Quick NHA CET Test #3 Questions and
Answers.
Identifying the patient -
\The Joint Commission mandates using two identifiers to verify each patient's identity
before performing any procedure. Ask the patient to state at least two of the following
acceptable identifiers: the patient's full name, date of birth, home address, telephone
number, or Social Security number (not often used for security reasons). Compare what
the patient says to the information on the test request. The patient can also produce a
photo identification card (driver's license, passport, student badge, employment card or
badge), and you can compare it with the corresponding information on the form.
Preparing the patient -
\Before performing an EKG, gather pertinent medical, social, surgical, and medication
history from the patient. Diseases, prior surgical procedures, and medications can all
affect the EKG tracing and must be documented.
Gathering patient history -
\Interviewing the patient and gathering pertinent health history is an important
responsibility of the EKG technician. This can provide clues to help providers form an
accurate diagnosis. Patient history includes social history, medical history, surgical
history, and a complete list of current medications. Social history can help to determine
the patient's risk for many cardiac conditions. Medical history includes information about
previous acute conditions, ongoing chronic conditions, and any current signs or
symptoms.
Social history -
\Example questions include the following. ⦁ Does the patient smoke? If so, how many
packs per day? If the patient quit smoking, how long ago did they quit? ⦁ Does the
patient drink alcohol or use drugs? How much? What kind? ⦁ Does the patient lead a
stressful life? Have they experienced any major life changes (caring for a sick loved
one, divorce, unemployment, relocation)? What does the patient do to cope with stress?
⦁ Does the patient exercise? If so, how often and what type of exercise do they do? ⦁
What does the patient eat? Do they consume high amounts of fat, sodium, or caffeine?
⦁ What is the patient's work environment? Are they exposed to chemicals or required to
wear a respirator? ⦁ What is the patient's support system like, such as family and
friends whom the patient can turn to for help? ⦁ Is the patient married and do they have
children?
Medical history -
,\Example questions include the following. ⦁ Does the patient have pertinent previous
medical conditions, including hospitalizations and illnesses? ⦁ Does the patient have a
history of heart attack, stroke, aneurysm, murmurs, endocarditis, pulmonary embolism,
or deep vein thrombosis? ⦁ Does the patient have chronic conditions (heart failure,
hypertension, hyperlipidemia, hyperglycemia or diabetes, COPD, cardiac arrhythmias,
obesity)? ⦁ Is the patient pregnant? ⦁ Does the patient have allergies, including drug,
food, and environmental allergies? ⦁ What current symptoms is the patient
experiencing? Use the mnemonic OPQRST (onset, provocation, quality, radiation,
severity, time) to get a description of the symptom. If the patient reports chest pain, ask
what they were doing when it began; what relieves or worsens it; if it is sharp, burning,
or dull; how severe it is; and how long ago it began. ⦁ Has the patient experienced any
of the following symptoms? $ Chest pain $ Shortness of breath $ Swelling of the legs
and feet $ Palpitations or racing heart $ Fluttering or sensations of skipping beats $
Fainting $ Fatigue or weakness $ Pallor $ Coughing up blood $ Pain in limbs, jaw, or
between shoulder blades $ Indigestion/heartburn not associated with eating
Surgical history -
\What surgeries has the patient had? When and where each surgery was performed,
and any complications. ⦁ Does the patient have a history of valve replacement, cardiac
catheterization, coronary artery bypass graft surgery, aneurysm repair, childhood
cardiac surgeries, pacemaker implant or heart transplant?
Medication history -
\⦁ Does the patient have any allergies or adverse responses to medications? Describe
the details of the allergic or adverse reaction. Document all medications that the patient
is currently taking, including the name, dose, how often, and the time of day the
medication is taken. ⦁ Does the patient take over-the-counter medications, herbal
supplements, or vitamins? ⦁ Does the patient take pharmacologic birth control or
erectile dysfunction medications? (Patients often forget to include them.)
Disrobing, gowning, and draping instructions -
\Take great care to protect privacy and make the patient feel as comfortable as
possible. When disrobed, the patient will be undressed from the waist up and have
lower legs or ankles accessible for lead placement. Panty hose or tights should be
removed, and socks adjusted to expose the skin for lead placement. A drape or gown
should be worn with the opening in the front. Have a light drape or blanket available to
place over the patient once the leads are placed. Always ask patients if they would like
to have an additional cover. Jewelry (bracelets, necklaces) that can interfere with
electrode placement or touch the lead wires during the procedure should be removed.
All electronic devices, such as cell phones, should be turned off and removed from the
patient. These items could lead to artifacts on the EKG tracing
electrode -
\Sensor placed on the skin that interfaces between the heart and an EKG machine.
PQRST waves -
,\Standard waveforms found on the EKG tracing, each corresponding to a specific event
within one full electrical cycle of the heart.
Preparations for EKG testing -
\The static EKG is a diagnostic test that allows the provider to assess the electrical
activity of the heart through a series of PQRST waves, a baseline, and measured
intervals. If the patient has had an EKG previously, they likely know what to expect.
However, if the patient has never had the test before or it has been a while, have a
conversation about what to expect and how to prepare. Explain the following points to
alleviate anxiety and encourage cooperation.
What should you do before EKG testing? -
\⦁ Explain that it is a noninvasive, painless procedure that takes only a few minutes to
complete. It records the electrical activity of the heart, but no electricity is sent through
the patient. There are no significant side effects to this procedure. ⦁ Ask the patient if
they have ever had a reaction to latex or rubber. Also ask if they have lotions, oils,
ointments, or powders on the skin where the electrodes will be placed. ⦁ Explain that
you will apply sticky electrodes to the patient's chest, arms, and legs. The electrodes
can easily be removed. You will clean the skin and trim hair if necessary to ensure
proper contact between the skin and electrode. ⦁ Instruct the patient to remove any
electronic devices from their pockets. ⦁ Instruct the patient to lie flat, or with the head
slightly elevated. Tell them to avoid touching anything that conducts electricity, such as
the handrails of the bed. ⦁ Instruct the patient to remain as still as possible and avoid
talking and moving for approximately 10 seconds while the machine records the EKG.
Patients who are nervous, experience tremors, or are cold sometimes relax more easily
if instructed to place their hands with palm side down and slightly under the buttocks. A
warm blanket can also be draped over the patient. ⦁ Advise the patient to notify the
technician of itching, swelling, or redness where the electrodes contact the skin.
Preparations for stress testing -
\A stress test is used to determine how the heart functions under the increased
workload caused by physical exercise. Specifically, the test is designed to provoke
myocardial ischemia under controlled settings. For patients who have heart disease,
symptoms can manifest during exercise that are not present at rest. Cardiac monitoring
is maintained throughout the procedure. If there are any concerns about the health and
safety of the patient, the test is stopped. Some patients require an IV and will receive
medication to cause coronary vasodilation, which increases the blood flow in normal
vessels and lessens blood flow in stenotic ones. Medications can be used if exercising
to raise the heart rate is not possible. Although uncommon, potential complications
include hypotension, arrhythmias, and myocardial infarction. For that reason,
emergency supplies such as a crash cart and defibrillator should be readily available
stenotic -
\Narrowed or constricted.
Patient education -
, \. Patients receive instructions prior to the day of the testing. This includes diet
alterations and appropriate clothing for the exam.
⦁ Preprocedure -
\Communicate the following items in advance. $ Avoid caffeine (coffee, tea, chocolate,
soda), tobacco, and alcohol for at least 3 hours prior to the test. Even decaffeinated
products contain caffeine so they should also be avoided. $ Eat a light meal 2 hours
prior to the test or according to the provider. $ Take medications as usual unless
directed otherwise by the provider. Patients might need to avoid taking beta blockers or
calcium channel blockers and should have inhalers accessible. $ Patients who have
diabetes mellitus should consult their primary care provider for directions regarding
insulin dosages. $ Wear comfortable, loose-fitting clothing and sturdy, nonskid walking
shoes. $ Plan to be in the office for 2 to 3 hours depending on the test performed and
provider consultation.
⦁ Intraprocedure -
\When preparing the patient and during testing, alert them to the following. $ The
amount of time necessary for the stress test varies. Allow 2 to 3 hours to complete the
entire procedure. Electrodes will be applied to the chest. If necessary, the skin will be
cleaned with alcohol and hair might be removed to make sure the electrodes stick. A
blood pressure cuff is placed on the upper arm to monitor blood pressure during the
test. $ If there is itching, swelling, or redness where the electrodes contact the skin,
notify the technician. $ A baseline EKG is taken at rest followed by walking on a
treadmill or using a stationary bike to gradually increase physical activity until symptoms
are experienced, fatigue or illness occurs, or a target heart rate is reached. $ Inform the
technician of any allergies or health issues, such as reactions to rubber or latex,
exercise-induced asthma or respiratory distress, or history of using an inhaler. $ The
test can be stopped at any time if fatigue, lightheadedness, dizziness, shortness of
breath, or chest pain occur.
⦁ Postprocedure -
\: After the test, instruct the patient to do the following. $ Sit or stand still for a few
minutes while the machine continues to record heart activity. $ Resume normal
activities as tolerated.
COMMUNICATION -
\Prior to performing any test, inform the patient about the procedure in order to build
trust and alleviate anxiety. The patient must understand the procedure in order to
provide consent. To facilitate communication, maintain a nonjudgmental attitude and
demonstrate good listening behaviors. ⦁ Make eye contact. ⦁ Face the patient. ⦁
Repeat or clarify what the patient says to show understanding.
When a patient has cognitive deficits, how should you ensure their understanding? -
\Assess the patient's knowledge to determine health literacy and ability to understand
new information. Patients who have cognitive disabilities can require extra time to
ensure that they understand the procedure. Additionally, people who have sensory
Answers.
Identifying the patient -
\The Joint Commission mandates using two identifiers to verify each patient's identity
before performing any procedure. Ask the patient to state at least two of the following
acceptable identifiers: the patient's full name, date of birth, home address, telephone
number, or Social Security number (not often used for security reasons). Compare what
the patient says to the information on the test request. The patient can also produce a
photo identification card (driver's license, passport, student badge, employment card or
badge), and you can compare it with the corresponding information on the form.
Preparing the patient -
\Before performing an EKG, gather pertinent medical, social, surgical, and medication
history from the patient. Diseases, prior surgical procedures, and medications can all
affect the EKG tracing and must be documented.
Gathering patient history -
\Interviewing the patient and gathering pertinent health history is an important
responsibility of the EKG technician. This can provide clues to help providers form an
accurate diagnosis. Patient history includes social history, medical history, surgical
history, and a complete list of current medications. Social history can help to determine
the patient's risk for many cardiac conditions. Medical history includes information about
previous acute conditions, ongoing chronic conditions, and any current signs or
symptoms.
Social history -
\Example questions include the following. ⦁ Does the patient smoke? If so, how many
packs per day? If the patient quit smoking, how long ago did they quit? ⦁ Does the
patient drink alcohol or use drugs? How much? What kind? ⦁ Does the patient lead a
stressful life? Have they experienced any major life changes (caring for a sick loved
one, divorce, unemployment, relocation)? What does the patient do to cope with stress?
⦁ Does the patient exercise? If so, how often and what type of exercise do they do? ⦁
What does the patient eat? Do they consume high amounts of fat, sodium, or caffeine?
⦁ What is the patient's work environment? Are they exposed to chemicals or required to
wear a respirator? ⦁ What is the patient's support system like, such as family and
friends whom the patient can turn to for help? ⦁ Is the patient married and do they have
children?
Medical history -
,\Example questions include the following. ⦁ Does the patient have pertinent previous
medical conditions, including hospitalizations and illnesses? ⦁ Does the patient have a
history of heart attack, stroke, aneurysm, murmurs, endocarditis, pulmonary embolism,
or deep vein thrombosis? ⦁ Does the patient have chronic conditions (heart failure,
hypertension, hyperlipidemia, hyperglycemia or diabetes, COPD, cardiac arrhythmias,
obesity)? ⦁ Is the patient pregnant? ⦁ Does the patient have allergies, including drug,
food, and environmental allergies? ⦁ What current symptoms is the patient
experiencing? Use the mnemonic OPQRST (onset, provocation, quality, radiation,
severity, time) to get a description of the symptom. If the patient reports chest pain, ask
what they were doing when it began; what relieves or worsens it; if it is sharp, burning,
or dull; how severe it is; and how long ago it began. ⦁ Has the patient experienced any
of the following symptoms? $ Chest pain $ Shortness of breath $ Swelling of the legs
and feet $ Palpitations or racing heart $ Fluttering or sensations of skipping beats $
Fainting $ Fatigue or weakness $ Pallor $ Coughing up blood $ Pain in limbs, jaw, or
between shoulder blades $ Indigestion/heartburn not associated with eating
Surgical history -
\What surgeries has the patient had? When and where each surgery was performed,
and any complications. ⦁ Does the patient have a history of valve replacement, cardiac
catheterization, coronary artery bypass graft surgery, aneurysm repair, childhood
cardiac surgeries, pacemaker implant or heart transplant?
Medication history -
\⦁ Does the patient have any allergies or adverse responses to medications? Describe
the details of the allergic or adverse reaction. Document all medications that the patient
is currently taking, including the name, dose, how often, and the time of day the
medication is taken. ⦁ Does the patient take over-the-counter medications, herbal
supplements, or vitamins? ⦁ Does the patient take pharmacologic birth control or
erectile dysfunction medications? (Patients often forget to include them.)
Disrobing, gowning, and draping instructions -
\Take great care to protect privacy and make the patient feel as comfortable as
possible. When disrobed, the patient will be undressed from the waist up and have
lower legs or ankles accessible for lead placement. Panty hose or tights should be
removed, and socks adjusted to expose the skin for lead placement. A drape or gown
should be worn with the opening in the front. Have a light drape or blanket available to
place over the patient once the leads are placed. Always ask patients if they would like
to have an additional cover. Jewelry (bracelets, necklaces) that can interfere with
electrode placement or touch the lead wires during the procedure should be removed.
All electronic devices, such as cell phones, should be turned off and removed from the
patient. These items could lead to artifacts on the EKG tracing
electrode -
\Sensor placed on the skin that interfaces between the heart and an EKG machine.
PQRST waves -
,\Standard waveforms found on the EKG tracing, each corresponding to a specific event
within one full electrical cycle of the heart.
Preparations for EKG testing -
\The static EKG is a diagnostic test that allows the provider to assess the electrical
activity of the heart through a series of PQRST waves, a baseline, and measured
intervals. If the patient has had an EKG previously, they likely know what to expect.
However, if the patient has never had the test before or it has been a while, have a
conversation about what to expect and how to prepare. Explain the following points to
alleviate anxiety and encourage cooperation.
What should you do before EKG testing? -
\⦁ Explain that it is a noninvasive, painless procedure that takes only a few minutes to
complete. It records the electrical activity of the heart, but no electricity is sent through
the patient. There are no significant side effects to this procedure. ⦁ Ask the patient if
they have ever had a reaction to latex or rubber. Also ask if they have lotions, oils,
ointments, or powders on the skin where the electrodes will be placed. ⦁ Explain that
you will apply sticky electrodes to the patient's chest, arms, and legs. The electrodes
can easily be removed. You will clean the skin and trim hair if necessary to ensure
proper contact between the skin and electrode. ⦁ Instruct the patient to remove any
electronic devices from their pockets. ⦁ Instruct the patient to lie flat, or with the head
slightly elevated. Tell them to avoid touching anything that conducts electricity, such as
the handrails of the bed. ⦁ Instruct the patient to remain as still as possible and avoid
talking and moving for approximately 10 seconds while the machine records the EKG.
Patients who are nervous, experience tremors, or are cold sometimes relax more easily
if instructed to place their hands with palm side down and slightly under the buttocks. A
warm blanket can also be draped over the patient. ⦁ Advise the patient to notify the
technician of itching, swelling, or redness where the electrodes contact the skin.
Preparations for stress testing -
\A stress test is used to determine how the heart functions under the increased
workload caused by physical exercise. Specifically, the test is designed to provoke
myocardial ischemia under controlled settings. For patients who have heart disease,
symptoms can manifest during exercise that are not present at rest. Cardiac monitoring
is maintained throughout the procedure. If there are any concerns about the health and
safety of the patient, the test is stopped. Some patients require an IV and will receive
medication to cause coronary vasodilation, which increases the blood flow in normal
vessels and lessens blood flow in stenotic ones. Medications can be used if exercising
to raise the heart rate is not possible. Although uncommon, potential complications
include hypotension, arrhythmias, and myocardial infarction. For that reason,
emergency supplies such as a crash cart and defibrillator should be readily available
stenotic -
\Narrowed or constricted.
Patient education -
, \. Patients receive instructions prior to the day of the testing. This includes diet
alterations and appropriate clothing for the exam.
⦁ Preprocedure -
\Communicate the following items in advance. $ Avoid caffeine (coffee, tea, chocolate,
soda), tobacco, and alcohol for at least 3 hours prior to the test. Even decaffeinated
products contain caffeine so they should also be avoided. $ Eat a light meal 2 hours
prior to the test or according to the provider. $ Take medications as usual unless
directed otherwise by the provider. Patients might need to avoid taking beta blockers or
calcium channel blockers and should have inhalers accessible. $ Patients who have
diabetes mellitus should consult their primary care provider for directions regarding
insulin dosages. $ Wear comfortable, loose-fitting clothing and sturdy, nonskid walking
shoes. $ Plan to be in the office for 2 to 3 hours depending on the test performed and
provider consultation.
⦁ Intraprocedure -
\When preparing the patient and during testing, alert them to the following. $ The
amount of time necessary for the stress test varies. Allow 2 to 3 hours to complete the
entire procedure. Electrodes will be applied to the chest. If necessary, the skin will be
cleaned with alcohol and hair might be removed to make sure the electrodes stick. A
blood pressure cuff is placed on the upper arm to monitor blood pressure during the
test. $ If there is itching, swelling, or redness where the electrodes contact the skin,
notify the technician. $ A baseline EKG is taken at rest followed by walking on a
treadmill or using a stationary bike to gradually increase physical activity until symptoms
are experienced, fatigue or illness occurs, or a target heart rate is reached. $ Inform the
technician of any allergies or health issues, such as reactions to rubber or latex,
exercise-induced asthma or respiratory distress, or history of using an inhaler. $ The
test can be stopped at any time if fatigue, lightheadedness, dizziness, shortness of
breath, or chest pain occur.
⦁ Postprocedure -
\: After the test, instruct the patient to do the following. $ Sit or stand still for a few
minutes while the machine continues to record heart activity. $ Resume normal
activities as tolerated.
COMMUNICATION -
\Prior to performing any test, inform the patient about the procedure in order to build
trust and alleviate anxiety. The patient must understand the procedure in order to
provide consent. To facilitate communication, maintain a nonjudgmental attitude and
demonstrate good listening behaviors. ⦁ Make eye contact. ⦁ Face the patient. ⦁
Repeat or clarify what the patient says to show understanding.
When a patient has cognitive deficits, how should you ensure their understanding? -
\Assess the patient's knowledge to determine health literacy and ability to understand
new information. Patients who have cognitive disabilities can require extra time to
ensure that they understand the procedure. Additionally, people who have sensory
