HCA ECG Test Exam
with Answers
Latest Version | 2026/2027
HCA Healthcare Nursing & Clinical Staff
Competency Examination
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
50 Questions • 10 Content Domains • Complete Rationales
, TABLE OF CONTENTS
Section 1: Cardiac Anatomy & Conduction System ......... Q1 – Q5
Section 2: Electrophysiology & ECG Waveforms ......... Q6 – Q10
Section 3: ECG Leads & Anatomic Views ......... Q11 – Q14
Section 4: Normal Sinus Rhythm & Sinus Dysrhythmias ......... Q15 – Q19
Section 5: Atrial Rhythms ......... Q20 – Q25
Section 6: Junctional Rhythms ......... Q26 – Q29
Section 7: Ventricular Rhythms ......... Q30 – Q37
Section 8: AV Heart Blocks ......... Q38 – Q42
Section 9: Bundle Branch Blocks & Pacemaker Rhythms ......... Q43 – Q46
Section 10: ST/T Wave Changes, MI Localization & Emergency Response ......... Q47 –
Q50
, Section 1: Cardiac Anatomy & Conduction System (Q1–Q5)
Q1. The sinoatrial (SA) node is often referred to as the heart's natural pacemaker. Where is
the SA node located, and what is its normal firing rate?
A) Right atrium near the opening of the superior vena cava; 60–100 bpm
B) Left atrium near the pulmonary veins; 60–100 bpm
C) Interatrial septum; 40–60 bpm
D) Right ventricle near the moderator band; 40–60 bpm
✓ Correct Answer: A) Right atrium near the opening of the superior vena cava; 60–100
bpm
Rationale: The SA node is located in the upper wall of the right atrium at the junction of the superior
vena cava and the right atrium. It is the primary pacemaker of the heart, normally firing at 60–100
beats per minute. The AV node, located in the interatrial septum, fires at 40–60 bpm as a backup.
Q2. A 72-year-old patient experiences a myocardial infarction involving the right coronary
artery (RCA). Which part of the cardiac conduction system is most likely to be affected?
A) Left bundle branch
B) SA node and AV node
C) Left anterior fascicle
D) Purkinje fibers of the left ventricle
✓ Correct Answer: B) SA node and AV node
Rationale: The right coronary artery (RCA) supplies blood to the SA node (in ~55–60% of the
population) and the AV node (in ~80–90% of the population). An RCA infarction can therefore
compromise both the SA and AV nodes, leading to bradyarrhythmias and heart blocks. The left bundle
branch and left anterior fascicle are supplied by the left anterior descending artery (LAD).
Q3. In the normal cardiac conduction sequence, the electrical impulse travels from the SA
node through which structures before reaching the ventricles?
A) SA node → Bundle of His → AV node → Bundle branches → Purkinje fibers
B) SA node → Internodal pathways → AV node → Bundle of His → Bundle branches → Purkinje
fibers
C) SA node → AV node → Internodal pathways → Purkinje fibers → Bundle branches
D) SA node → Bundle branches → Bundle of His → AV node → Purkinje fibers
✓ Correct Answer: B) SA node → Internodal pathways → AV node → Bundle of His →
Bundle branches → Purkinje fibers
Rationale: The normal conduction sequence begins at the SA node, travels through internodal pathways
(anterior, middle, and posterior Bachmann's pathway) to the AV node. The impulse then passes through
the Bundle of His, divides into right and left bundle branches, and finally reaches the Purkinje fibers,
which distribute the impulse throughout the ventricular myocardium.
Q4. The Bundle of His divides into the right bundle branch and the left bundle branch.
What is the clinical significance of the left bundle branch's anatomic division?
A) It supplies only the posterior papillary muscle
B) It divides into the left anterior fascicle (LAF) and left posterior fascicle (LPF), creating two
hemiblocks
C) It directly connects to the SA node for retrograde conduction
D) It has no clinical significance as it rarely is affected by disease
✓ Correct Answer: B) It divides into the left anterior fascicle (LAF) and left posterior
fascicle (LPF), creating two hemiblocks
with Answers
Latest Version | 2026/2027
HCA Healthcare Nursing & Clinical Staff
Competency Examination
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
50 Questions • 10 Content Domains • Complete Rationales
, TABLE OF CONTENTS
Section 1: Cardiac Anatomy & Conduction System ......... Q1 – Q5
Section 2: Electrophysiology & ECG Waveforms ......... Q6 – Q10
Section 3: ECG Leads & Anatomic Views ......... Q11 – Q14
Section 4: Normal Sinus Rhythm & Sinus Dysrhythmias ......... Q15 – Q19
Section 5: Atrial Rhythms ......... Q20 – Q25
Section 6: Junctional Rhythms ......... Q26 – Q29
Section 7: Ventricular Rhythms ......... Q30 – Q37
Section 8: AV Heart Blocks ......... Q38 – Q42
Section 9: Bundle Branch Blocks & Pacemaker Rhythms ......... Q43 – Q46
Section 10: ST/T Wave Changes, MI Localization & Emergency Response ......... Q47 –
Q50
, Section 1: Cardiac Anatomy & Conduction System (Q1–Q5)
Q1. The sinoatrial (SA) node is often referred to as the heart's natural pacemaker. Where is
the SA node located, and what is its normal firing rate?
A) Right atrium near the opening of the superior vena cava; 60–100 bpm
B) Left atrium near the pulmonary veins; 60–100 bpm
C) Interatrial septum; 40–60 bpm
D) Right ventricle near the moderator band; 40–60 bpm
✓ Correct Answer: A) Right atrium near the opening of the superior vena cava; 60–100
bpm
Rationale: The SA node is located in the upper wall of the right atrium at the junction of the superior
vena cava and the right atrium. It is the primary pacemaker of the heart, normally firing at 60–100
beats per minute. The AV node, located in the interatrial septum, fires at 40–60 bpm as a backup.
Q2. A 72-year-old patient experiences a myocardial infarction involving the right coronary
artery (RCA). Which part of the cardiac conduction system is most likely to be affected?
A) Left bundle branch
B) SA node and AV node
C) Left anterior fascicle
D) Purkinje fibers of the left ventricle
✓ Correct Answer: B) SA node and AV node
Rationale: The right coronary artery (RCA) supplies blood to the SA node (in ~55–60% of the
population) and the AV node (in ~80–90% of the population). An RCA infarction can therefore
compromise both the SA and AV nodes, leading to bradyarrhythmias and heart blocks. The left bundle
branch and left anterior fascicle are supplied by the left anterior descending artery (LAD).
Q3. In the normal cardiac conduction sequence, the electrical impulse travels from the SA
node through which structures before reaching the ventricles?
A) SA node → Bundle of His → AV node → Bundle branches → Purkinje fibers
B) SA node → Internodal pathways → AV node → Bundle of His → Bundle branches → Purkinje
fibers
C) SA node → AV node → Internodal pathways → Purkinje fibers → Bundle branches
D) SA node → Bundle branches → Bundle of His → AV node → Purkinje fibers
✓ Correct Answer: B) SA node → Internodal pathways → AV node → Bundle of His →
Bundle branches → Purkinje fibers
Rationale: The normal conduction sequence begins at the SA node, travels through internodal pathways
(anterior, middle, and posterior Bachmann's pathway) to the AV node. The impulse then passes through
the Bundle of His, divides into right and left bundle branches, and finally reaches the Purkinje fibers,
which distribute the impulse throughout the ventricular myocardium.
Q4. The Bundle of His divides into the right bundle branch and the left bundle branch.
What is the clinical significance of the left bundle branch's anatomic division?
A) It supplies only the posterior papillary muscle
B) It divides into the left anterior fascicle (LAF) and left posterior fascicle (LPF), creating two
hemiblocks
C) It directly connects to the SA node for retrograde conduction
D) It has no clinical significance as it rarely is affected by disease
✓ Correct Answer: B) It divides into the left anterior fascicle (LAF) and left posterior
fascicle (LPF), creating two hemiblocks
