22 Patient Safety & Professional Practice Practice Questions & Answers

1. 1. A technician is sent to record a 12-lead EKG on the patient in bed 2 of room 412. Before applying any electrodes, how should the technician confirm this is the right patient?

   • A.Ask the patient whether he is the man in bed 2 of room 412, since the unit assigns each bed to one patient at a time.
   • B.Match the room and bed number on the requisition to the door card and to the chart the nurse left at the bedside.
   • C.Read the name aloud from the requisition and begin once he nods, since a confused patient may forget a birth date.
   • D.Ask the patient to state his full name and date of birth, then compare both against the requisition and the wristband.✓ Answer

   Two patient-specific identifiers, such as full name and date of birth, must be verified against the order and the wristband before care is given. A room or bed number identifies a location, not a person: patients are moved between beds, so a location-based check can put the tracing on the wrong chart.

   Source: NHA CET Test Plan (patient identification); The Joint Commission patient-identification practice: two patient-specific identifiers, not room or bed numberReport a problem with this question

2. 2. A woman scheduled for a routine 12-lead EKG says she is afraid the machine will shock her. What is the technician's best response?

   • A.Tell her that staff may not discuss how the equipment works and that she should raise the question with her physician.
   • B.Explain that the current used is very weak and that most patients feel only a mild tingling in the arms and legs.
   • C.Tell her the shock lasts only a second and that she should hold still so the tracing will not have to be repeated.
   • D.Explain that the electrodes only pick up the heart's own signals and that the machine records them without sending current.✓ Answer

   A diagnostic electrocardiograph is a passive recording device: the electrodes sense the voltage the heart already generates and the machine prints it, so no current is delivered to the patient and the test is painless. Saying the shock is brief or that the current is weak both wrongly imply the machine stimulates the patient.

   Source: NHA CET Test Plan (explain the procedure in terms the patient understands); standard electrocardiography: a diagnostic ECG records intrinsic cardiac voltage and delivers no currentReport a problem with this question

3. 3. A patient speaks only Vietnamese. Her adult son offers to translate the instructions for the EKG. How should the technician proceed?

   • A.Ask a bilingual housekeeper on the unit to translate, since the instructions are simple and contain no medical terms.
   • B.Accept the son's offer, since a family member knows her history and can put the steps in words she already uses.
   • C.Request a qualified medical interpreter and give the instructions while looking at and speaking to the patient herself.✓ Answer
   • D.Hand her a printed Vietnamese instruction sheet and begin once she nods, since the tracing needs no spoken response.

   A qualified interpreter is trained in medical vocabulary and bound to confidentiality and accuracy, while a relative or a bilingual bystander may edit, soften, or misunderstand the message and has no right to the patient's health information. The technician addresses the patient directly, using the interpreter as the channel rather than the audience.

   Source: NHA CET Test Plan (communication barriers: language); HHS Office for Civil Rights language-access guidance on qualified interpretersReport a problem with this question

4. 4. An older patient with a significant hearing impairment removed his hearing aids before the test. Which approach best supports his understanding of the instructions?

   • A.Skip the spoken explanation and use gestures alone, since a hearing-impaired patient follows a demonstration better.
   • B.Stand at his better ear and raise your voice considerably, exaggerating each word so the sounds are easier to catch.
   • C.Face him at eye level in good light, speak clearly at a normal rate, and lower the background noise in the room.✓ Answer
   • D.Speak to the daughter at the bedside and let her repeat each instruction, since she is used to making herself heard.

   Hearing-impaired patients rely on lip movement, facial expression, and residual hearing, all of which are preserved by a normal speaking rate in good light with competing noise reduced. Shouting and exaggerated mouthing distort the lip pattern and the sound, and routing the explanation through a relative removes the patient from his own care.

   Source: NHA CET Test Plan (communication barriers: disability); standard practice for communicating with hearing-impaired patientsReport a problem with this question

5. 5. A 5-year-old scheduled for a 12-lead EKG is crying and pulling his arms away from the technician. What should the technician do?

   • A.Explain in simple words what the sticky patches do, let the parent stay and hold him, and show an electrode on a doll.✓ Answer
   • B.Tell him the test ends sooner if he stops crying, and warn that the tracing will be repeated if he moves his arms again.
   • C.Ask the parent to wait outside so he settles, then work fast while an aide holds his arms and legs against the table.
   • D.Warn him that the patches may sting a little so he is not surprised, then apply them before he can pull away again.

   Communication is matched to the child's developmental level: concrete words, a familiar caregiver present, and a demonstration on a toy convert an unknown threat into something the child can predict, which is what gains cooperation and reduces motion artifact. Telling a child the painless patches will sting is dishonest and destroys trust for every later test.

   Source: NHA CET Test Plan (communication barriers: developmental level); standard pediatric preparation practiceReport a problem with this question

6. 6. A male technician must expose a female patient's chest to place the precordial electrodes. What should he do?

   • A.Explain that a chaperone is required only for invasive procedures, then uncover the chest and work with the door open.
   • B.Close the curtain, uncover only the area needed for each electrode, drape the chest again, and offer her a chaperone.✓ Answer
   • C.Leave the gown in place and apply the chest electrodes over the fabric, so that the patient is never exposed at all.
   • D.Ask her to undress from the waist up and stay uncovered until the tracing prints, so the electrodes are not disturbed.

   Dignity and privacy are protected by controlling both who can see the patient and how much is uncovered at any moment, and a chaperone is offered whenever exposure of the chest could make the patient uncomfortable. Electrodes placed over a gown cannot make skin contact, so that tracing would be unusable and the test would have to be repeated.

   Source: NHA CET Test Plan (dignity, privacy and safety of all patients; NHA Code of Ethics); standard draping and chaperone practiceReport a problem with this question

7. 7. A patient in respiratory distress cannot tolerate lying flat, but the nurse says the 12-lead EKG is still needed now. What should the technician do?

   • A.Hold the study until he can lie flat, since a tracing taken in any other position cannot be compared with earlier ones.
   • B.Lower the head of the bed for the few seconds of the recording, since a tracing is valid only when taken fully supine.
   • C.Move the limb electrodes onto the chest wall so he can sit upright, and note the lead change rather than the position.
   • D.Record the tracing with the patient in a semi-Fowler position and note that position on the tracing itself.✓ Answer

   Patient safety outranks a standardized posture: a patient who cannot breathe flat is recorded in the position he can tolerate, and the position is written on the tracing because posture shifts the heart within the chest and changes waveform amplitude and axis. Without that note the interpreting physician may read a positional change as a new abnormality.

   Source: NHA CET Test Plan (positioning patients in respiratory distress; document any non-standard position on the tracing)Report a problem with this question

8. 8. A technician finishes a bedside EKG on a patient with Clostridioides difficile infection and removes his gloves. His hands are not visibly soiled. What hand hygiene is required?

   • A.Wash with soap and running water, because alcohol-based rub does not kill the spores this organism leaves on the hands.✓ Answer
   • B.Use alcohol-based hand rub, because it is the preferred product whenever the hands are not visibly soiled after a procedure.
   • C.Apply alcohol-based rub twice and let it dry each time, because the doubled contact time covers spore-forming organisms.
   • D.Rinse with water and dry with a paper towel, because soap is reserved for hands visibly contaminated with body fluid.

   Alcohol is not sporicidal, so after contact with a patient who has C. difficile or another spore-forming organism the spores are removed only by the mechanical friction and rinsing of soap and running water. Gloves do not replace hand hygiene, because hands can be contaminated during removal and through unnoticed glove defects.

   Source: CDC Guideline for Hand Hygiene in Healthcare Settings (soap and water after care of patients with C. difficile or other spore-forming organisms); NHA CET Test PlanReport a problem with this question

9. 9. A technician has just finished a bedside 12-lead EKG and must record another patient in the next room. What should be done with the disposable electrodes and the reusable lead wires?

   • A.Discard the electrodes after this single use and disinfect the lead wires and machine surfaces per the manufacturer's directions.✓ Answer
   • B.Keep the unused electrodes from the opened package for the next patient and wipe the lead wires only when they look soiled.
   • C.Peel the electrodes off gently and return them to the backing sheet for reuse, and disinfect the lead wires at end of shift.
   • D.Discard both the electrodes and the lead wires into the biohazard bag, since anything touching a patient's skin is infectious.

   Disposable electrodes are single-patient items whose gel is contaminated on contact, while lead wires, clips, and the machine are shared surfaces that carry organisms from one patient to the next unless disinfected between uses according to the manufacturer's instructions. Wires are reprocessed, not thrown away, and clean unused electrodes left on an opened sheet are not carried to the bedside of a different patient.

   Source: NHA CET Test Plan (single-use electrodes; disinfection of reusable lead wires and equipment per manufacturer instructions); CDC Standard PrecautionsReport a problem with this question

10. 10. Three minutes into a treadmill stress test the patient reports crushing chest pain spreading to his jaw and becomes pale and sweaty. What should the technician do first?

    • A.Reduce the treadmill speed and grade to the previous stage and continue, since the target heart rate is not yet reached.
    • B.Stop the test, alert the supervising provider at once, and stay with the patient while vital signs are taken.✓ Answer
    • C.Complete the current stage so the tracing is not lost, then report the symptoms when the recovery phase begins.
    • D.Leave to find the physician, after telling the patient to step off the treadmill and sit down until help arrives.

    Angina with pallor and diaphoresis during exercise is an absolute indication to terminate the test, because continued exertion increases myocardial oxygen demand in a heart that is already ischemic. The technician does not leave a symptomatic patient to fetch help; he calls for it and remains to monitor the patient.

    Source: NHA CET Test Plan (indications to stop a stress test; recognition of cardiopulmonary compromise)Report a problem with this question

11. 11. While the technician is applying electrodes to a patient seated on the exam table, the patient turns pale and says the room is spinning. What is the first action?

    • A.Walk him to a chair in the hallway where other staff can watch him, then come back to finish setting up the machine.
    • B.Hand him a cup of juice and keep placing electrodes, since light-headedness of this kind passes in a minute or two.
    • C.Help him lie down safely, raise his legs, remain at his side, and call out for the nurse without leaving him.✓ Answer
    • D.Finish the 12-lead quickly so the provider has a tracing from the episode, then report the dizziness after uploading it.

    Presyncope means cerebral perfusion is falling, so the patient is lowered before he falls and the legs are raised to return blood to the central circulation. Falls are the injury this prevents: a patient who faints while seated on a high table can strike his head, and leaving him alone or walking him anywhere increases that risk.

    Source: NHA CET Test Plan (recognize and respond to syncope and near-syncope during cardiac testing)Report a problem with this question

12. 12. As the technician removes the electrodes, the patient asks, "Does my EKG look normal?" How should the technician answer?

    • A.Acknowledge her concern and explain that the physician reads the tracing and will go over the results with her.✓ Answer
    • B.Tell her the tracing looks normal to you, adding that the physician will confirm that when he reviews the report.
    • C.Point out the evenly spaced complexes on the strip and reassure her that nothing on it looks alarming to you.
    • D.Reply that staff are forbidden to discuss the test in any way, and leave the room without answering her question.

    The EKG technician acquires the tracing; interpretation and the release of results belong to the licensed provider, so any statement about whether the tracing is normal, even a reassuring one, is practicing outside the scope. Refusing to speak at all is also wrong, because acknowledging the patient's anxiety and naming who will answer her is part of the technician's communication duty.

    Source: NHA CET Test Plan (scope of practice: the technician does not interpret or report results to the patient); NHA Code of EthicsReport a problem with this question

13. 13. An outpatient technician finishes a tracing and sees a pattern he was trained to recognize as a critical finding; the patient is awake and says his chest feels tight. What should he do?

    • A.Put the tracing on top of the pile for the cardiologist's afternoon reading session and ask the patient to wait in the lobby.
    • B.Check the patient, report the finding to the ordering provider or nurse at once, and stay with him until help arrives.✓ Answer
    • C.Show the tracing to the patient and ask whether he has seen this before, then judge from his answer how fast to report it.
    • D.Repeat the tracing twice to rule out artifact before telling anyone, since reporting artifact would waste the provider's time.

    Critical results must reach a licensed caregiver who can act on them on a timely basis, and the technician's duty is to recognize and report, not to grade urgency from the patient's opinion or to delay for a tidy tracing. The patient is assessed first because the person, not the paper, determines how fast the response must be.

    Source: NHA CET Test Plan (report critical findings immediately to the nurse or ordering provider); Joint Commission practice on timely reporting of critical test resultsReport a problem with this question

14. 14. After uploading a completed tracing, a technician realizes it was saved to the wrong patient's electronic record. What should she do?

    • A.Notify her supervisor and use the record system's correction process so the tracing is moved to the right chart.✓ Answer
    • B.Delete the tracing from that chart quietly and rerecord it, since a deleted entry disappears from the system for good.
    • C.Add a note in the wrong patient's chart saying the tracing belongs to someone else, and upload a copy to the right chart.
    • D.Leave the entry as it is because the strip itself is unlabeled, and simply record a new tracing for the correct patient.

    A tracing filed under the wrong name is a patient-safety event twice over: one chart holds data from a person who was never tested and the other is missing the study, so a provider may act on either. Electronic records are corrected through the system's documented amendment process, which leaves the original and the change visible in the audit trail; entries are never quietly deleted.

    Source: NHA CET Test Plan (use of the EHR: accurate entry, amendment process, audit trail)Report a problem with this question

15. 15. Before a scheduled exercise stress test, the technician measures a seated blood pressure of 192/116 mm Hg in a patient who has no symptoms. What should the technician do?

    • A.Have him walk the hallway for five minutes and remeasure, since activity settles a reading raised by anxiety about the test.
    • B.Recheck with the correct cuff size and the arm supported at heart level, then report the reading to the nurse before starting.✓ Answer
    • C.Chart the value and begin the test, since exercise lowers blood pressure and the reading will fall during the first stage.
    • D.Apply a larger cuff to the thigh and use that reading instead, since arm readings are unreliable above a systolic of 180.

    An abnormal baseline vital sign is confirmed with correct technique and reported to the nurse or provider before the patient is exercised, because that decision belongs to the licensed clinician and severe hypertension may be a reason to postpone. Exercising a patient to settle the reading, or assuming exertion will lower it, adds workload to a cardiovascular system already under high pressure.

    Source: NHA CET Test Plan (obtain vital signs with correct technique; report abnormal values before stress testing); AHA blood pressure measurement techniqueReport a problem with this question

16. 16. Two technicians discuss a named patient's tracing and diagnosis while riding a crowded staff elevator. Which statement about this conversation is correct?

    • A.It is permitted, because both technicians work for the facility and both already have access rights to his electronic record.
    • B.It is a privacy violation, because identifiable health information is disclosed where people uninvolved in his care can hear it.✓ Answer
    • C.It is permitted, because a spoken remark leaves no record in the chart and nothing was shown to anyone in the elevator.
    • D.It is a violation only if a relative of the patient happens to be in the elevator and recognizes the name being discussed.

    Protected health information is identifiable in any form, including spoken words, and it may be used only for treatment, payment, or health care operations by people involved in that patient's care. Having access rights to a chart is not authorization to discuss its contents, and the violation is complete whether or not a relative happens to overhear.

    Source: HIPAA Privacy Rule, 45 CFR 164.502 and 164.506 (uses and disclosures of PHI limited to treatment, payment and health care operations); NHA CET Test PlanReport a problem with this question

17. 17. A patient's husband telephones the department and asks for his wife's EKG results, explaining that he drove her to the appointment. What should the technician do?

    • A.Ask him for his wife's date of birth and release the results once it matches, since verifying identity satisfies the privacy rule.
    • B.Read the report to him, since a spouse counts as a personal representative for routine outpatient results under privacy rules.
    • C.Confirm only whether the tracing was normal or abnormal, since a yes-or-no answer discloses no identifiable detail about her.
    • D.Explain that results are released through the ordering provider and that the patient must authorize any release to him.✓ Answer

    Disclosure of results to anyone other than the patient generally requires the patient's authorization, and marriage by itself does not make a spouse a personal representative. Verifying the caller's knowledge of a birth date proves nothing about authorization, and even a normal-or-abnormal answer is protected health information about an identified person.

    Source: HIPAA Privacy Rule, 45 CFR 164.508 (authorization required for disclosures beyond treatment, payment and operations); NHA CET Test PlanReport a problem with this question

18. 18. A technician notices that she typed a patient's heart rate into the wrong field of the electronic record an hour ago. How should the entry be corrected?

    • A.Log in with a supervisor's account, which carries the rights needed to overwrite an entry made earlier in the shift.
    • B.Ask the unit secretary to erase the original entry from the record so that only the corrected value reaches the physician.
    • C.Use the system's amendment function, which records the correction while leaving the original entry in the audit trail.✓ Answer
    • D.Print the page, strike through the error with initials and date, and file that paper copy in place of the electronic entry.

    The medical record is a legal document, so an electronic error is corrected by an amendment or addendum that shows what was changed, by whom, and when, while the original remains retrievable in the audit trail. Erasing an entry, working under someone else's login, or replacing an electronic entry with paper all break that chain of accountability.

    Source: NHA CET Test Plan (documentation must be accurate and complete; corrections made through the record system's amendment process)Report a problem with this question

19. 19. A coworker who has forgotten her password asks a technician to log her into the EHR with his own credentials so she can finish charting. What should he do?

    • A.Log her in for this one entry and tell the supervisor afterward, since patient care should not wait on a forgotten password.
    • B.Log her in and watch her type, because he remains accountable for the session as long as he stays at the workstation.
    • C.Give her his password and change it at the end of the shift, since a password used only once cannot be traced back to him.
    • D.Decline and send her to the help desk, because every entry is tied to the login that made it and credentials are never shared.✓ Answer

    Every EHR user has a unique login precisely so the audit trail can attribute each entry and each record access to one identifiable person, and sharing credentials destroys that attribution and violates both HIPAA security safeguards and employer policy. Supervising the borrowed session does not help, because the documentation is still recorded under the wrong clinician's name.

    Source: HIPAA Security Rule, 45 CFR 164.312(a: unique user identification and access control); NHA CET Test PlanReport a problem with this question

20. 20. A requisition asks for a 12-lead EKG, but the patient says her physician ordered a Holter monitor, and the order in the chart is ambiguous. What should the technician do?

    • A.Perform both studies so that whichever was intended is on file, and let the provider disregard the one not wanted.
    • B.Perform the 12-lead exactly as printed, because the paper requisition is the document the department is required to follow.
    • C.Contact the ordering provider to clarify the order before recording anything, and document the clarification received.✓ Answer
    • D.Apply the Holter monitor as she describes it, because the patient's account of her visit is the most current information.

    A diagnostic test is performed only on a provider's order, and when the order is ambiguous the technician resolves it with the person who wrote it rather than choosing between versions. Performing an unordered study exposes the patient to an unnecessary procedure and a charge, and guessing from a requisition or a patient's recollection can leave the clinical question unanswered.

    Source: NHA CET Test Plan (work within scope under a provider's order; verify and document unclear orders)Report a problem with this question

21. 21. A competent adult inpatient states that he does not want the EKG and pulls his arm away as the technician begins applying electrodes. What should the technician do?

    • A.Stop, explain the purpose of the test without pressuring him, then notify the nurse and document his refusal.✓ Answer
    • B.Continue the tracing because a physician ordered it, and explain that an inpatient may not decline an ordered test.
    • C.Ask the relative in the room to talk him into it and proceed once the relative agrees the test should be done today.
    • D.Place the electrodes while he is distracted by the television, since the recording is painless and takes about a minute.

    A competent adult may refuse any procedure, and consent must be present at the moment of contact: touching a patient who has refused is battery regardless of the physician's order or a relative's opinion. The technician's duty is to stop, answer questions without coercion, and hand the decision back to the nurse and provider, documenting what the patient said.

    Source: NHA CET Test Plan (consent and refusal; ethical and legal standards); common-law battery as unconsented touchingReport a problem with this question

22. 22. After instructing a patient on wearing a 48-hour Holter monitor, how should the technician verify that she understood the instructions?

    • A.Give her the manufacturer's booklet and ask her to read it at home and telephone the department if anything is unclear.
    • B.Ask her to describe in her own words how she will keep the diary and what she will do if an electrode loosens.✓ Answer
    • C.Ask her whether she has questions and whether she understands, then chart that instructions were given and understood.
    • D.Ask the relative who drove her to repeat the instructions back, since the caregiver will be managing the monitor anyway.

    Teach-back verifies comprehension by making the patient reconstruct the instructions, which exposes gaps that a yes answer hides; a patient who is embarrassed or who misheard will still say she understands. The diary and electrode care are exactly the points that decide whether the recording can be correlated with symptoms, so those are the items she is asked to restate.

    Source: NHA CET Test Plan (instruct patients on ambulatory monitoring and verify understanding); teach-back methodReport a problem with this question

Practice questions based on the NHA Certified EKG Technician (CET) test plan, the standard 12-lead electrode positions defined by anatomical landmark, and durable cardiac electrophysiology. CET is a mark of the National Healthcareer Association; this site is not affiliated with or endorsed by NHA. An EKG technician records tracings and does not diagnose. Always follow your facility's policies, your state's scope of practice, and the direction of the ordering provider. About the CET exam →