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Quiz Session - Attempts With Random Questions

NHA CET Exam Questions

Page 9 of 30

161.

Patients whose chest pain is brought about only by exertion and is relieved with rest have which condition?

  • Stable angina

  • Unstable angina

  • STEMI

  • Idiopathic

 Correct answer: Stable angina

Patients whose chest pain is brought about by a given level of exertion and who rely on rest have stable angina.

Unstable angina occurs when there is the development of acute coronary syndrome caused by the rupture or erosion of an atherosclerotic plaque, which prompts the formation of a thrombus, limiting blood flow. STEMI is a term used for ST-elevation myocardial infarction, and idiopathic means an unknown cause. 

162.

Where is V6 placed on a patient?

  • In the fifth intercostal space at the midaxillary line

  • In the fourth intercostal space to the right of the sternum

  • In the fourth intercostal space to the left of the sternum

  • In the fifth intercostal space at the midclavicular line

Correct answer: In the fifth intercostal space in the midaxillary line

V6 is placed in the fifth intercostal space on the midaxillary line. 

V1 is placed in the fourth intercostal space to the right of the sternum. V2 is placed in the fourth intercostal space to the left of the sternum, and V4 is placed in the fifth intercostal space on the midclavicular line. 

163.

What deflection on the P wave of the EKG represents left atrial hypertrophy?

  • Increased amplitude of the second half of the P wave

  • Increased amplitude of the first half of the P wave

  • Increased duration of the first half of the P wave

  • Decreased duration of the entire P wave

Correct answer: Increased amplitude of the second half of the P wave

With right atrial enlargement (or hypertrophy), the first half of the P wave will increase in amplitude. The second half of the P wave will increase in amplitude with left atrial hypertrophy.

164.

A patient experiences occasional premature heartbeats that interrupt the regular sinus rhythm. These beats have P waves with an abnormal shape but occur earlier than expected, and the QRS complexes remain narrow and normal. 

Which of the following best explains the origin of these premature beats?

  • They are ectopic beats originating from atrial pacemaker cells acting prematurely, not at their intrinsic escape rate

  • They originate from atrial pacemaker cells firing at their intrinsic rate of 60-75 beats per minute

  • They are premature ventricular contractions initiated by ventricular pacemaker cells firing at 30-45 beats per minute

  • They are junctional escape beats arising from the AV node due to sinus node failure

Correct answer: They are ectopic beats originating from atrial pacemaker cells acting prematurely, not at their intrinsic escape rate

The description indicates premature atrial contractions (PACs), which are ectopic beats originating in the atrial pacemaker cells outside the SA node. These cells fire prematurely, interrupting the normal rhythm, rather than at their intrinsic escape rate of 60-75 beats per minute. The abnormal shape of the P waves reflects their origin from a different location within the atria. The QRS complexes remain narrow and normal because ventricular conduction is not affected.

  • Atrial Pacemaker Cells: Have an intrinsic rate of 60-75 bpm but can fire prematurely, causing PACs.
  • Junctional Pacemaker Cells: Fire at 40-60 bpm, usually as escape rhythms when the SA node fails.
  • Ventricular Pacemaker Cells: Fire at 30-45 bpm, associated with wide QRS complexes when they act as pacemakers.

165.

The heart is kept in place and prevented from over-expanding by what layer?

  • Pericardial layer

  • Precardial layer

  • Thoracic layer

  • Posterior layer

Correct answer: Pericardial layer

The heart is kept in place and prevented from over-expanding by the pericardial layer.

There is no precardial, thoracic, or posterior layer. 

166.

What is the intrinsic rate of a junctional escape rhythm? 

  • 40-60 bpm

  • 20-40 bpm

  • 60-80 bpm

  • 30-50 bpm

Correct answer: 40-60 bpm

A junctional escape rhythm has an intrinsic rate of 40-46 bpm.

167.

What is the product of a patient's blood pressure multiplied by their heart rate?

  • Double product

  • Stroke volume

  • Cardiac output

  • Diffusion

Correct answer: Double product

The product of a patient's blood pressure multiplied by their heart rate is called a double product. It is a good measurement of myocardial oxygen consumption.

Stroke volume is the volume of blood pumped out of the left ventricle during each contraction. Cardiac output is the product of the heart rate and the stroke volume and is measured in liters per minute. Diffusion is the movement of a substance from a higher concentration to a lower concentration. 

168.

How much does an average male heart weigh?

  • 10 to 12 oz (300 to 350 g)

  • 8 to 10 oz (250-300 g)

  • 6 to 8 oz (200-250 g)

  • 12 to 15 oz (350-400 g)

Correct answer: 10 to 12 oz (300 to 350 g)

The average male heart weighs 10 to 12 oz (300 to 350 g).

169.

In some circumstances, the HIPAA Privacy Rule allows disclosure of protected health information (PHI) without patient authorization. Which of the following is not an included instance?

  • If the patient has overdue medical bills 

  • If it is required by the law, such as a court subpoena

  • To report a death caused by criminal activity to the authorities

  • If the patient is a threat to themselves or others

Correct answer: If the patient has overdue medical bills 

The HIPAA Privacy Rule allows certain instances where disclosing PHI is allowed without the explicit consent of the patient. This includes instances where the health entity is subpoenaed by a court of law, if a patient is an immediate threat to themselves or the public, if a patient dies under criminal circumstances, or if a patient is the victim of a crime. 

The HIPAA Privacy Rule does not allow entities to disclose PHI on the basis of a delinquent account.

170.

Which heart valve is located between the right ventricle and the pulmonary artery?

  • Pulmonic valve

  • Aortic valve

  • Tricuspid valve

  • Mitral valve 

Correct answer: Pulmonic valve

The pulmonic valve is located between the right ventricle and the pulmonary artery. It is a semilunar valve that separates a ventricle from an artery.

The aortic valve is located between the aorta and the left ventricle.

The tricuspid valve is located between the right atrium and right ventricle.

The mitral valve is located between the left atrium and left ventricle.

171.

Which layer of the heart contains the coronary arteries?

  • Epicardium

  • Myocardium

  • Pericardium

  • Endocardium

Correct answer: Epicardium

The epicardium is the outermost layer of the heart. The coronary arteries are located in this layer. 

The myocardium is the thickest layer of the heart and is responsible for the contraction of the muscle. The endocardium is the innermost layer of the heart. The pericardium is a sac that encloses the heart as a protective layer.

172.

If the sinus node is firing at a rate of 60 bpm, and the AV node fires at a rate of 40 bpm, what will result?

  • Escape

  • Usurpation

  • Ventricular tachycardia

  • Cardiac arrest

Correct answer: Escape

Escape occurs when the sinus node fails to fire at a normal rate, allowing the AV node to take over. If the AV node fails, the ventricles will take over as the pacemaker.

Usurpation occurs when the cells of the lower pacemakers become irritable, taking control from the higher pacemaker.

Ventricular tachycardia and cardiac arrest do not initially occur because of escape.

173.

Somatic tremor, a type of artifact, can be caused by which of the following?

  • A patient having tremors

  • Deep breathing

  • Electrical interference

  • A broken wire

Correct answer: A patient having tremors 

Somatic tremors are caused by patient tremors or anything that shakes the electric wires. Baseline sways are related to a patient’s breathing pattern. A 60-cycle interference is caused by electrical interference. A broken recording is caused by a frayed or broken wire.

174.

ECG rhythms that are conducted by a pacemaker other than the sinus node are known as:

  • Ectopic rhythms

  • Normal rhythms

  • Irregular rhythms

  • Sinus rhythms

Correct answer: Ectopic rhythms 

Ectopic rhythms are all rhythms that are conducted by a pacemaker other than the sinus node.

Normal rhythms typically refer to sinus rhythms where the heart's pacemaker is the sinus node, indicating normal conduction pathways. Ectopic rhythms are not considered normal because they originate from an abnormal site.

Irregular rhythms describe the pattern of the heartbeats, which can be irregular in both sinus and ectopic rhythms. However, the term "irregular rhythms" does not specifically refer to the origin of the pacemaker cells.

Sinus rhythms are generated by the sinus node, the natural pacemaker of the heart. Ectopic rhythms, by definition, originate from a pacemaker other than the sinus node, so they are not considered sinus rhythms.

175.

What is a straight line connecting two waves?

  • Segment

  • Interval

  • QRS complex

  • Voltage

Correct answer: Segment

A segment is a straight line connecting two waves.

An interval encompasses at least one wave plus, in most cases, the connecting straight line. The QRS complex represents the ventricles demoralizing, and the voltage measures the vertical height of a rhythm. 

176.

Which of the following is true regarding the HIPAA complaint process?

  • A complaint can be filed via mail, fax, email, or online

  • A person has 60 days to file a HIPAA complaint

  • To keep your identity anonymous, only provide your first name in the complaint

  • Reports of HIPPA violations are handled by the Centers for Medicaid and Medicare Services (CMS)

Correct answer: A complaint can be filed via mail, fax, email, or online 

HIPAA privacy complaints are handled by the Office for Civil Rights (OCR). Complaints can be sent to the OCR via mail, e-mail, fax, or through their online portal. The complaint must be made within 180 days of the incident, but this time can be extended in special circumstances. 

While OCR needs personal information to investigate, the complainant's identity is confidential, and OCR prohibits retaliatory action of any kind.

177.

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

  • Directly below the clavicle and near the left shoulder

  • Directly below the clavicle and near the right shoulder

  • On the chest

  • On the left lower abdomen

Correct answer: Directly below the clavicle and near the left shoulder

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)

178.

A 56-year-old patient with a history of chronic hypertension undergoes an EKG. The tracing reveals P waves that are prolonged in duration (greater than 0.12 seconds) with a notched appearance in lead II. In lead V1, there is a pronounced negative deflection in the terminal portion of the P wave. There is no significant axis deviation observed. 

Which of the following is the most likely explanation for these EKG findings?

  • Left atrial enlargement

  • Right atrial enlargement

  • Left ventricular hypertrophy

  • Right bundle branch block

Correct answer: Left atrial enlargement

Left atrial enlargement is characterized by:

  • Increased P wave duration: The P wave represents atrial depolarization. In left atrial enlargement, the enlarged left atrium takes longer to depolarize, resulting in a P wave duration greater than 0.12 seconds.
  • Notched P waves in lead II: The prolonged depolarization can cause a bifid (notched or "M-shaped") P wave in lead II, known as P mitrale.
  • Pronounced negative deflection in lead V1: The terminal portion of the P wave becomes more negative and deeper in lead V1 due to the delayed left atrial activation.
  • No significant axis deviation.

179.

 Which of the following is not considered a violation of HIPAA?

  • Discussing your patient with the tech who is relieving you of your shift

  • Complaining about a patient to your coworkers during lunch

  • Telling your mother about a difficult patient (whose identity she does not know) during your shift

  • Leaving a patient's chart open as you run to the bathroom

Correct answer: Discussing your patient with the tech who is relieving you of your shift

Discussing your patient with the tech who is relieving you of your shift is an acceptable disclosure of patient information, as long as you are in a private area. Never discuss your patients with family or friends or in a public area, such as in a cafeteria or an elevator.

180.

What is measured in fractions of a second?

  • Duration

  • Amplitude

  • Configuration

  • Segment

Correct answer: Duration

Duration is measured in fractions of a second.

Amplitude is measured in millivolts.

Configuration is a more subjective criterion referring to the shape and appearance of a wave.

A segment is a straight line connecting two waves.

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