BayCare EKG Test 2025/2026 – Complete
Solved Exam with Correct Verified
Answers.
INTRODUCTION / EXAM OVERVIEW
This comprehensive study guide is designed for BayCare Health System nursing staff and telemetry
technicians preparing for the 2025/2026 EKG competency examination. The test assesses proficiency
in cardiac rhythm interpretation, 12-lead EKG analysis, and appropriate clinical responses aligned
with BayCare protocols.
Key Competencies Assessed:
• Basic EKG Concepts: Cardiac conduction anatomy, lead placement, interval measurement
• Rhythm Interpretation: Identification of all sinus, atrial, junctional, ventricular rhythms,
and AV blocks
• 12-Lead Interpretation: Ischemia, injury, infarct patterns, and STEMI localization
• Clinical Application: Recognition of lethal rhythms, rapid response activation, and
BayCare-specific treatment algorithms
• Documentation: Accurate description and charting of EKG findings per BayCare standards
SECTION 1: EKG Basics (Conduction System, Waveforms,
Intervals, Leads)
Questions 1-15
Q1: The EKG P wave represents which electrical event in the cardiac cycle?
A. Ventricular depolarization B. Atrial depolarization [CORRECT] C. Ventricular repolarization D.
Atrial repolarization
Correct Answer: B
Rationale:
• The P wave represents atrial depolarization (contraction of the right and left atria)
, • Atrial repolarization is not visible on standard EKG as it occurs during the QRS complex and
is masked by the larger ventricular electrical activity
• Ventricular depolarization creates the QRS complex; ventricular repolarization creates the T
wave
• Understanding waveform morphology is essential for identifying rhythm origin and
conduction abnormalities
Q2: In the standard cardiac conduction pathway, which structure serves as the primary pacemaker
of the heart?
A. AV node B. Bundle of His C. Sinoatrial (SA) node [CORRECT] D. Purkinje fibers
Correct Answer: C
Rationale:
• The SA node is the primary pacemaker with an intrinsic rate of 60-100 bpm
• The SA node is located in the right atrial wall near the superior vena cava opening
• Secondary pacemakers: AV node (40-60 bpm), ventricular escape rhythms (20-40 bpm)
• If the SA node fails, lower pacemakers can assume control (escape rhythms), but at slower
rates
Q3: What is the normal duration of the PR interval in adults?
A. 0.06-0.10 seconds B. 0.12-0.20 seconds [CORRECT] C. 0.20-0.40 seconds D. 0.04-0.10 seconds
Correct Answer: B
Rationale:
• Normal PR interval: 0.12-0.20 seconds (3-5 small boxes on EKG paper)
• The PR interval represents conduction time from atrial depolarization through the AV node,
Bundle of His, and bundle branches
• Prolonged PR interval (>0.20 sec) indicates first-degree AV block
• Short PR interval (<0.12 sec) may indicate pre-excitation syndromes (WPW) or junctional
rhythms
,Q4: On standard EKG paper, what does each small box (1mm) represent in terms of time?
A. 0.02 seconds B. 0.04 seconds [CORRECT] C. 0.10 seconds D. 0.20 seconds
Correct Answer: B
Rationale:
• Each small box = 0.04 seconds (1 mm horizontally)
• Each large box (5 small boxes) = 0.20 seconds
• 300 method for rate calculation: 300 divided by number of large boxes between R waves
• 1500 method: 1500 divided by number of small boxes between R waves (more precise for
slow rates)
Q5: Which EKG leads are considered the "inferior leads" and view the inferior wall of the heart?
A. I, aVL, V5, V6 B. II, III, aVF [CORRECT] C. V1, V2, V3, V4 D. I, II, III, aVR
Correct Answer: B
Rationale:
• Inferior leads: II, III, aVF (augmented vector foot)
• These leads view the diaphragm-facing surface of the heart (inferior wall)
• Inferior MI typically shows ST elevation in II, III, aVF with reciprocal changes in I, aVL
• Lead aVF is particularly sensitive for inferior wall ischemia and infarction
Q6: What is the normal QRS complex duration in adults?
A. <0.06 seconds B. <0.12 seconds [CORRECT] C. <0.20 seconds D. <0.40 seconds
Correct Answer: B
Rationale:
• Normal QRS duration: <0.12 seconds (<3 small boxes)
• Represents ventricular depolarization via the normal His-Purkinje system
• Prolonged QRS (>0.12 sec) indicates abnormal ventricular conduction: bundle branch
blocks, ventricular rhythms, paced rhythms, or hyperkalemia
• QRS duration measurement is critical for distinguishing supraventricular from ventricular
rhythms
, Q7: Which leads are considered the "lateral leads" in a standard 12-lead EKG?
A. V1-V4 B. II, III, aVF C. I, aVL, V5, V6 [CORRECT] D. V3R, V4R
Correct Answer: C
Rationale:
• Lateral leads: I, aVL, V5, V6 (high lateral and low lateral)
• Lead I and aVL view the high lateral wall; V5-V6 view the low lateral wall
• Lateral MI shows ST elevation in these leads with reciprocal changes in inferior leads
• Lateral leads are essential for detecting lateral STEMI and diagnosing left ventricular
hypertrophy
Q8: The QT interval represents which electrical events, and what is its clinical significance?
A. Atrial depolarization and repolarization; indicates atrial health B. Ventricular depolarization and
repolarization; risk assessment for torsades de pointes [CORRECT] C. AV nodal conduction only;
indicates AV block severity D. Bundle branch conduction; indicates risk for bundle branch blocks
Correct Answer: B
Rationale:
• The QT interval represents total ventricular activity: depolarization (QRS) and
repolarization (ST-T)
• Clinical significance: Prolonged QT increases risk for torsades de pointes (polymorphic
VT)
• QT prolongation causes: medications (antiarrhythmics, antipsychotics, antibiotics),
electrolyte abnormalities (hypokalemia, hypomagnesemia, hypocalcemia), congenital
syndromes
• Corrected QT (QTc) adjusts for heart rate; normal QTc <0.44 seconds in men, <0.46 seconds
in women
Q9: In lead placement for a 5-lead telemetry system, where is the V lead (C lead) typically
positioned?
Solved Exam with Correct Verified
Answers.
INTRODUCTION / EXAM OVERVIEW
This comprehensive study guide is designed for BayCare Health System nursing staff and telemetry
technicians preparing for the 2025/2026 EKG competency examination. The test assesses proficiency
in cardiac rhythm interpretation, 12-lead EKG analysis, and appropriate clinical responses aligned
with BayCare protocols.
Key Competencies Assessed:
• Basic EKG Concepts: Cardiac conduction anatomy, lead placement, interval measurement
• Rhythm Interpretation: Identification of all sinus, atrial, junctional, ventricular rhythms,
and AV blocks
• 12-Lead Interpretation: Ischemia, injury, infarct patterns, and STEMI localization
• Clinical Application: Recognition of lethal rhythms, rapid response activation, and
BayCare-specific treatment algorithms
• Documentation: Accurate description and charting of EKG findings per BayCare standards
SECTION 1: EKG Basics (Conduction System, Waveforms,
Intervals, Leads)
Questions 1-15
Q1: The EKG P wave represents which electrical event in the cardiac cycle?
A. Ventricular depolarization B. Atrial depolarization [CORRECT] C. Ventricular repolarization D.
Atrial repolarization
Correct Answer: B
Rationale:
• The P wave represents atrial depolarization (contraction of the right and left atria)
, • Atrial repolarization is not visible on standard EKG as it occurs during the QRS complex and
is masked by the larger ventricular electrical activity
• Ventricular depolarization creates the QRS complex; ventricular repolarization creates the T
wave
• Understanding waveform morphology is essential for identifying rhythm origin and
conduction abnormalities
Q2: In the standard cardiac conduction pathway, which structure serves as the primary pacemaker
of the heart?
A. AV node B. Bundle of His C. Sinoatrial (SA) node [CORRECT] D. Purkinje fibers
Correct Answer: C
Rationale:
• The SA node is the primary pacemaker with an intrinsic rate of 60-100 bpm
• The SA node is located in the right atrial wall near the superior vena cava opening
• Secondary pacemakers: AV node (40-60 bpm), ventricular escape rhythms (20-40 bpm)
• If the SA node fails, lower pacemakers can assume control (escape rhythms), but at slower
rates
Q3: What is the normal duration of the PR interval in adults?
A. 0.06-0.10 seconds B. 0.12-0.20 seconds [CORRECT] C. 0.20-0.40 seconds D. 0.04-0.10 seconds
Correct Answer: B
Rationale:
• Normal PR interval: 0.12-0.20 seconds (3-5 small boxes on EKG paper)
• The PR interval represents conduction time from atrial depolarization through the AV node,
Bundle of His, and bundle branches
• Prolonged PR interval (>0.20 sec) indicates first-degree AV block
• Short PR interval (<0.12 sec) may indicate pre-excitation syndromes (WPW) or junctional
rhythms
,Q4: On standard EKG paper, what does each small box (1mm) represent in terms of time?
A. 0.02 seconds B. 0.04 seconds [CORRECT] C. 0.10 seconds D. 0.20 seconds
Correct Answer: B
Rationale:
• Each small box = 0.04 seconds (1 mm horizontally)
• Each large box (5 small boxes) = 0.20 seconds
• 300 method for rate calculation: 300 divided by number of large boxes between R waves
• 1500 method: 1500 divided by number of small boxes between R waves (more precise for
slow rates)
Q5: Which EKG leads are considered the "inferior leads" and view the inferior wall of the heart?
A. I, aVL, V5, V6 B. II, III, aVF [CORRECT] C. V1, V2, V3, V4 D. I, II, III, aVR
Correct Answer: B
Rationale:
• Inferior leads: II, III, aVF (augmented vector foot)
• These leads view the diaphragm-facing surface of the heart (inferior wall)
• Inferior MI typically shows ST elevation in II, III, aVF with reciprocal changes in I, aVL
• Lead aVF is particularly sensitive for inferior wall ischemia and infarction
Q6: What is the normal QRS complex duration in adults?
A. <0.06 seconds B. <0.12 seconds [CORRECT] C. <0.20 seconds D. <0.40 seconds
Correct Answer: B
Rationale:
• Normal QRS duration: <0.12 seconds (<3 small boxes)
• Represents ventricular depolarization via the normal His-Purkinje system
• Prolonged QRS (>0.12 sec) indicates abnormal ventricular conduction: bundle branch
blocks, ventricular rhythms, paced rhythms, or hyperkalemia
• QRS duration measurement is critical for distinguishing supraventricular from ventricular
rhythms
, Q7: Which leads are considered the "lateral leads" in a standard 12-lead EKG?
A. V1-V4 B. II, III, aVF C. I, aVL, V5, V6 [CORRECT] D. V3R, V4R
Correct Answer: C
Rationale:
• Lateral leads: I, aVL, V5, V6 (high lateral and low lateral)
• Lead I and aVL view the high lateral wall; V5-V6 view the low lateral wall
• Lateral MI shows ST elevation in these leads with reciprocal changes in inferior leads
• Lateral leads are essential for detecting lateral STEMI and diagnosing left ventricular
hypertrophy
Q8: The QT interval represents which electrical events, and what is its clinical significance?
A. Atrial depolarization and repolarization; indicates atrial health B. Ventricular depolarization and
repolarization; risk assessment for torsades de pointes [CORRECT] C. AV nodal conduction only;
indicates AV block severity D. Bundle branch conduction; indicates risk for bundle branch blocks
Correct Answer: B
Rationale:
• The QT interval represents total ventricular activity: depolarization (QRS) and
repolarization (ST-T)
• Clinical significance: Prolonged QT increases risk for torsades de pointes (polymorphic
VT)
• QT prolongation causes: medications (antiarrhythmics, antipsychotics, antibiotics),
electrolyte abnormalities (hypokalemia, hypomagnesemia, hypocalcemia), congenital
syndromes
• Corrected QT (QTc) adjusts for heart rate; normal QTc <0.44 seconds in men, <0.46 seconds
in women
Q9: In lead placement for a 5-lead telemetry system, where is the V lead (C lead) typically
positioned?
