Free EKG Practice Test 👑
Stop memorizing pictures in a textbook. Read a strip, call it, and find out immediately whether you were right — and what you would actually do about it at the bedside.
The 6-step method for reading any strip
Every rhythm you will ever be tested on falls out of this sequence. Run it in order and you will not guess.
- Rate — count the R waves in a 6-second strip and multiply by 10. Under 60 is brady, over 100 is tachy.
- Rhythm — march out the R-R intervals. Regular, regularly irregular, or irregularly irregular?
- P waves — is there one before every QRS, and does every P have a QRS after it? Same shape each time?
- PR interval — normal is 0.12 to 0.20 seconds. Long, short, or changing?
- QRS width — under 0.12 seconds means the beat started above the ventricles. Wide means ventricular until proven otherwise.
- Interpret and act — name the rhythm, then say what you do: assess the patient, not the monitor.
The 15 rhythms nursing exams actually test
| Rhythm | Rate | Dead giveaway |
|---|---|---|
| Normal sinus rhythm | 60–100 | Everything normal and regular |
| Sinus bradycardia | <60 | NSR, just slow |
| Sinus tachycardia | 100–150 | NSR, just fast — find the cause |
| Atrial fibrillation | Variable | Irregularly irregular, no P waves |
| Atrial flutter | ~150 conducted | Sawtooth flutter waves |
| SVT | 150–250 | Too fast to see P waves, narrow QRS |
| 1st-degree AV block | Usually normal | PR >0.20, constant |
| 2nd-degree type I | Variable | PR lengthens, then a dropped QRS |
| 2nd-degree type II | Variable | PR constant, QRS drops out |
| 3rd-degree block | Slow | P waves and QRS totally unrelated |
| PVC | Underlying rate | Wide, early, bizarre, compensatory pause |
| Ventricular tachycardia | 100–250 | Wide and regular — check a pulse |
| Ventricular fibrillation | None | Chaotic squiggle — shock it |
| Asystole | 0 | Flat line — confirm in two leads |
| Paced rhythm | Set rate | Pacer spike before the complex |
Lethal rhythms: what you do, not just what you call
Certification exams and code situations both care about the action. Four rhythms need an immediate response:
- Ventricular fibrillation — unresponsive, no pulse. CPR and defibrillate. This is a shockable rhythm.
- Pulseless VT — same treatment as V-fib. Shock. If there is a pulse, it is a different algorithm entirely.
- Asystole — CPR and epinephrine. Not shockable. Confirm in two leads and check your leads are attached.
- PEA — an organized rhythm on the monitor with no pulse. CPR, epi, and hunt the reversible cause.
How to actually get faster at strips
Recognition speed comes from repetition spaced over time, not from one long cram session. Five strips a day for two weeks will beat a four-hour marathon every time. Read one strip daily on the free Rhythm of the Day page, and when you want timed drills with scoring and streaks, the members' EKG practice hub runs full sets with rationales.
Frequently asked
How do I read an EKG strip step by step?
Use the 6-step method: rate, rhythm regularity, P waves, PR interval, QRS width, then interpretation and action. Working the same order every time is what prevents you from guessing under pressure.
What EKG rhythms do nurses need to know?
The core 15: normal sinus, sinus brady, sinus tach, atrial fibrillation, atrial flutter, SVT, first-degree AV block, second-degree types I and II, third-degree block, PVCs, ventricular tachycardia, ventricular fibrillation, asystole, and paced rhythms.
What is the fastest way to calculate heart rate on a strip?
Count the QRS complexes in a 6-second strip and multiply by 10. It works for irregular rhythms, which the 300-150-100 big-box method does not.
Is this EKG practice test free?
Yes. Rhythm of the Day gives you a new strip daily with the rate, key features, and nursing action, and it requires no login. Timed scored drills with streak tracking are part of the Baddie RN membership.
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