NHA EKG CERTIFICATION EXAM– QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A patient is scheduled for a standard 12-lead ECG. As you begin preparing the skin for
electrode placement, you notice the patient has excessive chest hair. What is the most
appropriate action to take to ensure a quality tracing?
A. Apply a thick layer of conductive gel to help the electrodes adhere through the hair.
B. Request permission from the patient to clip the chest hair in the specific electrode areas.
C. Place the electrodes firmly over the hair and increase the baseline filter settings on the
machine.
D. Skip the chest leads and document that artifact prevented complete diagnostic acquisition.
ANSWER: B. Request permission from the patient to clip the chest hair in the specific
electrode areas.
Clipping excessive chest hair is the standard clinical intervention to ensure proper electrode-
to-skin contact and minimize somatic tremor or baseline wander artifact. Gels do not resolve
underlying poor adhesion caused by dense hair, filtering alters true electrical signals, and
skipping leads compromises diagnostic utility.
2. While performing an ECG, you notice erratic, random spikes and a wandering baseline
on leads I, II, and AVL. The patient is calm, but their phone is resting on their lap. What is
the most likely cause of this artifact?
A. Somatic tremor caused by involuntary muscle movement.
B. Alternating current (AC) interference from nearby electrical equipment.
C. Interrupted baseline caused by poor skin preparation or loose lead wires.
D. Wandering baseline caused by heavy breathing patterns.**
ANSWER: B. Alternating current (AC) interference from nearby electrical equipment.
AC interference typically manifests as uniform, narrow, jagged spikes or erratic spikes caused
by electrical devices (such as cell phones, lamps, or medical equipment) interacting with the
patient or cables. Somatic tremor creates irregular jagged peaks, while a wandering baseline
shows a drifting baseline due to movement or lotion.
,3. Which of the following heart rates is calculated when there are exactly 15 consecutive
small boxes between two consecutive R waves using the 1500 method?
A. 60 beats per minute
B. 100 beats per minute
C. 150 beats per minute
D. 300 beats per minute**
ANSWER: C. 150 beats per minute
The 1500 method calculates heart rate by dividing 1500 by the number of small boxes between
two consecutive R waves. Dividing 1500 by 15 yields exactly 150 beats per minute.
4. An EKG technician is reviewing a completed tracing and observes that the P waves are
entirely absent, the R-R interval is irregularly irregular, and the baseline shows chaotic
undulations. Which rhythm should the technician identify?
A. Ventricular fibrillation
B. Atrial flutter
C. Atrial fibrillation
D. Third-degree atrioventricular block**
ANSWER: C. Atrial fibrillation
Atrial fibrillation is characterized by the total absence of discrete P waves, replaced by
fibrillatory baseline waves, resulting in a classically irregularly irregular ventricular response
(R-R interval). Ventricular fibrillation displays chaotic, disorganized waveforms without
identifiable QRS complexes.
5. During a resting 12-lead ECG, a patient suddenly complains of severe dizziness,
shortness of breath, and chest pressure. Their blood pressure drops to 80/50 mm Hg. What
is your immediate priority action?
A. Complete the remaining leads quickly, then notify the physician.
B. Stop the ECG procedure immediately and summon emergency assistance or the provider.
C. Re-prep the patient's skin and check for loose lead connections causing false readings.
D. Administer nitroglycerin from the patient's purse while continuing the recording.**
,ANSWER: B. Stop the ECG procedure immediately and summon emergency assistance or
the provider.
Patient safety is always the primary concern. If a patient experiences acute hemodynamic
instability or worsening symptoms during diagnostic testing, the procedure must be halted
immediately, and clinical help summoned. Technicians must not administer medications or
prioritize finishing a tracing over acute distress.
6. Which of the following electrodes serves as the ground (reference) lead on a standard 12-
lead ECG?
A. Right arm (RA)
B. Left arm (LA)
C. Left leg (LL)
D. Right leg (RL)**
ANSWER: D. Right leg (RL)
The right leg (RL) electrode acts as the electrical ground or reference point to reduce
electrical interference on the tracing. The other limb leads participate in forming Einthoven's
triangle and augmented vectors.
7. When applying precordial leads, where should lead V4 be correctly 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 left midclavicular line
D. Fifth intercostal space at the left anterior axillary line**
ANSWER: C. Fifth intercostal space at the left midclavicular line
Lead V4 is anatomically placed at the fifth intercostal space at the intersection of the left
midclavicular line. V2 is at the fourth intercostal space left sternal border, and V5 is at the
anterior axillary line.
8. Which anatomical view of the heart is represented by leads II, III, and aVF?
A. Anterior wall
B. Inferior wall
, C. Lateral wall
D. Septal wall**
ANSWER: B. Inferior wall
Leads II, III, and aVF view the inferior wall of the left ventricle, which receives blood supply
predominantly from the right coronary artery. Leads V1 and V2 view the septal wall, V3 and
V4 view the anterior wall, and I, aVL, V5, and V6 view the lateral wall.
9. A patient with a documented history of dextrocardia requires a 12-lead ECG. How
should the technician modify the electrode placement?
A. Place all limb leads and precordial leads on the right side of the chest in a mirrored reflection.
B. Reverse only the arm leads while keeping the precordial leads in standard left-sided
positions.
C. Double the paper speed to 50 mm/second to compensate for altered electrical vectors.
D. Perform a standard 12-lead ECG without modifications, as dextrocardia does not affect
vectors.**
ANSWER: A. Place all limb leads and precordial leads on the right side of the chest in a
mirrored reflection.
Dextrocardia is a congenital condition where the heart is situated on the right side of the
thorax. To obtain a diagnostic tracing, both limb leads and precordial leads must be placed in
mirrored positions on the right side of the chest, and the tracing should be clearly labeled as a
right-sided ECG.
10. You observe a rhythm strip where the PR interval is constant and measures 0.28
seconds, followed by every QRS complex. How should you classify this PR interval
abnormality?
A. Normal PR interval
B. First-degree atrioventricular block
C. Second-degree AV block Type I
D. Complete heart block**
ANSWER: B. First-degree atrioventricular block
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A patient is scheduled for a standard 12-lead ECG. As you begin preparing the skin for
electrode placement, you notice the patient has excessive chest hair. What is the most
appropriate action to take to ensure a quality tracing?
A. Apply a thick layer of conductive gel to help the electrodes adhere through the hair.
B. Request permission from the patient to clip the chest hair in the specific electrode areas.
C. Place the electrodes firmly over the hair and increase the baseline filter settings on the
machine.
D. Skip the chest leads and document that artifact prevented complete diagnostic acquisition.
ANSWER: B. Request permission from the patient to clip the chest hair in the specific
electrode areas.
Clipping excessive chest hair is the standard clinical intervention to ensure proper electrode-
to-skin contact and minimize somatic tremor or baseline wander artifact. Gels do not resolve
underlying poor adhesion caused by dense hair, filtering alters true electrical signals, and
skipping leads compromises diagnostic utility.
2. While performing an ECG, you notice erratic, random spikes and a wandering baseline
on leads I, II, and AVL. The patient is calm, but their phone is resting on their lap. What is
the most likely cause of this artifact?
A. Somatic tremor caused by involuntary muscle movement.
B. Alternating current (AC) interference from nearby electrical equipment.
C. Interrupted baseline caused by poor skin preparation or loose lead wires.
D. Wandering baseline caused by heavy breathing patterns.**
ANSWER: B. Alternating current (AC) interference from nearby electrical equipment.
AC interference typically manifests as uniform, narrow, jagged spikes or erratic spikes caused
by electrical devices (such as cell phones, lamps, or medical equipment) interacting with the
patient or cables. Somatic tremor creates irregular jagged peaks, while a wandering baseline
shows a drifting baseline due to movement or lotion.
,3. Which of the following heart rates is calculated when there are exactly 15 consecutive
small boxes between two consecutive R waves using the 1500 method?
A. 60 beats per minute
B. 100 beats per minute
C. 150 beats per minute
D. 300 beats per minute**
ANSWER: C. 150 beats per minute
The 1500 method calculates heart rate by dividing 1500 by the number of small boxes between
two consecutive R waves. Dividing 1500 by 15 yields exactly 150 beats per minute.
4. An EKG technician is reviewing a completed tracing and observes that the P waves are
entirely absent, the R-R interval is irregularly irregular, and the baseline shows chaotic
undulations. Which rhythm should the technician identify?
A. Ventricular fibrillation
B. Atrial flutter
C. Atrial fibrillation
D. Third-degree atrioventricular block**
ANSWER: C. Atrial fibrillation
Atrial fibrillation is characterized by the total absence of discrete P waves, replaced by
fibrillatory baseline waves, resulting in a classically irregularly irregular ventricular response
(R-R interval). Ventricular fibrillation displays chaotic, disorganized waveforms without
identifiable QRS complexes.
5. During a resting 12-lead ECG, a patient suddenly complains of severe dizziness,
shortness of breath, and chest pressure. Their blood pressure drops to 80/50 mm Hg. What
is your immediate priority action?
A. Complete the remaining leads quickly, then notify the physician.
B. Stop the ECG procedure immediately and summon emergency assistance or the provider.
C. Re-prep the patient's skin and check for loose lead connections causing false readings.
D. Administer nitroglycerin from the patient's purse while continuing the recording.**
,ANSWER: B. Stop the ECG procedure immediately and summon emergency assistance or
the provider.
Patient safety is always the primary concern. If a patient experiences acute hemodynamic
instability or worsening symptoms during diagnostic testing, the procedure must be halted
immediately, and clinical help summoned. Technicians must not administer medications or
prioritize finishing a tracing over acute distress.
6. Which of the following electrodes serves as the ground (reference) lead on a standard 12-
lead ECG?
A. Right arm (RA)
B. Left arm (LA)
C. Left leg (LL)
D. Right leg (RL)**
ANSWER: D. Right leg (RL)
The right leg (RL) electrode acts as the electrical ground or reference point to reduce
electrical interference on the tracing. The other limb leads participate in forming Einthoven's
triangle and augmented vectors.
7. When applying precordial leads, where should lead V4 be correctly 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 left midclavicular line
D. Fifth intercostal space at the left anterior axillary line**
ANSWER: C. Fifth intercostal space at the left midclavicular line
Lead V4 is anatomically placed at the fifth intercostal space at the intersection of the left
midclavicular line. V2 is at the fourth intercostal space left sternal border, and V5 is at the
anterior axillary line.
8. Which anatomical view of the heart is represented by leads II, III, and aVF?
A. Anterior wall
B. Inferior wall
, C. Lateral wall
D. Septal wall**
ANSWER: B. Inferior wall
Leads II, III, and aVF view the inferior wall of the left ventricle, which receives blood supply
predominantly from the right coronary artery. Leads V1 and V2 view the septal wall, V3 and
V4 view the anterior wall, and I, aVL, V5, and V6 view the lateral wall.
9. A patient with a documented history of dextrocardia requires a 12-lead ECG. How
should the technician modify the electrode placement?
A. Place all limb leads and precordial leads on the right side of the chest in a mirrored reflection.
B. Reverse only the arm leads while keeping the precordial leads in standard left-sided
positions.
C. Double the paper speed to 50 mm/second to compensate for altered electrical vectors.
D. Perform a standard 12-lead ECG without modifications, as dextrocardia does not affect
vectors.**
ANSWER: A. Place all limb leads and precordial leads on the right side of the chest in a
mirrored reflection.
Dextrocardia is a congenital condition where the heart is situated on the right side of the
thorax. To obtain a diagnostic tracing, both limb leads and precordial leads must be placed in
mirrored positions on the right side of the chest, and the tracing should be clearly labeled as a
right-sided ECG.
10. You observe a rhythm strip where the PR interval is constant and measures 0.28
seconds, followed by every QRS complex. How should you classify this PR interval
abnormality?
A. Normal PR interval
B. First-degree atrioventricular block
C. Second-degree AV block Type I
D. Complete heart block**
ANSWER: B. First-degree atrioventricular block
