

29) Relative to the surrounding beats, premature ventricular contractions (PVCs) will display a QRS complex that is:

A) Wide

B) Narrow

C) Variable in width

D) Identical in width

30) Define the type of conduction delay present in this EKG.

A) Left bundle branch block

B) Right bundle branch block

C) Left anterior fascicular block

D) Mobitz type I AV block

Your score is

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