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Quiz Session - Attempts With Random Questions

NHA CET Exam Questions

Page 10 of 30

181.

You hook a patient to a 12-lead EKG and notice a small spike in the rhythm followed by a wide and bizarre QRS complex. Based on your knowledge of irregular rhythms, you identify this abnormality as which of the following?

  • The sign of a ventricular pacemaker

  • A PVC

  • The beginning of ventricular tachycardia

  • Prinzmetal angina

Correct answer: The sign of a ventricular pacemaker

When a ventricular pacemaker fires, it will show on the EKG as a small spike, followed by a wide QRS complex that looks similar to a PVC. The difference between this and a PVC is the presence of that pacemaker spike.

Ventricular tachycardia is usually preceded by a ventricular rhythm, which is caused by lethal rhythms such as a third-degree heart block. Prinzmetal angina is characterized by an elevated ST wave.

182.

What does the acronym "PHI" represent?

  • Protected health information

  • Patient health information

  • Public health information

  • Privacy health information

Correct answer: Protected health information 

Protected health information is an umbrella term for any patient information that is held by a covered entity; it is often abbreviated as the acronym PHI.

183.

According to the National Heart, Lung, and Blood Institute of the National Institute of Health, what value is the definition of high blood pressure? 

  • Systolic pressure of 140 mm Hg or greater

  • Systolic pressure of 180 mm Hg or greater

  • Systolic pressure of 125 mm Hg or greater

  • Diastolic pressure of 100 mm Hg or greater

Correct answer: Systolic pressure of 140 mm Hg or greater

The definition of high blood pressure is a systolic pressure of 140 mm Hg or greater or a diastolic pressure of 90 mm Hg or greater.

Pre-hypertension is considered greater than 120 mm Hg. When systolic pressure reaches over 180 mm Hg, this is defined as a hypertensive crisis, which is a medical emergency.

184.

What is a way to distinguish torsade de pointes from ventricular tachycardia?

  • The QRS complexes in torsade de pointes vary in axis and amplitude

  • The QRS complexes in torsades de pointes are more uniform than in ventricular tachycardia

  • In torsades de pointes, the QRS complexes maintain their axis and amplitude

  • There is no electrical activity in ventricular tachycardia

Correct answer: The QRS complexes in torsade de pointes vary in axis and amplitude

In torsade de pointes, the QRS complexes go around the baseline like a spiral, changing in axis and amplitude. This is the key difference between the two rhythms.

185.

Identify the following rhythm.

  • Sinus rhythm with PVC

  • Junctional rhythm

  • AV block

  • Ventricular tachycardia

Correct answer: Sinus rhythm with PVC 

PVCs are premature beats that originate in the ventricles and will be illustrated on the EKG as a wide, bizarre QRS complex. It is a normal rhythm that is interrupted.

Junctional rhythms originate in the AV junction and, therefore, will present as an irregular P wave. An AV block will present as an irregular PR interval or a dropped QRS. Ventricular tachycardia is a lethal rhythm characterized by large, malformed QRS complexes.

186.

During an EKG, the QRS complex in Lead II appears smaller than the QRS complexes in both Lead I and Lead III. 

Which of the following is the most likely cause of this abnormality based on Einthoven’s law?

  • Lead placement may be incorrect, and the electrodes should be checked

  • The patient has an underlying heart condition affecting the electrical activity

  • The EKG machine is malfunctioning and requires recalibration

  • This is a normal variation seen in patients with a high heart rate

Correct answer: Lead placement may be incorrect, and the electrodes should be checked

Einthoven’s law states that the height of the QRS complex in Lead II should equal the sum of the QRS heights in Lead I and Lead III, making Lead II the tallest QRS of the bipolar leads. If Lead II has a smaller QRS complex than expected, it likely indicates that the limb electrodes have been placed incorrectly. This can happen if the left arm and right leg electrodes are reversed, for example. 

While an underlying heart condition may alter EKG results, it would not directly violate Einthoven’s law. 

Malfunctioning of the EKG machine is less likely to affect the recording in this way.

This scenario is not a normal variation because Lead II should generally have the tallest QRS in a properly conducted EKG according to Einthoven’s law.

187.

A 72-year-old patient with a history of chronic pain presents to the ER complaining of persistent fatigue and episodes of light-headedness. His resting heart rate is measured at 52 beats per minute. He denies being an athlete and has no history of regular physical exercise. 

Which of the following is the most likely cause of his sinus bradycardia?

  • Side effects of opioid medications

  • Hyperthyroidism

  • Enhanced vagal tone

  • Strenuous exercise prior to measurement

Correct answer: Side effects of opioid medications

Sinus bradycardia is defined as a heart rate less than 60 beats per minute. In this patient, who is not an athlete and has not engaged in strenuous exercise, common causes of sinus bradycardia include certain medications such as opioids used to treat pain. 

Opioids are known to cause sinus bradycardia as a side effect. 

Hyperthyroidism typically presents with sinus tachycardia, not bradycardia. 

Enhanced vagal tone can happen as a result of regular exercise. Since the patient denies regular exercise, it is unlikely that his low heart rate is a result of enhanced vagal tone.

188.

What is the most common mistake technicians make when applying limb leads?

  • Reversing the electrodes

  • Forgetting to shave the patient

  • Applying them to a wet patient

  • Using the wrong type of electrode

Correct answer: Reversing the electrodes

The most common mistake technicians make when applying limb leads is reversing the electrodes. This error occurs when the electrodes are not placed on the correct limbs, which can result in incorrect readings.

Forgetting to shave the patient, applying electrodes to a wet patient, and using the wrong type of electrode are less common mistakes but can still affect the quality of the EKG recording. Shaving the patient helps ensure good contact between the skin and the electrode, applying electrodes to dry skin helps prevent poor adhesion and signal interference, and using the correct type of electrode ensures compatibility and accurate readings. However, these issues are secondary to the critical importance of correct electrode placement.

189.

What typically causes AV Nodal Reentrant Tachycardia (AVNRT)?

  • Over-excitement

  • Left heart failure

  • Cor pulmonale

  • Right atrial enlargement

Correct answer: Over-excitement 

AV Nodal Reentrant Tachycardia (AVNRT) is a common arrhythmia, usually caused by too much caffeine, too much alcohol, or over-excitement. Symptoms include palpitations, shortness of breath, and dizziness. It will manifest as a premature supraventricular beat. It is a benign arrhythmia and can be seen in healthy hearts.

Left heart failure is a condition where the left side of the heart is unable to pump blood effectively, leading to congestion in the lungs and other symptoms. It is not a typical cause of AVNRT.

Cor pulmonale refers to right-sided heart failure due to prolonged high blood pressure in the arteries of the lungs (pulmonary hypertension). This condition does not typically cause AVNRT.

Right atrial enlargement is a structural change in the heart often due to chronic lung disease or other conditions affecting the right side of the heart. It is not a common cause of AVNRT.

190.

For patients who are unable to exercise, there are alternatives to traditional stress testing. These include adenosine stress testing and what else?

  • Dobutamine stress testing

  • Cardizem stress testing

  • Amiodarone stress testing

  • Albuterol stress testing

Correct answer: Dobutamine stress testing

For patients who are unable to exercise, there are alternatives to traditional stress testing. These include adenosine stress testing and dobutamine stress testing. 

No stress tests are done with cardizem, amiodarone, or albuterol. 

191.

Under what circumstances can your medical information not be shared by your provider?

  • If requested by your employer

  • If a police report is required

  • To protect public health

  • To improve the coordination of your care

Correct answer: If requested by your employer 

The HIPAA privacy rule enforces situations in which PHI can and cannot be shared. Your health information can be shared in the following scenarios:

  • in a discussion between different providers to improve coordination of care
  • if you experience an injury that requires law enforcement to be involved (e.g., a gunshot wound)
  • if you suffer an illness that affects the public's health (e.g., influenza)
  • to pay providers and hospitals for care

Your information cannot be sent to your employers or used for marketing purposes.

192.

Under the omnibus rule of 2013, how long is patient health information protected? 

  • 50 years after death

  • Indefinitely

  • 25 years after death

  • 5 years after death

Correct answer: 50 years after death 

Under the omnibus rule of 2013, patient health information is protected for 50 years after a person's death.

193.

Identify the following rhythm.

  • Idioventricular rhythm

  • Ventricular tachycardia

  • Ventricular fibrillation

  • Asystole

Correct answer: Idioventricular rhythm

An idioventricular rhythm originates in the ventricles; it is an escape rhythm that only kicks in when all pacemakers have failed. It will have wide, bizarre QRS complexes and a rate between 20 and 40.

The difference between idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation is the rate. Asystole has no rate, rhythm, or electrical activity.

194.

Identify the following artifact.

  • Somatic tremor

  • Baseline sway

  • Broken recording

  • 60-cycle interference

Correct answer: Somatic tremor

A somatic tremor is an artifact usually caused by movement. It can be mistaken for an atrial flutter if not examined closely. The artifact can be identified by the shakiness of the rhythm.

195.

What is the physiology of a stress test based upon?

  • Graded exercise

  • Acute exercise

  • Chronic exercise

  • Non-graded exercise

Correct answer: Graded exercise

The physiology of stress testing is based upon graded exercise. This allows for a safe and gradual increase in a patient's heart rate and blood pressure. 

"Acute" and "chronic" are terms used to describe the onset of a medical condition.

196.

Identify the artifact.

  • Undersensing and loss of capture

  • Oversensing and failure to fire

  • Loss of capture only

  • No artifact

Correct answer: Undersensing and loss of capture

The pictured rhythm has pacemaker spikes in inappropriate locations, such as in the first QRS complex, signaling undersensing. There is also a loss of capture, as evidenced by the pacemaker spikes with no QRS rhythms following them.

197.

What are the irregular, web- or sponge-like ridges on the insides of the ventricle walls called?

  • Trabeculae carneae

  • Pillars

  • Bridges

  • Papillary muscles

Correct answer: Trabeculae carneae

The trabeculae carneae ("meaty ridges") are rounded, irregular muscular columns that project from the inner surface of the right and left ventricles of the heart.

Pillars are muscles attached to the tricuspid valve.

Papillary muscles match the three leaflets of the valves.

Bridges are structures in the right ventricle that contain electrical pathways of the heart's conduction system.

198.

Why is HIPAA needed?

  • Technology

  • National security

  • Hospital funding

  • Mental health information

Correct answer: Technology

HIPAA is needed because of the assessability of patients' health information due to technology. 

199.

On a 12-lead ECG, which leads would likely show ST-segment elevation for a septal heart attack?

  • V1 and V2

  • V1, V2, V3, and V4

  • I, aVL, V5, and V6

  • II, III, and aVF

Correct answer: V1 and V2

The leads showing ST-segment elevation for a septal heart attack would be V1 and V2.

200.

A patient is experiencing intermittent episodes of palpitations and dizziness that occur a few times a month. The healthcare provider recommends an ambulatory monitor to capture these irregular heartbeats. 

Which of the following types of monitors would be the most appropriate for this patient?

  • Event monitor

  • Holter monitor

  • Continuous telemetry monitor

  • Loop recorder

Correct answer: Event monitor

An event monitor is best suited for patients who experience symptoms intermittently, such as palpitations or dizziness that occur a few times a month. 

Unlike a Holter monitor, which continuously records for a short period (24-48 hours), an event monitor is activated by the patient when symptoms occur. This allows for longer monitoring periods (weeks to months) and captures EKG data only during symptomatic episodes, making it ideal for identifying infrequent arrhythmias.

A continuous telemetry monitor is typically used in a hospital setting for real-time monitoring and is not practical for outpatient use over long periods.

A loop recorder is typically implanted under the skin and can monitor for long periods (up to several years), but it is not typically used for short-term monitoring a few times in one month.

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