Junctional Rhythm Practice Questions

1. A patient's ECG shows a narrow QRS complex, a heart rate of 45 BPM, and absent P waves. The rhythm is regular. What is the most appropriate initial nursing action?

Administer atropine 1 mg IV if symptomatic

2. The nurse observes an inverted P wave appearing after the QRS complex. Which conduction pattern does this most likely indicate?

Retrograde atrial depolarization from a junctional rhythm

3. A patient with a heart rate of 65 BPM has a regular rhythm, inverted P waves in lead II, and a PR interval <0.12 seconds. What rhythm is most consistent with these findings?

Accelerated junctional rhythm

4. Which condition is most likely to result in a premature junctional contraction (PJC)?

Hypokalemia

5. A nurse observes three sequential inverted P waves with a ventricular rate of 105 BPM. What rhythm should be documented?

Junctional tachycardia

6. Which clinical manifestation would a nurse most likely observe in a patient with junctional bradycardia?

Dizziness and hypotension

7. Which ECG finding best distinguishes a junctional rhythm from a sinus rhythm?

P waves inverted or absent with a narrow QRS

8. Which nursing action is most appropriate when caring for a symptomatic patient with junctional rhythm at 50 BPM?

Prepare for transcutaneous pacing

9. A nurse notes early beats on the ECG with inverted P waves and narrow QRS complexes. The patient denies symptoms. What should the nurse do first?

Document the finding and continue monitoring

10. Which rhythm has P waves that may occur before, during, or after the QRS complex, and a heart rate between 61 and 100 BPM?

Accelerated junctional rhythm

11. What is the priority nursing action when caring for a patient with a junctional tachycardia and symptoms of hypotension?

Notify provider and prepare for cardioversion

12. What medication would be most appropriate for junctional tachycardia with a heart rate of 140 BPM?

Metoprolol

13. Which cause is associated with both junctional bradycardia and junctional tachycardia?

Digoxin toxicity

14. The PR interval is consistently less than 0.12 seconds in a regular rhythm with inverted P waves. What is the most accurate interpretation?

Upper nodal junctional rhythm

15. What differentiates a PJC from other premature beats?

Non-compensatory pause following the ectopic beat

16. A patient is hypotensive with cool, clammy skin and a junctional rate of 38 BPM. Which nursing intervention takes priority?

Apply oxygen and lower the HOB

17. Which rhythm originates when the SA node fails and the AV junction becomes the pacemaker?

Junctional rhythm

18. A nurse is reviewing ECGs and notes one strip with inverted P waves in leads II, III, and aVF, a rate of 58 BPM, and a narrow QRS. What is the likely diagnosis?

Junctional rhythm

19. If it happens frequently which rhythm is most likely to result in reduced cardiac output?

Junctional rhythm

20. Which finding should prompt a nurse to hold digoxin in a patient with a junctional rhythm?

New onset nausea and visual halos

21. A patient with a recent cardiac surgery develops a rhythm of 68 BPM with inverted P waves and a PR interval of 0.10 seconds. What rhythm is most likely?

Accelerated junctional rhythm

22. What intervention would the nurse expect for a patient with junctional tachycardia >160 BPM and no improvement after vagal maneuvers?

Administer a beta-blocker

23. Which medication would most likely cause a junctional rhythm as a side effect?

Digoxin

24. Which condition is not commonly associated with junctional rhythms?

Left bundle branch block

25. Which rhythm is most concerning due to its potential to severely compromise cardiac output?

Junctional bradycardia