EKG Practice Strips
This is a free 15-question sampler on reading EKG rhythm strips. Each strip is described in words rather than shown as an image: you get the rate, the regularity, the P waves, the PR interval and the QRS width, and you name the rhythm. Answer all 15 questions, then check your score and read the explanation for every question.
A six second rhythm strip contains 7 QRS complexes. Using the six second method, what is the approximate heart rate?
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All 15 questions at a glance
Prefer to read before you play? Every question in the sampler is listed below. Answers and explanations stay collapsed until you open them.
1. A six second rhythm strip contains 7 QRS complexes. Using the six second method, what is the approximate heart rate?
- A. 35 beats per minute
- B. 60 beats per minute
- C. 70 beats per minute
- D. 140 beats per minute
Show answer and explanation
Answer: C. 70 beats per minute
The six second method counts the QRS complexes on a six second strip and multiplies by 10, so 7 complexes is about 70 beats per minute. It is the fastest estimate and the only dependable one when the rhythm is irregular, because the interval based methods assume the beats are evenly spaced.
2. A strip shows a regular rhythm at 78 beats per minute. There is one upright P wave in front of every QRS, the PR interval is 0.16 seconds on every beat, and the QRS measures 0.08 seconds. Name the rhythm.
- A. Sinus bradycardia
- B. Normal sinus rhythm
- C. Sinus tachycardia
- D. Junctional rhythm
Show answer and explanation
Answer: B. Normal sinus rhythm
Normal sinus rhythm needs all of it at once: a rate of 60 to 100, a regular rhythm, one upright P wave before every QRS, a PR interval of 0.12 to 0.20 seconds and a QRS under 0.12 seconds. This strip meets every criterion, so there is nothing else to name.
3. A strip shows a regular rhythm at 46 beats per minute. Each QRS is preceded by one upright P wave, the PR interval is 0.16 seconds, and the QRS measures 0.08 seconds. Name the rhythm.
- A. Sinus bradycardia
- B. Junctional rhythm
- C. Second degree AV block type I
- D. Idioventricular rhythm
Show answer and explanation
Answer: A. Sinus bradycardia
Everything on this strip is normal except the rate, and a sinus rhythm under 60 is sinus bradycardia. The upright P wave in front of every QRS is what separates it from a junctional rhythm, which has no upright P wave and runs at its own rate of 40 to 60.
4. A strip shows a regular rhythm at 122 beats per minute. One upright P wave precedes each QRS, the PR interval is 0.14 seconds, and the QRS measures 0.08 seconds. Name the rhythm.
- A. Supraventricular tachycardia
- B. Atrial flutter with 2:1 conduction
- C. Sinus tachycardia
- D. Normal sinus rhythm
Show answer and explanation
Answer: C. Sinus tachycardia
A sinus rhythm above 100 is sinus tachycardia, and here the P waves are still clearly visible in front of every QRS. Rates in this range usually have a cause outside the heart, such as fever, pain, fear, dehydration or blood loss, so the cause gets treated rather than the rate.
5. A strip shows an irregularly irregular rhythm with a ventricular rate of about 110. No P waves can be identified anywhere, the baseline between QRS complexes is wavy, and the QRS measures 0.08 seconds. Name the rhythm.
- A. Atrial flutter
- B. Sinus rhythm with frequent premature beats
- C. Second degree AV block type I
- D. Atrial fibrillation
Show answer and explanation
Answer: D. Atrial fibrillation
No identifiable P waves plus an irregularly irregular ventricular response is the classic pair for atrial fibrillation. The atria quiver instead of contracting, so the AV node is bombarded with impulses and lets them through at unpredictable intervals.
6. Complete the sentence.
A strip shows a sawtooth baseline with flutter waves at about 300 per minute and regular QRS complexes at about 75 per minute, so the atrial flutter is conducting _____.
Options for blank 1: 1:1, 2:1, 3:1, 4:1
Show answer and explanation
Answer: 4:1
300 divided by 75 is 4, so four flutter waves arrive for every QRS that gets through, which is 4:1 conduction. The AV node blocks most flutter impulses, and because the ratio here is fixed the ventricular rhythm stays regular.
7. A strip shows a regular rhythm at 190 beats per minute. No P waves can be found in front of the QRS complexes, and the QRS measures 0.08 seconds. Name the rhythm.
- A. Sinus tachycardia
- B. Atrial fibrillation
- C. Ventricular tachycardia
- D. Supraventricular tachycardia
Show answer and explanation
Answer: D. Supraventricular tachycardia
A regular narrow complex rhythm this fast with no findable P waves is supraventricular tachycardia, and the P waves are usually hidden inside the preceding T waves. The narrow QRS rules out ventricular tachycardia, and the regular rhythm rules out atrial fibrillation.
8. A strip shows a regular rhythm at 68 beats per minute. Every QRS is preceded by one upright P wave, the PR interval measures 0.24 seconds and is the same on every beat, the QRS measures 0.08 seconds, and no beats are dropped. Name the rhythm.
- A. Normal sinus rhythm
- B. Third degree AV block
- C. First degree AV block
- D. Second degree AV block type I
Show answer and explanation
Answer: C. First degree AV block
A PR interval longer than 0.20 seconds that stays constant, with every P wave still followed by a QRS, is first degree AV block. Nothing is truly blocked here: every impulse reaches the ventricles, it just takes longer than normal to cross the AV node.
9. A strip shows a regular atrial rhythm. The PR interval measures 0.16 seconds on the first beat, 0.24 on the second and 0.32 on the third, then one P wave appears with no QRS after it, and the pattern starts over. The QRS complexes measure 0.08 seconds. Name the rhythm.
- A. First degree AV block
- B. Second degree AV block type I
- C. Second degree AV block type II
- D. Third degree AV block
Show answer and explanation
Answer: B. Second degree AV block type I
PR intervals that lengthen beat by beat until one P wave fails to conduct is second degree AV block type I, also called Wenckebach. The block sits in the AV node itself, which tires a little more with each beat and then recovers during the dropped beat, so the cycle repeats.
10. A strip shows a regular P to P interval at 80 per minute. Every conducted beat has the same PR interval of 0.18 seconds, then without warning one P wave is not followed by a QRS. The conducted QRS complexes measure 0.13 seconds. Which statements about this strip are correct?
Select all that apply.
- A. The PR interval lengthens before the dropped beat
- B. The rhythm is second degree AV block type II
- C. The PR interval on the conducted beats stays constant
- D. The rhythm is harmless and needs no follow up
- E. The wide QRS suggests the block sits below the AV node
Show answer and explanation
Answer: B. The rhythm is second degree AV block type II, C. The PR interval on the conducted beats stays constant, E. The wide QRS suggests the block sits below the AV node
Type II is the dropped beat that arrives with no warning: the PR interval never changes, and then a QRS simply goes missing. The block usually sits below the AV node in the bundle branches, which is why the conducted QRS is wide, and why this rhythm is watched closely and often paced.
11. A strip shows P waves marching out regularly at 88 per minute and QRS complexes marching out regularly at 34 per minute. The QRS measures 0.14 seconds and the distance from each P wave to the next QRS is different on every beat. Which statements about this strip are correct?
Select all that apply.
- A. The rhythm is third degree AV block
- B. The PR interval is fixed and only slightly prolonged
- C. The atria and the ventricles are beating independently of each other
- D. The wide slow QRS points to an escape pacemaker down in the ventricles
- E. There are fewer P waves than QRS complexes on the strip
Show answer and explanation
Answer: A. The rhythm is third degree AV block, C. The atria and the ventricles are beating independently of each other, D. The wide slow QRS points to an escape pacemaker down in the ventricles
In third degree block nothing crosses the AV node, so the atria keep their own regular rate and an escape pacemaker below the block drives the ventricles at its own slower regular rate. A ventricular escape site fires around 20 to 40 and produces a wide QRS, while a junctional escape site fires around 40 to 60 with a narrow one.
12. Complete the sentence.
A strip shows a regular rhythm at 45 beats per minute with a QRS of 0.08 seconds, no upright P wave before any QRS, and a small inverted P wave just after each QRS, so the rhythm is _____.
Options for blank 1: idioventricular rhythm, sinus bradycardia, junctional rhythm, first degree AV block
Show answer and explanation
Answer: junctional rhythm
The AV junction takes over at its intrinsic rate of 40 to 60 when the sinus node stops or slows, and it still uses the normal pathway down, which keeps the QRS narrow. The atria are depolarized backwards from the junction, so the P wave is inverted and can land just before, inside or just after the QRS.
13. A strip shows a regular rhythm at 170 beats per minute with wide QRS complexes measuring 0.16 seconds. No P waves can be identified, and the T waves point in the opposite direction to the QRS. Name the rhythm.
- A. Atrial flutter
- B. Supraventricular tachycardia
- C. Ventricular fibrillation
- D. Ventricular tachycardia
Show answer and explanation
Answer: D. Ventricular tachycardia
A QRS wider than 0.12 seconds at a rate above 100 with no P waves is ventricular tachycardia, because the beat starts in the ventricle and spreads slowly muscle cell to muscle cell instead of using the conduction system. Check the patient and not only the monitor: this same strip is treated one way when there is a pulse and another way when there is not.
14. A monitored patient collapses. The strip shows chaotic wavy deflections of changing height and width, with no identifiable P waves, QRS complexes or T waves and no measurable rate. Which statements about this strip are correct?
Select all that apply.
- A. The patient will have no pulse
- B. Synchronized cardioversion should be used instead
- C. The rhythm is ventricular fibrillation
- D. A rate can be counted with the six second method
- E. Defibrillation plus CPR is the treatment
Show answer and explanation
Answer: A. The patient will have no pulse, C. The rhythm is ventricular fibrillation, E. Defibrillation plus CPR is the treatment
Ventricular fibrillation is the ventricles quivering with no organized contraction, so there is no output and no pulse, and the only thing that restores a rhythm is defibrillation with good CPR between shocks. Synchronized cardioversion is impossible here because the machine has no R wave to synchronize with, and there is nothing to count for a rate.
15. Complete the sentence.
A pulseless, unresponsive patient shows an organized rhythm at 50 beats per minute with narrow QRS complexes on the monitor, which is called _____.
Options for blank 1: asystole, ventricular fibrillation, sinus bradycardia, pulseless electrical activity
Show answer and explanation
Answer: pulseless electrical activity
Pulseless electrical activity means the monitor shows organized complexes while the heart is producing no pulse, which is why the rhythm on screen never replaces checking the patient. Asystole is the other end of the same problem, a flat line with no electrical activity at all, and neither rhythm responds to a shock, so both are treated with CPR and epinephrine while the reversible causes are searched for.
What a rhythm strip test actually asks you to do
Strip interpretation is tested in a lot of places and it is not one standard exam. Nursing programs give dysrhythmia quizzes, hospitals run basic and advanced EKG courses before they let you watch a monitor, and telemetry technician courses and ACLS each have their own version. The number of strips, the time limit and the passing score are set by the program or the hospital, so a number a classmate quotes may not be the one you will sit.
What you have to produce varies too. Some tests only want the name of the rhythm. Others want you to measure and write down the atrial rate, the ventricular rate, the PR interval and the QRS width before you name anything, and they give partial credit for those measurements. Some hand you calipers and a paper strip, others put the strip on a screen. Ask your instructor which version you are getting, because the measuring version rewards a slow fixed routine and the naming version rewards pattern recognition.
The content itself is stable across all of them. You are expected to recognize the sinus rhythms and their fast and slow versions, the atrial rhythms including fibrillation and flutter, junctional rhythms, the AV blocks from first degree through complete heart block, the ventricular rhythms, and the arrest rhythms. Almost every list also includes asystole and pulseless electrical activity, because catching those is the reason anyone is watching a monitor.
How to use this sampler
The strips on this page are described in text rather than shown. Each question gives you the same five facts you would measure off a real strip: the rate, whether the rhythm is regular, whether P waves are present and what they look like, the PR interval and the QRS width. Picture versions of these strips are coming, and this page will be updated when they are ready.
Reading a strip in words is close to the routine you should use on a real one. Work through the same questions every time: what is the rate, is the rhythm regular, is there a P wave in front of every QRS, do the P waves all look alike, is the PR interval normal and constant, and is the QRS narrow or wide. Answer those in order and most rhythms name themselves before you have to guess.
Take all 15 in one sitting without notes, then read the explanation for every question, including the ones you got right. A wrong answer usually points at one step of the routine rather than one rhythm. If you mixed up type I and type II second degree block, the thing to drill is comparing PR intervals across a run of beats, not memorizing two names.
How StudyPDF builds full practice tests from your own materials
Fifteen questions can show you which rhythms you cannot yet tell apart. They will not get you ready on their own, and a generic question bank does not know which rhythms your course spends its time on.
StudyPDF works from your material instead. You upload your EKG course handouts, your ACLS book or the lecture slides your instructor posted, and Bo, the study agent, builds full-length practice tests from those exact pages. Every question is grounded in your material and every explanation cites where the answer came from, so you can check the source when something looks off. You can regenerate fresh tests as often as you want and narrow them to one area such as the AV blocks.
You do not need a document to start. You can also just name a topic, for example heart blocks or ventricular rhythms, and Bo builds a practice test on it without any upload. Starting is free.
Written by the StudyPDF team. Last updated 2026-08-19.