NHA EKG Technician (CET) — All Questions

A technician is setting up 5-lead telemetry monitoring. Which placement follows the standard color convention?

• a.White on the right shoulder, black on the left shoulder, green on the right lower torso, red on the left lower torso, brown on the chest✓
• b.White on the right shoulder, black on the left shoulder, red on the right lower torso, green on the left lower torso, brown on the mid-chest
• c.White on the left shoulder, black on the right shoulder, red on the left torso, green on the right torso, brown on the chest
• d.White on the right shoulder, black on the left shoulder, green on the left torso, red on the right torso, brown on the chest

The standard five-electrode convention is white on the right upper chest, black on the left upper chest, green on the right lower chest or abdomen, red on the left lower chest or abdomen, and brown as the chest electrode, remembered as white on the right, smoke over fire on the left, and clouds over grass on the right. The near-miss answer keeps the shoulders correct but swaps red and green, which reverses the lower half of the frontal plane and can invert lead II. Swapping white and black reverses lead I, and any placement that puts the wrong color on the wrong side changes the vectors the monitor computes.

How many electrodes are applied for standard 3-lead cardiac monitoring, and what do they produce?

• a.Five electrodes producing leads I, II, and III
• b.Three electrodes producing leads V1 through V3
• c.Three electrodes producing all 12 leads
• d.Three electrodes producing leads I, II, and III✓

Three-lead monitoring uses three electrodes, usually right arm, left arm, and left leg positions, and generates the three bipolar limb leads I, II, and III, with lead II most often selected because it shows P waves well. Twelve leads require ten electrodes. Five-lead systems add a ground and a chest lead, and V1 through V3 are precordial leads that a 3-lead setup cannot produce.

The QRS complexes on a 12-lead tracing are so tall that they run off the paper and overlap the lead above. What is the appropriate action?

• a.Switch to half standardization, 5 mm/mV, and mark the tracing✓
• b.Reduce the gain until the complexes match the previous tracing
• c.Increase the paper speed to 50 mm/sec and reprint the whole tracing
• d.Move the chest electrodes down one intercostal space

When complexes are too tall to fit, the machine is switched to half standardization, so 1 millivolt produces a 5 millimeter deflection, and the change is marked on the tracing so the physician can interpret amplitudes correctly. Reducing the gain by eye until the tracing resembles an earlier one is the tempting wrong answer: it changes amplitude by an undocumented amount, which destroys any comparison between the two studies. Increasing paper speed widens the complexes without lowering their height, and moving electrodes falsifies the anatomic view.

A patient's heart rate is so fast that the complexes are crowded together and hard to measure. Which machine adjustment can help, and what must the technician remember?

• a.Set the standardization to 20 mm/mV, since amplitude changes fix crowding
• b.Reduce the paper speed to 10 mm/sec, which doubles each interval
• c.Reduce the paper speed to 12.5 mm/sec, which spreads the complexes
• d.Increase the paper speed to 50 mm/sec, making each small box 0.02 second✓

Doubling the paper speed to 50 mm/sec spreads the complexes apart for easier measurement, but each small box then represents 0.02 second instead of 0.04 second, so the change must be documented or every interval will be misread as twice its true value. Slower speeds compress the tracing further, which is the opposite of what is needed, and no reduction in speed spreads complexes apart. Standardization changes amplitude, not timing, so it does nothing about complexes that are too close together.

What is the standard patient position for obtaining a resting 12-lead EKG?

• a.Sitting up with the arms folded on the chest
• b.Supine with arms at the sides and legs uncrossed✓
• c.Standing with the arms extended forward
• d.Left lateral with the knees drawn up

The standard resting EKG is taken with the patient supine, arms relaxed at the sides, legs flat and uncrossed, so muscle tension and limb contact do not distort the tracing. Folded arms and crossed legs create somatic tremor and can bridge electrodes electrically. Standing or lying on the side shifts the heart within the chest and changes waveform amplitude and axis, so any deviation from supine has to be documented on the tracing.

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

• a.Have the patient sit on the edge of the bed and hold the electrodes
• b.Postpone the test and document that the patient cannot lie flat
• c.Raise the head of the bed, obtain the tracing, and document the position✓
• d.Lay the patient flat quickly and finish before symptoms worsen

Patient comfort and safety come first, so the head of the bed is raised to a tolerable semi-Fowler position, the tracing is obtained, and the non-standard position is recorded on the tracing because it can alter waveform amplitude and axis. A documented semi-Fowler tracing is still diagnostically useful, which is why postponing the study is the wrong trade: it delays care for a test that could have been done. Forcing a dyspneic patient flat risks harm, and holding electrodes by hand introduces motion artifact and unreliable contact.

A physician orders right-sided chest leads on a patient with a suspected right ventricular infarction. Which electrode position corresponds to V4R?

• a.Fifth intercostal space, left midaxillary line
• b.Second intercostal space, right sternal border
• c.Fourth intercostal space, left sternal border
• d.Fifth intercostal space, right midclavicular line✓

Right-sided leads mirror the standard positions across the chest, so V4R sits in the fifth intercostal space at the right midclavicular line and is the single most useful lead for right ventricular infarction. The fourth space at the left sternal border is standard V2. The left midaxillary position is V6, and the second space at the right sternal border is not a chest electrode site.

A patient has a right below-the-knee amputation. How should the technician place the limb electrodes?

• a.Place both leg electrodes on the intact left leg, a few inches apart
• b.Place both leg electrodes symmetrically on the lower torso✓
• c.Move the right leg electrode to the right arm, above the elbow
• d.Omit the right leg electrode and record a nine-lead tracing

When a limb is missing, the electrode is moved to the nearest torso location on that side and the opposite limb electrode is moved to match, keeping the frontal-plane leads symmetric, and the modification is documented for the interpreting physician. Placing both leg electrodes on the remaining leg leaves them asymmetric with respect to the trunk and distorts the frontal plane. Moving a leg electrode onto an arm collapses Einthoven's triangle, and omitting the right leg electrode removes the reference the machine needs to produce a tracing at all.

When performing a 12-lead EKG on a female patient with large breast tissue, where should the V4 and V5 electrodes be placed?

• a.On the back, directly opposite the usual positions
• b.Above the breast to avoid contact with the tissue
• c.On top of the breast tissue at approximately the correct level
• d.Under the breast, on the chest wall at the correct landmarks✓

Chest electrodes are placed beneath the breast on the chest wall at the true anatomic landmarks, because breast tissue between the electrode and the heart attenuates voltage and distorts amplitude. Placing electrodes on top of the breast is the common shortcut and is exactly what causes falsely low voltage in the lateral leads. Moving them above the breast abandons the fifth intercostal space, and back placement is reserved for the special posterior leads. The patient's privacy is protected with draping throughout.

On a 12-lead tracing, leads I, II, and aVR are clean, but lead III alone shows an erratic, noisy trace. What is the most likely cause?

• a.The patient is having a myocardial infarction affecting only the inferior wall
• b.A single electrode or lead wire connection is loose or dried out✓
• c.Alternating current interference from the room lighting
• d.The paper speed is incorrect

Artifact confined to one lead points to a problem with a specific electrode or lead wire, since each limb lead uses a different combination of electrodes; the fix is to reapply that electrode and reseat the wire. A true infarction produces recognizable ST or Q wave changes across a group of leads rather than random noise. Paper speed errors and AC interference affect the entire tracing, not one lead.

A technician opens a package of disposable electrodes and finds the conductive gel is dry and crusted. What should be done?

• a.Discard the package and open fresh, unexpired electrodes✓
• b.Moisten the gel with alcohol to soften it
• c.Moisten the electrodes with tap water and use them
• d.Use them anyway and increase the gain to compensate

Dried electrodes cannot conduct properly and cause wandering baseline and unreliable amplitudes, so they are discarded and replaced with fresh electrodes from a sealed, unexpired package. Water and alcohol are not substitutes for conductive gel; alcohol in particular raises resistance once it dries. Increasing the gain amplifies the artifact along with the signal and leaves the contact problem untouched.

A tracing shows steady 60-cycle interference. Which troubleshooting sequence is most appropriate?

• a.Apply fresh electrodes and ask the patient to breathe deeply
• b.Increase the paper speed and print the tracing a second time
• c.Unplug nearby equipment and move cables off power cords✓
• d.Switch to half standardization and print the tracing again

Sixty-cycle interference comes from surrounding alternating current, so the corrections are environmental: turn off or unplug nearby devices, separate the patient cable from power cords, verify a good ground electrode, and keep the patient from touching bed rails or other metal. Paper speed and standardization changes alter how the tracing is displayed without removing the noise. Fresh electrodes fix contact problems, and deep breathing worsens baseline wander rather than removing interference.

Before beginning a shift, a technician inspects the EKG machine. Which finding requires the machine be removed from service?

• a.Electrode tabs stored in a sealed, unexpired package
• b.A standardization mark measuring exactly 10 millimeters
• c.A paper roll that is about half full
• d.A frayed patient cable with exposed wire✓

A frayed cable with exposed conductor is an electrical hazard and a source of artifact, so the machine is tagged and removed from service until repaired. A half-full paper roll is simply replaced or monitored. A 10 millimeter standardization mark is the correct calibration, and sealed unexpired electrodes are exactly what should be stocked.

What is the inherent firing rate of the sinoatrial node in a healthy adult?

• a.20 to 40 beats per minute
• b.100 to 150 beats per minute
• c.60 to 100 beats per minute✓
• d.40 to 60 beats per minute

The SA node in the upper right atrium is the heart's primary pacemaker and fires 60 to 100 times per minute, which is why normal sinus rhythm is defined by that range. The AV junction fires at 40 to 60 as a backup, and the Purkinje network fires at 20 to 40 as the last resort. A rate of 100 to 150 is a tachycardia, not an inherent pacemaker rate.

A patient's SA node fails completely. Which structure normally takes over, and at what rate?

• a.The bundle branches at 100 to 120 beats per minute
• b.The atrial muscle at 20 to 40 beats per minute
• c.The AV junction at 40 to 60 beats per minute✓
• d.The Purkinje fibers at 60 to 100 beats per minute

The AV junction is the secondary pacemaker and assumes control at 40 to 60 beats per minute when the SA node fails, producing a junctional escape rhythm with absent or inverted P waves. The Purkinje network fires only at 20 to 40 and takes over if the junction also fails. Bundle branches conduct rather than pace at a fast rate, and general atrial muscle is not a designated escape pacemaker.

What is the inherent rate of the Purkinje fibers, and what does a rhythm at that rate look like?

• a.40 to 60 beats per minute with inverted P waves
• b.20 to 40 beats per minute with wide QRS and no P waves✓
• c.100 to 150 beats per minute with sawtooth waves
• d.60 to 100 beats per minute with narrow complexes

The Purkinje network is the heart's pacemaker of last resort at 20 to 40 beats per minute, and because the impulse starts below the AV junction it spreads slowly through muscle, giving a wide QRS with no P wave in front of it. The 40 to 60 range with inverted P waves describes a junctional escape rhythm, one level higher in the conduction system. The 60 to 100 range with narrow complexes belongs to the SA node, and sawtooth waves indicate atrial flutter rather than any escape pacemaker.

What is the correct order of the cardiac electrical conduction pathway?

• a.SA node, bundle of His, AV node, Purkinje fibers, bundle branches
• b.AV node, SA node, Purkinje fibers, bundle of His, bundle branches
• c.SA node, AV node, bundle of His, right and left bundle branches, Purkinje fibers✓
• d.Purkinje fibers, bundle branches, bundle of His, AV node, SA node

The impulse begins in the SA node, spreads across the atria to the AV node, passes through the bundle of His, splits into the right and left bundle branches, and ends in the Purkinje fibers that depolarize the ventricular muscle. Any sequence that starts at the AV node or the Purkinje fibers reverses normal physiology, and the bundle of His always lies below the AV node, never above it.

Why does the impulse pause briefly at the AV node, and how does that pause appear on the EKG?

• a.To let the atria finish emptying; it is the flat part of the PR interval✓
• b.To let the coronary arteries fill before contraction; it is the ST segment
• c.To let the ventricles repolarize completely; it is seen as the T wave
• d.To slow the SA node so that it cannot fire too quickly; it is the TP segment

The AV node delays the impulse about a tenth of a second so the atria can complete their contraction and top off ventricular filling before the ventricles fire, and that delay is the flat portion of the PR interval between the end of the P wave and the start of the QRS. The T wave represents ventricular repolarization, which happens after the ventricles have already contracted. The ST segment sits between ventricular depolarization and repolarization, and the AV node does not regulate the rate of the SA node.

What is depolarization?

• a.The closing of the atrioventricular valves in systole
• b.Electrical discharge of the cardiac cells before contraction✓
• c.The filling of the coronary arteries in diastole
• d.The relaxation of cardiac muscle as it returns to rest

Depolarization is the rapid electrical change across the cell membrane that triggers mechanical contraction, and it produces the P wave in the atria and the QRS complex in the ventricles. Electrical recovery and relaxation are repolarization, which is the opposite half of the cycle. Coronary filling and valve closure are mechanical events of the cardiac cycle, and an EKG does not record either of them.

A student asks why an EKG can look normal in a patient whose heart is not pumping effectively. What is the best explanation?

• a.The EKG measures blood pressure rather than electrical activity
• b.EKG machines are frequently inaccurate when cardiac output is low
• c.Electrical activity can occur without effective contraction✓
• d.The EKG records only atrial activity and not ventricular output

An EKG records only the electrical events of the heart, so an organized rhythm can appear on the monitor while the heart produces no pulse, a situation called pulseless electrical activity. This is exactly why the technician confirms the patient's condition rather than treating the monitor. The machine is not measuring pressure or output at all, so it is not a question of accuracy, and the tracing records both atrial and ventricular electrical activity.

What is the correct path of blood through the heart, starting with deoxygenated blood returning from the body?

• a.Right atrium, mitral valve, right ventricle, aorta, lungs, left atrium, tricuspid valve, left ventricle
• b.Right ventricle, right atrium, lungs, left ventricle, left atrium, aorta
• c.Right atrium, tricuspid valve, right ventricle, pulmonic valve, lungs, left atrium, mitral valve, left ventricle, aorta✓
• d.Left atrium, mitral valve, left ventricle, lungs, right atrium, tricuspid valve, right ventricle, aorta

Deoxygenated blood enters the right atrium from the venae cavae, passes the tricuspid valve into the right ventricle, leaves through the pulmonic valve to the lungs, returns oxygenated to the left atrium, crosses the mitral valve into the left ventricle, and exits through the aortic valve to the body. The mitral valve is always on the left and the tricuspid on the right, and blood always flows atrium to ventricle, never the reverse.

Which valve separates the right atrium from the right ventricle?

• a.Aortic valve
• b.Pulmonic valve
• c.Tricuspid valve✓
• d.Mitral valve

The tricuspid valve, named for its three cusps, lies between the right atrium and right ventricle and prevents backflow during ventricular systole. The mitral valve is the corresponding atrioventricular valve on the left side. The pulmonic and aortic valves are semilunar valves that guard the exits from the right and left ventricles.

When does blood flow into the coronary arteries to supply the heart muscle itself?

• a.During ventricular diastole, when the muscle is relaxed✓
• b.Only during atrial contraction, in late diastole
• c.During ventricular systole, when pressure is highest
• d.Continuously and equally through the cardiac cycle

The coronary arteries branch from the base of the aorta and fill mainly during diastole, because during systole the contracting myocardium squeezes the vessels running through it. This is one reason very fast heart rates, which shorten diastole most, can provoke ischemia. Atrial contraction contributes to ventricular filling rather than coronary perfusion, and coronary flow is distinctly phasic rather than constant.

How is cardiac output calculated?

• a.Heart rate divided by stroke volume
• b.Heart rate multiplied by stroke volume✓
• c.Stroke volume multiplied by blood pressure
• d.Systolic pressure minus diastolic pressure

Cardiac output equals heart rate times stroke volume, the amount of blood ejected by the left ventricle each beat, and it is normally about 4 to 8 liters per minute in an adult. Subtracting diastolic from systolic pressure gives pulse pressure. Dividing rate by stroke volume or multiplying stroke volume by blood pressure produces no meaningful physiologic measurement.

What happens during ventricular diastole?

• a.Blood is forced into the aorta and pulmonary artery
• b.The atrioventricular valves snap shut
• c.The ventricles relax and fill with blood✓
• d.The ventricles contract and eject blood

Diastole is the relaxation and filling phase, during which the atrioventricular valves are open and blood flows from the atria into the ventricles. Contraction and ejection define systole. The atrioventricular valves close at the start of systole, and blood enters the great vessels only when the ventricles contract.

A patient arrives with crushing chest pain radiating to the left jaw. The 12-lead shows ST segment elevation in leads II, III, and aVF. What does this pattern most likely represent?

• a.Benign early repolarization in a young adult
• b.Acute pericarditis with diffuse ST elevation
• c.Acute infarction of the inferior wall✓
• d.Left atrial enlargement with a notched P

ST segment elevation confined to a group of anatomically related leads is the classic sign of acute myocardial injury, and leads II, III, and aVF all look at the inferior wall of the left ventricle. Pericarditis is the answer worth taking seriously, because it also elevates the ST segment, but it typically does so diffusely across leads from several different territories rather than in one region. The technician does not diagnose either one, but must recognize the pattern and notify the nurse or physician immediately. Atrial enlargement changes the P wave rather than the ST segment.

How does stable angina differ from a myocardial infarction?

• a.Angina causes permanent muscle death, while an infarction is reversible
• b.Angina occurs only at rest, while an infarction occurs with exertion
• c.Angina shows ST elevation, while an infarction shows ST depression
• d.Angina is reversible ischemia; an infarction kills muscle✓

Angina is chest pain from a temporary oxygen shortage in the myocardium, typically brought on by exertion and relieved within minutes by rest or nitroglycerin, and it may show transient ST depression or T wave inversion. A myocardial infarction is a sustained occlusion that kills muscle tissue and often produces ST elevation and, later, pathologic Q waves. The answers that reverse the two have the relationship backward: it is the infarction that causes permanent damage, and it is stable angina, not infarction, that is predictably provoked by exertion.

A patient scheduled for an EKG has ankle swelling, shortness of breath when lying flat, and a history of congestive heart failure. What is happening physiologically?

• a.The SA node has stopped firing and an escape rhythm has taken over
• b.The conduction system has been interrupted below the AV node
• c.The heart cannot pump well, so blood backs up behind it✓
• d.The coronary arteries are completely blocked by a fresh clot

In congestive heart failure the weakened ventricle cannot move the volume delivered to it, so fluid backs up behind the failing side, producing pulmonary congestion and orthopnea on the left and dependent edema on the right. Complete coronary occlusion describes an acute infarction, which presents with pain over minutes to hours rather than chronic swelling. SA node failure produces an escape rhythm, and a conduction block changes the rhythm without by itself causing fluid overload.

Long-standing untreated hypertension most commonly produces which EKG-related change?

• a.Absent P waves with an irregularly irregular ventricular response
• b.Pacemaker spikes in front of every QRS complex on the tracing
• c.A QT interval shortened to less than 0.20 second at any rate
• d.Left ventricular hypertrophy with tall left-sided R waves✓

Chronic high blood pressure forces the left ventricle to work against increased resistance, so the muscle thickens and generates larger voltage, appearing as tall R waves in the left-sided leads and deep S waves in V1 and V2. Atrial fibrillation is a genuine long-term complication of hypertension, but absent P waves are not the change hypertension most commonly produces, and the question asks for the usual finding. A QT under 0.20 second is not a hypertensive finding, and pacemaker spikes come from an implanted device.

Which layer of the heart wall is the thick muscular layer responsible for contraction?

• a.Myocardium✓
• b.Epicardium
• c.Pericardium
• d.Endocardium

The myocardium is the middle, muscular layer whose contraction generates the pumping force, and it is the tissue damaged in a myocardial infarction. The endocardium is the thin inner lining in contact with the blood. The epicardium is the outer surface layer of the heart, and the pericardium is the surrounding sac.

Why is the left ventricle the thickest chamber of the heart?

• a.It must generate the pressure for the entire systemic circuit✓
• b.It holds a much larger volume of blood than the other chambers
• c.It houses the SA node and needs extra muscle for protection
• d.It receives all of the blood returning through the venae cavae

The left ventricle pumps against the high resistance of the systemic circuit, so its wall is roughly three times thicker than the right ventricle, which only has to move blood to the nearby low-pressure lungs. Both ventricles eject about the same volume with each beat, so chamber volume is not the reason for the difference. The SA node sits in the right atrium, and the venae cavae empty into the right atrium as well.

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

• a.Ask the family member at the bedside to confirm who the patient is
• b.Check that the room number and bed number match the order sheet
• c.Call the patient by name and proceed if the patient answers to it
• d.Have the patient state name and birth date and check the band✓

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 that is read aloud. Room and bed numbers change with transfers and are never acceptable identifiers. Patients may answer to the wrong name when medicated, confused, or hard of hearing, and confirmation by a family member does not replace the two required 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.Yes, because a personal friendship gives a legitimate reason to look
• b.Yes, because employees may view records at the facility that employs them
• c.No; access without a treatment or operations purpose is a violation✓
• d.Yes, as long as the technician does not repeat what she reads

Federal privacy rules limit access to protected health information to what a person needs for their 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 work, not to the whole system. Keeping the information secret afterward 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.It is a problem only if a member of the patient's family is present
• b.Nothing, as long as they avoid using the patient's first and last name
• c.Nothing is wrong, because both of them work for the same facility
• d.Protected health information can be overheard by unauthorized people✓

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 name does not protect a patient who is still identifiable from the room, the diagnosis, or the 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 in the elevator.HIPAA

When must an EKG technician perform hand hygiene?

• a.Before and after every patient contact and after glove removal✓
• b.Only after contact with blood or other potentially infectious fluid
• c.Only at the beginning and at the end of each scheduled work shift
• d.Only when the hands look or feel visibly soiled during the shift

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 a blood or fluid exposure ignores the routine transfer of organisms from intact skin and from equipment. Visible soil is a reason to wash but not the threshold for washing, and 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.No special measures are needed, because an EKG is a noninvasive test
• b.Apply the electrode directly over the wound to keep placement accurate
• c.Postpone the test and send the patient home until the wound has healed
• d.Treat the drainage as infectious and keep electrodes off the site✓

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 not applied over broken or draining skin; the site is shifted slightly and the change is documented. A noninvasive test does not exempt the technician from precautions, and postponing an ordered test because of a wound withholds care that can be given safely.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 reads the tracing, and tell the nurse✓
• b.Hand the tracing to the patient so that he can read it for himself
• c.Reassure the patient that the tracing looks completely normal to you
• d.Tell the patient that the tracing looks like a heart attack to you

Interpreting and diagnosing are outside the EKG technician's scope of practice, so the appropriate response refers the question to the provider, acknowledges the patient's concern, and passes the question along to the nurse. Offering a reassuring reading is as far outside scope as offering an alarming one, and either may turn out to be wrong. Releasing the tracing directly to the patient bypasses both 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.Document the time and the rhythm in the patient's medical record
• b.Finish the 12-lead tracing so the physician has a complete record
• c.Call for help, activate the emergency response, and start CPR✓
• d.Reposition the electrodes first to rule out a movement artifact

Ventricular fibrillation in an unresponsive patient is a cardiac arrest, and survival depends on immediate activation of the emergency response followed by prompt CPR and defibrillation. Checking for artifact is the right instinct in the wrong patient: it applies when the person is awake and stable, and this patient is not. Completing the tracing or documenting first spends the minutes that determine the outcome.

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

• a.Tell the patient that chest discomfort is expected and continue the stage
• b.Stop the test, notify the supervising provider, and keep monitoring✓
• c.Turn the monitor away so that the patient does not become anxious
• d.Increase the treadmill speed to finish the protocol stage

New chest pain or significant ST changes are recognized indications to terminate a stress test, and the supervising provider is notified at once while the patient continues to be monitored through recovery. Advancing the protocol raises myocardial oxygen demand at exactly the moment the heart is showing it cannot meet demand. Dismissing the symptom is unsafe, and turning the monitor away removes the information needed to manage the event.

Which information must appear on every EKG tracing?

• a.The technician's home phone number and the machine's serial number only
• b.The patient's next scheduled appointment date and the clinic's location
• c.The patient's admitting diagnosis and the name of the insurance carrier
• d.The patient's name and identifier, the date and time, and who took it✓

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 deviation such as altered electrode placement or a non-standard setting. Diagnoses are supplied by the interpreting physician rather than the technician. Insurance and appointment details belong elsewhere in the record, and personal contact information for staff is never placed on a tracing.

What is appropriate routine maintenance for EKG equipment between patients?

• a.Clean the machine only when it looks visibly soiled or sticky
• b.Wipe the machine and cables with an approved disinfectant✓
• c.Wrap the lead wires tightly around the machine to save space
• d.Submerge the entire patient cable in a disinfectant solution

Between patients the machine surfaces, cables, and any reusable components are wiped with a facility-approved disinfectant, the wires are inspected for cracks and gently uncoiled, and supplies are restocked so the unit is ready for the next study. Immersing a patient cable ruins the connectors and creates an electrical hazard. Wrapping wires tightly breaks the internal conductors and causes artifact, and waiting for visible soil ignores contamination that cannot be seen.

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

• a.Keep a diary of activities and symptoms with the times they occur✓
• b.Avoid all physical activity so that the recording stays clean
• c.Take the monitor off for showers and write down the time
• d.Remove the electrodes at bedtime and reapply them the next morning

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 recorder stays on and dry for the whole recording period. Removing electrodes for a shower or overnight creates gaps in exactly the hours the study is trying to capture. Patients are told to follow their usual routine rather than to rest, because the point is to record everyday events.

What is the purpose of telemetry monitoring?

• a.It records the patient's heart sounds for a physician to review later
• b.It records a permanent 12-lead tracing once during every shift
• c.It sends the rhythm continuously to a central monitoring station✓
• d.It measures the blood pressure automatically every fifteen minutes

Telemetry uses a small battery-powered transmitter worn by the patient to send the cardiac rhythm wirelessly to a central station, allowing continuous observation while the patient moves about the unit. A 12-lead EKG is a separate diagnostic study recorded on a stationary machine, not something telemetry produces. Automated blood pressure monitoring and heart sound recording use entirely different equipment.

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

• a.Stop taking all prescription medications for one week before the test
• b.Avoid food, caffeine, and tobacco as directed; wear walking shoes✓
• c.Wear dress shoes and take all usual medications without mentioning them
• d.Eat a large meal beforehand and drink strong coffee for extra energy

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 current medications with the provider, since drugs such as beta blockers blunt the heart rate response. Patients do not stop medications on their own; that decision belongs to the ordering provider and stopping some drugs abruptly is dangerous. Eating heavily or drinking coffee alters the result, and dress shoes are unsafe on a treadmill.

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

• a.Explain simply that the machine records and delivers no current✓
• b.Explain the electrical engineering of the machine in full technical detail
• c.Have her sign the consent form and then start the test without discussion
• d.Tell her there is nothing at all to worry about and start attaching leads

A clear, simple explanation lowers anxiety, and a relaxed patient also produces a tracing free of somatic tremor artifact, so communication here is both a professional and a technical necessity. Dismissing the concern leaves the patient frightened and tense, which shows up in the tracing. An overly technical explanation confuses rather than reassures, and collecting a signature without answering the question is not informed cooperation.

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

• a.Tell the patient that he will be billed for the refused test
• b.Stop, respect the refusal, and notify the nurse or provider✓
• c.Perform the test anyway, because the physician has ordered it
• d.Have a family member give permission instead

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 ordering provider, and documents what happened. A physician order authorizes the test but does not override the patient's decision. Threatening the patient with a charge is coercion, and a family member cannot consent on behalf of 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 to someone at the end of the shift
• b.Document the incident in the patient's chart and then keep working
• c.Wash the area and report the exposure to the supervisor at once✓
• d.Cover it with a glove and continue with the rest of the patients

The bloodborne pathogens standard requires that an exposure incident 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 and loses effectiveness with every hour. Waiting until the shift ends can forfeit that protection. Covering the wound and continuing risks both the technician and the patients, and an employee exposure is recorded in an incident report rather than in 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.Shred the record and print a new one without noting that it changed
• b.Erase the wrong entry neatly and then write the correct date over it
• c.Draw a single line through the error, correct it, and initial it✓
• d.Cover the error with correction fluid and write the new date over it

A legal health record is corrected by drawing one line through the error so it stays 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 even when the intent is innocent. 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 provider at once✓
• b.Repeat the tracing until a normal one prints, then release him
• c.Give the patient the tracing to take to his next appointment
• d.Reassure the patient, let him leave, and file the tracing

A critical finding such as a run of ventricular tachycardia is reported to the provider immediately and the patient is kept under observation, because a patient who feels well can deteriorate without warning. Filing the tracing for later review delays urgent care by hours or days. Repeating the study until it looks normal conceals a real finding, and handing the tracing to the patient moves a clinical responsibility onto someone who cannot act on it.

Which action best reflects professional behavior for an EKG technician?

• a.Introduce herself by name and title and work within her scope✓
• b.Perform a lab draw because the unit is short staffed tonight
• c.Post an interesting anonymized rhythm strip on social media
• d.Tell the patient's spouse the results while the patient is away

Professionalism means identifying yourself and your role, explaining what you are about to 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 no matter how short staffed the unit is.