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Quizzes > Health & Medicine > Human Anatomy & Medicine

Ace Your ECG Technician Certification with Our Free EKG Practice Test

Take our 100-question EKG practice exam and boost your confidence!

Editorial: Review CompletedCreated By: Headsup CorporationUpdated Aug 25, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for EKG exam practice test quiz on sky blue background

Use this free EKG exam practice test to prepare for your ECG certification and the NHA EKG exam. Work through scored questions on lead placement, waveforms, and rhythms to spot gaps before the exam. For extra reps, try our free ECG practice quiz .

Which electrode pairing corresponds to Lead II in a standard 12-lead EKG?
Left arm to right leg
Left arm to left leg
Right arm to left arm
Right arm to left leg
Lead II records the electrical potential from the right arm (negative) to the left leg (positive), yielding a characteristic view of the heart's electrical axis. It's commonly used for rhythm monitoring because it often produces clear P waves and QRS complexes. Understanding limb lead configurations is fundamental for accurate EKG interpretation.
Where is the precordial lead V1 placed on the chest?
Second intercostal space at the right sternal border
Fourth intercostal space at the left sternal border
Fourth intercostal space at the right sternal border
Fifth intercostal space in the midclavicular line
V1 is positioned in the fourth intercostal space just to the right of the sternum, providing a view of the right ventricle and septum. Correct placement is crucial for accurate detection of septal infarcts or bundle branch blocks. Misplacement can lead to misinterpretation of QRS morphology.
What is the normal resting heart rate range for an adult on an EKG?
120 - 140 beats per minute
100 - 120 beats per minute
60 - 100 beats per minute
40 - 60 beats per minute
A normal adult resting heart rate on an EKG falls between 60 and 100 beats per minute. Rates below 60 indicate bradycardia, while rates above 100 signify tachycardia. Knowing these thresholds is essential for rhythm interpretation and patient assessment.
Which waveform on the EKG represents atrial depolarization?
T wave
U wave
P wave
QRS complex
The P wave corresponds to atrial depolarization, reflecting the electrical activity as it spreads through the atria. It precedes the QRS complex, which is ventricular depolarization. Recognition of P waves is essential to differentiate sinus rhythms from atrial arrhythmias.
What is the normal duration of the PR interval?
0.20 to 0.28 seconds
0.12 to 0.20 seconds
0.08 to 0.12 seconds
0.04 to 0.08 seconds
The PR interval normally ranges from 0.12 to 0.20 seconds (3 - 5 small boxes on EKG paper), indicating the time for atrial depolarization and conduction through the AV node. Prolongation suggests first-degree AV block, while shortening may occur in pre-excitation syndromes. Accurate measurement is vital for rhythm analysis.
What is the normal duration of the QRS complex in an adult?
0.16 to 0.20 seconds
Less than 0.12 seconds
0.12 to 0.16 seconds
Less than 0.08 seconds
A normal QRS complex duration is under 0.12 seconds (less than three small boxes), reflecting rapid ventricular depolarization. Prolongation indicates intraventricular conduction delay such as bundle branch blocks. Evaluating QRS width is essential for diagnosing conduction abnormalities.
Where should precordial lead V5 be placed?
Fifth intercostal space at the anterior axillary line
Sixth intercostal space at the midclavicular line
Fifth intercostal space at the midaxillary line
Fourth intercostal space at the left sternal border
V5 is located in the fifth intercostal space on the anterior axillary line, giving a lateral view of the left ventricle. Correct placement of V5 is crucial for detecting lateral wall ischemia or infarction. Misplacement can alter R-wave progression and ST-T interpretations.
ST segment elevation in contiguous leads on an EKG most likely indicates what?
Atrial flutter
Hypokalemia
Acute myocardial infarction
Pericarditis
ST segment elevation in two or more contiguous leads typically indicates an acute myocardial infarction due to transmural ischemia. Prompt recognition is critical for early reperfusion therapy. While pericarditis can also elevate ST segments, it does so diffusely rather than in specific contiguous leads.
Which feature is characteristic of atrial fibrillation on an EKG?
Fixed ventricular rate
Prolonged PR intervals
Regular R-R intervals with sawtooth P waves
Irregularly irregular R-R intervals and absence of distinct P waves
Atrial fibrillation is defined by an irregularly irregular ventricular response and absence of discrete P waves, replaced by fibrillatory waves. The ventricular rate varies unpredictably, distinguishing it from other atrial arrhythmias. Identifying these features guides management strategies such as rate control and anticoagulation.
How do you calculate heart rate using the 6-second method on an EKG strip?
Count P waves in 6 seconds and multiply by 10
Count QRS complexes in 3 seconds and multiply by 20
Count QRS complexes in 6 seconds and multiply by 10
Count large boxes in 6 seconds and divide into 300
The 6-second method involves counting the number of QRS complexes in a 6-second strip and multiplying by 10 to estimate heart rate. This technique is especially useful for irregular rhythms. Counting P waves would not reflect ventricular rate in arrhythmias like AFib.
Which leads provide the best view of the inferior wall of the left ventricle?
Leads V4, V5, and V6
Leads V1, V2, and V3
Leads II, III, and aVF
Leads I, aVL, and V6
Leads II, III, and aVF view the inferior wall of the left ventricle supplied by the right coronary artery in most individuals. ST changes in these leads suggest inferior myocardial ischemia or infarction. Knowledge of lead groupings is essential for localizing ischemic regions.
Which electrode placement error can cause a wandering baseline artifact?
Reversed limb leads
Misplacement of V1 and V2
Poor skin preparation leading to loose electrodes
Interference from muscle tremor
A wandering baseline is often due to poor skin preparation and loose electrodes that allow slight movement, causing slow shifts in the baseline. Proper skin cleaning and secure electrode adhesion minimize this artifact. Muscle tremor causes more rapid oscillations rather than slow wandering.
In Mobitz I (Wenckebach) second-degree AV block, what happens to the PR interval before a dropped beat?
It progressively lengthens until a QRS is dropped
It progressively shortens until a QRS is dropped
It varies randomly with no pattern
It remains constant then suddenly drops
Mobitz I block is characterized by progressive prolongation of the PR interval until an atrial impulse fails to conduct, dropping the QRS complex. After the dropped beat, the cycle repeats. Recognition of this pattern helps differentiate it from Mobitz II, which has fixed PR intervals.
Which EKG finding is most characteristic of ventricular tachycardia?
Regular narrow QRS tachycardia without P waves
Irregularly irregular rhythm with no P waves
Wide QRS complexes at a rate over 100 bpm with AV dissociation
Narrow QRS complexes with sawtooth waves
Ventricular tachycardia typically presents with wide (>0.12 s) QRS complexes at rates usually above 100 bpm and evidence of AV dissociation. The morphology often shows fusion or capture beats. Distinguishing VT from supraventricular tachycardia with aberrancy is critical for treatment decisions.
Prolongation of the QT interval can be caused by which electrolyte disturbance?
Hypokalemia
Hypercalcemia
Hypernatremia
Hypermagnesemia
Hypokalemia prolongs the QT interval by delaying ventricular repolarization, increasing the risk of torsades de pointes. Other factors include certain medications and congenital syndromes. Hypercalcemia typically shortens the QT interval.
Which artifact is most likely when V1 and V2 leads are accidentally swapped?
Reversed R-wave progression across precordial leads
AC interference (60 Hz)
Baseline wander
Muscle tremor
Swapping V1 and V2 reverses the early precordial R-wave progression pattern, leading to atypical R-wave amplitudes across the chest leads. Accurate precordial placement is essential for assessing anterior wall pathology. Other artifacts like baseline wander or tremor have different morphologies.
Which criterion is used to diagnose a left bundle branch block (LBBB) on an EKG?
PR interval prolongation without QRS widening
QRS duration ?0.12 seconds with broad, notched R waves in leads I and V6
QRS duration <0.10 seconds with rSR? pattern in V1
ST depression in V1 - V3
LBBB is diagnosed when the QRS duration is ?0.12 seconds with broad, often notched R waves in lateral leads such as I and V6, and deep S waves in V1. This pattern reflects delayed left ventricular activation. Distinguishing bundle branch blocks guides clinical management.
If the QRS is positive in Lead I but negative in aVF, what is the approximate frontal plane axis?
Extreme axis deviation (around +180°)
Normal axis (around +60°)
Right axis deviation (around +120°)
Left axis deviation (around -30°)
A positive QRS in Lead I and a negative QRS in aVF indicates left axis deviation, typically around -30°. This suggests altered conduction or chamber enlargement. Precise axis determination helps identify underlying pathology.
Electrical alternans on an EKG is highly suggestive of which condition?
Hyperthyroidism
Pulmonary embolism
Acute myocardial infarction
Pericardial effusion with tamponade
Electrical alternans - beat-to-beat alternation in QRS amplitude - is classically associated with large pericardial effusions and cardiac tamponade due to swinging of the heart in fluid. This finding necessitates urgent evaluation. Other conditions do not typically produce this pattern.
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Study Outcomes

  1. Apply Proper Lead Placement -

    Use the ekg exam practice test to master correct electrode positioning for accurate 12-lead ECG recordings and ensure diagnostic-quality tracings.

  2. Interpret Waveforms and Intervals -

    Analyze P waves, QRS complexes, and T waves to distinguish normal and abnormal intervals, boosting your confidence in rhythm assessment.

  3. Identify Common Arrhythmias -

    Recognize cardiac rhythm patterns such as atrial fibrillation, ventricular tachycardia, and asystole through targeted questions on the nha ekg practice test.

  4. Troubleshoot ECG Artifacts -

    Detect and resolve common recording errors and electrical interference, reinforcing your ability to maintain high-quality tracings during patient monitoring.

  5. Evaluate Performance and Plan Improvements -

    Use instant scoring from the ekg practice exam with answers to pinpoint strengths and weaknesses, then create a focused study strategy for exam success.

Cheat Sheet

  1. Accurate 12-Lead Electrode Placement -

    Correct electrode positioning - using the "white on right, smoke over fire" mnemonic - ensures reliable ECG tracings and prevents misdiagnosis of ischemia (American Heart Association). Reinforce placement skills with an ekg practice test free and by marking landmarks on a practice mannequin.

  2. Waveform Durations and Intervals -

    Know that a normal P wave lasts ≤0.12 s, PR interval is 0.12 - 0.20 s, and QRS complex <0.12 s (Textbook of Clinical Electrophysiology). Memorize "P's and Q's" by timing intervals on graph paper during your ekg exam practice test.

  3. Heart Rate Calculation Methods -

    Use the 1500 method for precise rates (1500 small squares/number of R - R intervals) or the quick 300 - 150 - 100 trick for regular rhythms (Cardiac Care Guidelines). Practice both techniques on an nha ekg practice test to build speed and accuracy under timed conditions.

  4. Recognizing Common Dysrhythmias -

    Differentiate atrial fibrillation's "irregularly irregular" pattern from atrial flutter's sawtooth waves by examining multiple ECG strips (Journal of Electrocardiology). Use mnemonics like "Some People Have Poor Circulation" (Supraventricular, PVCs, Heart blocks) during your ekg exam practice test.

  5. Artifact Identification and Troubleshooting -

    Distinguish muscle tremor (irregular spikes), AC interference (uniform 60 Hz zigzags), and wandering baseline by reviewing real-case ECG examples (American College of Cardiology). Apply filter settings and re-check leads on an ekg practice exam with answers to ensure clean, diagnostic-quality tracings.

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