Free PCT EKG Lead Placement & Rhythm Recognition Questions and Answers 1 — Questions and Answers
Question 1: When placing the precordial leads for a 12-lead EKG, where should the PCT place the V4 lead?
- 4th intercostal space, right sternal border
- 5th intercostal space, midclavicular line (Correct answer)
- 5th intercostal space, anterior axillary line
- 4th intercostal space, left sternal border
Correct answer: 5th intercostal space, midclavicular line
The V4 lead is placed in the 5th intercostal space at the midclavicular line. This specific placement is crucial for accurately capturing the electrical activity of the heart's ventricles. Remembering the sequence V1, V2, V4, V3, V5, V6 helps ensure correct placement.
Question 2: A PCT is preparing to perform an EKG on a patient with a left leg amputation below the knee. Where should the left leg electrode be placed?
- On the right lower leg
- On the left upper chest
- On the left lower abdomen/torso (Correct answer)
- Skip the left leg electrode entirely
Correct answer: On the left lower abdomen/torso
When a limb is amputated, the electrode should be placed on the remaining part of the limb, ensuring symmetrical placement with the opposite limb. Placing it on the lower abdomen or torso provides a stable and appropriate alternative location for capturing the electrical signal.
Question 3: Which of the following describes Normal Sinus Rhythm on an EKG strip?
- Irregularly irregular rhythm with no discernible P waves
- Regular rhythm, rate 60-100/min, P wave before each QRS (Correct answer)
- Regular rhythm, rate > 100/min, wide QRS complexes
- Regular rhythm, rate < 60/min, P wave before each QRS
Correct answer: Regular rhythm, rate 60-100/min, P wave before each QRS
Normal Sinus Rhythm is characterized by a regular rhythm, a heart rate between 60-100 beats per minute, a P wave preceding every QRS complex, and a consistent PR interval. This indicates the heart's electrical impulse is originating correctly from the sinoatrial (SA) node.
Question 4: A PCT notes an EKG rhythm that is 'irregularly irregular' with no clear P waves. This is most characteristic of which arrhythmia?
- Ventricular Tachycardia
- Sinus Bradycardia
- Atrial Fibrillation (Correct answer)
- Normal Sinus Rhythm
Correct answer: Atrial Fibrillation
Atrial Fibrillation (A-Fib) is defined by its chaotic and irregular atrial activity, which results in an irregularly irregular ventricular response. On an EKG, this appears as a wavy baseline with no discernible P waves and an irregular R-R interval.
Question 5: What is the most likely cause of a wandering baseline artifact on an EKG tracing?
- Patient movement or loose electrodes (Correct answer)
- Electrical interference from other equipment
- A life-threatening arrhythmia
- Incorrect lead placement
Correct answer: Patient movement or loose electrodes
A wandering baseline is often caused by patient movement, poor electrode contact, or respiratory interference. Ensuring the patient is still, the skin is properly prepped, and the electrodes are securely attached can minimize this type of artifact.
Question 6: A PCT identifies a rhythm with a rate of 160 beats per minute, a regular rhythm, and wide, bizarre-looking QRS complexes. This is most likely:
- Atrial Fibrillation
- Sinus Tachycardia
- Ventricular Tachycardia (Correct answer)
- Asystole
Correct answer: Ventricular Tachycardia
Ventricular Tachycardia (V-Tach) is a life-threatening arrhythmia originating in the ventricles. It is characterized by a rapid heart rate (typically >100 bpm) and wide QRS complexes because the electrical impulse does not follow the normal conduction pathway. This rhythm requires immediate medical attention.
Question 7: The Angel of Louis is an anatomical landmark used to help locate which intercostal space for EKG lead placement?
- First intercostal space
- Second intercostal space (Correct answer)
- Fourth intercostal space
- Fifth intercostal space
Correct answer: Second intercostal space
The Angle of Louis, or sternal angle, is the palpable ridge where the manubrium meets the body of the sternum. This landmark is directly adjacent to the 2nd rib, making it the starting point for counting down the intercostal spaces to accurately place the precordial leads, such as V1 in the 4th intercostal space.
Free PCT EKG Lead Placement & Rhythm Recognition Questions and Answers 1
When placing the precordial leads for a 12-lead EKG, where should the PCT place the V4 lead?