NHA EKG Technician (CET) — All Questions

A physician orders leads V3R through V6R on a patient in the emergency department. How are those four electrodes positioned?

• a.On the left chest, each one placed one intercostal space above its usual position
• b.On the back at the level of V6, spaced across the left shoulder blade
• c.On the right chest, mirroring the V3 through V6 positions across the sternum✓
• d.On the right chest, but one intercostal space higher than the left-sided positions

Right-sided chest leads are the mirror image of the standard ones: V4R goes to the fifth intercostal space at the right midclavicular line, V5R and V6R continue around the right chest at that same level, and V3R falls midway between V2 and V4R. The horizontal level does not change, so the answer that raises them an interspace describes no recognized position. Electrodes across the shoulder blade would be the posterior leads V7 through V9. Every right-sided tracing is labeled with the R designations, because unlabeled right chest leads read as an abnormal standard tracing.

A patient has a pacemaker generator lying directly under the usual V2 site, with a well-healed incision over it. What should the technician do?

• a.Place that electrode as near the correct site as the device allows and note the change✓
• b.Ask your supervisor whether an EKG may be recorded at all on a patient with a pacemaker
• c.Press the electrode down over the generator so that the site matches the standard position
• d.Leave that lead off and record the rest, marking the printout as incomplete

Electrodes are kept off implanted devices, incisions, and scars, so the electrode is moved the smallest distance that clears the generator and the change is written on the tracing for the reader. Placing it over the generator gives poor skin contact on a raised surface and presses on the pocket. Omitting a chest lead leaves an incomplete study that will have to be repeated, and the missing lead can be mistaken for lost R wave progression. A healed pacemaker pocket is not a reason to question whether the study may proceed, and the pacemaker spikes themselves are useful information for the physician.

During exercise testing the limb electrodes are moved onto the torso instead of the arms and legs. Why should that tracing not be compared with the patient's resting 12-lead?

• a.Torso placement drops the three augmented voltage leads from the printed tracing altogether
• b.Torso placement shifts the frontal plane axis and can imitate an inferior infarction✓
• c.Torso placement doubles the amplitude recorded in each of the six chest leads
• d.Torso placement records the rhythm alone, so no interval can be measured from it

Moving the limb electrodes onto the trunk changes the geometry of Einthoven's triangle, which rotates the frontal plane axis and alters the limb lead complexes; new Q waves or lost R waves in the inferior leads can appear from placement alone. That is why a torso-placed tracing is labeled as such and is compared only with other torso-placed tracings, not with a standard resting 12-lead. All twelve leads including the augmented ones are still produced, and every interval remains measurable. Chest lead amplitudes are affected far less than the limb leads, and they are not doubled.

On a 12-lead tracing, leads I and II carry the same fuzzy interference while lead III is clean. Which electrode is the most likely source?

• a.The right arm electrode, shared by leads I and II✓
• b.The left arm electrode, shared by lead I and aVL
• c.The left leg electrode, shared by leads II and aVF
• d.The right leg electrode, which serves as ground

Lead I records the left arm against the right arm and lead II records the left leg against the right arm, so the right arm electrode is the only site both of those leads use, and interference limited to that pair points straight at it. The technician reseats or replaces that electrode and inspects its wire. A failing left arm electrode would corrupt leads I and III, and a failing left leg electrode would corrupt leads II and III, so neither fits a clean lead III paired with dirty leads I and II. The right leg electrode is the ground reference, and trouble there shows up across the whole tracing rather than in two leads.

Every lead of a 12-lead tracing shows the same coarse interference, and the pattern does not change when the technician reseats individual electrodes. What does that pattern indicate?

• a.One limb electrode has lost contact with the patient's skin
• b.A lead wire has slipped off the electrode snap at its tip
• c.A chest electrode was placed over the sternum instead of a rib space
• d.The patient or the room, rather than one electrode, is the source✓

Trouble at one electrode can only corrupt the leads that use that electrode, so noise present in all twelve leads has to come from something common to the entire recording: the patient (tremor, shivering, movement), the surroundings (a nearby electrical device or power cord), or the ground and cable itself. The technician therefore looks at the patient and the room rather than continuing to swap single electrodes. A limb electrode that has lifted, a wire that has come off its snap, and a misplaced chest electrode each affect only their own leads and leave the rest of the tracing readable.

A monitor technician sees a completely flat, straight line in one monitored lead while the other displayed leads show normal complexes and the patient is sitting up talking. The nurse has just checked that lead's electrode at the bedside and reports that it is well adhered and that its gel is still moist. What is the most likely cause?

• a.A lead wire has pulled off its electrode or is broken internally✓
• b.The patient is in asystole and a code should be called at once
• c.The gel on that electrode has dried out and lost conductivity
• d.That electrode has slipped onto a bony area of the chest wall

A true straight line in one lead while the neighboring leads record normal complexes is an equipment failure, because the heart cannot stop for one lead and keep beating for the others. With the electrode itself confirmed as adhered and moist, the remaining break in the circuit is the wire: the technician traces it from the machine to the electrode, reconnects or replaces it, and confirms the display. Asystole appears in every lead at once and in a patient who is unresponsive and pulseless, not in one who is sitting up talking. Dried gel and an electrode sitting over bone degrade the signal into noise or low-amplitude waveforms rather than erasing every deflection, and the bedside check has already ruled the dried electrode out.

A technician is at the bedside finishing a 12-lead when the patient's monitor alarms and displays a wide, chaotic waveform that resembles ventricular fibrillation. What should the technician do first?

• a.Call the supervisor at once so that the code team can be activated
• b.Print a rhythm strip for the chart before doing anything else
• c.Switch the displayed lead to see whether the noise clears
• d.Check the patient at once for responsiveness and a carotid pulse✓

A monitor displays a signal, not a patient, and the only way to separate true ventricular fibrillation from artifact created by toothbrushing, chest percussion, or a scraped electrode is to look at the patient and feel for a pulse. Standing at the bedside, the technician can do that in seconds, which is why the assessment comes first here; a technician watching the same waveform from a central station cannot touch the patient and would have to send help to the room instead. A patient who is awake with a pulse is generating artifact, and a patient who is unresponsive and pulseless needs help immediately, so the bedside check drives everything that follows. Calling for the code team before anyone has laid eyes on the patient starts a resuscitation on someone who may be brushing their teeth; escalation follows the assessment rather than replacing it. Printing a strip or changing the displayed lead costs seconds that matter if the rhythm is real.

A patient with Parkinson disease has a resting tremor of both hands that fills the limb leads with continuous spiky artifact. What should the technician do?

• a.Move all four limb electrodes up onto fleshy sites on each limb✓
• b.Ask the patient to hold both hands still until the recording ends
• c.Have the patient sit up and grip the table edge to steady the arms
• d.Halve the sensitivity to 5 mm/mV so the spikes look smaller

Tremor artifact is generated by the skeletal muscle underneath the electrode, so moving all four limb electrodes proximally onto fleshy areas of the upper arms and thighs, keeping the four symmetric, puts them over quieter muscle; supporting the limbs on the bed helps further, and the altered placement is noted on the tracing. A resting tremor is involuntary and a patient cannot suppress it on request. Sitting up and gripping something tenses the arm and shoulder muscles and makes the artifact worse. Cutting the sensitivity in half shrinks the artifact and the QRS complexes by the same amount, so nothing is gained and the tracing is no longer standard.

During a resting 12-lead EKG the patient keeps talking and turning to look at the machine, and the tracing fills with irregular jagged deflections. What should the technician do?

• a.Report the poor tracing to the supervisor and let the nurse repeat it
• b.Accept the tracing and write "patient was moving" across the bottom
• c.Ask the patient to lie still and stay quiet, then record the tracing again✓
• d.Hold the patient's arms down gently against the bed while recording

Talking and turning contract the chest, neck, and shoulder muscles, and their electrical activity lands on the tracing as jagged somatic artifact. Because the recording itself takes only about ten seconds, telling the patient how brief it is and coaching stillness usually solves the problem outright, and a clean repeat costs almost nothing. Handing a movement-degraded tracing to the chart with a note leaves an unreadable study in the record, and handing the whole task upward for a problem the technician can fix at the bedside wastes the patient's and the nurse's time. Physically holding a patient down is outside a technician's scope and adds the muscle tension it is meant to prevent.

The baseline in lead V3 wanders up and down while every other lead sits steady and the patient is breathing quietly. What is the most likely cause and correction?

• a.That electrode is losing contact; apply a fresh one to the site✓
• b.The patient is breathing deeply; coach slow, shallow breathing
• c.The room is cold; cover the patient and warm the room, then rerun
• d.The cable lies on a power cord; separate the two, then rerun

A cause that acts on the patient as a whole, such as respiration or shivering, moves the baseline in many leads at once, so drift confined to a single lead localizes the problem to that one electrode's contact with the skin. Adhesive that is lifting or gel that is drying lets the contact resistance change from moment to moment, and the baseline follows it. Deep breathing would sway the chest leads together and would track the patient's respiratory rate, which is not what is happening here. A cold room produces muscle noise in several leads, and a cable running along a power cord produces a fine fuzzy band rather than a slow wandering baseline.

The chest lead wires hang straight down over the side of the bed, and the tracing shows repeated abrupt baseline shifts. What should the technician do?

• a.Lay the wires along the body with slack so they do not pull✓
• b.Press each chest electrode down harder and record the tracing again
• c.Tape the patient's gown over the wires to hold them against the bed
• d.Replace all six chest electrodes before recording again

Hanging wires put steady traction on the electrode snaps, and every small tug shifts the skin-to-electrode contact and jumps the baseline. Routing the wires along the contour of the patient's body with a little slack, so the cable carries its own weight, removes the traction and the jumps with it. Pressing harder on electrodes that are already stuck does nothing about the pull on them. Taping the gown over the loaded wires still leaves them under tension and can drag the electrodes when the patient shifts, and fresh electrodes would simply be pulled on by the same hanging wires.

A heavily diaphoretic patient's chest electrodes peel off within seconds of being applied. What is the appropriate response?

• a.Add extra conductive gel under each electrode before pressing it on
• b.Hold each electrode down for a full minute so it can set
• c.Record the tracing quickly, before the electrodes have time to lift
• d.Dry the skin, apply fresh electrodes, and secure them with tape✓

Sweat is a fluid layer between the adhesive and the skin, so nothing sticks until the site is dried; the technician pats each site dry, applies new electrodes, and holds them with tape or a wrap for the length of the recording. Many facilities also stock a skin-prep or antiperspirant product for this situation, and technicians should follow local policy on which is used. Extra gel makes the surface wetter still and can let signal bridge between neighboring chest sites. Pressing longer, or racing the recording, does not change the fact that the adhesive has no dry surface to grip.

Before a 12-lead EKG, a patient says that electrode adhesive has previously caused blistering and a spreading rash. What should the technician do?

• a.Apply the usual electrodes and take them off as soon as the tracing prints
• b.Apply the electrodes over a thin gauze square to protect the skin
• c.Report the reaction to the supervisor and use hypoallergenic electrodes✓
• d.Cancel the test and chart the reported reaction using the patient's own words

Blistering and a spreading rash describe a genuine contact allergy, so the technician stops before applying anything, passes the history to the nurse or supervisor so it is documented, and uses the latex-free, low-adhesive electrodes that facilities stock for this purpose. Applying the usual electrodes and removing them quickly still delivers the allergen to the skin and is a foreseeable injury. Gauze between the gel and the skin blocks conduction and produces an unusable tracing. A technician does not cancel a test that has been ordered; documenting the history is necessary but does not by itself get the study done safely.

A technician suspects that an infusion pump plugged in beside the bed is feeding interference into a monitored patient's tracing. What is the appropriate step?

• a.Move the patient cable and lead wires away from the pump and its power cord✓
• b.Unplug the infusion pump briefly to see whether the interference clears
• c.Display a different lead so that the interference is less noticeable
• d.Move the patient to another room and repeat the recording there

Interference from mains-powered equipment couples into the patient cable by proximity, so putting distance between the cable, the device, and the power cord is both the first correction and the safest one, and it usually works within a few inches. An infusion pump is delivering therapy, and interrupting a running infusion to test a theory about artifact is outside a technician's scope. Changing the displayed lead hides the noise without removing it, and the artifact will still be sitting on the recorded tracing. Relocating a patient is disruptive, often impossible, and unnecessary when routing the cable away from the cord solves the same problem.

In a dry room, sharp isolated spikes appear on the tracing each time the technician adjusts the synthetic blanket covering the patient. What is the most likely cause?

• a.Static discharge through the patient✓
• b.Alternating current from the bed's motor unit
• c.Muscle tremor from a patient who feels cold
• d.A lead wire broken inside its insulation

Nylon and other synthetic fabrics build up a charge in dry air, and each movement of the fabric discharges through the patient and the electrodes as a sharp, irregular spike that stops as soon as the fabric stops moving; changing to cotton coverings removes it. Alternating-current interference is a continuous, uniform band of small oscillations rather than isolated spikes tied to one person's hand. A cold, shivering patient produces continuous irregular fuzz across several leads rather than discrete spikes. A wire broken inside its insulation makes one lead flat or grossly erratic, and the disturbance would not be timed to the movement of the covers.

Why does a technician lightly abrade each electrode site with a dry gauze square or the abrasive tab on the electrode?

• a.It warms the site so that the conductive gel spreads more evenly
• b.It sterilizes the site so the electrode cannot introduce infection
• c.It removes dead surface skin, which lowers resistance to the signal✓
• d.It closes the pores so perspiration cannot loosen the electrode

The outer layer of dead skin cells is a poor conductor and is the largest source of resistance between the heart's signal and the electrode, so scrubbing it away with gauze or the abrasive patch on the electrode measurably cleans up the tracing. The abrasion is deliberately light: reddening the skin is enough, and it should stop well short of breaking the skin or drawing blood. Abrading is not a sterilizing step, and skin preparation for a surface EKG is not a sterile procedure. Rubbing does not warm the site in any way that changes gel behavior, and pores cannot be closed by friction.

A technician has replaced the electrodes, prepared the skin again, rerouted the cable, and coached the patient, and the tracing is still too noisy to be read. What should be done?

• a.Record it anyway and mark it as an acceptable study
• b.Reduce the sensitivity until the noisy baseline looks flatter
• c.Print the cleanest attempt and file it without any comment
• d.Tell the supervisor and document what was tried✓

Once the correctable causes have been worked through, the remaining step belongs to someone with more authority: the supervising nurse or supervisor decides whether a limited study is acceptable or whether the test is repeated later, and the record shows what was attempted so the reader knows the disturbance is technical rather than cardiac. Marking a noisy tracing as an acceptable study, or quietly filing the least bad attempt, invites a reader to interpret artifact as pathology. Lowering the sensitivity shrinks the noise and the complexes together, producing a non-standard tracing that is no easier to read.

A 12-lead tracing contains a five-second burst of artifact that occurred as the patient reached for a tissue. What is the appropriate way to handle the record?

• a.Delete the affected seconds from the stored file and print the rest
• b.Annotate the burst on the tracing as a short run of ventricular tachycardia
• c.Leave the burst unmarked so that the reader's judgment is not influenced
• d.Record the tracing again once the patient is settled and note the cause of the burst✓

The remedy for a movement burst is another ten-second acquisition, plus a short factual note of what the patient was doing, which lets the interpreting provider see immediately that the disturbance was mechanical. Deleting seconds from a stored file alters a medical record and hides information that the reader is entitled to. Writing a rhythm name on the tracing is interpretation and outside a technician's scope, and labeling artifact as ventricular tachycardia can set off treatment the patient does not need. Sending the burst through with no comment at all leaves the reader guessing and risks exactly the same misreading.

A patient arrives for a 12-lead EKG wearing a long metal necklace that lies across the chest and metal-framed eyeglasses, and has a stainless steel hip prosthesis. Which is most likely to disturb the tracing?

• a.The necklace, if it touches an electrode or a lead wire✓
• b.The hip prosthesis, since metal in the body conducts
• c.The eyeglass frames, since metal picks up room noise
• d.The prosthesis and necklace equally, both being metal

Metal lying on the skin can bridge across an electrode or drag against a lead wire as the patient breathes and moves, so a necklace draped over the chest is moved aside or removed before the chest electrodes go on. An implanted prosthesis is enclosed in tissue with no connection to the surface or to the cable, and it does not disturb the surface recording. Eyeglass frames sit far from every electrode and from the cable and have no path into the tracing. What matters is not whether metal is present but whether it can contact the recording circuit.

A confused patient repeatedly pulls the telemetry electrodes off, and the monitor alarms for a lost lead each time. What should the technician do?

• a.Tape the patient's hands to the bed rails until the leads stay on
• b.Report the situation to the supervisor for reassessment✓
• c.Silence the alarm and leave the leads off until the next shift
• d.Reapply the electrodes each time and add extra tape over them

Repeatedly pulling at monitoring equipment is a change in the patient's condition and a safety problem, so passing it to the supervising nurse or supervisor gets the patient reassessed and the monitoring plan adjusted. Applying restraints requires an order and is outside a technician's scope. Silencing the alarm and leaving the patient unmonitored removes the only warning the unit has that something is wrong. Simply reapplying and taping harder addresses the tracing but not the reason the patient is pulling, and it can injure fragile skin over repeated attempts.

A tracing shows a rapid, saw-toothed-looking baseline. Which finding points to somatic tremor rather than atrial flutter?

• a.Several leads have a clean, flat baseline✓
• b.The undulations are identical in every lead
• c.The ventricular rate sits near 150 beats per minute
• d.The waves stand out best in leads II, III, and aVF

Atrial activity is generated inside the heart, so flutter waves appear in every lead of the tracing, and a baseline that is completely clean in some leads while others oscillate has to come from muscle underneath particular electrodes. Flutter waves are also identical to one another and continue at a fixed atrial rate of roughly 250 to 350 per minute, often conducting two to one and giving a ventricular rate near 150 beats per minute, whereas tremor oscillations vary in both size and spacing. Because the two can look alike at a glance, the technician settles and supports the limb and repeats the tracing: artifact clears with the repeat and flutter does not.

During a 12-lead recording the two arm leads show fine, irregular baseline noise. The patient's right arm is hanging unsupported over the edge of the table. What should the technician do?

• a.Replace the electrode on that arm and repeat the recording
• b.Ask the patient to hold the arm straight out, away from the table
• c.Rest the arm flat and supported on the table beside the patient✓
• d.Turn on the artifact filter and repeat the recording

An arm that hangs unsupported keeps the shoulder and arm muscles working to hold it up, and that muscle activity is what puts the fine, irregular noise on the limb leads, so laying the arm flat and fully supported lets the muscles relax and the baseline settle. Holding the arm out in the air increases the muscle tension that is generating the noise. The artifact filter smooths the display without removing the cause, and it can blunt real detail such as the height of small waves, so it is not a substitute for correcting the position. Changing the electrode does nothing about the position that is producing the artifact in the first place.

A patient with persistent hiccups is being recorded, and tall, sharp deflections appear on the strip about once every two seconds. What should the technician do?

• a.Mark the deflections on the tracing as premature ventricular complexes
• b.Record a longer strip and note on it that the patient is hiccupping✓
• c.Wait until the hiccups have stopped before recording the tracing
• d.Apply a new set of electrodes and record the tracing over again

Hiccups are sudden diaphragmatic contractions that jolt the chest wall, and each one drops a sharp deflection onto the tracing at the rate of the hiccups rather than at any rate related to the underlying rhythm. A longer sample plus a factual note of the cause lets the interpreting provider match the deflections to the hiccups and separate them from genuine ectopic beats. Naming them premature ventricular beats is both an interpretation and a wrong one. New electrodes cannot exclude an artifact that the patient's own diaphragm is producing, and postponing an ordered study for hiccups that may last hours delays the patient's care.

A rhythm strip is labeled 50 mm/sec, and the QRS complexes on it measure five small boxes wide. What is the QRS duration?

• a.0.10 second, because each small box is 0.02 second at that speed✓
• b.0.20 second, because a small box is 0.04 second on any tracing
• c.0.05 second, because the box count is halved before converting it to time
• d.0.40 second, because a small box covers 0.08 second at that speed

Doubling the paper speed to 50 mm/sec spreads the tracing over twice as much paper, so each small box represents 0.02 second instead of 0.04 second: five boxes times 0.02 second equals 0.10 second, a normal QRS. Reading those same five boxes at 0.04 second each gives 0.20 second and would turn a normal QRS into an apparently wide, abnormal one. Halving the box count first, or treating a small box as 0.08 second, has no basis: changing the speed changes what a box is worth, not how many boxes the complex occupies. The recorded speed is printed on the tracing for exactly this reason.

An interpreting physician receives a 12-lead on which the standardization pulse measures 5 mm tall. What does that tell the physician about the tracing?

• a.The paper speed was lowered to 12.5 mm/sec, which compresses the complexes vertically
• b.It was run at half standard, so recorded amplitudes are half the true voltage✓
• c.The machine's calibration has drifted and the tracing must be repeated before it is read
• d.An artifact filter was applied, which cut the height of the calibration pulse in half

A standardization pulse 5 mm tall means the machine was set to 5 mm/mV, or half standard, so 1 mV produced only 5 mm of deflection instead of the usual 10 mm, and every measured amplitude must be doubled to recover the patient's true voltage. Half standard is a deliberate setting, chosen when complexes are so tall they overlap the channel above, and the pulse is printed precisely so the reader knows which gain was used. Paper speed changes the horizontal scale only and cannot shorten a complex. A machine whose calibration had genuinely drifted would not announce it with a clean, square 5 mm pulse, and filters do not rescale the calibration mark.

Muscle tremor artifact persists on a resting 12-lead after the technician supports the patient's arms and warms the room. The technician considers switching on the machine's artifact filter. What is the concern about relying on that filter?

• a.Filtering can distort the ST segment and reduce amplitude, so its use is noted on the tracing✓
• b.The filter erases the standardization pulse, leaving the reader no record of the settings used
• c.The filter works only at a paper speed of 50 mm/sec, so intervals need recalculating
• d.The filter removes 60-cycle interference only, so it has no effect on tremor artifact

An artifact or muscle filter narrows the frequency range the machine records; that smooths tremor, but it also alters the recorded waveform and can distort the ST segment and blunt QRS amplitude, which matters when the tracing is being read for ischemia. The better first move is to remove the cause at the patient, and when a filter is used the setting is printed or noted so the interpreter knows the tracing was filtered. The 60-cycle filter is a separate setting aimed at alternating-current interference, so a muscle filter does act on tremor. Filtering does not erase the calibration pulse and is independent of the paper speed.

A technician discovers that a 12-lead recorded an hour ago was printed under another patient's name and has already been filed in that patient's chart. What should the technician do?

• a.Cross out the wrong name, write the correct patient's name above it, and initial the change
• b.Pull the tracing from the chart, shred it, and record a new 12-lead on the correct patient
• c.Leave the tracing in place, since the interpreting physician will notice that it does not fit
• d.Report the error to a supervisor and follow the facility's correction policy✓

A tracing that has been filed is part of the medical record, and a technician does not alter it, discard it, or relabel it independently. Reporting the misidentified tracing so the facility's correction procedure can be followed produces a documented correction or addendum, a new tracing on the correct patient, and a trail showing who found the error and when. Crossing out a name and writing over it hides the change and leaves the other patient's chart still carrying a foreign result. Shredding destroys a record that has already been filed. Leaving it alone risks a patient being treated on the basis of someone else's tracing.

A technician has just recorded a resting 12-lead and is about to send it to the ordering provider. Which check must be completed before the tracing leaves the technician?

• a.That the heart rate printed by the machine matches a rate the technician counts by hand from the strip
• b.That the computerized interpretation printed by the machine agrees with the symptoms reported
• c.That patient identifiers, date and time, and technician identification are on the tracing and all 12 leads are legible✓
• d.That the patient has been shown the tracing and told which portions of it look normal before leaving

A tracing is not finished until it is identifiable and readable: full patient identifiers, the date and time of the recording, who recorded it, correct lead labels, all 12 leads present and legible, and a legible standardization mark showing the gain and speed used. Checking the machine-printed rate by hand is sound practice but is not what makes the record valid or attributable. Comparing the computerized statement with the patient's symptoms is interpretation and lies outside the technician's scope. Telling the patient which parts of the tracing look normal is also interpretation, and it is left to the provider even when the tracing appears unremarkable.

What does the transmitter worn by a patient on telemetry monitoring do?

• a.It stores the whole monitoring period in memory for a physician to download once the electrodes come off
• b.It analyzes the rhythm at the bedside and prints a 12-lead tracing whenever an alarm limit is crossed
• c.It delivers a small pacing stimulus if the patient's heart rate falls below the programmed low limit
• d.It converts the signal picked up by the electrodes into a radio signal that a central monitoring station receives and displays✓

Telemetry is live monitoring: the electrodes feed a small battery-powered transmitter the patient carries, and that unit sends the signal by radio to a receiver at a central station where the rhythm is watched continuously and stored there. Holding the entire recording in the device for later download describes a Holter monitor, which is reviewed after the fact rather than watched in real time, and that is the distinction most often missed. The transmitter itself does not analyze rhythms or print 12-leads; the central station displays, stores, and prints, and interpretation belongs to the provider. No telemetry transmitter paces the heart, which requires an implanted or external pacemaker.

Which practice protects a telemetry transmitter and its lead wires from failing during monitoring?

• a.Check the battery at the start of each shift and replace lead wires that are cracked or frayed✓
• b.Wrap the lead wires tightly around the transmitter case between patients so that they do not tangle
• c.Grasp the wire itself rather than the connector when taking a lead off an electrode
• d.Take the battery out whenever the patient leaves the unit so it does not run down

A transmitter is only as good as its power source and its wires, so batteries are checked and changed on the schedule the facility sets, and any wire with cracked insulation, a frayed conductor, or a bent pin is taken out of service because it produces intermittent signal loss and false alarms. Coiling wires tightly around the case stresses the conductor where it enters the housing and is a common cause of failure. Pulling on the wire instead of the connector damages that same junction. Removing the battery leaves the patient unmonitored without any record that monitoring stopped; a planned absence from the unit is handled through the facility's standby procedure instead.

The QRS complexes on a 12-lead are so small that the technician cannot measure their amplitude reliably. Which action addresses this?

• a.Record the tracing at double standard, 20 mm/mV, and note that setting✓
• b.Raise the paper speed to 50 mm/sec so the complexes are drawn taller
• c.Double each measured amplitude by hand and write the corrected values onto the tracing
• d.Record at half standard, 5 mm/mV, so more of each complex fits inside the channel

Low-amplitude complexes are handled at the machine rather than on paper: setting the sensitivity to 20 mm/mV makes 1 mV produce 20 mm of deflection, and the standardization pulse then prints 20 mm tall so the interpreter can see that every amplitude must be halved to recover true voltage. Paper speed changes only the horizontal scale, so running at 50 mm/sec spreads the complexes out without adding any height. Half standard shrinks them further, which is the opposite of what is needed. Writing corrected numbers onto the tracing alters a record the technician may not change, and it is unnecessary once the gain is documented by the calibration pulse.

A monitored patient is going off the unit for an approved test, and the nurse asks the technician to place that bed in standby on the central monitor. What must the technician keep in mind about standby on most monitoring systems?

• a.Standby keeps recording the patient's rhythm in the background and stores it for review after the return
• b.Standby automatically widens the alarm limits until the patient is back on the unit
• c.Alarms and monitoring are suspended, so the bed is taken off standby as soon as the patient returns✓
• d.Standby routes the patient's rhythm to the monitor in the department receiving the patient

Standby is a documented pause: on most systems it suspends the display, the alarms, and the recording for that bed so a patient who is legitimately off the unit does not generate a stream of false alarms. Because nothing is being watched during the pause, the bed has to be returned to active monitoring the moment the patient is back, and the time the pause started and ended is documented. Assuming the system keeps recording in the background is what leaves a patient unmonitored for hours after a return no one noticed. Standby does not adjust alarm limits, and it does not follow the patient to another department's monitor.

The central monitoring station alarms for asystole on a telemetry patient. What should happen first?

• a.Silence the alarm and watch the next several complexes to see whether the rhythm comes back
• b.Print a strip of the event and enter it in the monitoring log before anyone leaves the station
• c.Someone goes to the patient's bedside and checks the patient at once✓
• d.Notify your supervisor and wait for direction before anyone approaches the patient's room

Asystole on a monitor is treated as real until the patient shows otherwise, so the first action is to get eyes on the patient: a loose electrode, a detached lead wire, or a dead transmitter battery produces a flat line on a wide-awake patient, and only looking at the patient separates that from an arrest. Silencing the alarm and waiting for the rhythm to return spends the minutes that decide the outcome when the event is genuine, and alarms are not disabled or set outside safe limits to keep a station quiet. Printing and logging the event is required, but it follows the patient check. Escalating and waiting outside the room delays an assessment anyone at the bedside can make immediately, and notification happens alongside the response rather than in place of it.

A technician is cleaning an EKG machine and its patient cables between patients. Which practice is correct?

• a.Soak the cables in a basin of disinfectant so the solution reaches the connector pins and clips
• b.Rinse the cables under warm running water and dry them with a towel before storing the machine
• c.Disinfect the machine surfaces only when the patient tested is known to carry a resistant organism
• d.Wipe the cables and machine surfaces with a facility-approved disinfectant, observe the label's contact time, and let them dry✓

Cables, lead wires, and the surfaces a patient contacts are wiped between patients with a disinfectant approved for that device, kept wet for the contact time printed on the product label, and allowed to dry, which is what actually kills organisms without destroying the equipment. Immersing a cable or running it under water drives fluid into the connector and corrodes the pins, and the damage surfaces later as intermittent artifact or a dead lead. Cleaning only after a patient known to carry a resistant organism ignores every colonized patient nobody has identified. The manufacturer's instructions govern which product may be used, since some solutions degrade cable insulation.