Free Trial #7


The nurse reviews the following electrocardiogram (ECG) from a newly admitted client assigned to the telemetry floor. The nurse determines the ECG strip to be interpreted as:


  1. Normal Sinus Rhythm (NSR)
    • Rationale:
  2. Accelerated Junctional Rhythm (AJR)
    • Rationale:
  3. Atrial Fibrillation (AFib)
    • Rationale:
  4. Multiple Premature Atrial Contractions (PACs)
    • Rationale:



The ECG shows irregular rhythm with a rate of 100 beats per minute, with P waves of different morphology. When the electrical impulse in the atrium is prematurely discharged, it causes a premature contraction, which occurs earlier than the next regular beat should have occurred. The client may have had palpitations, skipped beats, or flip-flop feelings within the chest. Although PACs may change into atrial flutter or atrial fibrillation, the ECG does not indicate that either atrial flutter or atrial fibrillation are present. Irregular rhythm does not coincide with normal sinus rhythm. Accelerated Junctional Rhythm may have retrograde P waves, possible AV dissociation, shorter PR intervals (which will indicate junctional versus atrial focus), and occurs because the AV junctional pacemaker exceeds the sinus node rate. The ECG strip shown does not reflect AJR.

Learning Outcomes

Test Taking Tip

Video Rationale