EKG Acquisition Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   When the limb electrodes are moved to the torso for an exercise stress test, where do the V1 to V6 electrodes go?

   1. AA. On the back, so they stay clear of the treadmill handrails
   2. BB. One intercostal space higher, to avoid sweat under the breasts
   3. CC. At the standard 12-lead chest sites, the same as at rest
   4. DD. Across the upper abdomen, where they move less with walking
   Show answer to question 1

   Answer: C. At the standard 12-lead chest sites, the same as at rest

   During exercise testing only the limb electrodes move to the torso, and the chest electrodes stay at their standard V1 to V6 sites. Careful skin preparation and secure attachment matter even more because of sweat and movement.

   Why the other options are wrong

   • AChest leads on the back would not be V1 to V6 and would not match standard views.
   • BMoving the chest electrodes up an intercostal space changes the chest leads.
   • DThe upper abdomen is below the heart and is not a standard chest lead site.

2. Question 2 of 25Medium

   In a long-term care facility, an 84-year-old man has contractures that keep his elbows and knees bent, so his arms cannot rest straight at his sides. How should the technician place the limb electrodes?

   1. AA. Straighten each arm and leg firmly so the usual sites can be reached
   2. BB. Move the arm electrodes to his back, between the shoulder blades
   3. CC. Use reachable sites on each limb, at matching levels on both sides
   4. DD. Leave the limb electrodes off and record only the chest leads
   Show answer to question 2

   Answer: C. Use reachable sites on each limb, at matching levels on both sides

   Limb electrodes can go on any reachable part of each limb, such as the upper arms and thighs, as long as both sides are at matching levels. Pillows can support the bent limbs so he can relax, and the placement is noted on the tracing.

   Why the other options are wrong

   • AForcing contracted joints straight can cause pain and injury.
   • BSites between the shoulder blades are not limb sites and would distort the limb leads.
   • DLimb electrodes are needed for the limb leads and serve as the reference for the chest leads.

3. Question 3 of 25Hard

   Three minutes into recovery at a hospital stress lab, a 46-year-old man who had no symptoms during exercise is seated and says he feels fine. The monitor now shows frequent early beats with wide, oddly shaped QRS complexes and no P waves before them, which were not present during exercise. What should the technician do?

   1. AA. Mention them to the provider after recovery is finished
   2. BB. Remove the electrodes, since the exercise part of the test is over
   3. CC. Have him walk on the belt again to see if the beats go away
   4. DD. Report them to the provider at once and keep monitoring him
   Show answer to question 3

   Answer: D. Report them to the provider at once and keep monitoring him

   New arrhythmias can appear in recovery, even after an exercise phase without symptoms, so monitoring continues and new findings are reported to the supervising provider right away. The provider decides what further action is needed.

   Why the other options are wrong

   • AWaiting until recovery ends delays the report of a new arrhythmia that the provider needs to know about now.
   • BMonitoring continues through recovery; removing electrodes would stop it while a new change is occurring.
   • CRestarting exercise is not the technician's decision and could be unsafe.

4. Question 4 of 25Medium

   A technician preparing a thin 23-year-old woman for a resting EKG notices that the planned leg electrode sites are directly over her ankle bones. What is the best choice?

   1. AA. Use the ankle bones, since the signal is strongest over bone
   2. BB. Move them up to the kneecaps, where the surface is flatter
   3. CC. Use fleshy areas of both lower legs, placed symmetrically
   4. DD. Leave the leg electrodes off and record the chest leads only
   Show answer to question 4

   Answer: C. Use fleshy areas of both lower legs, placed symmetrically

   Bony prominences give poor electrode contact because bone conducts poorly and the surface is uneven. Fleshy areas of the lower legs, placed at the same level on each leg, give better contact while keeping the limb leads accurate.

   Why the other options are wrong

   • ABone is a poor conductor, and contact over a bony prominence is unreliable.
   • BThe kneecaps are also bony prominences with poor contact.
   • DWithout the leg electrodes, a standard 12-lead EKG cannot be recorded correctly.

5. Question 5 of 25Hard

   At a physician office, a 72-year-old man with Parkinson disease has a constant tremor in his hands. His first 12-lead tracing shows tremor artifact in the limb leads. Which change is most likely to produce a cleaner tracing?

   1. AA. Turn up the gain so the complexes stand out from the tremor
   2. BB. Lower each chest electrode by one intercostal space
   3. CC. Move the limb electrodes up to the upper arms and thighs
   4. DD. Ask him to grip the table edges firmly to steady his hands
   Show answer to question 5

   Answer: C. Move the limb electrodes up to the upper arms and thighs

   Placing the limb electrodes closer to the trunk, on the upper arms and thighs at matching levels, moves them away from the shaking hands and usually reduces tremor artifact. The alternate placement is noted on the tracing.

   Why the other options are wrong

   • ARaising the gain enlarges the artifact along with the complexes.
   • BThe artifact comes from the limbs, and lowering the chest electrodes only misplaces them.
   • DGripping tenses the arm muscles and usually adds artifact.

6. Question 6 of 25Easy

   During each stage of a treadmill test, the technician asks the patient to choose a number on a rating of perceived exertion scale. What does this rating describe?

   1. AA. How hard the patient feels the exercise is
   2. BB. The exact oxygen level in the patient's blood
   3. CC. The percent of target heart rate already reached
   4. DD. The severity of any chest pain the patient feels
   Show answer to question 6

   Answer: A. How hard the patient feels the exercise is

   A rating of perceived exertion scale, such as the Borg scale, records how hard the patient feels he or she is working. It helps the team follow effort along with heart rate, blood pressure and the EKG.

   Why the other options are wrong

   • BOxygen level is measured with a pulse oximeter, not a perceived exertion scale.
   • CPercent of target heart rate is calculated from the measured heart rate, not reported by the patient.
   • DChest pain is asked about and rated separately; perceived exertion describes overall effort.

7. Question 7 of 25Medium

   On a telemetry unit, a monitor technician prints a strip at 0215 and mounts it in the chart at 0630. Which time should be written on the strip's label?

   1. AA. 0630, the time it was mounted in the chart
   2. BB. 0215, the time the rhythm was recorded
   3. CC. 0700, the start of the next shift
   4. DD. No time, as long as the date is shown
   Show answer to question 7

   Answer: B. 0215, the time the rhythm was recorded

   The label shows when the rhythm was recorded, because the provider relates each strip to the patient's condition, symptoms and treatments at that moment. The mounting time says nothing about the rhythm.

   Why the other options are wrong

   • AThe mounting time is more than 4 hours later and would misplace the rhythm in the patient's timeline.
   • CThe shift change time has no connection to when the rhythm occurred.
   • DSeveral strips may be recorded on one date, so the time is needed to put them in order.

8. Question 8 of 25Medium

   While checking a just-printed 12-lead EKG for a 34-year-old woman, a technician notices that the calibration mark is shaped like a step, with one part 10 mm tall and the other part 5 mm tall. What does this indicate?

   1. AA. The limb and chest leads were recorded at different gain settings
   2. BB. The patient moved while the calibration pulse was being printed
   3. CC. The paper speed changed from 25 to 50 mm/s during the recording
   4. DD. The print head is failing and the machine must be taken out of use
   Show answer to question 8

   Answer: A. The limb and chest leads were recorded at different gain settings

   A stepped calibration mark shows that two gain settings were used, most often standard gain (10 mm/mV) for the limb leads and half standard (5 mm/mV) for the chest leads when chest complexes are very large. Each group of leads is then measured against its own setting.

   Why the other options are wrong

   • BPatient movement causes irregular artifact, not a clean two-level calibration mark.
   • CPaper speed changes the width of waveforms, not the height of the calibration mark.
   • DA failing print head causes blank streaks or missing dots, not a clean mark matching two standard gains.

9. Question 9 of 25Easy

   With the Mason-Likar placement used for exercise stress testing, where are the arm electrodes placed?

   1. AA. On the wrists, the same as for a resting EKG
   2. BB. On the upper back, over each shoulder blade
   3. CC. Just below the clavicles, near the shoulders
   4. DD. On the lower torso, between ribs and hip bones
   Show answer to question 9

   Answer: C. Just below the clavicles, near the shoulders

   Mason-Likar placement moves the arm electrodes to the torso, just below the clavicles near the shoulders, and the leg electrodes to the lower torso. This reduces motion artifact from swinging arms and moving legs during exercise.

   Why the other options are wrong

   • AWrist sites move constantly on a treadmill and add heavy motion artifact.
   • BThe upper back is not part of Mason-Likar placement.
   • DThe lower torso between the ribs and hip bones is where the leg electrodes go.

10. Question 10 of 25Medium

    A 19-year-old male college athlete has a resting EKG in a sports medicine clinic. The QRS complexes in leads V2 through V4 are so tall that they run into the leads printed above and below them. Which change should the technician make, as facility protocol allows?

    1. AA. Change the paper speed to 50 mm/s and repeat the tracing
    2. BB. Set the gain to 20 mm/mV so the complexes are easier to measure
    3. CC. Turn on the muscle filter to reduce the height of the complexes
    4. DD. Set the gain to 5 mm/mV and repeat with the setting shown
    Show answer to question 10

    Answer: D. Set the gain to 5 mm/mV and repeat with the setting shown

    Half standard gain, 5 mm/mV, draws every waveform at half height so very large complexes fit without overlapping. The calibration mark then measures 5 mm, and the setting must appear on the tracing so the reader judges voltage correctly.

    Why the other options are wrong

    • AA faster paper speed widens the waveforms but does not reduce their height.
    • BDouble standard makes complexes twice as tall and worsens the overlap.
    • CFilters are not used to shrink large complexes and can distort the waveforms.

11. Question 11 of 25Hard

    Before a treadmill test at an outpatient cardiology clinic, the technician sees that the stress system lists a target heart rate of 136 beats per minute for a 55-year-old woman. The lab uses 85% of the age-predicted maximum (220 minus age). Which statement is correct?

    1. AA. The target is correct for her age, so the test may begin
    2. BB. It fits an age of 60, so her date of birth should be checked
    3. CC. It is 85% of 160, which is the correct maximum for a 55-year-old
    4. DD. It was set at 70% of her predicted maximum instead of 85%
    Show answer to question 11

    Answer: B. It fits an age of 60, so her date of birth should be checked

    For a 55-year-old, the maximum is 220 minus 55, or 165, and 85% of 165 is about 140. A target of 136 is 85% of 160, the maximum for a 60-year-old, so the date of birth entered should be checked and corrected before testing.

    Why the other options are wrong

    • AHer correct target is about 140, so the listed value does not fit her age.
    • CThe maximum for a 55-year-old is 165, not 160.
    • DSeventy percent of 165 is about 116, not 136.

12. Question 12 of 25Hard

    Before a treadmill test at a cardiology practice, a 70-year-old man says that over the past week he has become short of breath walking across a room, has had to sleep sitting up in a recliner, and his ankles are more swollen than usual. What should the technician do?

    1. AA. Begin the test slowly, since the first stage is easy walking
    2. BB. Elevate his legs for 10 minutes and then start the test
    3. CC. Note the symptoms for the provider to review after the test
    4. DD. Report the new symptoms to the provider before exercise
    Show answer to question 12

    Answer: D. Report the new symptoms to the provider before exercise

    Worsening breathlessness with mild activity, needing to sleep upright and more ankle swelling are new symptoms the provider must review before exercise. The technician reports them right away.

    Why the other options are wrong

    • AEven the first stage adds stress on the heart, so the provider must review the symptoms first.
    • BRaising his legs does not address the symptoms and delays the needed report.
    • CA review after the test means exercise starts before the provider knows about the new symptoms.

13. Question 13 of 25Hard

    On a telemetry unit, a technician wipes a 39-year-old woman's electrode sites with alcohol pads and applies the electrodes right away. Within minutes, several electrodes are lifting at the edges. What is the most likely cause?

    1. AA. The alcohol was still wet, so the adhesive could not grip the skin
    2. BB. The alcohol removed the skin oils the electrode gel needs to bond
    3. CC. The electrodes were applied too soon after the monitor was turned on
    4. DD. The electrodes were placed over muscle instead of over bone
    Show answer to question 13

    Answer: A. The alcohol was still wet, so the adhesive could not grip the skin

    Electrodes need clean, dry skin to stick. Alcohol must evaporate completely before the electrodes are applied, or the adhesive and gel cannot make good contact.

    Why the other options are wrong

    • BRemoving skin oil is the purpose of cleaning and improves adhesion.
    • CWhen the monitor was turned on has no effect on how electrodes stick to skin.
    • DWhether a site lies over muscle or bone does not explain edges lifting within minutes; alcohol that has not dried does.

14. Question 14 of 25Medium

    An AED attached to a 77-year-old man who collapsed in a stress lab announces that a shock is advised. A coworker is still holding the patient's hand. What should the technician do?

    1. AA. Press the shock button, since a hand does not conduct current
    2. BB. Call out for everyone to stand clear before the shock
    3. CC. Remove the pads and wait until the coworker lets go
    4. DD. Turn the AED off and restart the analysis in 2 minutes
    Show answer to question 14

    Answer: B. Call out for everyone to stand clear before the shock

    Before a shock is delivered, the rescuer loudly states that everyone must stand clear and looks to confirm that no one is touching the patient. Anyone in contact could receive a shock.

    Why the other options are wrong

    • AA person touching the patient can be shocked, so no one may be in contact.
    • CRemoving the pads delays defibrillation; the coworker only needs to let go.
    • DTurning the AED off delays a shock the patient needs now.

15. Question 15 of 25Medium

    A technician working in a mobile health unit has trouble finding the sternal angle on a patient. Which technique helps locate it?

    1. AA. Slide down from the suprasternal notch to the first raised ridge
    2. BB. Count ribs upward from the lowest rib along the side of the chest
    3. CC. Find the nipple and move straight up toward the collarbone
    4. DD. Find the strongest heartbeat and mark that spot as the angle
    Show answer to question 15

    Answer: A. Slide down from the suprasternal notch to the first raised ridge

    From the suprasternal (jugular) notch at the top of the sternum, sliding the fingers down a short distance reaches a horizontal bony ridge: the sternal angle. The second rib attaches at this level.

    Why the other options are wrong

    • BThe lowest ribs do not attach to the sternum and are hard to count, so this method invites errors.
    • CNipple position varies widely between people and is not a reliable landmark.
    • DThe strongest heartbeat is usually felt near the apex, well below the sternal angle.

16. Question 16 of 25Easy

    How should extra packs of thermal EKG paper be stored?

    1. AA. In a refrigerator, to keep the heat-sensitive coating fresh
    2. BB. On top of the machine's power supply, to keep the paper dry
    3. CC. Unwrapped on a shelf near a window, so the paper can air out
    4. DD. In a cool, dry place, away from heat and direct sunlight
    Show answer to question 16

    Answer: D. In a cool, dry place, away from heat and direct sunlight

    Thermal paper reacts to heat and can discolor with light and humidity, which spoils the grid or the tracing. Keeping packs wrapped in a cool, dry place, away from heat and direct sunlight, keeps them ready to use.

    Why the other options are wrong

    • ARefrigeration can expose paper to moisture and condensation, and it is not how EKG paper is normally stored.
    • BHeat from a power supply can darken heat-sensitive paper before it is used.
    • COpen storage near a window exposes the paper to sunlight, heat and humidity.

17. Question 17 of 25Medium

    A provider asks the technician to repeat a 12-lead EKG on a 67-year-old woman whose complexes are very small and hard to measure, and requests that the gain be doubled. Which gain setting and calibration mark should the repeat tracing show?

    1. AA. 5 mm/mV with a 5 mm calibration mark
    2. BB. 10 mm/mV with a 20 mm calibration mark
    3. CC. 20 mm/mV with a 10 mm calibration mark
    4. DD. 20 mm/mV with a 20 mm calibration mark
    Show answer to question 17

    Answer: D. 20 mm/mV with a 20 mm calibration mark

    Doubling the standard gain gives 20 mm/mV, so the 1-millivolt calibration pulse is 20 mm tall, four large boxes. The larger waveforms are easier to measure, and the mark tells the reader the gain was changed.

    Why the other options are wrong

    • A5 mm/mV is half standard, which would make small complexes even smaller.
    • BAt 10 mm/mV the calibration mark is 10 mm, not 20 mm.
    • CAt 20 mm/mV the calibration mark is 20 mm, so a 10 mm mark would not match.

18. Question 18 of 25Medium

    During a graded treadmill test in a hospital stress lab, when is blood pressure usually measured?

    1. AA. Only before exercise and once more at the end of recovery
    2. BB. Only when the patient reports a symptom during exercise
    3. CC. In every stage, often near its end, and during recovery
    4. DD. One time only, at the moment of peak exercise
    Show answer to question 18

    Answer: C. In every stage, often near its end, and during recovery

    Blood pressure is checked at rest, during each stage of exercise (commonly in the last part of the stage) and at intervals during recovery, so the response to rising workload can be followed.

    Why the other options are wrong

    • AReadings during exercise are essential, because an abnormal blood pressure response shows up while the patient is walking.
    • BBlood pressure is checked on a schedule, not only when symptoms occur.
    • DA single reading cannot show how blood pressure changes as the workload rises.

19. Question 19 of 25Medium

    During a resting EKG at an outpatient clinic, a 70-year-old woman asks why electrodes are going on her arms and legs when the test is for her heart. Which fact supports the technician's answer?

    1. AA. They check blood pressure and circulation in the limbs
    2. BB. They anchor the cables so the chest electrodes stay in place
    3. CC. They record limb muscle activity so the machine can remove it
    4. DD. They produce 6 of the 12 views of the heart
    Show answer to question 19

    Answer: D. They produce 6 of the 12 views of the heart

    The limb electrodes produce the six limb leads (I, II, III, aVR, aVL and aVF), which view the heart in the frontal plane. The chest electrodes add the other six views.

    Why the other options are wrong

    • AAn EKG records electrical activity only; it does not measure blood pressure or circulation.
    • BLimb electrodes are recording sites, not anchors for the cables.
    • CLimb electrodes pick up the heart's electrical signal; muscle activity is unwanted artifact, not something they are placed to record.

20. Question 20 of 25Easy

    A standard 12-lead printout usually includes a long rhythm strip of one lead, most often lead II, across the bottom of the page. Why is it included?

    1. AA. It shows one lead for the full 10 seconds to help judge rhythm
    2. BB. It replaces lead II, which is then left out of the upper rows
    3. CC. It shows the calibration signal used to set the machine's gain
    4. DD. It proves that the paper speed was set to 50 mm/s for this test
    Show answer to question 20

    Answer: A. It shows one lead for the full 10 seconds to help judge rhythm

    Each lead in the upper rows appears only briefly, which is too short to judge many rhythms. The rhythm strip records one lead continuously for the whole 10 seconds, giving the reader a longer view of rate and regularity.

    Why the other options are wrong

    • BLead II still appears in the upper rows; the rhythm strip is an extra, longer view.
    • CThe calibration mark is a separate square pulse, not the purpose of the rhythm strip.
    • DRoutine tracings are recorded at 25 mm/s, and the rhythm strip does not indicate a different speed.

21. Question 21 of 25Hard

    A 56-year-old man in a cardiology clinic has a thick, raised scar from an old injury exactly where the V5 electrode belongs. What should the technician do?

    1. AA. Place the electrode directly on the scar, since scar tissue conducts well
    2. BB. Use intact skin right beside the scar, as near the site as possible
    3. CC. Leave V5 off and record the other leads as usual
    4. DD. Move it to the matching spot on the right side of the chest
    Show answer to question 21

    Answer: B. Use intact skin right beside the scar, as near the site as possible

    Scar tissue conducts poorly and gives unreliable contact. Placing the electrode on intact skin as close as possible to the correct site keeps the lead accurate, and any change is noted if facility policy requires.

    Why the other options are wrong

    • AScar tissue conducts poorly and can cause a weak or noisy signal.
    • CA complete 12-lead EKG needs every lead, including V5.
    • DMoving V5 to the right chest records a different lead, which is done only when ordered.

22. Question 22 of 25Hard

    On a cardiac step-down unit, a telemetry alarm shows a burst of fast, wide, bizarre waves for a 64-year-old man. The nurse finds him at the sink brushing his teeth, alert and without complaints, with a regular pulse. On the strip, normal QRS complexes continue at regular intervals through the waves. What does the burst most likely represent?

    1. AA. Ventricular tachycardia brought on by the effort of brushing
    2. BB. Movement artifact from the brushing motion of his arm
    3. CC. Ventricular fibrillation that stopped on its own
    4. DD. 60-cycle interference from the bathroom lights
    Show answer to question 22

    Answer: B. Movement artifact from the brushing motion of his arm

    Repetitive arm movement such as tooth brushing can produce fast, wide waves that look like ventricular tachycardia. An alert patient without symptoms, a regular pulse and normal QRS complexes continuing at regular intervals through the waves confirm artifact.

    Why the other options are wrong

    • ATrue ventricular tachycardia would replace the normal QRS complexes, not let them continue on schedule through the waves.
    • CVentricular fibrillation causes loss of consciousness within seconds, which did not happen.
    • DElectrical interference produces uniform fine spikes, not bursts tied to arm movement.

23. Question 23 of 25Easy

    Which two leads are known as the septal leads?

    1. AA. V1 and V2
    2. BB. V5 and V6
    3. CC. II and aVF
    4. DD. I and aVL
    Show answer to question 23

    Answer: A. V1 and V2

    V1 and V2 sit on either side of the sternum, close to the wall between the ventricles, so they view the septal area of the heart.

    Why the other options are wrong

    • BV5 and V6 view the lateral wall.
    • CII and aVF view the inferior wall.
    • DI and aVL view the high lateral wall.

24. Question 24 of 25Easy

    While a patient walks during a treadmill stress test, what should the technician do between scheduled blood pressure readings?

    1. AA. Step out to prepare the room for the next patient
    2. BB. Watch the monitor and the patient for any changes
    3. CC. Watch only the speed and incline settings on the treadmill
    4. DD. Pause the EKG display to reduce motion on the screen
    Show answer to question 24

    Answer: B. Watch the monitor and the patient for any changes

    The EKG is monitored continuously during exercise, and the patient's appearance and symptoms are watched at the same time. Changes in rhythm, ST segments or the patient's condition are reported to the supervising provider at once.

    Why the other options are wrong

    • AThe patient must never be left unwatched during exercise.
    • CTreadmill settings matter, but the patient and the EKG need constant attention.
    • DThe display stays on throughout exercise; pausing it could hide a dangerous change.

25. Question 25 of 25Easy

    On a 12-lead tracing, the complexes are clear and easy to count, but the baseline slowly drifts up and down across the paper instead of staying level. Which artifact is this?

    1. AA. Somatic tremor
    2. BB. 60-cycle interference
    3. CC. Wandering baseline
    4. DD. Interrupted baseline
    Show answer to question 25

    Answer: C. Wandering baseline

    A wandering baseline is a slow up-and-down drift of the whole tracing while the complexes stay recognizable. Common causes are breathing, lotion or oils under the electrodes, loose electrodes and tension on the lead wires.

    Why the other options are wrong

    • ASomatic tremor produces irregular, jagged spikes from muscle activity, not a slow, smooth drift.
    • B60-cycle interference produces regular, fine spikes that thicken the baseline rather than making it drift.
    • DInterrupted baseline shows sudden breaks or flat lines where the signal is lost.

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