NHA Patient Care Technician (CPCT) — All Questions

When placing precordial (chest) leads for a 12-lead EKG, where is lead V1 positioned?

• a.Fourth intercostal space at the right sternal border✓
• b.Fourth intercostal space at the left sternal border
• c.Fifth intercostal space at the anterior axillary line
• d.Fifth intercostal space at the midclavicular line

Lead V1 is placed in the fourth intercostal space at the right sternal border. Accurate placement of V1 is critical because the other chest leads are positioned relative to it. Misplacement produces inaccurate waveforms and can lead to misinterpretation.

Where is lead V2 placed during a 12-lead EKG?

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

Lead V2 is placed in the fourth intercostal space at the left sternal border, directly across from V1. V1 and V2 straddle the sternum in the same intercostal space. Correct placement ensures reliable recording of the heart's electrical activity.

Lead V4 of a 12-lead EKG is correctly positioned at:

• a.The fifth intercostal space at the left midclavicular line✓
• b.The fourth intercostal space at the right sternal border
• c.The left midaxillary line level with V4
• d.The fourth intercostal space at the left sternal border

Lead V4 is placed in the fifth intercostal space at the left midclavicular line. V4 is generally positioned before V3, and V3 is placed midway between V2 and V4. Correct V4 placement anchors the horizontal plane of the remaining chest leads.

When applying limb electrodes for a 12-lead EKG, where should they generally be placed?

• a.On the chest near the heart, just under the collarbones
• b.On the fingertips and the toes, one on each side
• c.Over bony areas such as the wrist bone and ankle bone
• d.On fleshy areas of the arms and legs, off the bone✓

Limb electrodes go on fleshy areas of the arms and legs, away from bony prominences and heavy muscle, and they are placed symmetrically on both sides so the frontal-plane leads stay accurate. Bone conducts poorly and gives a weak, unstable signal, and muscle over a joint produces tremor artifact. Moving limb electrodes onto the torso changes the recorded leads and is done only under a specific protocol that is then documented.

A monitored patient has a regular rhythm with a rate of 76, a P wave before each QRS, and normal intervals. This rhythm is best described as:

• a.Ventricular tachycardia
• b.Normal sinus rhythm✓
• c.Atrial fibrillation
• d.Sinus bradycardia

Normal sinus rhythm has a regular rate of 60 to 100 beats per minute with a P wave preceding each QRS complex and normal intervals. A rate of 76 with these features is normal. Recognizing normal rhythm helps the technician identify deviations quickly.

A cardiac monitor shows a regular rhythm with a P wave before each QRS at a rate of 48 beats per minute. This is best described as:

• a.Sinus tachycardia
• b.Sinus bradycardia✓
• c.Atrial fibrillation
• d.Normal sinus rhythm

Sinus bradycardia is a regular sinus rhythm with a rate below 60 beats per minute, so a rate of 48 with normal P waves fits. It may be normal in athletes or during sleep but can cause symptoms if the rate is too slow. Symptomatic bradycardia should be reported to the nurse promptly.

A monitored patient's rhythm is regular with a normal-appearing complex and P waves, at a rate of 120 beats per minute. This is best described as:

• a.Sinus bradycardia
• b.Sinus tachycardia✓
• c.Asystole
• d.Normal sinus rhythm

Sinus tachycardia is a regular sinus rhythm with a rate above 100 beats per minute, so 120 with normal P waves fits. It can result from fever, pain, anxiety, dehydration, or exertion. The underlying cause should be identified and reported as appropriate.

An EKG tracing shows fuzzy, erratic spikes in the baseline caused by the patient shivering. What is the most likely cause of this artifact?

• a.Wandering baseline from breathing
• b.60-cycle electrical interference
• c.Somatic (muscle) tremor artifact✓
• d.A loose electrode

Somatic tremor artifact is caused by muscle movement such as shivering, tremors, or tension, producing fuzzy, erratic spikes on the tracing. Warming the patient and helping them relax can reduce it. Distinguishing artifact from true rhythm prevents misinterpretation.

An EKG shows a baseline that gradually drifts up and down across the tracing. This wandering baseline is most often caused by:

• a.An unrecognized run of ventricular fibrillation
• b.A normal variation seen in a healthy adult heart
• c.Movement, respiration, or loose electrodes✓
• d.Sixty-cycle interference from equipment

A wandering baseline is a slow up-and-down drift of the whole tracing, caused by patient movement or respiration or by loose, dried, or poorly attached electrodes. Sixty-cycle interference is the answer worth ruling out and looks completely different: a fine, fast, uniform fuzz rather than a slow roll. Good skin preparation and secure electrode contact correct the drift. Recognizing it as artifact is what keeps it from being reported as a rhythm abnormality.

A tracing shows a uniform, thick, fuzzy line with small regular spikes about 60 times per second. This artifact is most consistent with:

• a.Normal sinus rhythm at a very fast rate
• b.Somatic tremor caused by patient shivering
• c.A slowly wandering and drifting baseline
• d.Sixty-cycle AC electrical interference✓

Sixty-cycle interference produces a uniform band of small, perfectly regular spikes picked up from nearby electrical equipment, cords, or faulty grounding, and the giveaway is that the spikes repeat at exactly 60 per second. No physiologic source is that regular: muscle tremor from shivering is irregular and varies in size, and a wandering baseline is a slow roll rather than fine spikes. Unplugging non-essential devices and checking cables and the ground electrode reduces it.

An EKG shows an irregularly irregular rhythm with no clearly identifiable P waves. This is most consistent with:

• a.First-degree heart block
• b.Sinus bradycardia
• c.Atrial fibrillation✓
• d.Normal sinus rhythm

Atrial fibrillation appears as an irregularly irregular rhythm with no discernible P waves, replaced by a chaotic, wavy baseline. It results from disorganized electrical activity in the atria. The technician should document the finding and notify the nurse, especially if the rate is rapid or the patient is symptomatic.

A cardiac monitor suddenly shows a flat line and the patient is unresponsive with no pulse. After confirming the patient and checking leads, what does this rhythm represent and what is the priority?

• a.Normal rhythm; continue monitoring
• b.Sinus bradycardia; recheck in an hour
• c.Artifact; ignore it and reset alarms
• d.Asystole; call for help and start CPR now✓

A flat line in a patient who is unresponsive and pulseless is asystole, a cardiac arrest. The technician confirms the patient rather than the monitor first, which also rules out a disconnected lead, then activates the emergency response and begins CPR if trained. A lead that has come off produces the same flat line in a patient who is awake, which is why the patient is checked before the alarm is dismissed as artifact and why it must never be dismissed in a pulseless patient.

Lead V6 of a 12-lead EKG is placed at:

• a.The fourth space at the right sternal border
• b.The second intercostal space at the sternum
• c.The left midclavicular line, fourth space
• d.Fifth intercostal space at the left midaxillary line✓

V6 is placed at the fifth intercostal space in the left midaxillary line, horizontally level with V4 and V5, completing the lateral view. V5 sits between them at the anterior axillary line. The fourth intercostal space at the right sternal border is V1, and keeping V4, V5, and V6 on one horizontal plane rather than following the rib line is what makes the lateral leads comparable.

To obtain a clear EKG tracing, how should the technician prepare the skin before applying electrodes?

• a.Apply the electrodes over body lotion for better adhesion
• b.Place the electrodes directly over the thick chest hair
• c.Wet the skin thoroughly just before applying them
• d.Clean the site, clip excess hair, and abrade lightly✓

Good skin preparation means cleaning the site, clipping excess hair only where an electrode will sit, and lightly abrading dry or oily skin so the electrode makes solid contact with a low-resistance surface. Lotions and oils insulate the skin and are a frequent cause of wandering baseline. Hair holds the electrode off the skin, and wet skin lets the electrode slide and lift. Secure contact is what produces a clean, interpretable tracing.

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.