BayCare EKG Competency Exam | Graded A+
BAYCARE EKG TEST | 2026/2027 | ACTUAL
QUESTIONS AND VERIFIED ANSWERS
COMPETENCY EXAM PREP | GRADED A+
Aligned with BayCare Health System EKG Competency Standards, AHA Guidelines for Cardiac Monitoring,
and Basic/Advanced Electrocardiogram Interpretation Competencies (2026/2027 Edition)
Total Questions: 100 Cognitive Mix: 20% Recall / 50% Application / 30% Analysis
Sections: 9 Format: Multiple Choice (A-D), Single Best Answer
Time: 120 minutes Passing Score: 85% (BayCare Competency Standard)
Section 1: Cardiac Anatomy & Electrophysiology
Q1: Which structure normally initiates the electrical impulse in a healthy adult heart?
A. AV node
B. Bundle of His
C. SA node [CORRECT]
D. Purkinje fibers
Correct Answer: C
Rationale: The SA node, located in the right atrium, is the heart's primary pacemaker with an intrinsic firing rate
of 60-100 bpm. Per AHA cardiac monitoring guidelines and BayCare competency standards, recognizing the SA
node as the dominant pacemaker is foundational to EKG interpretation. The AV node (40-60 bpm), Bundle of
His, and Purkinje fibers serve as subordinate escape pacemakers.
Q2: The intrinsic firing rate of the AV junction (AV node + Bundle of His) is:
A. 20-40 bpm
B. 40-60 bpm [CORRECT]
C. 60-100 bpm
D. 100-150 bpm
Correct Answer: B
Rationale: The AV junction has an intrinsic rate of 40-60 bpm, classified as a 'junctional escape' rhythm when
the SA node fails. The Purkinje/ventricular escape rate is 20-40 bpm. Knowing these rates is essential for
identifying escape rhythms on telemetry per BayCare monitoring standards.
BayCare EKG Competency Exam 2026/2027 | Page 1
, BayCare EKG Competency Exam | Graded A+
Q3: Which action potential phase corresponds to rapid depolarization in ventricular muscle cells?
A. Phase 0 [CORRECT]
B. Phase 1
C. Phase 2
D. Phase 3
Correct Answer: A
Rationale: Phase 0 represents rapid depolarization caused by the sudden influx of sodium (Na+) ions. Phase 1 is
initial repolarization, Phase 2 is the plateau (Ca2+ influx balanced by K+ efflux), and Phase 3 is rapid
repolarization (K+ efflux). Understanding these phases is foundational to EKG waveform correlation per AHA
guidelines.
Q4: During which phase of the action potential is the cell absolutely refractory?
A. Phase 1
B. Phase 2
C. Phase 3 (early) [CORRECT]
D. Phase 4
Correct Answer: C
Rationale: The absolute refractory period spans Phase 0 through mid-Phase 3, during which no
stimulus—regardless of strength—can trigger another depolarization. This protects against tetany in cardiac
muscle. The relative refractory period occurs later in Phase 3, where a strong stimulus may depolarize the cell.
BayCare telemetry competency requires distinguishing these periods when evaluating rhythm stability.
Q5: The Purkinje fibers distribute electrical impulses primarily to the:
A. Atria
B. AV node
C. Ventricular myocardium [CORRECT]
D. SA node
Correct Answer: C
Rationale: The Purkinje fiber network rapidly distributes the electrical impulse throughout the ventricular
myocardium (rate 20-40 bpm), enabling synchronized ventricular contraction. This conduction is responsible for
the narrow QRS complex (<0.12 sec) seen in normal rhythms. BayCare competency standards emphasize
identifying when Purkinje system dysfunction produces wide QRS complexes.
Q6: Which structure serves as the only normal electrical connection between the atria and ventricles?
A. Bundle of Kent
B. AV node and Bundle of His [CORRECT]
C. Bachmann's bundle
D. Purkinje fibers
Correct Answer: B
Rationale: The AV node and Bundle of His constitute the only normal electrical pathway between atria and
ventricles. Bachmann's bundle conducts between atria, the Bundle of Kent is an accessory pathway
(Wolff-Parkinson-White), and Purkinje fibers are ventricular. This anatomical principle is essential for
understanding AV blocks per BayCare competency.
BayCare EKG Competency Exam 2026/2027 | Page 2
, BayCare EKG Competency Exam | Graded A+
Q7: The plateau phase (Phase 2) of the cardiac action potential is primarily due to:
A. Sodium influx
B. Potassium efflux
C. Calcium influx [CORRECT]
D. Chloride influx
Correct Answer: C
Rationale: Phase 2 (plateau) is sustained by slow calcium (Ca2+) influx through L-type channels, balanced by
K+ efflux. This plateau phase is unique to cardiac muscle and corresponds to the ST segment on the EKG.
Understanding this mechanism is critical per AHA guidelines for interpreting ST-segment changes during
ischemia.
Q8: The normal PR interval represents the time required for:
A. Atrial depolarization only
B. AV nodal conduction delay [CORRECT]
C. Ventricular depolarization
D. Ventricular repolarization
Correct Answer: B
Rationale: The PR interval (0.12-0.20 sec) measures the time from atrial depolarization through AV nodal delay
to the onset of ventricular depolarization. The delay in the AV node allows adequate ventricular filling before
contraction. Prolongation indicates AV block per BayCare EKG interpretation standards.
Q9: Which electrolyte is most responsible for the repolarization phase (Phase 3) of cardiac action
potentials?
A. Sodium
B. Calcium
C. Potassium [CORRECT]
D. Magnesium
Correct Answer: C
Rationale: Phase 3 (rapid repolarization) is driven by potassium (K+) efflux from the cell. This is why
hyperkalemia prolongs repolarization producing peaked T waves, and hypokalemia delays repolarization
producing U waves. Per AHA guidelines, nurses must recognize these EKG-electrolyte correlations during
telemetry monitoring.
Q10: Bachmann's bundle conducts electrical impulses from the SA node to the:
A. AV node
B. Left atrium [CORRECT]
C. Right ventricle
D. Bundle of His
Correct Answer: B
Rationale: Bachmann's bundle (interatrial tract) conducts the impulse from the SA node across the right atrium
to the left atrium, allowing simultaneous atrial depolarization. This produces the normal P wave on EKG.
BayCare competency requires recognizing P-wave abnormalities that may indicate interatrial conduction issues.
BayCare EKG Competency Exam 2026/2027 | Page 3
, BayCare EKG Competency Exam | Graded A+
Q11: A patient has an intrinsic heart rate of 45 bpm with narrow QRS complexes and inverted P waves in
lead II. The most likely pacemaker site is the:
A. SA node
B. AV junction [CORRECT]
C. Purkinje fibers
D. Ventricular myocardium
Correct Answer: B
Rationale: A rate of 40-60 bpm with narrow QRS and retrograde (inverted) P waves indicates a junctional
escape rhythm originating from the AV junction. The SA node would produce 60-100 bpm with upright P waves;
Purkinje/ventricular escape produces 20-40 bpm with wide QRS. BayCare competency standards require precise
identification of pacemaker site based on these features.
Q12: The refractory period of the AV node is clinically important because it:
A. Prevents retrograde conduction
B. Limits ventricular rate during atrial tachyarrhythmias [CORRECT]
C. Enhances AV synchrony
D. Decreases myocardial oxygen demand
Correct Answer: B
Rationale: The AV node's inherent refractory property filters rapid atrial impulses, limiting the ventricular
response during atrial tachyarrhythmias such as atrial fibrillation or flutter. This protective mechanism prevents
lethal ventricular rates. Recognizing this principle is foundational to ACLS and BayCare cardiac monitoring
competency.
Q13: The T wave on an EKG represents:
A. Atrial depolarization
B. Atrial repolarization
C. Ventricular depolarization
D. Ventricular repolarization [CORRECT]
Correct Answer: D
Rationale: The T wave represents ventricular repolarization (recovery). Atrial repolarization is typically hidden
within the QRS complex. Ventricular depolarization produces the QRS. T-wave changes (inversion, peaking,
hyperacute) signal ischemia, electrolyte abnormalities, or other pathology per AHA interpretation guidelines.
Q14: Which autonomic nervous system influence increases the SA node firing rate?
A. Parasympathetic (vagal)
B. Sympathetic [CORRECT]
C. Both equally
D. Neither
Correct Answer: B
Rationale: Sympathetic stimulation (norepinephrine) increases SA node automaticity, producing sinus
tachycardia in response to stress, exercise, fever, or hypovolemia. Parasympathetic (vagal) stimulation
decreases the rate, producing sinus bradycardia. BayCare telemetry competency requires correlating autonomic
influences with rhythm changes during clinical assessment.
BayCare EKG Competency Exam 2026/2027 | Page 4
BAYCARE EKG TEST | 2026/2027 | ACTUAL
QUESTIONS AND VERIFIED ANSWERS
COMPETENCY EXAM PREP | GRADED A+
Aligned with BayCare Health System EKG Competency Standards, AHA Guidelines for Cardiac Monitoring,
and Basic/Advanced Electrocardiogram Interpretation Competencies (2026/2027 Edition)
Total Questions: 100 Cognitive Mix: 20% Recall / 50% Application / 30% Analysis
Sections: 9 Format: Multiple Choice (A-D), Single Best Answer
Time: 120 minutes Passing Score: 85% (BayCare Competency Standard)
Section 1: Cardiac Anatomy & Electrophysiology
Q1: Which structure normally initiates the electrical impulse in a healthy adult heart?
A. AV node
B. Bundle of His
C. SA node [CORRECT]
D. Purkinje fibers
Correct Answer: C
Rationale: The SA node, located in the right atrium, is the heart's primary pacemaker with an intrinsic firing rate
of 60-100 bpm. Per AHA cardiac monitoring guidelines and BayCare competency standards, recognizing the SA
node as the dominant pacemaker is foundational to EKG interpretation. The AV node (40-60 bpm), Bundle of
His, and Purkinje fibers serve as subordinate escape pacemakers.
Q2: The intrinsic firing rate of the AV junction (AV node + Bundle of His) is:
A. 20-40 bpm
B. 40-60 bpm [CORRECT]
C. 60-100 bpm
D. 100-150 bpm
Correct Answer: B
Rationale: The AV junction has an intrinsic rate of 40-60 bpm, classified as a 'junctional escape' rhythm when
the SA node fails. The Purkinje/ventricular escape rate is 20-40 bpm. Knowing these rates is essential for
identifying escape rhythms on telemetry per BayCare monitoring standards.
BayCare EKG Competency Exam 2026/2027 | Page 1
, BayCare EKG Competency Exam | Graded A+
Q3: Which action potential phase corresponds to rapid depolarization in ventricular muscle cells?
A. Phase 0 [CORRECT]
B. Phase 1
C. Phase 2
D. Phase 3
Correct Answer: A
Rationale: Phase 0 represents rapid depolarization caused by the sudden influx of sodium (Na+) ions. Phase 1 is
initial repolarization, Phase 2 is the plateau (Ca2+ influx balanced by K+ efflux), and Phase 3 is rapid
repolarization (K+ efflux). Understanding these phases is foundational to EKG waveform correlation per AHA
guidelines.
Q4: During which phase of the action potential is the cell absolutely refractory?
A. Phase 1
B. Phase 2
C. Phase 3 (early) [CORRECT]
D. Phase 4
Correct Answer: C
Rationale: The absolute refractory period spans Phase 0 through mid-Phase 3, during which no
stimulus—regardless of strength—can trigger another depolarization. This protects against tetany in cardiac
muscle. The relative refractory period occurs later in Phase 3, where a strong stimulus may depolarize the cell.
BayCare telemetry competency requires distinguishing these periods when evaluating rhythm stability.
Q5: The Purkinje fibers distribute electrical impulses primarily to the:
A. Atria
B. AV node
C. Ventricular myocardium [CORRECT]
D. SA node
Correct Answer: C
Rationale: The Purkinje fiber network rapidly distributes the electrical impulse throughout the ventricular
myocardium (rate 20-40 bpm), enabling synchronized ventricular contraction. This conduction is responsible for
the narrow QRS complex (<0.12 sec) seen in normal rhythms. BayCare competency standards emphasize
identifying when Purkinje system dysfunction produces wide QRS complexes.
Q6: Which structure serves as the only normal electrical connection between the atria and ventricles?
A. Bundle of Kent
B. AV node and Bundle of His [CORRECT]
C. Bachmann's bundle
D. Purkinje fibers
Correct Answer: B
Rationale: The AV node and Bundle of His constitute the only normal electrical pathway between atria and
ventricles. Bachmann's bundle conducts between atria, the Bundle of Kent is an accessory pathway
(Wolff-Parkinson-White), and Purkinje fibers are ventricular. This anatomical principle is essential for
understanding AV blocks per BayCare competency.
BayCare EKG Competency Exam 2026/2027 | Page 2
, BayCare EKG Competency Exam | Graded A+
Q7: The plateau phase (Phase 2) of the cardiac action potential is primarily due to:
A. Sodium influx
B. Potassium efflux
C. Calcium influx [CORRECT]
D. Chloride influx
Correct Answer: C
Rationale: Phase 2 (plateau) is sustained by slow calcium (Ca2+) influx through L-type channels, balanced by
K+ efflux. This plateau phase is unique to cardiac muscle and corresponds to the ST segment on the EKG.
Understanding this mechanism is critical per AHA guidelines for interpreting ST-segment changes during
ischemia.
Q8: The normal PR interval represents the time required for:
A. Atrial depolarization only
B. AV nodal conduction delay [CORRECT]
C. Ventricular depolarization
D. Ventricular repolarization
Correct Answer: B
Rationale: The PR interval (0.12-0.20 sec) measures the time from atrial depolarization through AV nodal delay
to the onset of ventricular depolarization. The delay in the AV node allows adequate ventricular filling before
contraction. Prolongation indicates AV block per BayCare EKG interpretation standards.
Q9: Which electrolyte is most responsible for the repolarization phase (Phase 3) of cardiac action
potentials?
A. Sodium
B. Calcium
C. Potassium [CORRECT]
D. Magnesium
Correct Answer: C
Rationale: Phase 3 (rapid repolarization) is driven by potassium (K+) efflux from the cell. This is why
hyperkalemia prolongs repolarization producing peaked T waves, and hypokalemia delays repolarization
producing U waves. Per AHA guidelines, nurses must recognize these EKG-electrolyte correlations during
telemetry monitoring.
Q10: Bachmann's bundle conducts electrical impulses from the SA node to the:
A. AV node
B. Left atrium [CORRECT]
C. Right ventricle
D. Bundle of His
Correct Answer: B
Rationale: Bachmann's bundle (interatrial tract) conducts the impulse from the SA node across the right atrium
to the left atrium, allowing simultaneous atrial depolarization. This produces the normal P wave on EKG.
BayCare competency requires recognizing P-wave abnormalities that may indicate interatrial conduction issues.
BayCare EKG Competency Exam 2026/2027 | Page 3
, BayCare EKG Competency Exam | Graded A+
Q11: A patient has an intrinsic heart rate of 45 bpm with narrow QRS complexes and inverted P waves in
lead II. The most likely pacemaker site is the:
A. SA node
B. AV junction [CORRECT]
C. Purkinje fibers
D. Ventricular myocardium
Correct Answer: B
Rationale: A rate of 40-60 bpm with narrow QRS and retrograde (inverted) P waves indicates a junctional
escape rhythm originating from the AV junction. The SA node would produce 60-100 bpm with upright P waves;
Purkinje/ventricular escape produces 20-40 bpm with wide QRS. BayCare competency standards require precise
identification of pacemaker site based on these features.
Q12: The refractory period of the AV node is clinically important because it:
A. Prevents retrograde conduction
B. Limits ventricular rate during atrial tachyarrhythmias [CORRECT]
C. Enhances AV synchrony
D. Decreases myocardial oxygen demand
Correct Answer: B
Rationale: The AV node's inherent refractory property filters rapid atrial impulses, limiting the ventricular
response during atrial tachyarrhythmias such as atrial fibrillation or flutter. This protective mechanism prevents
lethal ventricular rates. Recognizing this principle is foundational to ACLS and BayCare cardiac monitoring
competency.
Q13: The T wave on an EKG represents:
A. Atrial depolarization
B. Atrial repolarization
C. Ventricular depolarization
D. Ventricular repolarization [CORRECT]
Correct Answer: D
Rationale: The T wave represents ventricular repolarization (recovery). Atrial repolarization is typically hidden
within the QRS complex. Ventricular depolarization produces the QRS. T-wave changes (inversion, peaking,
hyperacute) signal ischemia, electrolyte abnormalities, or other pathology per AHA interpretation guidelines.
Q14: Which autonomic nervous system influence increases the SA node firing rate?
A. Parasympathetic (vagal)
B. Sympathetic [CORRECT]
C. Both equally
D. Neither
Correct Answer: B
Rationale: Sympathetic stimulation (norepinephrine) increases SA node automaticity, producing sinus
tachycardia in response to stress, exercise, fever, or hypovolemia. Parasympathetic (vagal) stimulation
decreases the rate, producing sinus bradycardia. BayCare telemetry competency requires correlating autonomic
influences with rhythm changes during clinical assessment.
BayCare EKG Competency Exam 2026/2027 | Page 4
