Free NHA CET Practice Test: 50 Questions With Answers

C — 75 beats per minute.

Four large squares is 20 small squares, which is 20 mm of paper. At 25 mm per second, 20 mm takes 20 ÷ 25 = 0.8 seconds. One beat every 0.8 seconds is 60 ÷ 0.8 = 75 beats per minute.

The shortcut gets you there faster: at 25 mm/s, divide 300 by the number of large squares between R waves. 300 ÷ 4 = 75.

A would need five large squares, B three, and D two. Memorising the ladder — 300, 150, 100, 75, 60, 50 for one through six large squares — is worth learning.

Enlarge this educational schematic

Domain 3, Task A — calculate heart rate

Source: Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads). Arithmetic uses the stated inputs.

A — 66 beats per minute.

Ten seconds is one sixth of a minute, so 11 complexes across the strip works out to 11 × 6 = 66 beats per minute. Counting across the whole window averages the beat-to-beat variation, which is exactly what you want when the rhythm is irregular.

Use the duration actually printed on the recording; do not assume every displayed rhythm strip is ten seconds long.

B multiplies by 10, which is the rule for a six-second strip, not a ten-second one. C and D both measure one interval and treat it as the patient's rate. On an irregular rhythm that can be badly wrong — the fastest interval might read 100 while the slowest reads 55, and neither is the answer.

Domain 3, Task A — calculate heart rate

Source: Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads). Arithmetic uses the stated inputs.

C — the paper speed is doubled.

The 300-divided-by-large-squares shortcut assumes 25 mm per second. At that speed a small square is 0.04 seconds and a large square is 0.20 seconds. Double the paper speed and the paper is the same but the time it represents is halved — a small square becomes 0.02 seconds.

Check the numbers. A true rate of 75 means an R-to-R of 0.8 seconds. At 50 mm/s that 0.8 seconds spans 40 mm, or 8 large squares. Apply 300 ÷ 8 and you get 37.5 — about half the real rate. Reset the machine, repeat, and if a non-standard speed was used deliberately, mark it on the tracing.

B confuses the two axes: gain changes height, speed changes width. A dismisses the mismatch instead of checking it. A manual pulse count is useful evidence, not an infallible measurement. D is invented — filters affect the signal, not the time scale.

Domain 3, Tasks A and C — heart rate and graph paper units

Source: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations). Arithmetic uses the stated inputs.

D — regularly irregular.

Three ways to describe regularity, and they're worth using precisely:

• Regular — R-to-R intervals essentially constant.
• Regularly irregular — the irregularity itself repeats. Grouped beating, like the pattern here, belongs in this bucket.
• Irregularly irregular — no repeating pattern anywhere.

Here, 20 small squares is 0.80 seconds and 29 is 1.16 seconds, and the long one arrives after every third short one. That repeating group is worth writing down, but the R-to-R pattern alone does not establish its cause. Naming the pattern accurately is yours.

A overlooks the recurring longer interval. C is the trap — spotting "not regular" and stopping there. B is wrong: regularity is measured on any adequate rhythm strip.

Domain 3, Task B — regularity

Source: How to measure the pulse (Procedure steps 4–6 and 8). Arithmetic uses the stated inputs.

D — 0.20 seconds, at the upper limit.

Five small squares × 0.04 seconds = 0.20 seconds.

The precision matters. First-degree AV block is defined as a PR interval greater than 0.20 seconds with all P waves conducting (University of Utah ECG Learning Center, Lesson 6). Exactly 0.20 is not greater than 0.20. It sits right at the boundary, and calling it first-degree AV block on that measurement alone would misapply the definition.

C reads each square as 0.10 seconds. A reads them as 0.01. Both are arithmetic slips that turn a normal tracing into an abnormal one, which is why fixing the square values in your head is worth more than memorising any rhythm name.

Domain 3, Task C — measure intervals

Source: Utah AV-block lesson (First-degree AV block; Type I and Type II second-degree AV block; 2:1 limitation). Arithmetic uses the stated inputs.

B — 0.14 seconds.

3.5 × 0.04 = 0.14 seconds. That's wider than the roughly 0.12-second mark where conduction delay is usually described, so it's worth reporting rather than passing over.

Measure the interval, not just the sharpest visible part of the R wave. QRS duration runs from the beginning to the end of ventricular depolarization; a duration alone does not establish the cause of a widened complex.

C has the arithmetic right and the judgement wrong. A and D are decimal-place errors.

Domain 3, Tasks C and D — measure intervals and inspect waveforms

Sources: Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads); QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations). Arithmetic uses the stated inputs.

A — first-degree AV block.

Two features, both required: a PR interval greater than 0.20 seconds, and every P wave conducting through to a QRS (Utah ECG Learning Center, Lesson 6). At 0.26 seconds with nothing dropped, that's what you have. The rate and the QRS width are both ordinary, which is typical.

B ignores the prolonged PR. C requires the PR interval to lengthen from beat to beat and then a P wave not to be followed by a QRS — neither happens here; the PR is constant and nothing is dropped. D would show the atria and ventricles running independently, with P waves marching through at their own rate and no fixed relationship to the QRS complexes.

"First-degree AV block" describes a conduction finding on a tracing. What it means for this patient is the provider's read.

Domain 3, Task E — identify arrhythmias

Source: Utah AV-block lesson (First-degree AV block; Type I and Type II second-degree AV block; 2:1 limitation).

B — Type I, or Wenckebach.

The signature is progressive PR lengthening ending in a P wave that doesn't conduct, then the cycle repeating. Notice the increments get smaller as it goes — 0.16 to 0.26 is a jump of 0.10, then 0.26 to 0.32 is only 0.06. That shrinking increment is part of the classic description, and it's why the pause after the dropped beat ends up shorter than two of the intervals before it. The QRS staying narrow fits too: Type I block usually sits in the AV node (Utah ECG Learning Center, Lesson 6).

C is the one to rule out carefully. In Type II the PR intervals stay constant before a P wave fails to conduct. Here they clearly lengthen. A has no dropped beats at all. D doesn't fit either — the P-to-P timing never varies, so nothing arrives early.

Domain 3, Task E — identify arrhythmias

Source: Utah AV-block lesson (First-degree AV block; Type I and Type II second-degree AV block; 2:1 limitation). Arithmetic uses the stated inputs.

A — call it 2:1 AV block and stop there.

To call a block Type II you need to see two consecutive constant PR intervals before the dropped beat. In 2:1 conduction you never get two conducted beats in a row, so that comparison is impossible — and by the same logic you can't watch a PR interval lengthen either. The Utah ECG Learning Center says it plainly: with 2:1 AV block, "we can't be sure if it's type I or II" (Lesson 6).

C is the trap, and it's tempting: the PRs are constant. But those conducted beats are separated by nonconducted P waves. You cannot observe the PR trend across consecutive conducted beats in this 2:1 sequence. B invents lengthening that isn't there. D would show P waves and QRS complexes with no fixed relationship at all; here every conducted beat has the same PR, so they're clearly related.

Record what you measured — regular P waves, 2:1 conduction, PR 0.20 seconds on conducted beats, narrow QRS — and route it. Precision beats a confident wrong label.

Domain 3, Task E — identify arrhythmias

Source: Utah AV-block lesson (First-degree AV block; Type I and Type II second-degree AV block; 2:1 limitation).

B — absence of a visible spike does not establish device failure.

Demand pacemakers do not have to stimulate every beat. The sensing function can inhibit pacing when intrinsic beats occur above the programmed lower rate. That is a supported explanation for this patient’s recording; it is not proof that every aspect of the device is functioning normally.

A turns a single observation into an unsupported device-failure diagnosis. C changes the recorder’s gain but cannot make a pacemaker deliver a stimulus. D cannot establish device function by changing an ECG filter.

Document the actual recording and route it for review rather than telling the patient that her pacemaker has failed.

Domain 3, Task F — pacemaker activity

Source: AHA pacemaker explanation (How does a pacemaker work?).

C — repeat it correctly and be transparent about why.

V1 and V2 belong in the fourth intercostal spaces at the right and left sternal borders. Placing them in the second intercostal spaces changes the views being recorded. Correct the known acquisition error and label the repeat so the provider can interpret it in context.

The machine’s interpretation is not a reason to ignore a known placement error. Nor does finding that error prove the patient has no cardiac disease.

A treats a machine statement as a diagnosis. B hides a known error and violates the record-retention procedure given in the question. D substitutes an unsupported interpretation instead of correcting the acquisition and routing the tracing for review.

Reproducible placement makes the next comparison more useful too.

Domain 3, Tasks D and G — waveform characteristics and ischemia patterns

Sources: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations); NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

D — stay, escalate, keep monitoring.

You did the most important thing already by going to look at the patient. A sustained wide-complex tachycardia in a symptomatic patient is escalated now, not at the end of your list. Staying with her matters because her condition can change in the time it takes to walk down a corridor, and because you are the person watching the monitor.

A dismisses a finding without evidence. Being awake does not rule out a significant tachyarrhythmia; symptoms make prompt clinical assessment especially urgent. B leaves a symptomatic patient alone; use the call system. C treats a time-critical rhythm as paperwork.

Recognise, stay, escalate, document. Follow your training and the emergency-response protocol if her condition changes; do not withhold an indicated emergency response while waiting for an interpretation.

Domain 3, Task H — action on life-threatening arrhythmias

Sources: AHA adult advanced life support (Section 15, Wide-Complex Tachycardia, synopsis and recommendations); AHA adult BLS (Recognition of cardiac arrest and initiation of CPR; adult healthcare-professional algorithm).

A — this one needs written authorization, and it isn't your call to process.

The Privacy Rule permits use and disclosure without authorization for treatment, payment and health care operations. This employer request has no applicable permission or exception in the facts given. HHS names this situation specifically: disclosing the results of a pre-employment physical or lab test to an employer is an example of a disclosure that requires the individual's written authorization (HHS, Summary of the HIPAA Privacy Rule, "Authorized Uses and Disclosures").

C confuses paying a bill with a right to the clinical result. B is still a disclosure — "normal" is protected health information about an identified person. D gets the form wrong: the authorization needed for this request must be written and specific. It also bypasses the records process stated in the question.

Domain 1, Task A — HIPAA

Source: HHS Privacy Rule summary (Authorized Uses and Disclosures; Public Interest and Benefit Activities (exceptions excluded by the stem)).

A — this is a treatment disclosure, and it's permitted.

Treatment includes consultation between providers about a patient and referral of a patient from one provider to another. Those disclosures are permitted without the patient's authorization. There's a second point worth knowing: the minimum necessary standard does not apply to a disclosure to, or a request by, a health care provider for treatment (HHS, Summary of the HIPAA Privacy Rule, "Limiting Uses and Disclosures to the Minimum Necessary").

Put Questions 13 and 14 side by side. Same tracing, same technician, opposite answers — because the purpose of the request is what decides.

B over-restricts and delays care. C strips the identifiers the cardiologist needs. D misstates the rule in exactly the direction people get it wrong.

Domain 1, Task A — HIPAA

Sources: HHS Privacy Rule summary (Permitted Uses and Disclosures—Treatment; Limiting Uses and Disclosures to the Minimum Necessary); 45 CFR 164.514(h) (Paragraph (h)(1), verification requirements).

B — hand hygiene is indicated immediately after glove removal.

CDC lists it as one of the clinical indications for hand hygiene, alongside immediately before touching a patient, after touching a patient or the patient's immediate environment, and after contact with blood, body fluids or contaminated surfaces (CDC, Core Infection Prevention and Control Practices, section 5a). Gloves are a barrier, not a substitute.

D is the interesting wrong answer, because it names a real indication — you do owe hand hygiene before touching the next patient. It just doesn't cancel the one you owe now. Two separate moments.

C mixes up the two rules. Visible soiling determines the product (soap and water rather than alcohol-based rub); it doesn't determine whether hand hygiene happens.

Domain 1, Task B — infection control

Source: CDC core infection-prevention practices (Section 5a, indications immediately after glove removal).

C — reprocess them, and keep clean and soiled separate.

Reusable medical equipment is cleaned and reprocessed before use on another patient or when soiled, following the manufacturer's instructions for that specific device, and clean equipment is kept separated from soiled equipment to prevent cross-contamination (CDC, Core Infection Prevention and Control Practices, section 5f). Lead wires and clips can become contaminated through contact with the patient, gown, bedding or your gloves, even when an electrode sits between a clip and the skin.

A assumes the reusable wires cannot become contaminated. B wastes reusable equipment; the answer is reprocessing, not the bin. D inverts standard precautions, which apply to every patient regardless of known infection status.

Why the manufacturer's instructions rather than a rule of thumb? Because contact time, dilution and material compatibility differ by product, and an incompatible agent may damage equipment or fail to provide the required disinfection.

Domain 1, Task B — infection control

Source: CDC core infection-prevention practices (Section 5f, reprocessing and separating clean/soiled equipment).

D — document what you measured, not what it means.

An EKG technician records the tracing and documents observable, measurable findings: rate, regularity, intervals, artifact, position and lead modifications, and the patient's condition during the recording. Entering the final diagnostic interpretation is outside the role described in this question, and being asked nicely by a busy colleague doesn't extend it.

A is the natural mistake because the reading is probably right. Being right isn't the issue — a final diagnostic statement entered under your name would exceed the authority specified in your job description, and once it's in the chart, someone will rely on it.

C overcorrects. The tracing belongs in the record now; delaying it can bury a time-sensitive finding.

B substitutes an unsupported label for the measured findings the question permits you to document. A misleading flag is not a substitute for review.

Domain 1, Task C — scope of practice

Source: NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

D — you can't remove it, and she has a route that isn't you.

A completed diagnostic recording is part of the medical record. A patient’s concern does not authorise you to delete or invalidate it outside the facility’s correction process. Doing so could hide a finding that needs attention.

The part that makes this a good answer rather than a brush-off is the second half. Patients do have rights here: they can ask a provider about the finding and request an amendment if they believe the record is inaccurate or incomplete. An amendment request is not an automatic right to erase an accurate result. Point her at the real process instead of leaving her with "no."

A, C and B are three versions of the same act — deciding on your own which version of the truth goes in the chart.

Domain 1, Task C — scope and ethical standards

Sources: HHS Privacy Rule summary (Individual Rights—Amendment); NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

C — ask him, then use what works.

The patient is the authority on how he communicates. Some people will want written instructions, some a clear-panel mask if your facility stocks them, some a qualified interpreter arranged through your facility. Ask which aid or service works for him, and arrange effective communication for the complexity of the discussion.

A is the reflex answer and it doesn't help — volume isn't the barrier; the mask covering your lips is. B assumes his daughter should interpret without asking him or arranging an appropriate aid. A family member is not the default substitute for effective communication; the ADA permits reliance on an accompanying adult only in limited circumstances. D removes his ability to consent to and cooperate with the procedure, which also makes for a worse tracing.

Domain 1, Task D — communication

Source: DOJ effective-communication guidance (Choosing effective aids; Use of Accompanying Adults or Children as Interpreters).

D — clarify before you acquire.

Clarify an ambiguous order rather than guessing and risking a repeat. Clarifying is a routine part of working inside a care team, not an admission that you don't know your job.

A sounds efficient and is a decision about what test the patient receives — which is the provider's. B adds a test without resolving which test was requested. C asks the patient to be responsible for the accuracy of a clinical order.

Domain 1, Task D — coordinated care

Source: NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

A — full minute, and say that it was irregular.

A 15-second count multiplied by four assumes the next 45 seconds look like the first 15. On an irregular pulse they don't, and small counting windows magnify the error — one extra or missing beat in 15 seconds moves the reported rate by four. Counting the full minute averages the variation.

Documenting the irregularity matters as much as the number. The person reading the tracing later may see a shorter recording window; you were at the bedside for a minute. That observation is genuinely yours to contribute.

B is the standard shortcut applied where its assumption fails. C and D substitute a device reading for a clinical observation, and neither one tells the provider what your fingers told you.

Domain 1, Task E — vital signs

Source: How to measure the pulse (Procedure steps 4–6 and 8). Arithmetic uses the stated inputs.

C — accurate, and it gives her something to do.

Three true things fit together: report symptoms immediately, you can stop if you need to, and the clinical team can also end the test for safety. She leaves the conversation knowing her role and knowing she isn't trapped on the treadmill.

A makes stopping depend on permission the patient does not need to withdraw from the test. B is both wrong and unsafe — a target heart rate is not a reason to keep going through symptoms. D pressures a patient to suppress exactly the information the test depends on her reporting.

The EKG technician's job here is instruction and monitoring, not setting or overriding the stopping criteria.

Domain 1, Task F — stress testing instruction

Source: AHA stress-test guidance (PDF p. 1: preparation and alternative stress; p. 2: stopping and recovery).

A — flag it; a different type of stress test may be the answer.

Exercise isn't the only way to stress the heart. When a patient can't exercise adequately, a pharmacologic stress test — where a medication produces the stress instead of a treadmill — is one of the options a provider can order. Recognising that the ordered test may not fit the patient in front of you, and saying so before anyone steps on a treadmill, is squarely part of the technician's role.

B puts an unsteady patient on a moving belt without addressing the limitation. D changes the protocol without an authorised plan. C sends him away before the clinical team can decide the appropriate next step.

Choosing the alternative protocol is the provider's decision. Surfacing the problem in time is yours.

Domain 1, Task F — stress testing

Source: AHA stress-test guidance (PDF p. 1: preparation and alternative stress; p. 2: stopping and recovery).

D.

The two answer different questions. A Holter stores a continuous ECG over the prescribed recording period. The external loop recorder in this question samples continuously into a short rolling memory and saves a segment when activated, including activity before the button press. That lets the clinician examine the ECG around an episode.

That difference changes your instructions. A Holter patient needs to wear it and log what happened and when. This event-recorder patient also needs to know how to activate and transmit a recording as instructed.

C reverses the devices’ roles. A collapses a real distinction. B is invented, and would defeat the point of monitoring symptoms during ordinary activities.

Not all event monitors work this way: some detect events automatically, some are handheld, and some patch monitors record continuously. Always teach from the instructions for the device in your hand — wear time, water exposure and triggering are device-specific and facility-specific.

Domain 1, Task G — ambulatory monitoring

Sources: AHA cardiac event recorder (Types of cardiac event recorders; What should I expect?); AHA Holter monitor (What is a Holter monitor?; What should I expect?).

D — have him tell you the plan back.

The CET test plan doesn't just ask you to instruct patients on ambulatory monitors; it asks you to verify their understanding. "No questions" doesn't do that. People say it when they're embarrassed, rushed, or don't yet know enough to know what to ask.

Asking him to walk through what he'll actually do turns a yes/no into something you can check — and if a step is missing, you find out while he's still in front of you.

C repeats the message without checking whether it landed. B is a fine supplement and a poor substitute; you learn nothing about whether he can use the device. A is the one that feels like a complete interaction and isn't.

Domain 1, Task G — verifying understanding

Source: AHRQ teach-back guidance (Overview; Try the teach-back method; clarify and check again).

C — two identifiers, checked against the patient and the order.

Use the two identifiers required in this question: full name and date of birth. Match them across the patient, order, tracing and destination record before attaching the file. Looking twice at the same ambiguous screen is not an independent identity check.

A uses one weak identifier, and appointment times get moved. B puts one patient's tracing in another patient's record — a documented error affecting two people. D postpones the identification problem and creates an unnecessary separate copy of protected information instead of following the approved filing process.

Domain 1, Task H — electronic health record

Sources: HHS Privacy Rule summary (Permitted Uses and Disclosures; Authorized Uses and Disclosures; Minimum Necessary; Amendment; Administrative Requirements); NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

C — stop, keep her flat, stay, call from where you are.

New pallor, clamminess and near-fainting in a patient who is already lying down are a reason to stop and get help, not to assume a harmless cause. Two parts of the answer matter equally. Keeping her supine is protective if she's about to faint. Staying with her is protective because she is now someone who could lose consciousness with nobody watching.

D is the one that catches people, because going to get help feels like getting help. Use the call system; that's what it's for.

A prioritises a document over a patient. B moves a lightheaded patient upright, the wrong direction if she's about to pass out.

You are not diagnosing what caused this. You're stopping, protecting, summoning and staying.

Domain 1, Task I — cardiopulmonary compromise

Source: AHA syncope guidance (Vasovagal warning symptoms and assessment; higher-risk features including episodes while supine).

B — start compressions.

Occasional gasping is not normal breathing. An unresponsive adult who isn't breathing normally, with no definite pulse found within 10 seconds, is treated as cardiac arrest, and early high-quality chest compressions with prompt defibrillation are the interventions most associated with survival (2025 AHA Guidelines for CPR and ECC, Part 7: Adult Basic Life Support).

A is the trap for people who work around monitors all day. The patient's condition, not the waveform, tells you what to do. D delays compressions for equipment that's already on its way — compressions start now, with interruptions kept brief for AED analysis and shock delivery as prompted. C reverses the sequence.

This question is about recognising arrest and starting. It isn't a substitute for BLS certification, and the CET test plan lists CPR and basic life support as core knowledge that can appear anywhere on the exam — worth knowing cold for that reason alone.

Domain 1, Task I — basic life support

Source: AHA adult BLS (Recognition of cardiac arrest; initiation of resuscitation; healthcare-professional algorithm).

A — open a fresh pack.

Dried gel can cause a noisy or unusable tracing. Conduction between skin and electrode depends on that gel being intact.

B improvises a repair instead of using electrodes with intact gel as intended. C confuses adhesion with conduction; an electrode can stick perfectly and still record badly. D invents a hierarchy that doesn't exist: limb-electrode contact matters too, and one poor limb connection can affect several derived leads.

Domain 2, Task A — maintain equipment

Sources: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations); QAS cardiac-monitoring procedure (PDF p. 2, artifact causes); Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7).

B.

CDC's core practices are specific on this point twice over: follow manufacturers' instructions for the proper use of cleaning and disinfecting products, including dilution, contact time, material compatibility, storage and shelf life; and consult and adhere to manufacturers' reprocessing instructions for reusable equipment (CDC, Core Infection Prevention and Control Practices, sections 5b and 5f).

Material compatibility matters even when a surface looks clean: an incompatible product can damage the equipment.

A treats "disinfectant" as one product. C ignores everything the patient and your gloves touched. D doesn't disinfect anything.

Domain 2, Task A — maintain equipment

Source: CDC core infection-prevention practices (Sections 5b and 5f, manufacturer instructions and material compatibility).

A — half the standard printed height.

Gain sets the vertical scale: how many millimetres of paper represent one millivolt of signal. Halve it and every wave prints at half the height it would have at the original gain; the heart’s signal has not halved. That's a legitimate thing to do when complexes are so tall they overlap the channels above and below — but only if you mark the change on the tracing, so the scale is unambiguous. The calibration pulse itself is also a scale reference — here, a 1-mV pulse printed at 5 mm shows 5 mm/mV.

C and D both belong to the horizontal axis, which is paper speed. Gain doesn't touch timing, so the rate is unaffected.

Two habits follow from this. Look at the calibration mark before you read anything off a tracing. And if you change speed or gain deliberately, write it on the page.

Domain 2, Task B — verify machine settings

Source: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations). Arithmetic uses the stated inputs.

C — speed is sideways, gain is up and down.

Increasing the paper speed is not a way to fix tall complexes, and halving the gain is not a way to fix long intervals.

Anchor it to the paper. At the standard 25 mm per second, one small square is 0.04 seconds and one large square is 0.20 seconds — that’s speed. Gain governs the other axis: how tall one millivolt prints. The page layout is a separate display choice, not something the paper speed dictates.

Change speed and the tracing stretches or compresses sideways. Change gain and it grows or shrinks vertically. Nothing else moves.

A and D assign both controls to one axis. B reverses the axes.

Domain 2, Task B — verify machine settings

Source: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations). Arithmetic uses the stated inputs.

A — fix the cause, and use the specified recording settings.

The question supplies the setting required for this device and protocol. A smoother-looking trace is not a reason to substitute a different mode. Here there is also a visible source to address: sustained muscle tension can introduce artifact.

B ignores the diagnostic setting stated in the question. C documents a change but does not make that change appropriate. D assumes filtering is harmless without checking the device instructions.

The real fix is upstream — relax and support the patient, re-prep the skin if needed, and check contact. Filter settings are device- and purpose-specific; the numbers in this scenario are not a universal NHA machine-setting rule.

Domain 2, Tasks B and G — machine settings and artifact

Source: QAS cardiac-monitoring procedure (PDF p. 2, artifact causes).

D — clean it off, let it dry.

Clean and dry the correct electrode sites before applying electrodes. Lotion is both an insulating layer and an adhesion problem, so it has to come off the sites.

B is the trap, and it's the one that does real damage. A precordial electrode's position is the measurement — move V3 somewhere convenient and you've changed what that lead records, without giving the reader the intended view. Prepare the correct site; never relocate a chest electrode for convenience.

A and C both try to bridge the barrier instead of removing it, and neither restores clean contact.

Domain 2, Task C — prepare the skin

Sources: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations); AHA cardiac event recorder (Types of cardiac event recorders; What should I expect?).

D — clean and gently abrade.

Loose surface skin sits between the electrode and the tissue you're trying to record from. Follow the preparation instructions given in the question, then reassess the recording. Do not abrade damaged or fragile skin. "Gentle" is doing work in that sentence — you're removing loose surface cells, not scrubbing.

A amplifies noise and signal equally, so the ratio doesn't improve. C doesn't help if the contact surface is the problem rather than its size. B documents a problem you could have solved and hands the reader a degraded tracing.

Domain 2, Task C — prepare the skin

Sources: AHA cardiac event recorder (What should I expect?—preparing skin; device-specific preparation supplied in the stem); QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations).

A — record it in the position she can tolerate, and say so on the page.

Record the position actually used. A semi-recumbent position can accommodate a patient who cannot comfortably lie flat, and the record should make that difference clear to the reader. If breathlessness is new or worsening, escalate it rather than treating it only as a positioning problem.

B hands the reader a tracing that looks standard and isn't. C does not replace the required documentation and assumes another recording is necessary; follow the clinical team’s directions rather than deciding that from position alone. D downgrades the test the provider ordered.

Same principle throughout acquisition: when you deviate from standard for a good reason, deviate and document. What you never do is deviate silently.

Domain 2, Task D — position the patient

Sources: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations); NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).

A — relax and support the limbs.

Tensed muscle produces somatic artifact, and gripping her own elbows means both arms are working continuously. Supporting the limbs so no muscle group is holding a position removes the source. Address that source and check the repeat instead of only changing the display.

B changes filtering before addressing an obvious source and checking the required diagnostic settings. C amplifies the artifact too. D changes the electrode locations rather than first correcting the arm tension; a modified placement must be deliberate and documented.

Domain 2, Tasks D and G — positioning and artifact

Sources: QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations); QAS cardiac-monitoring procedure (PDF p. 2, artifact causes); Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7).

B — midway between V4 and V6.

Use the midpoint between V4 and V6, keeping V5 in the same horizontal plane. The acquisition procedure linked below lists V5 midway between those two positions. Do not trace an intercostal space downward around the chest instead.

D follows the intercostal space downward, instead of keeping the electrode in the horizontal plane of V4. C uses a landmark that moves between patients and isn't a standard reference. A keeps estimating the line you already said you couldn't find.

Reproducibility is the whole point. Consistent precordial placement makes serial comparison more useful.

Domain 2, Task E — apply electrodes

Source: QAS ECG acquisition procedure (PDF p. 3, chest-electrode table: V5 midway between V4 and V6).

B — left arm and right arm reversed.

This has a fingerprint, and it's worth memorising because the pattern follows from the lead connections. Swapping the two arm electrodes inverts lead I, swaps leads II and III, swaps aVR and aVL, and leaves aVF untouched. The chest leads are unaffected because the reference used to derive them isn't disturbed (12-Lead ECG System, sections 15.1, 15.3 and 15.4; the reversal pattern follows by exchanging RA and LA in the lead relationships).

C is the answer worth knowing how to exclude, since dextrocardia can look similar in the limb leads. Check the actual cable connections rather than diagnosing dextrocardia from an inverted lead I. The complete swap pattern and preserved chest-lead recording described here point to the arm connections.

A produces a different picture — see the next question. D would change the chest leads, which look normal here.

Fix it and repeat. A reversal can create false-positive or false-negative signs of ischemia.

Domain 2, Task E — apply electrodes

Sources: Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7); Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads). The connection effects follow from the linked lead relationships.

A — right arm and right leg reversed.

Lead II normally records the potential difference between the left leg and the right arm. Swap the right arm and right leg cables and lead II ends up recording the difference between the two legs, which is nearly zero — so it prints as a near-flat line while other leads can still show complexes. Their shapes need not remain normal. This pattern is a reason to inspect the connections, not proof of a particular reversal.

D does not fit the awake patient with a palpable pulse and QRS complexes in other simultaneous leads. A flat channel can be a recording problem; it does not by itself diagnose asystole. Always assess the patient as well as the tracing.

B would affect a chest lead, not lead II. C changes the time scale, not the amplitude.

Domain 2, Task E — apply electrodes

Sources: Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads); Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7); AHA adult BLS (Recognition of cardiac arrest and initiation of CPR; adult healthcare-professional algorithm). The connection effects follow from the linked lead relationships.

C — V4’s right-sided counterpart, clearly labelled.

V4R is the right-sided counterpart of standard V4: the fifth intercostal space on the right midclavicular line. Follow the ordered lead set and label each actual position; do not assume that every facility uses the same repeat-recording sequence.

Labelling is not a nicety. An unlabelled right-sided tracing filed as a standard 12-lead is genuinely misleading to whoever opens it next.

B describes posterior leads — see Question 42. A and D are invented.

These leads have been ordered in the question. Acquiring them accurately and labelling them clearly is your task; the question is not asking you to decide their clinical indication.

Domain 2, Task E — special considerations

Sources: QAS ECG acquisition procedure (PDF p. 3, chest-electrode table: V4R); Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7).

D.

V7 sits at the left posterior axillary line, V8 at the left scapular-tip landmark and V9 in the left paraspinal region, each in the same horizontal plane as V6 (QAS 12-Lead ECG Acquisition, PDF page 3, chest-electrode placement table).

Notice the pattern shared with V5 and V6 in Question 38: the reference is a horizontal plane, not an intercostal space you trace around the body. B repeats that error on the back.

C describes right-sided leads. A is invented.

Label these clearly too, and record what the patient's position was — the position during recording matters, not just a temporary turn while attaching the electrodes.

Domain 2, Task E — special considerations

Source: QAS ECG acquisition procedure (PDF p. 3, chest-electrode table: V7, V8, V9).

B — that isn't a complete tracing yet.

The printout does not meet the filing requirements stated in the question. Verify the correct patient and recording time, then reprint from the verified recording with the required identifiers and settings. The calibration pulse or explicit gain information tells the reader the voltage scale; it must not be guessed.

A treats the waveform as the whole product. C relies on your memory and your presence, neither of which is in the record. D is better than nothing and still leaves the timestamp and calibration missing — and a name alone does not meet this question’s two-identifier requirement.

Check the header before you leave the room, while the patient is still there so a missing field can be resolved before filing.

Domain 2, Task F — verify all leads recorded

Sources: NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question); QAS ECG acquisition procedure (PDF p. 3: preparation, position, chest-electrode table; p. 6: measurement units; p. 9: recording annotations). Arithmetic uses the stated inputs.

B — one flat lead points to one electrode.

Each chest lead uses its own chest electrode, so an isolated problem in one chest channel is a sensible reason to inspect that electrode, snap and cable first. It is a troubleshooting clue, not certainty about the fault.

The chest leads are not independent of the limb electrodes. Their shared reference — the Wilson central terminal — is derived from the right-arm, left-arm and left-leg potentials. A problem affecting that reference can affect several chest leads as well as limb leads.

A involves the common connection system rather than the isolated chest channel identified here. D starts over at every site before checking the isolated chest-channel connection identified by the tracing. C affects the whole tracing, not one lead.

Domain 2, Task F — verify all leads recorded

Sources: Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7); QAS cardiac-monitoring procedure (PDF p. 2, artifact causes).

C — somatic tremor.

These patterns can help you troubleshoot, but appearance alone does not prove the cause:

• Somatic tremor — irregular, spiky, rapid; from muscle activity; usually worst where the muscle is.
• AC interference — a repetitive high-frequency disturbance from electrical interference; its distribution can vary.
• Wandering baseline — a slow rolling drift that can accompany respiration, movement or poor electrode contact.

Support the limbs and let the patient settle. When the tremor persists despite appropriate positioning and preparation, record the best tracing you can and note the tremor, so the reader doesn't mistake it for a rhythm disturbance.

A and B treat the wrong artifact. D replaces equipment when the source is the patient's muscle.

Domain 2, Task G — identify and resolve artifact

Source: QAS cardiac-monitoring procedure (PDF p. 2, artifact causes).

B — use the pattern and the visible loose contact.

This is the same method as Question 44, applied to artifact instead of a flat line. When a disturbance shows up in some leads and not others, ask which electrode those leads have in common. The visibly loose left-leg electrode makes that connection the first place to check. Lead I uses the arm potentials, so it can remain relatively clean. The other augmented leads and chest leads may also be affected through their reference connections.

Check adhesion, re-prep the site if needed, replace the electrode, repeat.

A ignores an observed contact problem and assumes nothing can be done. C and D are machine settings, which would affect the tracing globally rather than in one group of leads.

Domain 2, Task G — identify and resolve artifact

Sources: Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7); QAS cardiac-monitoring procedure (PDF p. 2, artifact causes).

B.

Two pieces of evidence support checking for movement artifact: the disturbance starts with arm movement, and the underlying QRS complexes continue at their previous timing. The patient assessment adds useful context, but looking comfortable does not by itself rule out a significant arrhythmia.

Ask her to stop moving, check contact, and examine the repeat. A limb-electrode disturbance can also reach the chest leads through their shared reference, so “the chest leads don’t depend on the arms” is not a valid rule.

A declares a diagnosis from a distorted segment instead of evaluating the evidence. C changes filtering without correcting the movement or contact problem. D changes the time scale, not electrode contact.

Continue observing the patient. Persistent, uncertain or clinically concerning findings need prompt escalation; do not dismiss them because the patient is talking.

Domain 2, Task G — artifact versus rhythm

Sources: QAS cardiac-monitoring procedure (PDF p. 2, artifact causes); Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3–15.7; equations 15.1–15.7); AHA adult advanced life support (Section 15, Wide-Complex Tachycardia, synopsis and recommendations).

C.

Everything a reader needs to interpret the strip has to survive the mounting: which lead they're looking at, what the machine's settings were, whose strip it is and when it was taken. Do not trim away this information just to make the strip fit a page.

A and B discard context. The beats around an abnormality are often what make it interpretable — a pause means something different depending on what came before it. D is impractical and buries the relevant section.

The same discipline applies electronically: verify identifiers, confirm you're transmitting to the correct record, and check that what arrives in the chart is legible.

Domain 2, Task H — mount and transmit the tracing

Sources: NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question); Utah ECG definitions (ECG Waves and Intervals; Bipolar and augmented limb leads).

C — label it, and don't compare it like for like.

Moving the limb electrodes onto the torso is standard practice for exercise testing, because arm and leg movement would otherwise wreck the tracing. The precordial electrodes stay in their standard positions in the Mason–Likar modification.

The limb-electrode locations have changed, so the spatial measurements are not the same recording arrangement. Label the torso placement so serial readers can take it into account rather than assuming the standard limb sites were used. The ECG lead definitions and the exercise modification are described in Bioelectromagnetism, chapter 15, sections 15.1–15.6.

A is the assumption that causes the problem. B overstates it — the tracing is perfectly useful for its purpose, which is exercise monitoring. D has it backwards: torso placement changes the limb leads directly and also alters the reference used to derive the precordial leads.

Domain 2, Task I — monitoring during stress testing

Source: Bioelectromagnetism, chapter 15 (Sections 15.1, 15.3 and 15.6; differences in measurement sites and exercise modification). The connection effects follow from the linked lead relationships.

D — stay with the patient and keep monitoring.

The immediate stopping and transfer have already been handled in the question. Monitoring continues into recovery — the recovery period is part of the test, and heart rate, blood pressure and the patient’s condition still need observation.

A leaves the patient unobserved after a safety event. C removes the monitoring exactly when it's most needed. B leaves her alone; send someone else, or use the call system.

Documentation comes after the patient is safe, and it should describe what happened and when, not what you think it meant.

Domain 2, Task J — responding to complications during stress testing

Sources: AHA stress-test guidance (PDF p. 1: preparation and alternative stress; p. 2: stopping and recovery); NHA Candidate Handbook (Code of Ethics, printed p. 27; the role/record rule is supplied in the question).