NHA CET Exam Questions

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101.

An 85-year-old male comes to the clinic for a stress test using an exercise bike. What is his target heart rate?

  • 135

  • 150

  • 100

  • 220

Correct answer: 135

The target heart rate of a patient can be calculated by subtracting the patient's age from 220.

220 - 85 = 135

102.

Which of the following is not one of the steps to correctly interpreting a heart rhythm?

  • How many P waves are present?

  • How many QRS complexes are present?

  • Is the heart rate regular or irregular?

  • Are the P waves in the same shape?

Correct answer: How many P waves are present? 

The five steps of rhythm interpretation are as follows:

  1. Examine the QRS complexes
  2. Compare the R-R intervals (to determine regular vs. irregular rhythm
  3. Calculate the heart rate
  4. Examine the P waves with respect to the QRS complexes
  5. Examine the PR and QRS intervals.

Because the QRS is the same as heart rate, the number of QRS complexes is needed. For P waves, quality, shape, and their place on the EKG are more important than simply the number.

103.

Which segment on the EKG measures the time from the beginning of atrial depolarization to the start of ventricular depolarization?

  • PR interval

  • QRS complex

  • ST segment

  • T wave

Correct answer: PR interval

The PR interval includes the P wave and the line that connects it to the QRS complex. It measures the time from the beginning of atrial depolarization to the beginning of ventricular depolarization.

The QRS complex illustrates the entirety of ventricular depolarization.

The ST segment measures the time from the end of ventricular depolarization to the time of ventricular repolarization.

The T wave illustrates ventricular repolarization.

104.

What is a diagnostic feature of left ventricular hypertrophy?

  • Increased R wave amplitude

  • Increased R wave duration

  • Increased Q wave amplitude

  • Increased S wave amplitude

Correct answer: Increased R wave amplitude 

In left ventricular hypertrophy, the R wave amplitude will exceed 26 mm in V5 and 20 mm in lead V6. The R wave amplitude may be higher in V6 than in V5.

105.

On an EKG, what illustrates the direction of the current flow?

  • Vector

  • Electrode

  • Telemetry

  • Frontal lead

Correct answer: Vector 

A vector is an arrow that points in the direction of the electrical current in an EKG.

Electrodes are placed on the skin and pick up electrical currents to send to the leads.

A frontal lead views the heart’s current from the frontal plane.

Telemetry is the monitoring of a patient’s heart rate from a remote area.

106.

What does the term enlargement mean?

  • The dilation of a heart chamber

  • The dilatation of the arteries

  • The dilatation of the heart valves

  • The dilatation of the blood cells

Correct answer: The dilation of a heart chamber

Enlargement is typically caused by volume overload; the chamber dilates to accommodate an increased amount of blood. An enlarged ventricle can hold more blood than a normal ventricle.

107.

Which of the following rhythms requires cardioversion for treatment?

  • Junctional tachycardia

  • Junctional bradycardia

  • Junctional rhythm

  • Accelerated junctional rhythm

Correct answer: Junctional tachycardia 

The treatment for junctional tachycardia is cardioversion, while the treatment for junctional bradycardia is pacing. Junctional rhythm and accelerated junctional rhythms are treated by identifying the cause.

108.

Which lead should be placed at the level of the nipple, to the left of the patient's sternum?

  • V2

  • V1

  • V3

  • V6

Correct answer: V2

The nipple typically sits within the fourth intercostal space on the chest wall. Therefore, the nipple line is generally considered to be at the level of the fourth intercostal space. V2 is placed in the fourth intercostal space to the left of the sternum.

V1 is placed in the fourth intercostal space to the right of the sternum.

V3 is placed between V2 and V4.

V6 is placed at the mid-axillary line, in the fifth intercostal space.

109.

Patient health information is considered which of the following?

  • IIHI

  • GINA

  • ARRA

  • HITEACH

Correct answer: IIHI

Patient health information (PHI) is a subset of individually identifiable health information (IIHI). 

GINA stands for Genetic Information Nondiscrimination Act. ARRA stands for the American Recovery and Reinvestment Act (2009), and HITECH stands for Health Information Technology for Economic and Clinical Health Act. 

110.

A complete bundle branch block is diagnosed by looking at the width and configuration of the QRS complexes. 

Which of the following is part of the configuration for a right bundle branch block (RBBB)?

  • Reciprocal changes in V5, V6, I, and aVL

  • Narrow QRS complex

  • Left axis deviation

  • Reciprocal changes in V1 and V2

Correct answer: Reciprocal changes in V5, V6, I, and aVL

The criteria for a complete RBBB include: 

  • The QRS complex widened to greater than 0.12 seconds
  • RSR' (rabbit ears) or a tall R wave in V1 and V2 with ST-segment depression and T-wave inversion
  • Reciprocal changes in V5, V6, I, and aVL

111.

What represents atrial enlargement on an EKG strip?

  • Prolonged P wave

  • Short P wave

  • Prolonged QRS complex

  • Prolonged T wave

Correct answer: Prolonged P wave 

The P wave represents atrial depolarization and is irregular with atrial abnormalities. A prolonged P wave usually shows atrial enlargement because the atria take longer to depolarize due to the increased size.

A short P wave does not indicate atrial enlargement.

The QRS complex represents ventricular depolarization. A prolonged QRS complex indicates abnormalities in the ventricles, such as bundle branch blocks, not the atria.

The T wave represents ventricular repolarization. A prolonged T wave does not relate to atrial enlargement but may indicate other issues like electrolyte imbalances or ischemia.

112.

How is respiratory rate accurately measured?

  • Observe the patient's normal breathing pattern for one full minute

  • Observe the patient's breathing pattern for 10 seconds, then multiply by six

  • Ask the patient to take several deep breaths for one minute 

  • Monitor the respiratory value on the vital signs monitor

Correct answer: Observe the patient's normal breathing pattern for one full minute 

Because each person's normal breathing pattern is not regular, the most accurate assessment is to watch a patient breathe for one full minute. For accuracy, it is best to observe the rate without telling the patient to breathe differently. 

A respiratory rate can be measured on the vital signs monitor if the patient is receiving oxygen; however, this is not the best indication of a correct rate. 

113.

A patient is nervous about undergoing an EKG and asks the technician why the test is being done. 

Which of the following is the most appropriate response to help the patient understand the purpose of the EKG?

  • "The EKG records the heart’s electrical activity, which helps us detect any irregularities or conditions affecting the heart."

  • "The EKG is a test that measures how well your heart is pumping blood through your body."

  • "The EKG works by taking images of your heart to see if there are any blockages in your arteries."

  • "The EKG is used to monitor the strength of your heart muscles and diagnose muscle disorders."

Correct answer: "The EKG records the heart’s electrical activity, which helps us detect any irregularities or conditions affecting the heart."

An EKG (electrocardiogram) records the heart’s electrical activity by measuring the electrical impulses that cause the heart to contract and relax. It provides valuable information about the heart’s rhythm, rate, and electrical conduction patterns, which can help detect irregularities such as arrhythmias, ischemia, or other conditions that affect the heart’s function.

An EKG does not measure the heart’s ability to pump blood. It only records electrical activity, not mechanical function.

An EKG does not take images of the heart or detect blockages in arteries. Imaging tests like echocardiograms or angiograms are used for visualizing blockages.

The EKG does not measure the strength of the heart muscles or diagnose muscle disorders. It focuses on the electrical patterns of the heart.

114.

Which of the following is not a major goal of the HIPAA Privacy Rule?

  • To punish hospitals for violating the rule

  • To protect the public's health and well-being

  • To ensure the privacy of patients while allowing the flow of health information to continue smoothly

  • To permit the important exchange of patient information while protecting confidentiality

Correct answer: To punish hospitals for violating the rule 

The HIPAA Privacy Rule's goal is to protect the privacy of a patient while maintaining the flow of information, to ensure that important information is transferred between healthcare providers while maintaining confidentiality, and to promote the general health and well-being of the public. 

While there are serious consequences for violating the rule, the goal of the HIPAA Privacy Rule is not simply to punish.

115.

A 79-year-old patient arrives at the clinic complaining of dizziness and fatigue. An EKG reveals a heart rate of 45 beats per minute, absent P waves, and normal QRS complexes. 

Based on these findings, which part of the heart's conduction system is most likely acting as the primary pacemaker?

  • Atrioventricular (AV) node

  • Sinoatrial (SA) node

  • Purkinje fibers

  • Ventricular myocardium

Correct answer: Atrioventricular (AV) node

The patient's symptoms and EKG findings indicate that the SA node is not functioning properly, as evidenced by the absence of P waves (which represent atrial depolarization initiated by the SA node). A heart rate of 45 beats per minute suggests a rhythm slower than the normal sinus rate (60–100 bpm) but consistent with the intrinsic rate of the AV node, which is 40–60 bpm.

Since the QRS complexes are normal in appearance, ventricular conduction is occurring through the usual pathways. This implies that the pacemaker activity is originating from the AV node, resulting in a junctional escape rhythm. The AV node has taken over as the primary pacemaker due to SA node failure.

Ventricular myocardial cells can act as pacemakers at a rate of 20–40 bpm and typically produce wide QRS complexes due to abnormal conduction pathways.

Purkinje fibers have an intrinsic rate of 20–40 bpm, slower than the observed heart rate.

116.

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

  • Below the clavicle and near the right shoulder

  • Above the clavicle and near the right shoulder

  • On the right side at the base of the rib cage

  • On the chest and near the right of the sternum at the 4th intercostal space

Correct answer: Below the clavicle and near the right 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, which uses 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 seven 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 your required lead selection (4th intercostal space, the right side of the sternum)

117.

Identify the following artifact.

  • Baseline sway

  • 60-cycle interference

  • Somatic tremor

  • Broken recording

Correct answer: Baseline sway 

Baseline sway is easily recognizable. Instead of staying on the same horizontal axis, the rhythm will sway up and down on the EKG paper. This is usually caused by lotion on the patient's skin.

118.

Which of the following lead placements is correct on a five-lead EKG?

  • Black lead to left arm

  • White lead to chest

  • Green lead to left leg

  • Brown lead to right leg

Correct answer: Black lead to left arm

In a five-lead EKG, lead placement is as follows: 

  • White lead: Right arm
  • Black lead: Left arm
  • Green lead: Right leg
  • Red lead: Left leg
  • Brown lead: Chest

119.

Which of the following is the correct QRS deflection in the precordial leads?

  • V1 is negative

  • V5 is negative

  • V2 is isoelectric

  • V6 is isoelectric

Correct answer: V1 is negative

In the precordial leads, the current is negative in V1 and V2, turns isoelectric in V3 and V4, and becomes positive in V5 and V6.

120.

The HIPAA Privacy rule includes business associates as entities that are required to comply with the Privacy Rule. Which of the following is not an example of a business associate?

  • A third-party construction team hired to renovate a clinic

  • A third-party business that assists in processing claims

  • An accounting firm that handles a healthcare provider's billing

  • A third-party consultant that performs utilization reviews

Correct answer: A third-party construction team hired to renovate a clinic

A business associate is defined as a contractor hired by a covered entity to perform services that involve the transfer of protected health information. The contractor must have direct access to protected health information to be subject to the HIPAA Privacy Rule.