NHA EKG Technician (CET) — All Questions

During the second stage of a treadmill stress test, the patient's systolic blood pressure has fallen about 15 mmHg below the resting value even though the workload has increased. What should the technician do?

• a.Repeat the blood pressure at the next stage and continue the protocol if that reading is higher
• b.Stop the test, notify the supervisor and the covering clinician at once, and keep monitoring rhythm and pressure in recovery✓
• c.Slow the treadmill to a walking pace for two minutes and then resume the protocol from that stage
• d.Continue the stage as ordered, because systolic pressure normally falls as the exercise workload rises

Systolic pressure is expected to rise as workload rises. A fall below the resting value during increasing exercise suggests the heart cannot raise its output against the demand and is a recognized indication to terminate the test, so the treadmill stops and the supervising clinician is told immediately rather than at the end. Monitoring continues into recovery, because rhythm changes and ischemic changes often appear after exercise stops. Waiting for the next stage, or slowing the belt and then resuming, keeps a patient exercising through the very finding that says to stop.

A patient has finished the exercise portion of a stress test and the treadmill belt has stopped. What does monitoring during the recovery period require?

• a.Recording ends when the belt stops, and the patient waits in the reception area until discharge
• b.Recovery tracings are recorded only for the patients who reported symptoms during the exercise stages
• c.The patient stays monitored until heart rate, blood pressure, and the EKG return toward baseline✓
• d.Monitoring stops once the heart rate drops below the target rate calculated for the patient's age

Recovery is part of the test, not the end of it. Ischemic ST changes and exercise-induced arrhythmias frequently appear or persist after exercise stops, and hypotension and fainting are most likely in the first minutes off the treadmill, so electrodes and the blood pressure cuff stay on and readings continue until heart rate, pressure, and the tracing approach the patient's baseline. Removing the leads when the belt stops throws away the segment most likely to show the abnormality. Recording recovery only for symptomatic patients misses silent ischemia, and dropping below the target heart rate says nothing about whether pressure or the ST segments have recovered.

A technician has to move a heavy portable EKG machine into a room and then help turn a patient in bed. Which approach best protects the technician from injury?

• a.Reach across the bed and draw the patient toward the far rail in one smooth motion
• b.Lift with the arms and shoulders while the knees stay straight and the feet stay together
• c.Raise the bed toward waist height, keep the feet apart, bend at the knees, and push the machine rather than pull it✓
• d.Turn at the waist to swing the machine into position instead of stepping around it

Sound body mechanics keep the load close, the base of support wide, and the work near waist level, so the large muscles of the legs do the lifting and the spine stays neutral. Pushing a wheeled machine uses body weight and is easier on the back than pulling it. Reaching across a bed puts the load far from the technician's center of gravity and is a common cause of back strain, which is why a turn is done from the near side or with a second person. Keeping the knees locked while lifting with the arms and twisting at the waist under load are the two motions most often behind lifting injuries.

A technician with a fever and a productive cough is assigned to record a 12-lead on a neutropenic patient in a protective environment room. What should the technician do?

• a.Enter wearing a surgical mask and gloves and keep the visit as brief as the study allows
• b.Record the tracing while standing at arm's length from the patient's head the whole time
• c.Report the symptoms to the supervisor and ask to be reassigned away from this patient✓
• d.Delay the study until the end of the shift and clean the machine first

A protective environment exists to keep organisms away from a patient whose neutrophil count leaves almost no defense, and a staff member with fever and a productive cough is exactly the exposure it is designed to exclude. Reporting the symptoms so the assignment can be changed protects the patient and follows the occupational health policy that governs working while ill. A surgical mask reduces droplet spread but does not make a febrile, coughing worker safe for a neutropenic patient, and no working distance is safe when electrodes must be placed on the chest. Postponing the study to the end of the shift changes only the hour, not the risk the technician brings into the room.

While removing electrodes from a patient with a bleeding puncture site, a technician gets a splash of blood in one eye. What is the immediate action?

• a.Flush the eye at an eyewash station with water for at least 15 minutes, then report the exposure✓
• b.Blot the eye with gauze, finish the study, and rinse at the sink once the patient has left the room
• c.Notify the supervisor and complete the exposure report form before rinsing the eye
• d.Rinse the eye briefly with sterile saline and carry on with the next scheduled patient

A mucous membrane exposure is decontaminated first, and the standard first aid is copious flushing with water or saline at an eyewash station for a sustained period, on the order of 15 minutes. Reporting follows immediately afterward so that the source patient can be evaluated and post-exposure prophylaxis considered within the window in which it works, but paperwork does not come before flushing. Blotting with gauze spreads rather than removes the blood and delays irrigation for the length of a study. A few seconds of saline is not irrigation, and continuing to the next patient skips the reporting that makes any later treatment or claim possible.

The code team has arrived and taken over the resuscitation of a monitored patient. How can the EKG technician best help while the code continues?

• a.Announce a formal rhythm interpretation and tell the team which drug should be given
• b.Take the pads from the defibrillator and place them while compressions are in progress
• c.Run rhythm strips, note the times of events, and keep the tracings for the record✓
• d.Leave and ask the supervisor which tasks are permitted during a code

Once the code team is present, the technician contributes within the certified scope: producing and labeling rhythm strips, recording the times of rhythm changes and interventions, and fetching supplies. That documentation is genuinely useful and is work the team cannot do while managing the airway and compressions. Calling the monitor for the team is ordinary practice, but announcing a formal interpretation and telling the team which drug to give converts that reading into a treatment decision, which a CET is not credentialed to make. Applying defibrillator pads belongs to the team members trained and authorized to defibrillate. Walking out of an active code to ask what is allowed removes a trained pair of hands at the worst possible moment.

A portable EKG machine is being set up in a crowded patient room, and the nearest wall outlet sits behind the bed. What is the correct way to power the machine?

• a.Plug it into a hospital-grade wall outlet, or run the study on the machine's own battery✓
• b.Plug it into the multi-outlet power strip that already serves the infusion pumps and the bed
• c.Run a household extension cord under the bed so that the outlet behind it can be reached easily
• d.Join a second power strip to the first one so that the cord will reach the machine

Equipment used in the patient care vicinity is plugged directly into a hospital-grade receptacle, and a machine with a charged battery can simply be run on battery power when no suitable outlet is within reach. Loading a portable machine onto a power strip that is already carrying pumps and a bed adds to a shared load and to a shared point of failure, and daisy-chaining one relocatable power tap into another is prohibited in patient care areas for that reason. A household extension cord is not built for this service, and running it under a bed exposes it to crushing and turns it into a trip hazard. Convenience does not justify adding a failure point between the machine and the wall.