NHA EKG Module 1: Safety, Compliance, and Coordinated Patient Care

An EKG technician releases information about a patient's diagnosis to the patient's employer. Which of the following patient rights was violated?

A. Assignment of benefits

B. Patient confidentiality

C. Access to treatment

D. Power of attorney

B. Patient confidentiality

A patient follows an EKG technician to the examination room, voluntarily undresses from the waist up, and lies on the examination table. Which of the following types of consent is the patient giving?

A. Expressed written

B. Informed

C. Implied

D. None

C. Implied

What is medical asepsis?

"clean technique"

the removal or reduction of micro-organisms after they leave the body and breaking the chain of infection

An EKG technician greets a patient, takes the patient to the examination room, and asks "Could you please state your name?" and "What medications do you take?" Which of the following techniques is the technician using?

A. Reflection

B. Empathy

C. Active listening skills

D. Skilled interviewing

D. Skilled Interviewing

Communication with members of the health care team can be accomplished through which of the following methods?

A. Electronic health record

B. Verbal exchange

C. Text messages between coworkers

A. Electronic health record

B. Verbal exchange

What factors can affect vital signs?

Stress, food or liquid intake, medical conditions, age, physical activity

Expected reference ranges for blood pressure

Systolic : <120

Diastolic: <80

Elevated blood pressure

Systolic: 120-129

Diastolic: <80

High blood pressure stage 1

Systolic: 130-139

Diastolic: 80-89

High blood pressure stage 2

Systolic: 140 or greater

Diastolic: 90 or greater

Hypertensive crisis

Systolic: 180 or greater

Diastolic: 120 or greater

Pulse sites

temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, pedal

Average heart rate for newborn (birth to 1 month)

120-160 bpm

Average heart rate for infant (1-12 months)

80-140 bpm

Toddler (1-3 years)

80-130 bpm

Preschool-age (3-5 years)

80-120 bpm

School-age (6-15 years)

70-100 bpm

Adult (older than 15 years)

60-100 bpmRate

Respirations are evaluated on what 3 factors?

Rate

Rhythm

Depth

What do vital signs consist of?

Blood pressure, heart rate, respirations, temperature, oxygen saturation

A pulse oximeter reading of what percent is normal?

95% or higher

Pulse oximeter is unreliable when?

If the patient has cold hands, colored nail polish or acrylic nails, edema, CO poisoning

What are signs of adequate perfusion?

Warm skin, pink mucous membranes, strong peripheral pulses, capillary refill less than 2 seconds

Patients who have hypoxia (low SpO2) can experience what symptoms?

Anxiety, confusion, increased respiratory rate

Which test can show compromised oxygen saturation rates?

Cardiac stress test

Before performing an EKG on a patient, what information/history should you gather?

Medical, social, surgical, medication

What does OPQRST stand for?

Onset

Provocation

Quality

Radiation

Severity

Time

Surgical history questions

What surgeries has the patient had, when where was each performs and were there any complications?

Hx of valve replacement, cardiac catheterization, coronary artery bypass graft surgery, aneurysm repair, childhood cardiac surgeries, pacemaker implant or heart transplant

What is a stress test used for?

To determine how the heart functions under the increased workload caused by exercise

What is a stress test specifically used to provoke?

To provoke myocardial ischemia under controlled settings

How should a patient prepare for a stress test?

Avoid caffeine, tobacco, and alcohol for at least 3 hours prior

Eat a light meal 2 hours prior

Take medications as usual unless directed otherwise (patients may need to avoid taking beta blockers or calcium channel blockers)

Patients who have diabetes mellitus should consult their PCP for directions regarding insulin dosages

Wear comfortable, loose-fitting clothing and sturdy, nonskid walking shoes

Plan to be in the office for 2-3 hours

Intraprocedure: When preparing the patient and during testing, alert them to the following:

The amount of time necessary for the stress test varies. Allow 2-3 hours to complete the entire procedure. Electrodes will be applied to the chest. If necessary, the skin will be cleaned with alcohol and hair might be removed to make sure the electrodes stick. A blood pressure cuff is placed on the upper arm to monitor blood pressure during the test.

If there is itching, swelling, or redness where the electrodes contact the skin, notify the technician.

A baseline EKG is taken at rest followed by walking on a treadmill or using a stationary bike to gradually increase physical activity until symptoms are experienced, fatigue or illness occurs, or a target heart rate is reached.

Inform the technician of any allergies or health issues (reactions to rubber or latex, exercise-induced asthma or respiratory distress, history of using an inhaler)

The test can be stopped at any time if fatigue, lightheadedness, dizziness, shortness of breath, or chest pain occur

Postprocedure: After the test, instruct the patient to do the following.

Sit or stand still for a few minutes while the machine continues to record heart activity

Resume normal activities as tolerated

How long is a Holter monitor used for?

24-48 hours (sometimes longer)

How many leads does a Holter monitor use?

3 or 5 leads

What is one downside of a Holter monitor?

It might not detect irregularities that occur only periodically

Signs and symptoms of cardiopulmonary distress

Tachycardia or bradycardia

Pallor

Diaphoresis

Low bp

Fast, labored, shallow or slow respirations

Anxiety or confusion

Cyanosis

Chest pain that radiates to the back, arms, or jaw

Chest tightness (squeezing sensation)

Shortness of breath

Nausea and vomiting

Lightheadedness

Weakness

Syncope (temporary loss of consciousness due to low bp)

Patient is placed in what position during 12 Lead EKG?

Supine

How many electrodes does a 12 lead EKG use?

10

Which of the following takes the least amount of time to complete?

-EKG

-Stress test

-Ambulatory monitoring

EKG

Which requires blood pressure checks throughout the procedure?

Stress test

Which test has the goal of raising the heart rate?

Stress test

Which of the following uses 3 or 5 electrodes?

-Standard EKG

-Stress test

-Ambulatory monitoring

Ambulatory monitoring

Which of the following actions by an EKG technician is an example of adhering to the ethical principle of professional liability?

Recommending an otc medication to treat a patient's condition

Monitoring a patient's condition during an exercise stress test

Interpreting the results of an EKG test for a patient

Informing a patient about available treatment options

Monitoring a patient's condition during an exercise stress test

An EKG technician is interviewing a patient who states, "My chest has been hurting for the last 2 days." Which of the following responses by the tech is an example of the active listening technique of restating?

"You have been having chest pain?"

"Tell me more about your pain"

"You seem concerned about your pain"

"Have you had this kind of pain before?"

"You have been having chest pain?"

An EKG technician is preparing to perform a standard 12-lead EKG for a 9-year-old child. Which of the following actions should the technician take to reduce the child's anxiety?

Give the child the option to ask their parent to leave the room.

Wait 15 min before entering the child's room.

Explain the procedure to the child using medical terminology.

Allow the child to touch the equipment before the procedure.

Allow the child to touch the equipment before the procedure.

An EKG technician is observing a patient during a stress test. Which of the following findings is a sign of cardiovascular distress?

-Heart rate 100/min

-Blood pressure 138/78 mm Hg

-SaO2 82%

-Respiratory rate 24/min

SaO2 82%

Which of the following actions should an EKG technician take to identify a patient according to The Joint Commission guidelines?

Ask the patient to provide their account number and their provider's name

Ask the patient to provide their medical record number and room number

Ask the patient to state their room number and their provider's name

Ask the patient to state and spell their full name and date of birth

Ask the patient to state and spell their full name and date of birth

Which of the following health care professionals is responsible for communicating the results of a cardiac stress test to the patient?

-Medical Assistant

-EKG technician

-Registered nurse

-Cardiologist

Cardiologist

An EKG technician is providing instructions to a patient who has an ambulatory monitor. Which of the following statements by the patient indicates an understanding of the instructions?

"I was going to have dinner with friends, but will reschedule that for next week."

"I will keep the monitor out of the tub and keep my chest dry when I take a bath."

"If a lead becomes detached, I will reattach it and write this down."

"If the monitor makes a beeping noise, I should change the batteries immediately."

"If a lead becomes detached, I will reattached it and write this down."

While performing a standard 12-lead EKG, an EKG technician notices the patient has stopped breathing and has no pulse. Which of the following actions should the technician take first?

-Call for help and begin CPR

-Provide two breaths to the patient

-Review and interpret the EKG tracing

-Obtain a defibrillator

Call for help and begin CPR

An EKG technician is assisting a patient during a stress test. The patient develops nausea and vomits blood-tinged fluid. In which of the following locations should the technician place a cloth hand towel that is soiled by the vomit?

-Trash can

-Sharps container

-Biohazard bag

-Soiled utility sink

Biohazard bag

Which of the following findings should an EKG technician expect for a patient who is experiencing cardiopulmonary compromise?

-Warm, dry skin

-Hypertension

-Persistent chest discomfort

-Sudden weight loss

Persistent chest discomfort

An EKG technician is instructing a patient about preparing for a stress test. Which of the following instructions should the technician include?

-"You can drink caffeinated beverages up to 30 minutes prior to starting the test."

-"You should fast for 24 hours prior to starting the test."

-"You should avoid taking beta-blockers on the day of the test."

-"You can use tobacco products up to 1 hour prior to starting the test."

"You should avoid taking beta-blockers on the day of the test."

Which of the following is an important factor in preparing a patient for EKG stress testing?

-Instruct the patient to stop taking all medications for a minimum of 24 hours prior to the test

-Ask the patient to keep a journal for the duration of the test

-Inform the patient to plan to be in the office for only a brief amount of time as the test records for 10 seconds

-Advise the patient to wear comfortable, loose-fitting clothing and sturdy, nonskid walking shoes

Advise the patient to wear comfortable, loose-fitting clothing and sturdy, nonskid walking shoes

An EKG technician is evaluating a patient's understanding of a scheduled cardiac test. The patient states, "I will continue with my normal routine and record all my activities in a journal." The technician should recognize that this statement is true for which of the following cardia tests?

-12-Lead EKG

-Holter monitoring

-Nuclear stress test

-Echocardiogram

Holter monitoring

An EKG technician should recognize that which of the following is the most important action to take to break the chain of infection when preparing to perform an EKG procedure for a patient?

-Sanitizing the examination table

-Washing hands

-Wearing PPE

-Disinfecting the EKG leads

Washing hands

An EKG technician is obtain a health history from a patient. The patient tells the technician that they underwent coronary artery bypass grafting 2 years ago. In which of the following sections of the EMR should the technician put this information?

-Review of systems

-Social history

-Family history

-Past medical history

Past medical history

A technician receives a requisition for an EKG. Which of the following patient information from the EHR is necessary to complete the EKG as ordered?

-Birthdate

-Address

-Next of kin

-Marital status

Birthdate

An EKG technician is collecting a blood pressure measurement from a healthy adult patient. The technician should recognize that which of the following blood pressure measurements is within the expected reference range for this patient?

-85/55 mm Hg

-100/62 mm Hg

-110/56 mm Hg

-122/84 mm Hg

100/62 mm Hg

(100-119 systolic, 60-79 diastolic)

An EKG technician should recognize that which of the following statements is in compliance with HIPAA regulations?

-The patient diagnosis is considered protected health information

-The patient's vital signs should be disclosed only to the provider

-The patient's treatment plan can be shared with their family

-The patient's id # cannot be disclosed as a part of providing facility health care statistics.

The patient diagnosis is considered protected health information

Which of the following actions should an EKG technician recognize as a technical safeguard for maintaining patient privacy?

-Using a person-specific password to access the EHR

-Using a computer privacy screen when entering patient information

-Enabling automatic log-off from the EHR

-Including a confidentiality disclosure on emails that contain patient information

Using a person-specific password to access the EHR

An EKG technician is preparing to measure the heart rate of an adolescent patient. Which of the following resting heart rates is within the expected reference range for this patient?

-15/min

-80/min

-120/min

-185/min

15/min