CSLB General Building (B) — All Questions

Before performing an EKG on an inpatient, how should the technician identify the patient?

• a.Confirm the room and bed number on the order
• b.Call the patient's name and proceed if someone answers
• c.Use two patient identifiers, such as having the patient state name and date of birth and comparing them to the armband and order✓
• d.Ask the family member at the bedside to confirm who the patient is

Two patient identifiers, most commonly full name and date of birth verified against the armband and the order, are the accepted standard, and the patient states them rather than confirming a name read aloud. Room and bed numbers change and are never acceptable identifiers. Patients may answer to the wrong name when medicated or hard of hearing, and family confirmation does not replace the required two identifiers.The Joint Commission National Patient Safety Goal 01.01.01

An EKG technician looks up the chart of a coworker who was admitted overnight, out of concern for her wellbeing. Is this permitted?

• a.No, accessing records without a treatment, payment, or operations purpose violates patient privacy law✓
• b.Yes, because the technician is an employee of the facility
• c.Yes, as long as the technician does not tell anyone what she reads
• d.Yes, if the coworker is a personal friend

Federal privacy rules limit access to protected health information to what is necessary for a person's own job duties, so browsing a coworker's chart out of curiosity or concern is a reportable violation regardless of intent. Employment grants access only to the records needed for assigned care. Keeping the information secret does not cure the improper access, and a personal relationship is not a permitted purpose.HIPAA

Two technicians are discussing a patient's abnormal EKG in a crowded elevator. What is the problem?

• a.Nothing, as long as they do not use the patient's last name
• b.Nothing, because both are employees of the facility
• c.It is only a problem if a family member is present
• d.Protected health information is being disclosed where unauthorized people can overhear it✓

Discussing a patient where visitors and unrelated staff can overhear is an improper disclosure of protected health information, and clinical conversations belong in private areas. Omitting the last name does not protect a patient who can still be identified from context. Being coworkers permits discussion only when there is a treatment need and a private setting, and the violation exists whether or not a relative happens to be present.HIPAA

When must an EKG technician perform hand hygiene?

• a.Only after contact with blood or body fluids
• b.Before and after every patient contact, after removing gloves, and after contact with contaminated equipment✓
• c.Only at the beginning and end of the shift
• d.Only when the hands look visibly soiled

Hand hygiene is required before and after every patient contact, after glove removal, and after touching potentially contaminated surfaces or equipment, because gloves can have unseen defects and hands become contaminated during removal. Waiting for visible soil or for blood exposure ignores the routine transfer of organisms. Shift-based washing leaves every patient in between unprotected.CDC Guideline for Hand Hygiene in Health-Care Settings

A patient's chest has an open, draining wound near a chest electrode site. What does the bloodborne pathogens standard require of the technician?

• a.Nothing special, since EKG testing is noninvasive
• b.Apply the electrode directly over the wound to preserve accurate placement
• c.Treat blood and body fluids as infectious, wear appropriate personal protective equipment, and avoid placing the electrode on broken skin✓
• d.Refuse to perform the test and send the patient home

The bloodborne pathogens standard requires that all blood and other potentially infectious material be treated as infectious, so gloves and any other indicated protective equipment are worn and contaminated items are disposed of properly. Electrodes are never applied over broken or draining skin; the site is shifted slightly and the change documented. Noninvasive testing does not exempt the technician, and refusing care is not an option.OSHA 29 CFR 1910.1030

A patient asks the EKG technician, "Does this tracing mean I had a heart attack?" What is the appropriate response?

• a.Explain that the physician interprets the tracing and will discuss the results, and notify the nurse of the patient's question✓
• b.Tell the patient the tracing looks like an infarction
• c.Reassure the patient that the tracing looks completely normal
• d.Hand the tracing to the patient so he can read it himself

Interpreting and diagnosing are outside the EKG technician's scope of practice, so the correct answer refers the question to the provider while acknowledging the patient's concern and passing it on to the nurse. Offering either an abnormal or a reassuring interpretation exceeds the technician's role and may be wrong. Releasing the tracing directly to the patient bypasses the provider and the facility's record release process.

While attaching electrodes, the technician sees ventricular fibrillation appear on the screen and the patient becomes unresponsive. What is the first action?

• a.Finish the 12-lead so the physician has a complete record
• b.Document the time and rhythm in the chart
• c.Reposition the electrodes to rule out artifact
• d.Call for help and activate the facility's emergency response, then begin CPR according to training✓

Ventricular fibrillation in an unresponsive patient is a cardiac arrest, and survival depends on immediate activation of the emergency response and prompt CPR and defibrillation. Completing the test or charting first wastes critical minutes. Checking for artifact is appropriate only when the patient is awake and stable, which is not the case here.

During a treadmill stress test, the patient reports chest pain and the monitor shows new ST segment depression. What should the technician do?

• a.Increase the speed to complete the protocol stage
• b.Stop the test, notify the supervising physician or nurse immediately, and monitor the patient✓
• c.Tell the patient the pain is normal and continue
• d.Turn off the monitor so the patient does not become anxious

New chest pain or significant ST changes are recognized indications to terminate a stress test, and the supervising provider must be notified at once while the patient is monitored during recovery. Advancing the protocol increases myocardial oxygen demand and risk. Dismissing symptoms is unsafe, and turning off monitoring removes the very information needed to manage the event.

Which information must appear on every EKG tracing?

• a.The technician's home phone number and the machine serial number only
• b.The patient's diagnosis and insurance carrier
• c.The patient's full name and identifier, the date and time of the tracing, and the technician's identification✓
• d.The patient's next appointment date

A tracing is a legal part of the medical record and must identify the patient, the exact date and time it was taken, and the person who took it, along with any deviations such as altered electrode placement or non-standard settings. Diagnoses are supplied by the interpreting physician, not the technician. Insurance and appointment details belong elsewhere in the record, and personal contact information is never placed on a tracing.

What is appropriate routine maintenance for EKG equipment between patients?

• a.Wipe the machine, cables, and any reusable electrodes with an approved disinfectant, untangle and inspect the lead wires, and restock supplies✓
• b.Soak the entire patient cable in disinfectant solution
• c.Wrap the lead wires tightly around the machine to save space
• d.Clean the machine only when it appears visibly dirty

Between patients the machine surfaces, cables, and reusable components are wiped with a facility-approved disinfectant, wires are inspected for cracks and gently uncoiled, and supplies are restocked so the unit is ready. Immersing a patient cable damages the connectors and creates an electrical hazard. Wrapping wires tightly breaks the internal conductors and causes artifact, and waiting for visible soil ignores unseen contamination.

A patient is being fitted with a 24-hour Holter monitor. Which instruction is correct?

• a.Remove the electrodes at night and reapply them in the morning
• b.Avoid all physical activity so the recording stays clean
• c.Take the monitor off for showers and note the time
• d.Keep a diary of activities and symptoms with the times they occur, and do not get the monitor wet✓

The value of a Holter study comes from matching recorded rhythm changes to the patient's diary of activities and symptoms, so accurate timed entries are essential and the device must stay on and dry for the full recording period. Removing electrodes at night or for showers creates gaps in exactly the data being sought. Patients are told to follow their normal routine, not to avoid activity, because the goal is to capture everyday events.

What is the purpose of telemetry monitoring?

• a.To record a permanent 12-lead tracing once per shift
• b.To transmit a patient's cardiac rhythm continuously by radio signal to a central monitoring station✓
• c.To measure blood pressure automatically every fifteen minutes
• d.To record heart sounds for later review

Telemetry uses a small battery-powered transmitter worn by the patient to send the rhythm wirelessly to a central station, allowing continuous observation while the patient moves about the unit. A 12-lead EKG is a separate diagnostic test taken with a stationary machine. Blood pressure monitoring and heart sound recording use entirely different equipment.

Which instructions should a patient receive before a scheduled exercise stress test?

• a.Eat a large meal beforehand and drink coffee for energy
• b.Wear dress shoes and take all usual medications without mentioning them
• c.Avoid food, caffeine, and tobacco for the hours before the test as directed, wear comfortable clothing and walking shoes, and review current medications with the provider✓
• d.Stop all medications for one week before the test

Standard stress test preparation includes fasting and avoiding caffeine and tobacco for the period the facility specifies, wearing comfortable two-piece clothing and supportive walking shoes, and reviewing medications with the provider since drugs such as beta blockers affect the heart rate response. Eating heavily or drinking coffee alters the results. Dress shoes are unsafe on a treadmill, and patients never stop medications on their own.

An anxious patient is trembling and asks whether the EKG will shock her. What is the best response?

• a.Explain in simple terms that the machine only records the heart's own electrical signals and does not deliver any current, then help her get comfortable✓
• b.Tell her not to worry about it and start the test
• c.Explain the full electrical engineering of the machine in technical detail
• d.Have her sign the consent form and proceed without discussion

Clear, simple explanation reduces anxiety, and a relaxed patient also produces a tracing free of somatic tremor artifact, so communication is both a professional and a technical necessity. Dismissing the concern leaves the patient frightened and tense. Overly technical explanations confuse rather than reassure, and obtaining a signature without addressing the question is not informed cooperation.

A competent adult patient refuses to allow an ordered EKG. What should the technician do?

• a.Perform the test anyway because a physician ordered it
• b.Tell the patient he will be billed if he refuses
• c.Have a family member give permission instead
• d.Stop, respect the refusal, and notify the nurse or ordering provider and document what occurred✓

A competent adult has the right to refuse any procedure, and proceeding without consent could constitute battery, so the technician stops, reports the refusal to the nurse or provider, and documents it. A physician order does not override the patient's decision. Threatening the patient with charges is coercion, and a family member cannot consent for a competent adult.

A technician sustains a needlestick-free but bloody scratch from a broken bed rail while positioning a patient. What is the required response?

• a.Finish the EKG and mention it at the end of the shift
• b.Wash the area immediately, report the exposure incident to the supervisor at once, and follow the facility's post-exposure evaluation protocol✓
• c.Cover it with a glove and continue with all patients
• d.Document it in the patient's chart only

The bloodborne pathogens standard requires that exposure incidents be washed immediately and reported without delay so the employer can provide a confidential medical evaluation and any indicated post-exposure follow-up, which is time-sensitive. Delaying the report until the shift ends can forfeit protection. Covering the wound and continuing risks both the technician and patients, and an employee exposure belongs in an incident report, not the patient's chart.OSHA 29 CFR 1910.1030

A technician notices she wrote the wrong date on a completed paper EKG record. How should the correction be made?

• a.Erase the entry and write the correct date
• b.Cover the error with correction fluid and write over it
• c.Draw a single line through the error, write the correct information, and add her initials and the date of the correction✓
• d.Shred the record and print a new one without noting the change

Legal health records are corrected by drawing one line through the error so it remains readable, entering the correct information, and initialing and dating the change, which preserves an honest audit trail. Erasing or covering the entry destroys the original and looks like concealment. Destroying a record and silently replacing it is falsification of a medical record.

An outpatient's routine 12-lead shows a run of ventricular tachycardia, but the patient feels fine and asks to leave. What should the technician do?

• a.Keep the patient in the department and notify the physician or nurse immediately about the critical finding✓
• b.Give the patient the tracing and let him take it to his next appointment
• c.Repeat the tracing until a normal one is obtained, then release the patient
• d.Reassure the patient and let him leave, filing the tracing for review later

A critical finding such as ventricular tachycardia is reported to the provider immediately and the patient is kept under observation, because a symptom-free patient can deteriorate without warning. Filing the tracing for later review delays urgent care. Repeating the study until it looks normal conceals a real finding, and handing the tracing to the patient shifts a clinical responsibility onto him.

Which action best reflects professional behavior for an EKG technician?

• a.Posting an interesting anonymized rhythm strip on social media
• b.Telling a patient's spouse the results while the patient is in radiology
• c.Performing a lab draw because the unit is short staffed and the tech has watched it done
• d.Introducing herself by name and title, explaining the procedure, and performing only tasks within her training and scope✓

Professionalism means identifying yourself and your role, explaining what you will do, and working strictly within your training and scope of practice. Posting strips online risks re-identification and violates patient privacy even when names are removed. Sharing results with a spouse without authorization is an improper disclosure, and performing an untrained procedure exceeds scope regardless of staffing pressure.