{"id":7644,"date":"2025-08-16T13:11:12","date_gmt":"2025-08-16T21:11:12","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7644"},"modified":"2025-10-02T13:11:21","modified_gmt":"2025-10-02T21:11:21","slug":"guess-the-rhythm-normal-sinus-rhythm-nsr","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-normal-sinus-rhythm-nsr","title":{"rendered":"Guess the Rhythm: Normal sinus rhythm (NSR)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">The findings of the above ECG indicate a normal sinus rhythm and normal cardiac electrical activity. Remember, the ECG paper has large squares with thick lines, and inside each are 25 smaller squares with thinner lines. Horizontally, each small square represents 0.04 seconds.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are eight main things to look for on an ECG to ensure everything is normal. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>First,<\/strong> the heart rate can be calculated by counting the number of QRS complexes in six seconds and multiplying that number by 10. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Second,<\/strong> the heart rhythm regularity can be assessed by checking the distance between the peaks of two consecutive P waves and two consecutive R waves. If the ratio of the P-P and R-R intervals is 1, then the heart rhythm is regular. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Third,<\/strong> the P wave should be checked to ensure it is present, regular in timing and shape, and that there is one for each QRS complex. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fourth<\/strong>, the PR interval is checked to make sure it\u2019s consistently between 0.12 to 0.20 seconds, which is three to five little boxes. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fifth<\/strong>, the QRS duration should be consistently less than 0.1 seconds, which is two and a half little boxes. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Sixth<\/strong>, the ST segment should not be elevated or depressed more than 1 small box. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Seventh<\/strong>, the T wave shape should be asymmetric and height should be less than 5 millimeters in precordial leads and less than 10 millimeters in limb leads. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>And last, but not least,<\/strong> the QT interval should be <em>less than or equal to<\/em> half of a cardiac cycle, which can be calculated by measuring the distance between two successive R waves.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Learn more about this and other types of cardiac rhythms in Osmosis: <a href=\"https:\/\/www.osmosis.org\/learn\/Basic_electrocardiogram_-_Normal_sinus_rhythm_(NSR)%3A_Nursing\">Electrocardiogram (ECG) &#8211; Normal sinus rhythm (NSR): Nursing<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Key Takeaways<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Calculate heart rate by counting QRS complexes in 6 seconds times 10.<\/li>\n\n\n\n<li>Assess rhythm regularity using P-P and R-R interval comparisons.<\/li>\n\n\n\n<li>Check P wave presence, timing, and one per QRS complex.<\/li>\n\n\n\n<li>Ensure PR interval is between 0.12 and 0.20 seconds consistently.<\/li>\n\n\n\n<li>Verify QRS duration is less than 0.1 seconds and ST segment is normal.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png?w=700\" alt=\"\" class=\"wp-image-5064\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more practice questions? Try Osmosis by Elsevier today! Access your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>\u00a0and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Discover the key steps to evaluate a normal sinus rhythm ECG, including heart rate, rhythm regularity, waveforms, and interval measurements.<\/p>\n","protected":false},"author":207,"featured_media":7645,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[10,30,32],"tags":[429,431,1470,1469,392,286,245,1475,1473,1472,1471,1474],"class_list":["post-7644","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-skills","category-np","category-nursing","tag-cardiac-assessment","tag-ecg-interpretation","tag-heart-rate","tag-normal-sinus-rhythm","tag-nurse-practitioner","tag-nursing","tag-nursing-education","tag-pr-interval","tag-qrs-complex","tag-qt-interval","tag-st-segment","tag-t-wave"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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Today\u2019s question focuses on recognizing a normal PQRST wave. 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Learn how to recognize key ECG features for prompt care.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the Rhythm: Ventricular tachycardia","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Guess_the_rhythm_Ventricular_tachycardia.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Guess_the_rhythm_Ventricular_tachycardia.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Guess_the_rhythm_Ventricular_tachycardia.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Guess_the_rhythm_Ventricular_tachycardia.png 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Guess_the_rhythm_Ventricular_tachycardia.png 3x"},"classes":[]},{"id":9016,"url":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac","url_meta":{"origin":7644,"position":3},"title":"Guess the Rhythm: Premature atrial contractions (PAC)","author":"Amber Dortch, FNP","date":"December 7, 2025","format":false,"excerpt":"Premature atrial contractions (PACs) cause early atrial beats originating outside the sinoatrial node. Recognize PAC features on ECG like irregular rhythm and abnormal P waves.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the Rhythm: Premature atrial contractions (PAC)","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png 3x"},"classes":[]},{"id":8117,"url":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-asystole","url_meta":{"origin":7644,"position":4},"title":"Guess the Rhythm: Asystole","author":"Amber Dortch, FNP","date":"October 13, 2025","format":false,"excerpt":"Understand the characteristics and clinical significance of asystole, an emergency cardiac rhythm requiring immediate intervention by healthcare teams.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the rhythm: Asystole","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 3x"},"classes":[]},{"id":9023,"url":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-atrial-flutter","url_meta":{"origin":7644,"position":5},"title":"Guess the Rhythm: Atrial flutter","author":"Amber Dortch, FNP","date":"December 29, 2025","format":false,"excerpt":"Atrial flutter is a fast, abnormal heart rhythm with characteristic sawtooth waves on ECG. 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