ECG quiz on junctional escape for nurses!
This quiz will test your knowledge on how to identify junctional escape, characteristics of the rhythm, the nurse’s role, and treatments.
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Junctional Escape Rhythm ECG Quiz
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Junctional Escape Rhythm Quiz (ECG)
1. Junctional escape rhythms originate from which part of the heart’s electrical conduction system?
A. Purkinje fibers
B. Sinoatrial node
C. AV node and bundle of His
D. Bachmann’s bundle
The answer is C. Junctional escape rhythms originate from the AV junction. This is the part of the heart that separates the atria from the ventricles and includes the AV node and bundle of His.
2. Which rhythm demonstrates junctional escape?
A
B
C
The answer is B.
3. For a rhythm to be classified as a junctional escape rhythm the rate must be?
A. 40-60 bpm
B. 60-100 bpm
C. >100 bpm
The answer is A: 40-60 bpm
4. Which options are correct about junctional escape rhythms? Select all that apply:
A. P waves appear upside down in leads II, III, aVF.
B. P waves are always found after QRS complexes.
C. P waves can be concealed within the QRS complexes.
D. P waves appear retrograde in leads I, II, III.
The answers are A and C. P waves can have a variety of characteristics in junctional escape. They will appear inverted (upside) in leads II, III, and aVF. In addition, they can be found in front of or behind the QRS complex. If the P waves are in front of the QRS complex, it will be very close to the QRS complex, which makes the PR interval very short <0.12 seconds.
5. The nurse is assessing the patient’s ECG strip. How would the PR interval present in junctional escape? Select all that apply:
A. short (<0.12 seconds)
B. absent
C. long (>0.20 seconds)
D. normal (0.12-0.20 seconds)
The answers are A and B. In junctional escape, the PR interval will be short (this is the case if the P wave presents in front of the QRS complex) and absent if the P wave is concealed within the QRS complex or after the complex.
6. How should the QRS complex measure in junctional escape?
A. wide (>0.12 seconds)
B. narrow (<0.12 seconds)
C. absent
The answer is B: narrow (<0.12 second). Ventricular depolarization will be normal in junctional escape. Therefore, the QRS complex, QT interval, and T wave will be normal.
7. True or False: Junctional escape is an irregular type of rhythm.
True
False
FALSE: Junctional escape is a regular rhythm. The ventricular rate will be regular. This is noted by measuring from R wave to R wave.
8. Select what parts of the ECG waveform that are NORMAL in junctional escape:
P waves
QRS complex
QT interval
T waves
The answers are QRS complex, QT interval, and T waves. These areas are normal on the ECG waveform because ventricular depolarization is normal. Retrograde electrical signals flow upward to the atria which creates the abnormal P waves. Remember normally the SA node depolarizes the atria downward (not upward). However, in this rhythm generally the AV junction is depolarizing the atria.
9. A patient is presenting with junctional escape. What signs and symptoms demonstrate the patient is NOT tolerating the rhythm? Select all that apply:
A. shortness of breath
B. blood pressure of 104/82
C. chest pain
D. 5 second capillary refill
The answers are A, C, and D. These are signs and symptoms of low cardiac output, which can occur with a low heart rate in junctional escape.
10. A patient in junctional escape has a heart rate of 42 bpm. The patient is symptomatic. The nurse notifies the rapid response team and anticipates/prepares what treatments next? Select all that apply:
A. Amoidarone
B. Atropine
C. Cardioversion
D. Temporary pacemaker
E. Epinephrine
The answer is B and D. Atropine is given to increase the heart rate and cardiac output. Temporary pacing will help improve cardiac output until a permanent can be placed (if needed).
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