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Quiz Session - Attempts With Random Questions

NHA CET Exam Questions

Page 2 of 30

21.

What part of the myocardium is the thickest?

  • Left ventricle

  • Right ventricle

  • Left atrium

  • Right atrium

Correct answer: Left ventricle

The left ventricle is the thickest part of the myocardium. 

22.

Where is lead aVL located?

  • Left arm

  • Right leg

  • Right arm

  • Left leg

Correct answer: Left arm

The aVL lead is placed on the left arm. "aV" stands for augmented voltage, and "L" is the left arm.

23.

You prepare to place electrodes on a 55-year-old female for a 12-lead EKG when she asks about the risks associated with the test. What is your response?

  • Possible skin irritation from the adhesive

  • Possible mild burns on the skin from the electrodes

  • Rare but serious risk of cardiac arrest

  • No risks 

Correct answer: Possible skin irritation from the adhesive 

A 12-lead EKG is a safe procedure and only carries a small risk of skin irritation from the EKG electrodes. The electrodes do not cause any burns, and there is no risk of cardiac arrest from performing an EKG.

24.

Identify the following artifact. 

  • 60-cycle interference

  • Baseline sway

  • Toothbrush tachycardia

  • Artifact from performing CPR

Correct answer: 60-cycle interference 

The defining image of a 60-cycle interference is the thick baseline pattern, as it looks like a large block. This is caused by interference from other electronic devices.

25.

Which of the following is not a cause of a widened QRS complex?

  • Low potassium levels (hypokalemia)

  • Having hypothermia

  • Using a ventricular pacemaker

  • Tricyclic antidepressant overdose

Correct answer: Low potassium levels (hypokalemia)

Hypokalemia does not cause a wide QRS complex, but it does cause a prolonged Q-T interval.

Hypothermia, ventricular pacemaker, and TCA overdose are causes of a widened QRS complex.

26.

What important component of the cardiovascular system is being assessed during a cardiac stress test?

  • The coronary arteries

  • The aorta

  • The pulmonary arteries

  • The superior vena cava

Correct answer: The coronary arteries 

The goal of a cardiac stress test is to diagnose the presence of coronary artery disease. The patient's symptoms and EKG changes during the test can determine the patency of the coronary arteries.

27.

What is the pressure range of the right atrium?

  • 4-5 mm Hg

  • 5-25 mm Hg

  • 80-120 mm Hg

  • 15-120 mm Hg

Correct answer: 4-5 mm Hg

The pressure range of the atrium is 4-5 mm Hg. 

Pressure ranges include 5-25 mm Hg for the right ventricle, 15-120 mm Hg for the left ventricle, and 80-120 mm Hg is the pressure of the aorta.

28.

aVR, aVL, and aVF are what kind of leads?

  • Augmented leads

  • Limb leads

  • Precordial leads

  • Terminal leads

Correct answer: Augmented leads

aVR, aVL, and aVF are called augmented leads. aVR points to the right at 30 degrees. aVL points to the left at 30 degrees, and aVF points straight down toward the foot. 

Limb leads include LL, LA, RL, and RA. Precordial leads include V1-V6, and there is no such thing as a terminal lead. 

29.

The sinus node is firing at a rate of 70 bpm; however, the AV node begins to fire at a rate of 80 bpm. What is occurring?

  • Usurpation

  • Escape

  • Cardiac arrest

  • Ventricular tachycardia

Correct answer: Usurpation

Usurpation occurs when the lower pacemaker cells become irritable and fire at a rate faster than the sinus node, usurping the higher pacemaker.

30.

During a patient assessment, their pulse is weak, thready, and rapid. What does this finding indicate?

  • Cardiogenic shock

  • High blood pressure

  • Hyperkalemia

  • Normal finding

Correct answer: Cardiogenic shock

A weak, thready pulse with a rapid heart rate indicates low blood pressure, which is often seen in severely ill patients suffering from cardiogenic shock.

Pulse rate does not indicate a patient's potassium level.

31.

Which chamber of the heart receives deoxygenated blood from the body’s circulation?

  • Right atrium

  • Left atrium

  • Right ventricle

  • Left ventricle

Correct answer: Right atrium

The right atrium is the chamber of the heart that receives deoxygenated blood from the body. It sends blood to the right ventricle, the lungs, the left atrium, and the left ventricle.

32.

Which of the following is true regarding electrocardiography?

  • An upward QRS complex occurs when an electrical impulse travels toward a positive electrode

  • A downward QRS complex occurs when there is no electrical impulse

  • An impulse traveling away from a negative electrode to a positive electrode will write a negative, or upward, QRS complex

  • An impulse traveling at a right angle to a negative electrode writes an isoelectric complex

Correct answer: An upward QRS complex occurs when an electrical impulse travels toward a positive electrode 

Four unequivocal truths pertain to electrocardiography:

  • An upward QRS complex occurs when an electrical impulse travels toward a positive electrode.
  • A downward QRS complex occurs when an electrical impulse travels toward a negative OR, away from a positive electrode.
  • An isoelectric complex is written when an impulse is traveling at a right angle to a positive electrode, and this complex is equally positive and negative.
  • If there is no impulse, there will be no activity on the EKG.

33.

Which of the following is the correct way to place Holter monitor leads?

  • Clipping a male patient's chest hair to allow the electrodes to adhere properly

  • Placing the electrodes on top of a female patient's breasts

  • Avoid taping electrodes to the chest to prevent skin irritation

  • Placing four of the five leads on the patient's limbs to prevent muscle artifact

Correct answer: Clipping a male patient's chest hair to allow the electrodes to adhere properly 

To ensure placement of the Holter monitor electrodes, attach the electrodes to the patient's chest (not the extremities) to prevent muscle artifact, clip a male patient's chest hair to ensure adherence, place the electrodes under a female patient's breasts, and tape the electrodes to the skin to keep them from falling.

34.

What term refers to the strength or force of a contraction? 

  • Inotropy

  • Chronotrophy

  • Dromotrophy

  • Interdromotrophy

Correct answer: Inotropy 

Inotropy refers to the strength or force of a contraction. Some drugs will increase the heart's inotropy, and others will decrease it.

35.

What axis deviation would you expect to see in left posterior fascicular block (left posterior hemiblock)?

  • Deviation to the right between 90 and 180 degrees

  • Deviation to the left between 90 and 180 degrees

  • No deviation

  • Deviation to the left between 30 and 90 degrees

Correct answer: Deviation to the right between 90 and 180 degrees

Left posterior fascicular block (LPFB), also called left posterior hemiblock, involves damage or blockage in the left posterior fascicle of the left ventricle. 

Criteria when looking for an LPFB include:

  1.  Right axis deviation between 90 and 180 degrees
  2. qR complex (small q wave and bigger R wave) in lead III
  3. rS (smaller R wave and bigger S wave) in lead I

36.

An EKG technician is preparing to perform an electrocardiogram on a patient with congestive heart failure who experiences orthopnea (difficulty breathing when lying flat). The patient can only tolerate lying with the head of the bed slightly elevated. 

What should the technician do to ensure accurate EKG results while accommodating the patient's comfort?

  • Elevate the head of the bed just enough for the patient's comfort but keep it as flat as possible to minimize EKG changes

  • Proceed with the EKG with the patient in a fully upright seated position to maximize comfort

  • Insist the patient lies completely flat to prevent any alterations in the EKG readings

  • Notify the doctor, since accurate results cannot be obtained if the patient cannot lie flat

Correct answer: Elevate the head of the bed just enough for the patient's comfort but keep it as flat as possible to minimize EKG changes

While patient comfort is important, it is also crucial to obtain accurate EKG readings. Elevating the head of the bed slightly accommodates the patient's breathing difficulties due to orthopnea while keeping them as flat as possible to minimize changes in the heart's position. This position reduces the potential for subtle alterations in voltage measurements, ST segments, and the appearance of new Q waves on the EKG.

Performing the test in a fully upright position can significantly affect the heart's position and lead to inaccurate results. 

Laying the patient completely flat may not be feasible due to their medical condition. 

Notifying the doctor is unnecessary since reasonable accommodations can be made to perform the EKG effectively.

37.

During a patient assessment, their pulse is full, bounding, and rapid. What does this finding indicate?

  • Heart failure

  • Sepsis

  • Normal finding

  • Shock

Correct answer: Heart failure 

A full, bounding pulse that is racing indicates an abnormality of the heart (e.g., aortic insufficiency, abnormal rhythm, or heart failure), especially in patients who feel symptomatic.

Sepsis and shock cause severely low blood pressure and will present with a weak, thready pulse.

38.

An EKG technician is reviewing a patient’s 12-lead EKG and notes T-wave inversion and ST-segment depression in leads V2 through V4. 

Which of the following best describes what these findings most likely indicate?

  • Myocardial ischemia affecting the anterior wall of the heart

  • Acute myocardial injury with ST-segment elevation

  • Previous myocardial infarction with the presence of pathological Q waves

  • Normal EKG changes that do not require further investigation

Correct answer: Myocardial ischemia affecting the anterior wall of the heart

T-wave inversion and ST-segment depression are classic signs of myocardial ischemia, indicating that part of the myocardium is not receiving sufficient oxygen. These changes in leads V2 through V4 suggest that ischemia is affecting the anterior wall of the heart, which is supplied by the left anterior descending (LAD) artery.

Acute myocardial injury typically presents with ST-segment elevation, not ST-segment depression or T-wave inversion. Injury indicates active damage to the myocardium, which is a more severe condition compared to ischemia.

A previous myocardial infarction (MI) would present with pathological Q waves and may show residual ST-segment changes, but not typically isolated T-wave inversion and ST depression. Pathological Q waves indicate a loss of viable myocardium due to a past infarction.

T-wave inversion and ST-segment depression are not considered normal findings.

39.

Which type of monitoring is used for cardiac stress testing? 

  • 12-lead EKG

  • Holtzer monitor

  • 5-lead EKG

  • 3-lead EKG

Correct answer: 12-lead EKG

A 12-lead EKG is considered the gold standard for diagnosing cardiac arrhythmias. 

Each lead and electrode records the heart's electrical rhythm from 12 different angles, making it a more specific diagnostic tool than a 3- or 5-lead EKG.

A Holtzer monitor is the machine that records EKGs.

40.

When applying electrodes to a patient for Holter monitoring, where do you place the brown (V) lead?

  • On the chest, depending on lead selection

  • Directly below the clavicle and near the left shoulder

  • Directly below the clavicle and near the right shoulder

  • On the right lower abdomen

Correct answer: On the chest, depending on lead selection

Commonly used lead systems include:

  • 3-lead monitoring, with 3 electrodes on the torso
  • 5-lead monitoring, with 5 electrodes on the torso
  • 12-lead monitoring, with 10 electrodes on the torso and limbs

12-lead monitoring is generally considered the standard form of ECG and provides the most information. However, it is not always feasible. A 5-wire lead set can monitor 7 ECG vectors (I, II, III, aVR, aVL, aVF, and V) simultaneously. The recommended 5-wire ECG lead placement is as follows:

RA placementWHITE directly below the clavicle and near the right shoulder
LA placementBLACK directly below the clavicle and near the left shoulder
RL placementGREEN on the right lower abdomen
LL placementRED on the left lower abdomen
V placementBROWN on the chest, the position depends on the required lead selection (4th intercostal space, at the right side of the sternum)
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