BAYCARE EKG TEST – PRACTICE
QUESTIONS & COMPLETE SOLUTIONS
(2025/2026)
Introduction
This 2025/2026 BayCare EKG practice exam simulates clinical rhythm interpretation for
nurses and providers, aligned with ACLS and BayCare standards. It includes 100
questions balanced across 6 domains, with descriptions based on standard 12-lead and
rhythm strip criteria. Questions are scenario-based for real-world application. Rationales
reference EKG rules (rate, rhythm, P waves, PR, QRS, ST, axis) and AHA/ACLS. Use for
competency; review BayCare EKG manual and ACLS handbook.
Domain 1: Basic Rhythms (Questions 1-17)
Question [1]:
A 45-year-old patient presents with a regular rhythm at 85 bpm, upright P waves before
each QRS, normal PR interval of 0.16 sec, and narrow QRS complexes. This is most
likely?
A. Atrial fibrillation
B. Normal sinus rhythm
C. Junctional rhythm
D. Sinus tachycardia
Answer: B — Normal sinus rhythm
Rationale: Normal sinus rhythm has regular rate 60-100 bpm, consistent P waves (SA
node), PR 0.12-0.20 sec, narrow QRS <0.12 sec per AHA criteria; AFib irregular no P (A),
junctional no/inverted P (C), tachycardia >100 bpm (D).
Question [2]:
The strip shows irregular rhythm with no distinct P waves, undulating baseline, and
irregular R-R intervals at 110 bpm. Diagnosis?
A. Sinus arrhythmia
B. Atrial fibrillation
C. Supraventricular tachycardia
,D. Second-degree AV block
Answer: B — Atrial fibrillation
Rationale: AFib features chaotic atrial activity (f waves), irregular ventricular response,
no P waves per ACLS; arrhythmia P waves (A), SVT regular narrow (C), block dropped
QRS (D).
Question [3]:
Rhythm is regular at 40 bpm, no P waves, narrow QRS, and retrograde P waves after
QRS. This indicates?
A. Sinus bradycardia
B. Junctional escape rhythm
C. First-degree AV block
D. Complete heart block
Answer: B — Junctional escape rhythm
Rationale: Junctional rhythm rate 40-60 bpm, no P or inverted after QRS (AV node
pacemaker) per AHA; sinus P before (A), first prolonged PR (C), complete dissociation
(D).
Question [4]:
Patient has a regular rhythm at 140 bpm, narrow QRS, and no P waves before QRS. This
is?
A. Atrial flutter
B. Supraventricular tachycardia (SVT)
C. Ventricular tachycardia
D. Sinus tachycardia
Answer: B — Supraventricular tachycardia (SVT)
Rationale: SVT narrow QRS >150 bpm, no P or buried, regular per ACLS; flutter sawtooth
F waves (A), VT wide (C), sinus P waves (D).
Question [5]:
Strip shows regular sawtooth waves at 300/min atrial rate, 4:1 conduction, ventricular
rate 75 bpm. Interpretation?
A. Atrial fibrillation
B. Atrial flutter
C. Multifocal atrial tachycardia
D. Sinus rhythm with PACs
, Answer: B — Atrial flutter
Rationale: Flutter F waves 250-350/min, sawtooth in II/III/aVF, variable block per AHA;
AFib irregular (A), MAT ≥3 P shapes (C), sinus P before (D).
Question [6]:
Rhythm is irregular at 88 bpm, varying P wave shapes, and normal QRS. This is?
A. Sinus arrhythmia
B. Multifocal atrial tachycardia (MAT)
C. Atrial fibrillation
D. Wandering atrial pacemaker
Answer: B — Multifocal atrial tachycardia (MAT)
Rationale: MAT irregular >100 bpm, ≥3 P morphologies, common in COPD per ACLS;
arrhythmia varying R-R (A), AFib no P (C), wandering <100 bpm (D).
Question [8]:
Patient with regular rhythm at 110 bpm, P waves before each QRS, but PR interval 0.28
sec. This is?
A. First-degree AV block
B. Sinus tachycardia
C. Second-degree AV block
D. Junctional rhythm
Answer: A — First-degree AV block
Rationale: First-degree prolonged PR >0.20 sec, all conducted per AHA; tachycardia
normal PR (B), second dropped (C), junctional short PR (D).
Question [9]:
Strip shows regular rhythm, P waves before QRS, but PR interval lengthens
progressively until a dropped QRS, then repeats. This is?
A. First-degree AV block
B. Second-degree AV block type I (Wenckebach)
C. Second-degree AV block type II
D. Third-degree AV block
Answer: B — Second-degree AV block type I (Wenckebach)
Rationale: Type I progressive PR lengthening with dropped beat (group beating) per
ACLS; first constant PR (A), type II constant PR drop (C), third dissociation (D).
Question [10]:
QUESTIONS & COMPLETE SOLUTIONS
(2025/2026)
Introduction
This 2025/2026 BayCare EKG practice exam simulates clinical rhythm interpretation for
nurses and providers, aligned with ACLS and BayCare standards. It includes 100
questions balanced across 6 domains, with descriptions based on standard 12-lead and
rhythm strip criteria. Questions are scenario-based for real-world application. Rationales
reference EKG rules (rate, rhythm, P waves, PR, QRS, ST, axis) and AHA/ACLS. Use for
competency; review BayCare EKG manual and ACLS handbook.
Domain 1: Basic Rhythms (Questions 1-17)
Question [1]:
A 45-year-old patient presents with a regular rhythm at 85 bpm, upright P waves before
each QRS, normal PR interval of 0.16 sec, and narrow QRS complexes. This is most
likely?
A. Atrial fibrillation
B. Normal sinus rhythm
C. Junctional rhythm
D. Sinus tachycardia
Answer: B — Normal sinus rhythm
Rationale: Normal sinus rhythm has regular rate 60-100 bpm, consistent P waves (SA
node), PR 0.12-0.20 sec, narrow QRS <0.12 sec per AHA criteria; AFib irregular no P (A),
junctional no/inverted P (C), tachycardia >100 bpm (D).
Question [2]:
The strip shows irregular rhythm with no distinct P waves, undulating baseline, and
irregular R-R intervals at 110 bpm. Diagnosis?
A. Sinus arrhythmia
B. Atrial fibrillation
C. Supraventricular tachycardia
,D. Second-degree AV block
Answer: B — Atrial fibrillation
Rationale: AFib features chaotic atrial activity (f waves), irregular ventricular response,
no P waves per ACLS; arrhythmia P waves (A), SVT regular narrow (C), block dropped
QRS (D).
Question [3]:
Rhythm is regular at 40 bpm, no P waves, narrow QRS, and retrograde P waves after
QRS. This indicates?
A. Sinus bradycardia
B. Junctional escape rhythm
C. First-degree AV block
D. Complete heart block
Answer: B — Junctional escape rhythm
Rationale: Junctional rhythm rate 40-60 bpm, no P or inverted after QRS (AV node
pacemaker) per AHA; sinus P before (A), first prolonged PR (C), complete dissociation
(D).
Question [4]:
Patient has a regular rhythm at 140 bpm, narrow QRS, and no P waves before QRS. This
is?
A. Atrial flutter
B. Supraventricular tachycardia (SVT)
C. Ventricular tachycardia
D. Sinus tachycardia
Answer: B — Supraventricular tachycardia (SVT)
Rationale: SVT narrow QRS >150 bpm, no P or buried, regular per ACLS; flutter sawtooth
F waves (A), VT wide (C), sinus P waves (D).
Question [5]:
Strip shows regular sawtooth waves at 300/min atrial rate, 4:1 conduction, ventricular
rate 75 bpm. Interpretation?
A. Atrial fibrillation
B. Atrial flutter
C. Multifocal atrial tachycardia
D. Sinus rhythm with PACs
, Answer: B — Atrial flutter
Rationale: Flutter F waves 250-350/min, sawtooth in II/III/aVF, variable block per AHA;
AFib irregular (A), MAT ≥3 P shapes (C), sinus P before (D).
Question [6]:
Rhythm is irregular at 88 bpm, varying P wave shapes, and normal QRS. This is?
A. Sinus arrhythmia
B. Multifocal atrial tachycardia (MAT)
C. Atrial fibrillation
D. Wandering atrial pacemaker
Answer: B — Multifocal atrial tachycardia (MAT)
Rationale: MAT irregular >100 bpm, ≥3 P morphologies, common in COPD per ACLS;
arrhythmia varying R-R (A), AFib no P (C), wandering <100 bpm (D).
Question [8]:
Patient with regular rhythm at 110 bpm, P waves before each QRS, but PR interval 0.28
sec. This is?
A. First-degree AV block
B. Sinus tachycardia
C. Second-degree AV block
D. Junctional rhythm
Answer: A — First-degree AV block
Rationale: First-degree prolonged PR >0.20 sec, all conducted per AHA; tachycardia
normal PR (B), second dropped (C), junctional short PR (D).
Question [9]:
Strip shows regular rhythm, P waves before QRS, but PR interval lengthens
progressively until a dropped QRS, then repeats. This is?
A. First-degree AV block
B. Second-degree AV block type I (Wenckebach)
C. Second-degree AV block type II
D. Third-degree AV block
Answer: B — Second-degree AV block type I (Wenckebach)
Rationale: Type I progressive PR lengthening with dropped beat (group beating) per
ACLS; first constant PR (A), type II constant PR drop (C), third dissociation (D).
Question [10]:
