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Chapter 06: Ventricular Rhythms
Test Bank

TRUE/FALSE

1. The term premature ventricular complex is technically more correct than premature
ventricular contraction.

ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

2. Transcutaneous pacing is the treatment of choice for pulseless ventricular tachycardia or

ventricular fibrillation.

ANS: F
Cardiopulmonary resuscitation and defibrillation are the treatments of choice for pulseless
ventricular tachycardia or ventricular fibrillation.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for ventricular fibrillation.

3. Medications to suppress an idioventricular rhythm should generally be avoided.

ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

4. An idioventricular (ventricular escape) rhythm has an intrinsic rate of 40 to 60 beats/min.

ANS: F
An idioventricular rhythm (IVR), which is also called a ventricular escape rhythm, exists
when three or more ventricular escape beats occur in a row at a rate of 20 to 40 beats/min (i.e.,
the intrinsic firing rate of the Purkinje fibers).

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

5. Sustained monomorphic VT is often associated with underlying heart disease, particularly

myocardial ischemia, and rarely occurs in patients without underlying structural heart disease.

ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

MULTIPLE CHOICE

1. Which of the following best describes an idioventricular rhythm?

a. Rapid, chaotic rhythm with no pattern or regularity
b. Gradual alteration in the amplitude and direction of the QRS; atrial rate
 indiscernible; ventricular rate 150 to 250 beats/min
c. Essentially regular ventricular rhythm with QRS complexes measuring 0.12
seconds or greater; atrial rate not discernible; ventricular rate 20 to 40 beats/min
d. Regular ventricular rhythm with QRS complexes measuring less than 0.10
seconds; P waves may occur before, during, or after the QRS; ventricular rate 40 to
60 beats/min
ANS: C
An idioventricular rhythm (IVR), which is also called a ventricular escape rhythm, exists
when three or more ventricular escape beats occur in a row at a rate of 20 to 40 beats/min (i.e.,
the intrinsic firing rate of the Purkinje fibers). The QRS complexes seen in IVR are wide and
bizarre because the impulses begin in the ventricles, bypassing the normal conduction
pathway. When the ventricular rate slows to a rate of less than 20 beats/min, some
practitioners refer to the rhythm as an agonal rhythm or dying heart.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

2. What is meant by the term pulseless electrical activity (PEA)?

a. A chaotic rhythm that is likely to degenerate into cardiac arrest
b. An organized rhythm on the cardiac monitor (other than VT), although a pulse is
not present
c. A slow rhythm with a wide QRS complex
d. A flat line on the cardiac monitor
ANS: B
If the patient is not breathing and has no pulse despite the appearance of organized electrical
activity on the cardiac monitor (other than VT), pulseless electrical activity (PEA) exists.

OBJ: Explain the term pulseless electrical activity.

3. How would you differentiate a junctional escape rhythm at 40 beats/min from a ventricular
escape rhythm at the same rate?
a. It is impossible to differentiate a junctional escape rhythm from a ventricular
escape rhythm.
b. The junctional escape rhythm will have a narrow QRS complex; the ventricular
escape rhythm will have a wide QRS complex.
c. The rate (40 beats/min) would indicate a junctional escape rhythm, not a
ventricular escape rhythm.
d. The junctional escape rhythm will have a wide QRS complex; the ventricular
escape rhythm will have a narrow QRS complex.
ANS: B
Although junctional and ventricular rhythms are ectopic pacemaker sites, their rhythms can
generally be differentiated by the width of their QRS complexes. The junctional escape
rhythm will have a narrow QRS complex; the ventricular escape rhythm will have a wide
QRS complex.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.
 4. Which of the following best describes an accelerated idioventricular rhythm (AIVR)?
a. Rapid, chaotic rhythm with no pattern or regularity
b. Gradual alteration in the amplitude and direction of the QRS; atrial rate
indiscernible, ventricular rate 150 to 250 beats/min
c. Regular ventricular rhythm with QRS complexes measuring 0.10 seconds or less;
P waves may occur before, during or after the QRS; ventricular rate 41 to 60
beats/min
d. Essentially regular ventricular rhythm with QRS complexes measuring 0.12
seconds or greater; atrial rate not discernible; ventricular rate 41 to 100 beats/min
ANS: D
Characteristics of accelerated idioventricular rhythm:
Rhythm Ventricular rhythm is essentially regular.
Rate 41 to 100 (41 to 120 per some cardiologists) beats/min
P waves Usually absent or, with retrograde conduction to the atria, may
appear after the QRS (usually upright in the ST segment or T
wave)
PR interval None
QRS duration Greater than 0.12 seconds; the T wave frequently in the opposite
direction of the QRS complex

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated idioventricular rhythm.

5. The rate of an idioventricular rhythm is _____ beats/min.

a. 20 to 40
b. 41 to 60
c. 61 to 100
d. 101 to 180
ANS: A
The intrinsic rate of an idioventricular rhythm, which is also called a ventricular escape
rhythm, is 20 to 40 beats/min (i.e., the intrinsic firing rate of the Purkinje fibers).

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

SHORT ANSWER

1. List four reasons why the ventricles may assume responsibility for pacing the heart.

ANS:
The ventricles may assume responsibility for pacing the heart if the sinoatrial (SA) node fails
to discharge, an impulse from the SA node is generated but blocked as it exits the SA node,
the rate of discharge of the SA node is slower than that of the ventricles, or an irritable site in
either ventricle produces an early beat or rapid rhythm.

OBJ: N/A

2. Complete the following ECG criteria for ventricular fibrillation:

 Rhythm ________________________________________
Rate ________________________________________
P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Rapid and chaotic with no pattern or regularity.
Rate Cannot be determined because there are no discernible waves
or complexes to measure.
P waves Not discernible.
PR interval Not discernible.
QRS duration Not discernible.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for ventricular fibrillation.

3. Identify the following rhythm (lead II): ____________________

ANS:
Monomorphic ventricular tachycardia at 150 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

4. Identify the following rhythm (lead II): ____________________

ANS:
Sinus bradycardia with a PVC (third complex from the left) and a fusion beat (fourth complex
from the left)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

5. Identify the following rhythm (lead II): ____________________

 ANS:
Sinus tachycardia with multiform PVCs

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

6. Identify the following rhythm (lead II): ____________________

ANS:
Idioventricular rhythm (ventricular escape rhythm)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

7. Identify the following rhythm (lead II): ____________________

ANS:
Accelerated idioventricular rhythm (AIVR)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated idioventricular rhythm.

8. Complete the following ECG criteria for asystole:

Rhythm ________________________________________
Rate ________________________________________
P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Ventricular not discernible; atrial may be discernible.
Rate Ventricular not discernible but atrial activity may be observed (i.e.,
P-wave asystole).
P waves Usually not discernible.
PR interval Not measurable.
QRS duration Absent.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for asystole.
 9. Identify the following rhythm (lead II): ____________________

ANS:
Monomorphic ventricular tachycardia

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

10. Identify the following rhythm (lead II): ____________________

ANS:
Sinus bradycardia with an interpolated PVC and ST-segment elevation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

11. Identify the following rhythm (lead II): ____________________

ANS:
Sinus tachycardia with frequent uniform PVCs

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

12. Identify the following rhythm (lead II): ____________________

ANS:
Polymorphic VT
 OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for PMVT.

13. Complete the following ECG criteria for an accelerated idioventricular rhythm:
Rhythm ________________________________________
Rate ________________________________________
P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Ventricular rhythm is essentially regular.
Rate 41 to 100 (41 to 120 per some cardiologists) beats/min.
P waves Usually absent or, with retrograde conduction to the atria, may
appear after the QRS (usually upright in the ST segment or T
wave).
PR interval None.
QRS duration Greater than 0.12 seconds; the T wave is frequently in the opposite
direction of the QRS complex.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated idioventricular rhythm.

14. Identify the following rhythm (lead II): ____________________

ANS:
Fine ventricular fibrillation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for ventricular fibrillation.

15. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 60 beats/min with an R-on-T interpolated PVC

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

16. Complete the following ECG criteria for polymorphic ventricular tachycardia:
 Rhythm ________________________________________
Rate ________________________________________
P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Ventricular rhythm may be regular or irregular.
Rate Ventricular rate 150 to 300 beats/min; typically 200 to 250
beats/min.
P waves None.
PR interval None.
QRS duration 0.12 seconds or more; there is a gradual alteration in the amplitude
and direction of the QRS complexes; a typical cycle consists of 5 to
20 QRS complexes.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for PMVT.

17. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm with a run of VT (i.e., nonsustained VT) and one episode of ventricular couplets

OBJ: Explain the terms sustained and nonsustained VT, monomorphic VT, and polymorphic VT.

18. List three potential sites of origin of ectopic beats.

ANS:
Atria (PACs); AV junction (PJCs); and ventricles (PVCs)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

19. Identify the following rhythm (lead II): ____________________

 ANS:
Sinus tachycardia at 102 beats/min with uniform PVCs; ST-segment elevation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

20. Identify the following rhythm (lead II): ____________________

ANS:
Accelerated idioventricular rhythm (AIVR) at 42 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated idioventricular rhythm.

21. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm with two R-on-T PVCs

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

22. List four common causes of premature ventricular complexes.

ANS:
Common causes of PVCs include acid-base imbalance, acute coronary syndromes,
cardiomyopathy, digitalis toxicity, electrolyte imbalance (e.g., potassium, magnesium),
exercise, heart failure, hypoxia, an increase in catecholamines and sympathetic tone (e.g.,
emotional stress, anxiety), medications (e.g., sympathomimetic drugs), normal variant,
stimulants (e.g., caffeine, tobacco), valvular heart disease, and ventricular aneurysm.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

23. What is the name given to polymorphic VT that occurs in the presence of a long QT interval?

ANS:
Polymorphic VT that occurs in the presence of a long QT interval is called torsades de
pointes.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
 care for PMVT.

24. Complete the following ECG criteria for monomorphic ventricular tachycardia:
Rhythm ________________________________________
Rate ________________________________________
P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Ventricular rhythm is essentially regular.
Rate 101 to 250 (121 to 250 per some cardiologists) beats/min.
P waves Usually not seen; if present, they have no set relationship with the
QRS complexes that appear between them at a rate different from
that of the VT.
PR interval None.
QRS duration 0.12 seconds or greater; often difficult to differentiate between the
QRS and T wave.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

25. Identify the following rhythm (lead II): ____________________

ANS:
Polymorphic VT at 250 to 333 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for PMVT.

26. Identify the following rhythm (lead II): ____________________

ANS:
Accelerated idioventricular rhythm (AIVR) at 94 beats/min (lead III)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated idioventricular rhythm.

27. Complete the following ECG criteria for an idioventricular rhythm:

Rhythm ________________________________________
Rate ________________________________________
 P waves ________________________________________
PR interval ________________________________________
QRS duration ________________________________________

ANS:
Rhythm Ventricular rhythm is essentially regular.
Rate Ventricular rate 20 to 40 beats/min.
P waves Usually absent or, with retrograde conduction to the atria; may
appear after the QRS (usually upright in the ST segment or T
wave).
PR interval None.
QRS duration 0.12 seconds or greater; the T wave is frequently in the opposite
direction of the QRS complex.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

28. Identify the following rhythm (lead II): ____________________

ANS:
Sinus bradycardia at 54 beats/min with ventricular bigeminy; ventricular rate approximately
100 beats/min if PVCs counted in the rate

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

29. Identify the following rhythm (lead II): ____________________

ANS:
Coarse ventricular fibrillation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for ventricular fibrillation.

30. Identify the following rhythm (lead II): ____________________

 ANS:
Idioventricular rhythm at less than 25 beats/min (may also be called an agonal rhythm when
ventricular rate is less than 20 beats/min)

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

31. Identify the following rhythm (lead II): ____________________

ANS:
P-wave asystole

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for asystole.

32. Identify the following rhythm (lead II): ____________________

ANS:
Polymorphic VT

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for PMVT.

33. Identify the following rhythm: ____________________

ANS:
Sinus rhythm at 94 beats/min with an episode of couplets and a run of VT (i.e., nonsustained
VT)

OBJ: Explain the terms sustained and nonsustained VT, monomorphic VT, and polymorphic VT.
34. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 94 beats/min

OBJ: Describe the ECG characteristics of a sinus rhythm.

35. Identify the following rhythm (lead II): ____________________

ANS:
Ventricular fibrillation, shock (defibrillation), idioventricular rhythm at 40 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an idioventricular rhythm.

36. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 62 beats/min with an interpolated PVC; inverted T waves

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

37. Identify the following rhythm (lead II): ____________________

ANS:
Narrow-QRS tachycardia (SVT) at 147 beats/min with ST-segment depression

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for atrioventricular nodal reentrant tachycardia (AVNRT).
38. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 88 beats/min with a PVC and a run of VT, ST-segment depression, inverted T
waves

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

39. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 94 beats/min to monomorphic ventricular tachycardia (VT) at 150 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

40. Identify the following rhythm (lead II): ____________________

ANS:
Agonal rhythm, asystole

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for asystole.

41. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 83 beats/min with ventricular trigeminy

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
 care for premature ventricular complexes.

42. Identify the following rhythm (lead II): ____________________

ANS:
Atrial fibrillation with a rapid ventricular response of 150 to 250 beats/min and a run of VT.

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

43. Identify the following rhythm (lead II): ____________________

ANS:
Sinus bradycardia at 30 beats/min with ventricular bigeminy (ventricular rate approximately
60 if PVCs counted), inverted T waves, horizontal ST-segments

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

44. Identify the following rhythm: ____________________

ANS:
Sinus rhythm at 86 beats/min with uniform PVCs

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature ventricular complexes.

45. Identify the following rhythm: ____________________

 ANS:
Monomorphic VT at 150 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for monomorphic VT.

46. Identify the following rhythm (lead II): ____________________

ANS:
Coarse ventricular fibrillation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for ventricular fibrillation.

47. Identify the following rhythm (lead II): ____________________

ANS:
Sinus rhythm at 60 beats/min with a PAC

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for premature atrial complexes.

48. Identify the following rhythm: ____________________

 ANS:
Sinus bradycardia at 52 beats/min

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and emergency
management of sinus bradycardia.

49. Identify the following rhythm (lead II): ____________________

ANS:
Accelerated junctional rhythm at 79 beats/min with ST-segment elevation

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for an accelerated junctional rhythm.

50. Identify the following rhythm (lead II): ____________________

ANS:
Sinus beat to junctional escape rhythm at 52 beats/min with inverted T waves

OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial emergency
care for a junctional escape rhythm.
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