NHA Patient Care Technician (CPCT) — All Questions

The date of birth printed on a requisition does not match the date of birth on the inpatient's armband. What should the technician do?

• a.Correct the requisition at the bedside once the patient has confirmed the right birth date
• b.Draw the specimen and label the tubes with the date of birth printed on the requisition
• c.Draw the specimen and label the tubes using the birth date shown on the armband
• d.Stop and report the discrepancy to the nurse or supervisor before collecting anything✓

Two identifiers must agree across the requisition, the armband, and the label before any tube is filled, and a mismatch means the technician cannot yet prove which patient the order belongs to. Collecting anyway and choosing one source over the other simply moves the error onto the specimen, where it can put one patient's results in another patient's chart, and correcting a requisition from what a patient says is outside the technician's role and does not resolve where the error came from. The right move is to leave the order uncollected, report the discrepancy so nursing or the ordering area can reconcile the record, and draw only after the two identifiers match. Nothing about this delay harms the patient, which is what separates it from a situation that demands immediate action.

Which set of elements must appear on a blood specimen label before the tubes leave the bedside?

• a.The patient's full name and identification number, the room number, and the ordering provider's full name
• b.The patient's full name and date of birth, the name of the test, and the courier's pickup time
• c.The patient's full name and record number, the date and time of collection, and the collector's initials✓
• d.The patient's full name, the diagnosis being investigated, and the tube's expiration date

A specimen label has to carry the patient's full name, a unique identification number such as the medical record number, the date and time the specimen was collected, and the initials or identification of the person who collected it. Those four elements let the laboratory tie the tube to one patient and let anyone reviewing a result know when the sample was taken and who is accountable for it, which is why they are checked at the bedside rather than at the workstation. A room number changes when a patient is moved and identifies a bed rather than a person, so it can never stand in for the identification number. The courier's pickup time, the working diagnosis, and the tube's expiration date belong to other records and have no place on the label.

An inpatient is confused and cannot state a name or a date of birth. How should the technician confirm identity before drawing the specimen?

• a.Ask the patient's roommate to confirm the name and then compare it with the requisition
• b.Use the room and bed assignment on the printed collection label to identify the patient
• c.Match the armband to the requisition and have the nurse confirm the identity✓
• d.Draw the specimen first and have the nurse verify identity when the labels are applied

When a patient cannot participate in identification, the attached armband becomes the primary identifier and it must be compared element by element against the requisition, with a caregiver such as the assigned nurse or a family member at the bedside confirming that this is the right patient. A roommate is not an authorized source of another patient's identity, and a room and bed assignment is not an identifier at all, since patients are moved and beds are reassigned during a stay. Labeling after the fact, away from the bedside, is how specimens get switched, so the tubes are labeled at the bedside once identity is settled. The verification and the draw happen in that order, not the reverse.

A blood specimen is collected for a pre-employment drug screen. Which handling requirement applies here that does not apply to a routine chemistry specimen?

• a.The specimen has to be divided into two tubes so a second laboratory can repeat the test
• b.The specimen has to be centrifuged at the collection site before it leaves the room
• c.A chain-of-custody form has to record every person who handles the specimen and each transfer✓
• d.The specimen has to be labeled with the employer's account name in place of the patient's

Forensic and employment testing is defensible only if the specimen can be tracked from the donor to the analyzer with no unexplained gap, so a chain-of-custody form travels with it and each person who takes possession signs and dates the transfer. The specimen is sealed with tamper-evident tape in the donor's presence and is never left unattended, and the technician's signature on that form is a legal statement about what was collected. Splitting the sample and spinning it at the collection site are not what makes a specimen forensic, and neither one preserves the custody record. The label still carries the donor's own identifiers, since replacing them with an employer's account name would destroy the identification the chain of custody exists to protect.

A requisition lists a test code the technician does not recognize, and the department's collection manual shows no tube for that code. What should the technician do?

• a.Draw a gold-top serum tube, since the large majority of chemistry tests are run on serum
• b.Draw one tube of every stopper color available so the laboratory can pick the right one
• c.Collect nothing and send the requisition back to the unit clerk to be entered again later
• d.Ask the laboratory or the supervisor which tube this test requires before drawing✓

The tube a test requires is a laboratory specification, and when the requisition and the collection manual do not settle it, the technician confirms the requirement before the needle goes in rather than guessing at it. Choosing a serum tube because most chemistry runs on serum sends the patient for a second stick whenever the assay turns out to need plasma or whole blood. Drawing a tube of every color takes blood the patient does not need to give and still may miss a specimen with a special container or handling requirement. Returning the requisition without collecting delays care for an order that is probably valid and simply needs a tube identified, which one telephone call accomplishes.

The laboratory reports that a lavender-top tube sent for a CBC contains a clot. What should the technician do?

• a.Recollect the specimen in a new lavender tube and mix it right after the draw✓
• b.Ask the laboratory to report the platelet count alone, since a clot will not change it
• c.Invert the original tube ten more times to break the clot up and resend the specimen
• d.Send a green-top heparin tube instead so that this specimen cannot clot a second time

A clot in an EDTA tube traps platelets and white cells, so every cell count from that specimen reads falsely low and the laboratory cannot correct for it; the only remedy is a fresh draw into a new lavender tube, mixed by gentle inversion immediately after collection so the additive reaches the blood before clotting starts. The platelet count is in fact the value most damaged by a clot, since platelets are consumed first, so reporting it alone would be worse than reporting nothing. Breaking up a clot after the fact does not return the trapped cells to suspension and adds hemolysis on top of the original problem. Heparin is not an acceptable substitute for a CBC, because it distorts the white cell and platelet appearance on the stained smear.

A technician is sent to collect a CBC. The patient's left arm has an arteriovenous fistula used for dialysis, and an IV is infusing in the right forearm. The requisition gives no site instruction. What should the technician do?

• a.Ask the nurse or the supervisor how to proceed before choosing a site✓
• b.Draw from a hand vein below the running IV after stopping the infusion
• c.Apply the tourniquet above the fistula and use the cephalic vein there
• d.Use the fistula arm, since the vessels there fill quickly and stay firm

Both arms carry a restriction the technician cannot lift alone, so the draw stops until someone with the authority to decide is involved. A dialysis fistula is off limits for venipuncture anywhere in that limb, above or below it, because a puncture can damage the access the patient's dialysis depends on and can bleed heavily. Drawing distal to an infusion after it has been stopped for two minutes is a real technique, but stopping an IV is the nurse's action and not the collector's. Using the fistula because it fills well is exactly the reasoning that destroys an access.

The basilic vein is ranked as the last choice among the antecubital veins for a routine venipuncture. Which anatomy explains that ranking?

• a.It runs directly over the radial artery and a branch of the ulnar nerve
• b.It rolls away from the needle far more readily than the other antecubital veins
• c.The brachial artery and the median nerve lie immediately beneath it✓
• d.It sits deeper than the cephalic vein and can rarely be palpated at all

The basilic vein lies on the medial, little-finger side of the antecubital fossa, and the brachial artery and the median nerve run close underneath it, so a needle that goes too deep or wanders can strike an artery or a nerve. That injury risk, not technical difficulty, is what puts it behind the median cubital and the cephalic. The basilic does tend to roll, but rolling alone would only make it harder to hit, not dangerous. The radial artery runs on the thumb side of the wrist, nowhere near it, and the basilic is often easy to see and palpate, which is precisely why inexperienced collectors reach for it.

A technician inserts the needle and engages the tube, but no blood appears. Palpating above the needle finds the vein lying clearly to the side of the needle shaft. What should the technician do?

• a.Redirect the needle sideways beneath the skin until it enters the vein
• b.Remove the needle and restart at another site with fresh equipment✓
• c.Advance the needle further along its present path to reach the vessel
• d.Seat a fresh tube on the holder, since the first tube may have no vacuum

Palpation has already answered the question: the needle is beside the vein rather than in it, so this attempt is over and the next one begins with a new needle and a new site. Moving the needle laterally under the skin is probing, which is painful and can lacerate the vein or contact a nerve, and it is outside accepted technique. Pushing straight ahead only drives the needle deeper alongside the vessel. A tube that has lost its vacuum is a genuine cause of no flow and changing tubes is worth doing when the needle is seated in a vein, but that is not the situation here.

During a fingerstick the technician wipes away the first drop of blood with clean gauze before beginning to collect. What is the reason for discarding that drop?

• a.It is the richest drop in red cells and would falsely raise the hemoglobin
• b.It is diluted by tissue fluid and by any alcohol left on the skin✓
• c.It carries skin bacteria that would contaminate the microcollection tube
• d.It has begun to clot already and would leave fibrin strands in the sample

The first drop out of a skin puncture is a mixture of blood and interstitial fluid, and it may pick up residual alcohol from the prep, so it is wiped away and collection begins with the second drop. Discarding it is about dilution and contamination by fluid, not about cell concentration; the first drop is not richer in red cells. Skin flora is a concern when blood cultures are collected, which is a venous procedure and not what a microcollection tube is for. Clotting has not had time to occur in the first seconds, although squeezing the finger hard will cause both hemolysis and tissue-fluid contamination and must be avoided.

Veins of the foot and the ankle may be used for venipuncture only after permission is obtained from the patient's physician. What is the main reason for that restriction?

• a.Puncture there carries a raised risk of thrombosis and of poor healing✓
• b.Foot veins are too narrow to accept any standard multisample needle
• c.Blood from the lower extremities cannot be used for coagulation testing
• d.A tourniquet cannot be positioned correctly anywhere above an ankle vein

The lower extremities are the site most prone to clot formation and to slow, complicated healing, and patients with diabetes, peripheral vascular disease, or heart failure are at real risk of thrombophlebitis or a deep vein thrombosis from a foot puncture. That is why facility policy generally requires physician authorization before the site is used. Equipment is not the barrier: a small-gauge or winged needle fits a foot vein and a tourniquet sits above the ankle without difficulty. Blood drawn from the foot is valid for routine testing, including coagulation studies, so the objection is to harming the patient rather than to spoiling the specimen.

Where should the tourniquet be applied for a venipuncture in the antecubital fossa?

• a.Three to four inches above the intended puncture site✓
• b.Directly over the antecubital crease so the vein bulges below it
• c.One inch above the site so that the vein fills as fast as possible
• d.At the wrist, below the site, to trap blood in the forearm veins

A tourniquet placed three to four inches, roughly 7.5 to 10 cm, proximal to the site slows venous return without cutting off arterial inflow, so the veins below it distend and can be felt. Placed on the crease itself it covers the very skin that must be cleaned and punctured and it sits where the needle and holder need to be. One inch above is close enough to interfere with the equipment and with the angle of insertion. At the wrist it is distal to the antecubital veins and cannot fill them, because a tourniquet only distends the vessels downstream of it.

A patient who takes warfarin has just had blood drawn from the antecubital fossa. How should the technician manage the puncture site?

• a.Bandage the site at once and have the patient raise the arm above the head
• b.Hold firm pressure with the arm held straight until the bleeding has stopped✓
• c.Press for about fifteen seconds and then let the patient hold the gauze
• d.Have the patient bend the elbow over the gauze and hold it there five minutes

A patient on an anticoagulant bleeds for longer, so the technician holds direct pressure over the puncture with the arm extended and inspects the site before any bandage goes on; five minutes or more is ordinary and the dressing is applied only once bleeding has stopped. Bandaging immediately traps continued oozing under the dressing and produces a hematoma that nobody sees until later. Fifteen seconds is too short even for a patient on no medication at all. Bending the elbow over the gauze is a habit many patients bring with them, but it reopens the puncture about as often as it seals it and does not replace direct pressure.

A technician cleanses a venipuncture site with 70 percent isopropyl alcohol. What must happen next, before the needle is inserted?

• a.The site is dried with a sterile gauze pad to take up the excess alcohol
• b.The site is wiped a second time with alcohol, working in a circle outward
• c.The alcohol is left to air-dry completely, with no fanning or blowing on it✓
• d.The site is covered with dry gauze for thirty seconds while the alcohol acts

Alcohol has to evaporate on its own before the skin is punctured. A wet site stings sharply on insertion, and alcohol carried into the tube hemolyzes red cells and distorts results. Fanning the area or blowing on it puts organisms from the air and from the technician's breath straight back onto skin that was just disinfected. Wiping the site with gauze drags resident skin flora back across the cleaned area and undoes the antisepsis. A second alcohol pass or a gauze cover changes nothing about the drying time the technique depends on.

An 82-year-old patient needs a CBC. Her antecubital veins cannot be palpated, and the only accessible vessels are small, fragile veins on the back of the hand. Which equipment is the best choice?

• a.A 21-gauge multisample needle and holder used in the antecubital fossa
• b.A 25-gauge needle on a 10 mL syringe, with the plunger drawn back briskly
• c.A 16-gauge needle and holder, so the tube fills before the vein collapses
• d.A 23-gauge winged collection set with a holder and a small-volume tube✓

A winged, or butterfly, set with a 23-gauge needle and short flexible tubing is made for small, fragile vessels such as the dorsal hand veins, and pairing it with a small-volume tube keeps the vacuum from pulling the vein flat. The 21-gauge multisample needle is the routine choice for an antecubital draw, which makes it tempting here, but this patient has no palpable antecubital vein for it to enter. A 25-gauge needle is narrower than blood collection allows and shears red cells, and yanking a syringe plunger hemolyzes the sample as well. A 16-gauge needle is an infusion size that would tear a hand vein rather than preserve it.

During a multiple-tube venipuncture, at what point must the tourniquet be released?

• a.After the needle is out and the gauze is pressed down
• b.Before the needle is withdrawn from the vein✓
• c.Once the bandage has been placed over the puncture
• d.Just before the needle is inserted into the vein

The tourniquet comes off before the needle does. Usual practice is to release it as soon as blood begins to flow into the first tube, and it must be off in every case before withdrawal, because a needle pulled out of a vein still under tourniquet pressure lets blood escape into the surrounding tissue. Releasing it only after the needle is out, or after the bandage is on, is the exact sequence that produces a hematoma and prolonged bleeding at the site. Releasing it just before insertion collapses the vein that was distended for the stick and the attempt fails.

A technician has attempted a venipuncture on the same patient twice and has not obtained blood either time. What should the technician do next?

• a.Attempt a third stick in the opposite arm with a larger-gauge needle
• b.Ask another technician or the supervisor to make the next attempt✓
• c.Reinsert the used needle at the second site and search for the vein
• d.Document that no specimen could be obtained and cancel the order

Two unsuccessful sticks is the customary limit, after which the patient is handed to a second collector who brings fresh eyes and may find a vein the first person could not. A third attempt by the same technician adds pain and bruising without improving the odds, and a wider needle does nothing to locate a vein that has not been found. Reinserting a needle that has already been in the skin is a contamination and injury hazard and has no place in the technique. Cancelling an ordered test is a decision for the provider who ordered it, not for the person collecting.

As the needle enters the arm the patient cries out and describes a sharp, shooting, electric pain running down the forearm into the hand. What should the technician do?

• a.Withdraw the needle slightly and redirect it toward the median cubital vein
• b.Remove the needle immediately and discontinue the draw✓
• c.Loosen the tourniquet and pause until the pain settles, then continue
• d.Finish the collection quickly using the smallest tube available

Shooting, electric pain that radiates toward the hand is the classic sign of needle contact with a nerve, and the only acceptable response is immediate withdrawal; every extra second of contact adds to the risk of lasting injury. Redirecting the needle drags it across the injured nerve again. Waiting for the pain to settle with the needle still in the arm keeps the source of the injury in place. Finishing quickly with a small tube treats the specimen as more important than the patient. After withdrawal the technician holds pressure, records what the patient described in the patient's own words, and reports the incident.

A requisition asks for a basic metabolic panel on a patient who had a right mastectomy with axillary lymph node removal. Why is the right arm avoided for the draw?

• a.Surgical scarring has hardened the veins in that arm so a needle cannot enter cleanly
• b.Blood from the operated side clots faster and would gel inside a chemistry tube
• c.The operated arm carries weaker arterial pressure, so the tubes fill too slowly to use
• d.Lymph node removal impairs drainage, so the arm risks infection and skewed results✓

Taking out the axillary lymph nodes leaves that arm without normal lymphatic drainage, so it swells easily, clears infection poorly, and the fluid changes in the tissue can alter test values; the restriction lasts indefinitely unless the physician specifically authorizes the limb. Scarring is a genuine reason to avoid one patch of skin, but it is local and it is not what makes an entire post-mastectomy arm off limits. A mastectomy does not change how quickly blood clots or how hard the artery pushes, so the tubes would fill and behave normally. With one arm restricted, the unaffected arm is used.

Midway through a venipuncture the technician sees the area around the needle swelling rapidly and the skin starting to discolor. What should the technician do?

• a.Leave the needle in and ask the supervisor to look at the swelling
• b.Stop the draw and hold firm pressure over the site✓
• c.Continue the draw and ice the arm once the tubes are filled
• d.Advance the needle deeper and fill the remaining tubes

Rapid swelling with discoloration at the needle means a hematoma is forming: blood is leaking into the tissue, and the response belongs to the person already at the bedside. The tourniquet is released, the needle is withdrawn, and firm pressure is held over the site for several minutes. Waiting for someone else to come and look leaves a needle in a leaking vessel while the hematoma grows, and this is a situation the technician is trained to manage without delay. Ice may be offered after bleeding is controlled, but collecting more tubes while the tissue fills with blood is not acceptable, and pushing the needle deeper only enlarges the tear.

Before a routine draw, a patient tells the technician that she has fainted at every blood collection she has ever had. What is the best action?

• a.Seat her upright in the drawing chair and talk her through each step of the draw
• b.Have her sip a cup of juice while the tubes are being collected
• c.Hold an ammonia inhalant open near her face throughout the collection
• d.Position her reclined or lying flat for the draw and observe her afterward✓

A patient with a history of syncope at every draw is positioned reclined or supine before the needle goes in, so that losing consciousness cannot become a fall, and she is watched for several minutes after the collection. Talking an anxious patient through the steps is good practice and worth doing, but it does not protect someone who faints regardless of how calm she feels. Anything to eat or drink during the collection becomes a choking hazard the moment she loses consciousness. Ammonia inhalants are no longer recommended, because they can provoke bronchospasm in a patient with asthma and can cause a sudden head jerk that injures the neck.

A technician is performing a capillary puncture on an adult patient. Which site and lancet orientation are correct?

• a.The very center of the fingertip of the index finger, along the fingerprint lines
• b.The pad of the thumb, angled across the print lines toward the nail bed
• c.Slightly off center on the fleshy pad of the middle finger, across the prints✓
• d.The side of the tip of the fifth finger, running along the print lines

An adult skin puncture is taken from the palmar surface of the last segment of the middle or the ring finger, just off the center of the pad, with the lancet placed across the lines of the fingerprint so the blood beads up rather than running down a groove. The center of the fingertip is the most sensitive point and the bone sits closest to the surface there, and the index finger is more calloused and more sensitive than its neighbors. The thumb is calloused and has a palpable pulse. The fifth finger has too little tissue over the bone, which makes bone injury a real risk.

The small rounded wave that appears just before each QRS complex on an EKG tracing represents which event?

• a.The mechanical contraction of the atria pushing blood forward
• b.The spread of electrical depolarization across both atria✓
• c.The electrical recovery of the ventricles after a beat
• d.The impulse pausing at the AV node before the ventricles

The P wave is produced by electrical depolarization moving across the right and left atria, and the atria squeeze a moment later, so the tracing shows the signal rather than the mechanical event. An EKG records electrical activity only, which is why describing the atria physically pushing blood forward is wrong even though the two events are linked in time. Ventricular recovery produces the T wave, and the delay at the AV node appears as the flat segment after the P wave rather than as the wave itself.

The PR interval on a 12-lead tracing measures the time from:

• a.the start of the P wave to the peak of that same P wave
• b.the end of the QRS complex to the start of the T wave
• c.the beginning of the P wave to the start of the QRS complex✓
• d.the start of one QRS complex to the start of the next

The PR interval runs from the onset of the P wave to the onset of the QRS complex, so it measures how long the impulse takes to travel from the atria through the AV node to the ventricles. Measuring within the P wave alone gives atrial depolarization time, not conduction time down to the ventricles. The stretch from the end of the QRS to the start of the T wave is the ST segment, and the distance from one QRS to the next is the R-R interval, which is used to calculate rate.

EKG paper is running at the standard speed of 25 mm/sec. One small box on that paper represents:

• a.0.20 second, one large box wide
• b.0.10 second, two large boxes
• c.0.02 second, half a small box
• d.0.04 second, or 1 mm wide✓

At 25 mm/sec each small box is 1 mm wide, so 25 mm of paper passes in one second and one small box equals 1 divided by 25, or 0.04 second. Five small boxes make one large box, which is 5 mm wide and represents 0.20 second. A small box measures 0.02 second only when the paper speed has been doubled to 50 mm/sec. A span of 0.10 second is two and a half small boxes, not one.

A monitored rhythm is regular, and the technician counts 4 large boxes between two R waves. Using the 300 method, the rate is about:

• a.60 beats per minute (300 divided by 5)
• b.100 beats per minute (300 divided by 3)
• c.150 beats per minute (300 divided by 2)
• d.75 beats per minute, from 300 over 4✓

The 300 method divides 300 by the number of large boxes between two consecutive R waves, so 300 over 4 gives about 75 beats per minute. Five large boxes would give 60, three would give 100, and two would give 150, so each of those answers counts the wrong number of boxes. The method works because one large box is 0.20 second and 300 large boxes pass in a minute. It applies only to a regular rhythm; an irregular one is counted with the six-second method instead.

A technician checks the standardization mark printed at the beginning of a 12-lead tracing. On a machine set to normal calibration, that mark is:

• a.5 mm tall, marking half a millivolt
• b.10 mm tall, marking one millivolt✓
• c.20 mm tall, marking two millivolts
• d.25 mm tall, matching paper speed

Standard calibration is 10 mm per millivolt, so a correctly set machine prints a mark two large boxes tall at the start of the tracing. Half standardization prints a 5 mm mark and is used when complexes are so tall they overlap, while double standardization prints 20 mm for very small complexes; either change alters the height of everything on the strip and has to be noted. The 25 mm figure belongs to paper speed, which is a horizontal setting and has no effect on the height of the calibration mark.

A technician has placed the V1, V2, and V4 electrodes on a patient's chest. Where does the V3 electrode go?

• a.Midway between the V2 and V4 electrodes, on a line between them✓
• b.In the fifth intercostal space at the left sternal border
• c.Midway between V1 and V2 in the fourth intercostal space
• d.On the left anterior axillary line at the level of V4

V3 sits midway between V2 and V4, which is why those two electrodes are applied first and V3 is positioned only after both landmarks are on the chest. V2 already sits at the left sternal border in the fourth intercostal space, so placing V3 beside the sternum one space lower is far too medial. Putting it between V1 and V2 crowds two electrodes that are only a few centimeters apart across the sternum. The left anterior axillary line at the level of V4 is where V5 belongs, well lateral to the gap V3 has to fill, so an electrode there leaves the anterior wall unrecorded. Misplaced precordial electrodes change what the tracing shows without producing any obvious artifact.

A technician cannot get the chest electrodes to stick to a patient with dense chest hair. Where facility policy permits, the technician should:

• a.Move each chest electrode to the nearest hairless patch of skin
• b.Clip the hair at each site, then apply the electrodes✓
• c.Ask the supervisor whether this tracing can be rescheduled
• d.Tape the electrodes down firmly over the hair

Hair holds the adhesive sensor away from the skin, so clipping a small patch at each site is the accepted fix and it takes only a moment. Moving the sites to hairless skin changes the anatomic landmarks, which changes what each chest lead is looking at, so it is not an acceptable substitute. Taping over hair still leaves an air gap and usually produces a noisy or wandering tracing. Escalating is not called for either, because the obstacle is one the technician can correct at the bedside right now.

A technician is applying the V4 through V6 electrodes to a woman with large breasts. Those electrodes should be placed:

• a.over the top of the breast tissue at the same intercostal spaces
• b.under the breast, on the chest wall at the usual landmarks✓
• c.closer to the sternum, medial to the breast tissue itself
• d.one rib space lower than usual to clear the breast

The accepted practice is to lift or displace the breast and place the electrodes on the chest wall underneath it at the standard landmarks, because tissue between the sensor and the chest wall weakens the recorded signal. Recording over the top of the breast keeps the rib space correct but adds distance and lowers the voltage the machine sees. Shifting the sites toward the sternum or down a rib space moves the electrode off the anatomy it is meant to view and can imitate an abnormal finding. Draping the patient and exposing one site at a time protects privacy while the electrodes go on.

Before starting a 12-lead EKG on an inpatient, the technician confirms identity with two identifiers. Which pair meets that requirement?

• a.The patient's room number and the name on the door
• b.The patient's first name and the room number
• c.The patient's stated name and the assigned bed number
• d.The patient's full name and date of birth✓

Both identifiers must belong to the person rather than to a place, and the standard pair is the full name with the date of birth, checked against the wristband and the order. A room number, a bed number, or a name posted on a door identifies a location, and patients get moved between rooms during a shift. A first name alone is not unique on a unit where two patients may share it. Confirming identity before any electrode is applied keeps the tracing from being filed under the wrong record.

A new technician uses the words electrode and lead as if they mean the same thing. Which statement states the difference correctly?

• a.An electrode is the wire from the machine; a lead is the sticky disc
• b.An electrode is a single tracing on the paper; a lead is the cable
• c.An electrode is the sensor on the skin; a lead is a view between electrodes✓
• d.An electrode measures voltage; a lead is the printed rhythm strip

An electrode is the adhesive sensor stuck to the skin, and a lead is the electrical picture of the heart obtained by comparing the signals from two or more electrodes. That is why a 12-lead EKG needs only 10 electrodes: the machine derives 12 views from those 10 points of contact, so leads and electrodes cannot be counted as the same thing. Calling the cable itself a lead is common on the unit, but the wire is properly a lead wire and is not what the term means on the exam. The paper coming out of the machine is the recording of those views, and one tracing on it is a lead's worth of signal rather than the sensor that produced it.

A patient scheduled for a 12-lead EKG has a below-the-knee amputation of the left leg. Where should the left leg electrode be placed?

• a.On the remaining part of the left limb, with the right leg electrode moved to match✓
• b.On the lower left abdomen, with the other three electrodes left in place
• c.On the left shoulder, just below the left arm electrode site
• d.On the left hip, paired with the electrode on the left arm

The electrode goes on the residual limb, and the electrode on the intact leg is moved to the same level so the two sides stay symmetric and the frontal-plane leads remain comparable. Moving one electrode onto the trunk while the others stay on the limbs makes the sides unequal and shifts the tracing. The shoulder and the hip are not limb-lead positions, and the shoulder site would sit close enough to the arm electrode to distort the recording. Whatever placement is used must be written on the tracing so the provider who reads it knows the electrodes were not in standard positions.

A patient with shortness of breath cannot tolerate lying flat while a 12-lead EKG is recorded. What should the technician do?

• a.Lower the head of the bed to flat for the few seconds needed
• b.Record with the head of the bed up and note the position✓
• c.Seat the patient upright on the edge of the bed with feet down
• d.Wait for the breathing to improve before recording

The tracing may be recorded with the head of the bed elevated when a patient cannot lie flat, and the position is written on the strip so the provider knows the leads were not recorded supine. Forcing the patient flat even briefly worsens the breathing and usually fills the tracing with motion artifact, which defeats the purpose. Sitting on the edge of the bed leaves the arms and legs unsupported and adds muscle noise to the limb leads. Waiting for the breathing to improve delays a test that was very likely ordered because of that breathing.

A technician finds a surgical dressing covering the skin where the V4 electrode belongs. What should the technician do?

• a.Ask the nurse or supervisor how to proceed before recording✓
• b.Take the dressing off, place the electrode, and redress the site
• c.Press the V4 electrode onto the surface of the dressing itself
• d.Move V4 below the dressing and label the strip as usual

A technician does not remove or disturb a surgical dressing, so the nurse responsible for the wound decides whether the site can be uncovered or whether the tracing is taken with a documented adjustment. An electrode pressed onto a dressing has no skin contact and records nothing usable. Shifting the site to another rib space and labeling the strip as a standard tracing hides a change that alters what that lead is looking at. Any departure from the standard landmarks has to be documented on the tracing itself.

A technician has finished a 12-lead EKG and is about to hand the tracing off. What must appear on the tracing first?

• a.The rhythm the technician identified and the name of the physician
• b.The patient's name and ID number, the date, and the time✓
• c.The patient's vital signs and the medications given that morning
• d.The patient's name and the room where it was recorded

A tracing is identified by the patient's name and identification number together with the date and time it was recorded, plus the initials of the person who ran it and a note about any nonstandard placement or changed setting. Writing an interpretation on the strip is outside the technician's role, since reading the tracing belongs to the provider who ordered it. Vital signs and medications are charted elsewhere and do not identify the strip. A room number does not identify the patient, because the patient can be moved before anyone reads it.

A monitored patient's rhythm changes to a wide, regular complex at about 180 beats per minute, and the technician finds the patient unresponsive with no palpable pulse. What should the technician do first?

• a.Silence the monitor alarm and print a rhythm strip for the nurse to review
• b.Report the rhythm to the nurse or the shift supervisor before touching him
• c.Reattach the chest electrodes and watch the tracing for another minute
• d.Call for help, activate the emergency response, and start chest compressions✓

A wide, regular complex near 180 beats per minute in a pulseless patient is ventricular tachycardia without a pulse, one of the lethal rhythms; survival depends on immediate compressions and early defibrillation, so the technician shouts for help, activates the code, and begins CPR. The patient has already been checked, so stepping away to route the finding up the chain of command only delays the response. Silencing the alarm to print a strip and reworking the electrodes both treat the monitor at a moment when the patient needs hands on the chest. Once the team arrives, the technician assists as directed and does not interpret the rhythm or direct treatment.

During continuous monitoring, a technician sees that an alert, comfortable patient has begun having six or more early, wide beats each minute where there had been none an hour ago. What is the appropriate action?

• a.Continue monitoring and mention the change in the end-of-shift handoff report
• b.Widen the alarm limits so the early beats stop setting off the monitor alarm
• c.Obtain a fresh 12-lead tracing to compare with the admission strip
• d.Report the new frequent early beats to the nurse or supervisor promptly✓

Early, wide beats with no P wave in front of them are premature ventricular contractions, and a new increase in their frequency can precede ventricular tachycardia, so the finding goes to the nurse now rather than at the end of the shift. Holding the change for handoff leaves several hours in which the pattern could worsen unseen. Widening the alarm limits hides the very beats the monitor was set to catch. Running a new 12-lead is a procedure done on an order, not something the technician initiates, and it would not replace telling the nurse.

A monitor shows chaotic, irregular waves of constantly changing height with no identifiable P waves, QRS complexes, or T waves. This tracing is most consistent with:

• a.atrial fibrillation conducting at a rapid ventricular rate
• b.coarse artifact from the patient turning himself in bed
• c.asystole showing a few widely spaced complexes
• d.ventricular fibrillation, which is a pulseless emergency rhythm✓

Ventricular fibrillation is chaotic quivering of the ventricles, and the tracing shows disorganized waves of varying size with nothing that can be measured as a complex; the patient has no pulse and needs CPR and defibrillation at once. Atrial fibrillation has a wavy baseline but still produces recognizable QRS complexes, which this tracing lacks. Asystole is a flat or nearly flat line rather than large chaotic waves. Movement artifact is the trap here, and the technician settles it the same way every time, by going to the patient: someone in true ventricular fibrillation is unresponsive within seconds.

A telemetry technician sees a flat line in one lead while the remaining leads show a normal rhythm, and the patient is sitting up talking with a visitor. The most likely cause is:

• a.a broken lead wire or an electrode that has come loose from the skin✓
• b.asystole that is showing in the affected lead before it reaches the others
• c.static from an electrical device running next to the bed
• d.a failing battery in the patient's telemetry transmitter

A flat line confined to a single lead while every other lead traces normally points to a mechanical problem in that channel, so the technician goes to the room, checks the electrode and its wire, and replaces whichever has failed. True asystole is a whole-heart event that flattens all leads at the same moment and leaves the patient unresponsive, which rules it out in a patient who is talking. Static from nearby equipment and a weakening transmitter battery both degrade the entire tracing rather than one lead. The rule the technician works by is to look at the patient before believing the monitor.

A monitored patient's tracing shows repeating sawtooth waves between the QRS complexes, with an atrial rate of about 300 per minute. This pattern is best described as:

• a.atrial flutter, an organized rapid atrial rhythm✓
• b.sinus tachycardia with tall, peaked T waves
• c.atrial fibrillation with an irregular baseline
• d.a paced atrial rhythm with pacing spikes

Repeating sawtooth flutter waves at roughly 250 to 350 per minute, with the ventricles responding at a fraction of that rate, are the signature of atrial flutter. Atrial fibrillation produces a chaotic wavy baseline with no repeating wave shape and an irregularly irregular ventricular response. Sinus tachycardia shows one upright P wave for every QRS rather than several waves between complexes, and tall T waves do not repeat across the baseline. Pacing spikes are thin vertical marks, so a run of them looks nothing like a rolling sawtooth. Because interpreting a rhythm is outside the technician's scope in most facilities, the finding is described and reported to the nurse promptly rather than charted as a diagnosis.

A tracing shows a narrow vertical spike immediately in front of each wide QRS complex, at a regular rate. The technician should recognize this as:

• a.a premature ventricular contraction following each beat
• b.artifact from static electricity building up near the electrodes
• c.a tall, narrow P wave in front of every wide complex
• d.an artificial pacemaker rhythm, seen as regular pacing spikes✓

A pacemaker fires a small electrical impulse that the machine records as a thin vertical spike, and a ventricular paced beat produces a wide QRS immediately after the spike, so a regular spike-then-wide-complex pattern is a paced rhythm. A premature ventricular contraction comes early, has no spike and no P wave, and interrupts the underlying rhythm instead of repeating regularly. Static artifact is random and would not land in the same position before every complex. A P wave is a small rounded deflection, not a hairline spike. What the technician watches for and reports is a spike that is not followed by a complex.

On a monitored strip the rhythm is regular at 72, every P wave is followed by a QRS complex, and the PR interval is a constant 0.28 second. This is most consistent with:

• a.first-degree AV block, reported routinely rather than urgently✓
• b.complete heart block, with the atria and ventricles beating independently
• c.normal sinus rhythm with a PR interval at the long end
• d.a premature atrial contraction after each conducted beat

A PR interval that stays constant and longer than 0.20 second while every P wave still conducts to a QRS defines first-degree AV block; at 0.28 second this tracing is outside the normal range, so calling it normal sinus rhythm is the near miss a candidate has to reject. In complete heart block the P waves and the QRS complexes march at their own separate rates with no fixed relationship, which is not what a constant PR interval shows. A premature atrial contraction is an early beat, and this rhythm is regular. First-degree block is usually asymptomatic, so the technician documents it and reports it in the normal course rather than as an emergency.

A telemetry alarm announces ventricular fibrillation on a patient who was last seen standing at the sink brushing his teeth. What should the technician do first?

• a.Document the alarm and reset the monitor from the central station
• b.Print the strip and compare it with the patient's earlier tracings
• c.Call the emergency response team without leaving the station
• d.Go to the bedside and check the patient at once✓

Brushing teeth produces rapid, jagged motion artifact that can imitate ventricular fibrillation on a single-lead telemetry screen, and the only way to separate artifact from a lethal rhythm is to look at the patient, who in true ventricular fibrillation is unresponsive within seconds. Summoning the emergency team is exactly right the moment the patient is found unresponsive, but summoning it from the station before anyone has laid eyes on him sends a resuscitation team to a man who may be standing at the sink. Printing strips and documenting the alarm treat the monitor instead of the person. From the bedside the technician either calls out for help and starts the facility's response or corrects the artifact, then reports what happened.

A monitor alarms repeatedly during a busy shift on a telemetry unit. Which action is appropriate for the technician?

• a.Turn the alarm volume off until the nurse has time to look at the tracing
• b.Widen the heart rate alarm limits far enough that the alarm stops sounding
• c.Log each alarm and review the pattern at the end of the shift
• d.Check the patient and the electrodes each time the alarm sounds✓

Alarm limits are set according to the order and facility policy, and every alarm is answered by looking at the patient and then at the electrodes and lead wires, with true rhythm changes reported to the nurse. Turning the volume off can leave a lethal rhythm sounding into an empty room. Widening the limits until the noise stops disables the very range the alarm exists to catch, which is the reasoning behind the rule that a technician does not silence or shut off alarms to reduce nuisance. Logging alarms for later review is useful record keeping but does nothing for the patient whose alarm is sounding now.

A patient on continuous telemetry is scheduled for an imaging study, and a transport aide arrives to take him off the unit. Under typical facility policy, what should the technician do?

• a.Switch the transmitter off to save its battery until the patient returns
• b.Notify the nurse before the patient leaves so monitoring coverage is arranged✓
• c.Take the electrodes off and apply a fresh set when the patient comes back
• d.Note the departure in the log and resume watching the bed on his return

Monitoring is ordered by a provider, so a patient does not go off a monitored unit until the nurse knows and coverage during the trip has been arranged; the technician tells the nurse before the aide leaves. Recording the time monitoring stops and restarts is required, but it is documentation of a decision the nurse makes, not a substitute for making the call. Switching off the transmitter or pulling the electrodes ends the ordered monitoring on the technician's own initiative and leaves the screen blank with no one knowing why.

A completed 12-lead tracing contains a stretch of artifact running through two of the leads. What should the technician do with that tracing?

• a.Erase the artifact from the printout before the tracing is filed in the chart
• b.Cut the clean complexes out and tape them onto a fresh strip for the chart
• c.Write a note on the tracing stating that the machine was malfunctioning
• d.Correct the cause of the artifact and record the tracing again✓

A tracing is part of the permanent medical record, so nothing on it is erased, cut apart, redrawn, or explained away; the technician finds the cause, whether that is a loose electrode, dried gel, movement, or a lead wire pulled tight, corrects it, and runs a new tracing labeled with the patient's identifiers, the date, and the time. Erasing and re-taping alter a legal document and destroy the evidence a clinician needs to judge whether the tracing is trustworthy. Writing that the machine malfunctioned records a cause the technician has not established and still leaves an unreadable tracing in the chart.

A technician gets a noisy tracing on a patient who is lying still and relaxed, with the lead wires slack and firmly connected at both ends. What should the technician check next?

• a.Whether the tracing improves when the patient is asked to hold his breath
• b.Whether the electrode gel has dried out or the electrodes have expired✓
• c.Whether the room is cool enough to be making the patient tense his arms
• d.Whether the machine is due for its scheduled maintenance check

Electrode gel dries out once a package has been opened or the expiration date has passed, and a dry electrode makes poor contact with the skin, which shows up as a noisy, unstable tracing; fresh electrodes from a sealed package are the next thing to try after the patient and the cables have been ruled out. A cold, tense patient is a genuine cause of muscle noise, but this patient is described as relaxed and still. Breath holding is used for a baseline that swings with respiration, not for a noisy signal. Machine maintenance matters, but it does not explain a tracing that a new set of electrodes will usually fix.

While a technician applies telemetry electrodes, the patient looks at the monitor and asks whether his heart rhythm is dangerous. What is the best response?

• a.Explain that the nurse or physician will go over the tracing with him✓
• b.Reassure him that the rhythm looks normal and that there is nothing to worry about
• c.Show him the strip and point out the places where the complexes look regular
• d.Tell him not to worry about anything he sees on the screen

Reading a tracing for a patient is interpretation, which belongs to the nurse and the physician, so the technician acknowledges the question, tells the patient who will answer it, and passes it along at once. Saying the rhythm looks normal is an interpretation as well, and a comforting one that turns out to be wrong is worse than no answer. Pointing out regular complexes on the strip is the same interpretation delivered in pictures. Brushing the question aside by telling him not to think about the screen dismisses a real concern and leaves an anxious patient more worried, not less; scope of practice bars the technician from interpreting the tracing, not from listening and relaying the question.

A healthy 19-year-old is monitored with an upright P wave before every QRS, but the R-R interval shortens as she breathes in and lengthens as she breathes out. This rhythm is best described as:

• a.sinus arrhythmia, a normal variant that follows the breathing cycle✓
• b.wandering baseline artifact created by the patient's breathing
• c.frequent premature atrial contractions breaking up the rhythm
• d.sinus bradycardia with occasional dropped beats

Sinus arrhythmia is a sinus rhythm whose rate rises with inspiration and falls with expiration, and it is a common, harmless finding in children and young adults; the P waves stay upright and uniform and each one conducts, which is what this strip shows. A wandering baseline moves the tracing up and down on the paper but leaves the spacing between beats alone, so it cannot explain a changing R-R interval. Premature atrial contractions are early beats with an odd-looking P wave rather than a smooth cyclic speeding and slowing. Sinus bradycardia runs slow and steady and does not drop beats.