NHA Certified EKG Technician (CET) — Questions and Answers

Question 1: Under HIPAA, sharing a patient's ECG tracing with a family member without consent is:

Only prohibited if the patient objects verbally
A HIPAA violation that can result in civil and criminal penalties (Correct answer)
Acceptable if the family member is present
Permitted because ECG results are not diagnostic information

Correct answer: A HIPAA violation that can result in civil and criminal penalties

ECG results are protected health information (PHI) under HIPAA; disclosing them without proper authorization constitutes a privacy breach with serious legal consequences.

Question 2: A sawtooth baseline pattern with atrial waves at about 300 bpm and a regular 2:1 ventricular response best describes which rhythm?

Sinus rhythm
Atrial fibrillation
Atrial flutter (Correct answer)
Ventricular tachycardia

Correct answer: Atrial flutter

The sawtooth flutter waves near 300 bpm with a fixed conduction ratio are classic for atrial flutter.

Question 3: For an accurate ECG on a female patient, where are the chest electrodes placed relative to breast tissue?

Under the breast on the chest wall (Correct answer)
On top of the breast tissue
Above the clavicle
On the abdomen

Correct answer: Under the breast on the chest wall

Chest leads should be placed under the breast on the chest wall for accurate signal capture.

Question 4: Which precaution is essential when performing an ECG near an MRI suite?

Use longer lead wires
Do not bring ferromagnetic ECG equipment into the MRI environment zone (Correct answer)
Record at 50 mm/sec paper speed
Increase ECG sensitivity

Correct answer: Do not bring ferromagnetic ECG equipment into the MRI environment zone

Ferromagnetic objects can become dangerous projectiles in the MRI magnetic field; only MRI-compatible ECG equipment should be used in or near an MRI suite.

Question 5: Posterior leads V7, V8, and V9 are used primarily to detect:

Lateral wall MI
Anterior wall MI
Pericarditis
Posterior wall MI (Correct answer)

Correct answer: Posterior wall MI

Posterior leads help identify posterior wall myocardial infarction.

Question 6: The QRS complex primarily represents which cardiac event?

SA node firing
Ventricular depolarization (Correct answer)
Atrial repolarization
Atrial depolarization

Correct answer: Ventricular depolarization

The QRS complex records the rapid depolarization of the right and left ventricles.

Question 7: A junctional rhythm arising from the AV node typically produces which finding?

Inverted or absent P waves with a rate of 40-60 bpm (Correct answer)
Upright P waves at 100 bpm
Sawtooth flutter waves
Wide QRS at 180 bpm

Correct answer: Inverted or absent P waves with a rate of 40-60 bpm

Junctional rhythms arise near the AV node, causing inverted or absent P waves at a rate of about 40-60 bpm.

Question 8: The QT interval represents:

Sinoatrial conduction time
AV nodal conduction time
Total ventricular depolarization and repolarization (Correct answer)
Atrial depolarization only

Correct answer: Total ventricular depolarization and repolarization

The QT interval spans from the start of the QRS to the end of the T-wave, encompassing all of ventricular electrical activity (depolarization and repolarization).

Question 9: A rhythm alternating between one normal beat and one PVC repeatedly is termed what?

Ventricular tachycardia
Atrial fibrillation
Ventricular bigeminy (Correct answer)
Trigeminy

Correct answer: Ventricular bigeminy

A repeating pattern of one normal beat followed by one PVC is called ventricular bigeminy.

Question 10: At standard calibration, one small (1 mm) box on the horizontal axis represents how much time?

0.20 seconds
0.10 seconds
1.0 second
0.04 seconds (Correct answer)

Correct answer: 0.04 seconds

Each small box equals 0.04 seconds when paper runs at 25 mm/sec.

Question 11: In ventricular fibrillation, the ECG most characteristically shows what?

Sawtooth atrial waves
Chaotic waveforms with no identifiable QRS complexes (Correct answer)
Regular narrow QRS at 75 bpm
A flat isoelectric line

Correct answer: Chaotic waveforms with no identifiable QRS complexes

Ventricular fibrillation produces disorganized, chaotic deflections with no discernible QRS complexes.

Question 12: The PR interval measures the time from:

End of T wave to next P wave
Start of the P wave to the start of the QRS complex (Correct answer)
Peak of R wave to next R wave
Start of QRS to end of T wave

Correct answer: Start of the P wave to the start of the QRS complex

The PR interval reflects conduction from the atria through the AV node to the ventricles.

Question 13: Hypokalemia from loop diuretic use (e.g., furosemide) produces which characteristic ECG change?

Peaked T waves and narrow QRS
Shortened QT interval
Elevated J-point with delta waves
Flat or inverted T waves and prominent U waves (Correct answer)

Correct answer: Flat or inverted T waves and prominent U waves

Hypokalemia flattens or inverts the T wave and causes prominent U waves (deflection after the T wave) due to delayed ventricular repolarization.

Question 14: A prolonged QT interval on the ECG is clinically significant because it increases the risk of which arrhythmia?

First-degree AV block
Sinus bradycardia
Atrial flutter
Torsades de pointes (Correct answer)

Correct answer: Torsades de pointes

A prolonged QT interval predisposes the patient to torsades de pointes, a dangerous polymorphic ventricular tachycardia.

Question 15: If the precordial chest leads show poor signal but limb leads are clear, what is the likely cause?

AC power interference
RL electrode disconnection
Machine calibration error
One or more chest electrode connections are loose or poorly adhered (Correct answer)

Correct answer: One or more chest electrode connections are loose or poorly adhered

When only precordial leads are affected and limb leads are clear, the problem is isolated to the chest electrode connections rather than a systemic machine issue.

Question 16: When performing a 12-lead ECG on a female patient, chest electrodes V4-V6 should be placed:

On top of the breast tissue
Above the clavicle
On the right side only
Under or below the left breast (Correct answer)

Correct answer: Under or below the left breast

Electrodes are placed beneath the breast to reach the correct intercostal spaces.

Question 17: Hypocalcemia (e.g., from loop diuretics or hypoparathyroidism) produces which ECG finding?

Peaked T waves
Shortened QT interval
Prolonged QT interval due to a long ST segment (Correct answer)
Delta waves

Correct answer: Prolonged QT interval due to a long ST segment

Hypocalcemia prolongs the ST segment, lengthening the QT interval, because calcium is essential for the plateau phase of the cardiac action potential.

Question 18: When placing precordial leads, lead V1 is positioned where?

Fifth intercostal space, midclavicular line
Fourth intercostal space, right sternal border (Correct answer)
Second intercostal space, left sternal border
Left leg

Correct answer: Fourth intercostal space, right sternal border

Lead V1 is placed in the fourth intercostal space at the right sternal border.

Question 19: Patient confidentiality regarding an ECG recording is protected under:

CDC
OSHA
FDA
HIPAA (Correct answer)

Correct answer: HIPAA

HIPAA governs the privacy of patient health information including ECGs.

Question 20: A standard ECG is normally calibrated so that 10 mm of vertical deflection equals what voltage?

2 millivolts
0.5 millivolt
1 millivolt (Correct answer)
10 millivolts

Correct answer: 1 millivolt

Standard calibration sets 10 mm vertical equal to 1 mV.

Question 21: When performing an ECG on a patient with a pacemaker, what should the technician note?

Use double paper speed
Disable the pacemaker before recording
Record only precordial leads to avoid interference
Document pacemaker presence and note pacemaker spikes on the tracing (Correct answer)

Correct answer: Document pacemaker presence and note pacemaker spikes on the tracing

The presence of a pacemaker should be noted in the documentation because pacemaker spikes alter waveform morphology and are essential context for accurate ECG interpretation.

Question 22: What is the minimum acceptable skin impedance reduction before recording a diagnostic ECG?

Below 5,000 ohms (5 kΩ) (Correct answer)
Below 1,000,000 ohms (1 MΩ)
Below 500,000 ohms (500 kΩ)
Impedance does not matter

Correct answer: Below 5,000 ohms (5 kΩ)

Skin impedance should ideally be below 5 kΩ per electrode site; skin preparation such as light abrasion and alcohol cleansing helps achieve this.

Question 23: The two-identifier rule for patient safety requires confirming:

Room number and bed number
Patient age and gender only
Insurance ID and address
Patient name and date of birth (or medical record number) (Correct answer)

Correct answer: Patient name and date of birth (or medical record number)

Joint Commission standards require using at least two patient identifiers (name and DOB, or name and MRN) before any procedure to prevent wrong-patient errors.

Question 24: The primary role of an ECG technician is to:

Prescribe cardiac medication
Diagnose heart disease
Obtain accurate ECG tracings (Correct answer)
Perform cardiac surgery

Correct answer: Obtain accurate ECG tracings

The technician's job is to obtain accurate, artifact-free ECG tracings, not to diagnose.

Question 25: Which action is required if an ECG technician notices a life-threatening arrhythmia on the tracing?

Immediately repeat the ECG to confirm
Disconnect the electrodes and inform the next shift
Notify the responsible clinician immediately and do not leave the patient alone (Correct answer)
File the ECG and wait for physician review

Correct answer: Notify the responsible clinician immediately and do not leave the patient alone

Critical ECG findings must be reported immediately to the responsible clinician; the technician should remain with the patient until qualified help arrives.

Question 26: Which of the following rhythm's origins is most likely?

Sinus node
Ventricle
AV node
Atria (Correct answer)

Correct answer: Atria

Rhythms originating in the atria, such as atrial fibrillation, atrial flutter, or premature atrial contractions, are characterized by distinct atrial activity (e.g., fibrillatory waves, flutter waves, or premature P waves) and typically a narrow QRS complex. This indicates that the electrical impulse originates above the ventricles, specifically within the atria.

Question 27: What does the calibration pulse at the beginning of an ECG strip verify?

1 mV standardization mark (Correct answer)
Battery level
Correct lead placement
Paper speed

Correct answer: 1 mV standardization mark

The calibration pulse (1 mV square wave, 10 mm tall) confirms the machine is set to standard sensitivity so tracings can be accurately interpreted.

Question 28: A wandering baseline artifact on an ECG is most often caused by:

A defective paper feed
A fast heart rate
AC electrical interference
Patient movement or loose electrodes (Correct answer)

Correct answer: Patient movement or loose electrodes

Baseline wander typically results from patient motion, respiration, or poorly attached electrodes.

Question 29: Which class of antiarrhythmic drugs primarily works by blocking sodium channels and may widen the QRS complex?

Class I (Correct answer)
Class IV
Class III
Class II

Correct answer: Class I

Class I antiarrhythmics (e.g., lidocaine, flecainide) block sodium channels, slowing depolarization and widening the QRS complex.

Question 30: A normal adult resting heart rate falls within which range?

60-100 bpm (Correct answer)
30-50 bpm
140-180 bpm
100-140 bpm

Correct answer: 60-100 bpm

A normal adult resting heart rate is 60 to 100 beats per minute.

NHA Certified EKG Technician (CET)

The NHA CET exam certifies EKG technicians on patient safety, EKG acquisition, and rhythm analysis/interpretation, validating competency to perform electrocardiograms in clinical settings.

Questions

35 min

Time Limit

70%

To Pass

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