BayCare EKG Competency Exam
2026/2027: Actual Questions & Correct
Answers – Graded A+
SECTION 1: RHYTHM IDENTIFICATION (Questions 1-12) | 40%
Q1. A patient on telemetry shows the following rhythm characteristics:
● Rate: Atrial not discernible, Ventricular 110-130
● Rhythm: Irregularly irregular
● P Waves: Not visible; baseline shows fine, chaotic undulations
● P:QRS Ratio: Not applicable
● PR Interval: Not measurable
● QRS Width: Narrow (<0.10 sec)
● Key Features: No consistent isoelectric baseline; R-R intervals vary with no
pattern
What is the MOST likely rhythm?
A. Atrial Flutter with variable block
B. Atrial Fibrillation with rapid ventricular response
C. Multifocal Atrial Tachycardia
D. Sinus Tachycardia with frequent PVCs
Correct Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular ventricular rhythm,
absence of distinct P waves (replaced by fibrillatory waves creating a wavy baseline),
,and narrow QRS complexes unless aberrant conduction occurs. The rate of 110-130
indicates rapid ventricular response (RVR). Atrial flutter (A) demonstrates regular atrial
activity with sawtooth flutter waves and typically regular or patterned irregular
ventricular response; MAT (C) requires at least three distinct P wave morphologies and
is usually regular-irregular rather than chaotic; sinus tachycardia with PVCs (D) would
show underlying regular rhythm with upright P waves preceding normal QRS complexes.
Category: Rhythm Identification
Cognitive Level: Application
Q2. A post-operative patient has this rhythm:
● Rate: Atrial 72, Ventricular 72
● Rhythm: Regularly irregular with pauses
● P Waves: Present, upright in lead II; occasional early P waves with different
morphology
● P:QRS Ratio: 1:1 with underlying rhythm; early beats also conducted 1:1
● PR Interval: 0.16-0.18 sec constant in underlying rhythm; 0.14 sec in early beats
● QRS Width: Narrow (0.08 sec)
● Key Features: Underlying rhythm interrupted by early beats that reset the sinus
node; compensatory pause is incomplete
This rhythm is BEST described as:
A. Sinus arrhythmia with respiration
B. Wandering atrial pacemaker
C. Normal sinus rhythm with premature atrial complexes (PACs)
D. Second-degree AV block Type I (Wenckebach)
Correct Answer: C
, Rationale: The description indicates normal sinus rhythm interrupted by premature atrial
complexes. Key identifiers: early P waves with different morphology (ectopic atrial
focus), narrow QRS (supraventricular conduction), and incomplete compensatory pause
(PAC resets sinus node). Sinus arrhythmia (A) shows gradual, respiration-related rate
variation without premature beats; wandering atrial pacemaker (B) requires at least
three distinct P wave morphologies and is typically slower (60-100 bpm) with gradual
shifts; Wenckebach (D) demonstrates progressive PR lengthening before dropped QRS,
not early conducted beats.
Category: Rhythm Identification
Cognitive Level: Analysis
Q3. A monitor tech calls you to view this rhythm:
● Rate: Atrial 300, Ventricular 150
● Rhythm: Regular atrial, regular ventricular
● P Waves: Sawtooth pattern best seen in leads II, III, aVF; flutter waves present
● P:QRS Ratio: 2:1 conduction
● PR Interval: Not measurable (F waves buried in QRS or T wave)
● QRS Width: Narrow (0.09 sec)
● Key Features: Atrial rate ~300 bpm; every other flutter wave conducted to
ventricles
What is the rhythm?
A. Atrial fibrillation with controlled response
B. Atrial flutter with 2:1 AV block
C. Supraventricular tachycardia (SVT)
D. Sinus tachycardia
2026/2027: Actual Questions & Correct
Answers – Graded A+
SECTION 1: RHYTHM IDENTIFICATION (Questions 1-12) | 40%
Q1. A patient on telemetry shows the following rhythm characteristics:
● Rate: Atrial not discernible, Ventricular 110-130
● Rhythm: Irregularly irregular
● P Waves: Not visible; baseline shows fine, chaotic undulations
● P:QRS Ratio: Not applicable
● PR Interval: Not measurable
● QRS Width: Narrow (<0.10 sec)
● Key Features: No consistent isoelectric baseline; R-R intervals vary with no
pattern
What is the MOST likely rhythm?
A. Atrial Flutter with variable block
B. Atrial Fibrillation with rapid ventricular response
C. Multifocal Atrial Tachycardia
D. Sinus Tachycardia with frequent PVCs
Correct Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular ventricular rhythm,
absence of distinct P waves (replaced by fibrillatory waves creating a wavy baseline),
,and narrow QRS complexes unless aberrant conduction occurs. The rate of 110-130
indicates rapid ventricular response (RVR). Atrial flutter (A) demonstrates regular atrial
activity with sawtooth flutter waves and typically regular or patterned irregular
ventricular response; MAT (C) requires at least three distinct P wave morphologies and
is usually regular-irregular rather than chaotic; sinus tachycardia with PVCs (D) would
show underlying regular rhythm with upright P waves preceding normal QRS complexes.
Category: Rhythm Identification
Cognitive Level: Application
Q2. A post-operative patient has this rhythm:
● Rate: Atrial 72, Ventricular 72
● Rhythm: Regularly irregular with pauses
● P Waves: Present, upright in lead II; occasional early P waves with different
morphology
● P:QRS Ratio: 1:1 with underlying rhythm; early beats also conducted 1:1
● PR Interval: 0.16-0.18 sec constant in underlying rhythm; 0.14 sec in early beats
● QRS Width: Narrow (0.08 sec)
● Key Features: Underlying rhythm interrupted by early beats that reset the sinus
node; compensatory pause is incomplete
This rhythm is BEST described as:
A. Sinus arrhythmia with respiration
B. Wandering atrial pacemaker
C. Normal sinus rhythm with premature atrial complexes (PACs)
D. Second-degree AV block Type I (Wenckebach)
Correct Answer: C
, Rationale: The description indicates normal sinus rhythm interrupted by premature atrial
complexes. Key identifiers: early P waves with different morphology (ectopic atrial
focus), narrow QRS (supraventricular conduction), and incomplete compensatory pause
(PAC resets sinus node). Sinus arrhythmia (A) shows gradual, respiration-related rate
variation without premature beats; wandering atrial pacemaker (B) requires at least
three distinct P wave morphologies and is typically slower (60-100 bpm) with gradual
shifts; Wenckebach (D) demonstrates progressive PR lengthening before dropped QRS,
not early conducted beats.
Category: Rhythm Identification
Cognitive Level: Analysis
Q3. A monitor tech calls you to view this rhythm:
● Rate: Atrial 300, Ventricular 150
● Rhythm: Regular atrial, regular ventricular
● P Waves: Sawtooth pattern best seen in leads II, III, aVF; flutter waves present
● P:QRS Ratio: 2:1 conduction
● PR Interval: Not measurable (F waves buried in QRS or T wave)
● QRS Width: Narrow (0.09 sec)
● Key Features: Atrial rate ~300 bpm; every other flutter wave conducted to
ventricles
What is the rhythm?
A. Atrial fibrillation with controlled response
B. Atrial flutter with 2:1 AV block
C. Supraventricular tachycardia (SVT)
D. Sinus tachycardia
