EKG and cardiovascular testing is 6 of the 150 scored items on the NHA CCMA. Answer 10 exam style questions on EKG rhythms and cardiac testing and see exactly which concepts would cost you points on test day.
Start the 10 questions →What is the generally accepted normal duration of the PR interval in an adult?
These questions cover intervals, rhythm recognition, pacemakers, patient positioning and artifact. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the CCMA.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: B. The PR interval, from the start of the P wave to the start of the QRS, normally measures 0.12 to 0.20 seconds (3 to 5 small boxes). It reflects the time for the impulse to travel from the atria through the AV node. A longer interval suggests a conduction delay.
Why not A: This range is shorter than a normal PR interval and closer to a narrow QRS duration.
Why not C: This is far longer than any normal PR interval.
Why not D: A PR interval in this range would indicate a significant AV conduction delay.
Exam tactic: PR 3 to 5 small boxes. QRS under 3 small boxes.
Answer: C. First-degree AV block is a consistent delay through the AV node: the PR interval is longer than 0.20 seconds, but every P wave still conducts to a QRS. Higher-degree blocks include dropped beats.
Why not A: An irregular rhythm without P waves describes atrial fibrillation.
Why not B: A sawtooth baseline describes atrial flutter.
Why not D: Dropped QRS complexes indicate second-degree or higher block.
Exam tactic: First degree = long PR, nothing dropped.
Answer: D. Pacemaker stimuli appear as sharp spikes. A spike before the P wave indicates atrial pacing; a spike before the QRS indicates ventricular pacing, often followed by a wide complex. The presence of a pacemaker is noted on the tracing for the provider.
Why not A: A paced rhythm produces QRS complexes after ventricular spikes.
Why not B: Alternating flat segments would indicate a malfunction or artifact, not normal pacing.
Why not C: A sawtooth pattern is atrial flutter.
Exam tactic: Spike then complex = paced beat. Note 'pacemaker' on the tracing.
Answer: C. The patient lies supine and still with arms relaxed at the sides and legs uncrossed. If they cannot lie flat, a semi-reclined position is used and noted on the tracing, since position can affect the recording.
Why not A: Dangling legs and an unsupported posture create muscle artifact.
Why not B: Chest leads cannot be placed on a patient lying prone.
Why not D: Standing with raised arms creates muscle tension and artifact.
Exam tactic: Supine, still, arms down, legs uncrossed. Document any different position.
Answer: D. Somatic tremor artifact comes from muscle activity: shivering, anxiety, tension, or talking. Warmth, reassurance, a comfortable position with supported limbs, and asking the patient not to talk usually resolve it.
Why not A: Moving electrodes off their landmarks creates an incorrect tracing.
Why not B: Removing electrical interference addresses regular 60-cycle spikes, not muscle tremor.
Why not C: Doubling the calibration enlarges the artifact along with the complexes.
Exam tactic: Jagged irregular spikes = muscles. Warm, calm, and still.
Answer: B. Lead II runs roughly in the direction of normal atrial and ventricular depolarization, so P waves and QRS complexes are usually upright and easy to see, which makes it the default rhythm strip lead.
Why not A: aVR normally shows inverted complexes, which makes rhythm reading harder.
Why not C: V6 is a chest lead not typically used as the default rhythm strip.
Why not D: aVL often shows small or variable P waves.
Exam tactic: Rhythm strip default: lead II.
Answer: C. Event monitors are used for symptoms that occur infrequently. They are worn for longer periods, commonly up to about 30 days, and save a recording when the patient activates them during symptoms or when the device detects an abnormal rhythm. Holter monitors record continuously for a shorter period, usually 24 to 48 hours.
Why not A: Treadmill monitoring is exercise stress testing.
Why not B: That describes a Holter more closely, and Holters are also worn at home.
Why not D: Periodic blood pressure measurement describes ambulatory blood pressure monitoring.
Exam tactic: Holter = continuous, short. Event monitor = triggered, long.
Answer: C. An echocardiogram uses sound waves to image heart structure and motion. An electrocardiogram records electrical activity. Holter monitoring records rhythm over time. Cardiac catheterization is an invasive procedure using a catheter and contrast.
Why not A: Catheterization is invasive and not based on ultrasound.
Why not B: Holter monitoring records rhythm over 24 to 48 hours.
Why not D: The electrocardiogram records electrical activity, not images.
Exam tactic: Echo = sound waves = pictures. EKG = electricity = waves on paper.
Answer: D. Correct patient identification prevents misfiled tracings, and many machines use age and sex in their automated interpretation criteria. Entering the data before recording ensures every printed page is labeled.
Why not A: Unlabeled tracings risk being misfiled or attributed to the wrong patient.
Why not B: The EKG machine does not bill insurers.
Why not C: Paper speed is a separate setting, normally left at the 25 mm/sec standard.
Exam tactic: Identify before you record, so every page is labeled.
Answer: B. The 1,500 method divides 1,500 by the number of small boxes between R waves: 1,500 ÷ 15 = 100. It is the most precise method for regular rhythms. (Fifteen small boxes are three large boxes, and 300 ÷ 3 also gives 100.)
Why not A: 30 would require 50 small boxes.
Why not C: 150 would require 10 small boxes.
Why not D: 75 would require 20 small boxes.
Exam tactic: 1,500 / small boxes, or 300 / large boxes. Both must agree.
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