Free NHA CET practice questions with answers

Twenty-five original, source-verified NHA CET questions with full answers and rationale below, free to read, no account required. A new set every day.

1. Question 1

   What are 'reciprocal changes' on an ECG during an acute myocardial infarction?

   • A gradual, benign lengthening of the PR interval
   • Identical ST elevation appearing in every lead simultaneously
   • Mirror-image ST depression seen by the lead directly opposite the infarctCorrect
   • A doubling of the QRS voltage in the affected leads

   Why: Reciprocal changes are described as the mirror-image pattern seen when a lead on the wall directly opposite an infarct records the same underlying electrical events from a different angle, typically showing ST depression and an upright T wave where the infarct-facing lead shows ST elevation. Identical elevation appearing everywhere at once does not describe a mirror-image relationship between opposing leads. A gradual PR-interval change is unrelated to this ST-segment mirroring concept entirely. A doubling of QRS voltage describes an amplitude change, not the ST-segment mirroring that defines a reciprocal change. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 15, PDF p. 568.

2. Question 2

   A relative who is not listed as the patient's authorized representative asks to review the patient's chart. What must occur before that relative may view the record?

   • It may be shown once the relative shows a photo identification card
   • No consent is needed if the relative accompanied the patient to the appointment
   • A signed consent form authorizing that third party to view the record must be obtainedCorrect
   • The technician may allow it verbally as long as the relative shares the patient's last name

   Why: Before a third party who is not already authorized may view a patient's record, a signed consent form giving that person the right to see the information is required. Allowing access based only on a verbal claim of shared surname provides no actual verification of authorization. Showing a photo identification card confirms the visitor's own identity but does not establish that the patient consented to disclosure. Having accompanied the patient to an appointment does not by itself grant a right to review the chart. Primary reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, Chapter 3, PDF p. 2.

3. Question 3

   An adult's respiration rate is measured at 16 breaths per minute at rest. How does this compare with the typical adult resting respiratory rate?

   • It is far above the typical range
   • It falls within the typical 12-to-20 rangeCorrect
   • It matches the typical newborn average instead
   • It is far below the typical range

   Why: A rate of 16 breaths per minute lands exactly on the average given for the adolescence-to-adulthood range of 12 to 20, making it a typical resting value. It is not far above that range, since 20 is the upper limit and 16 sits comfortably under it. It is not far below the range either, since 12 is the lower limit and 16 sits above it. It does not match the newborn average, which is listed separately as 40, a much higher rate than this adult reading. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 20, PDF p. 6.

4. Question 4

   Leads I, II, and III are produced by the ECG machine reading what?

   • The positive and negative poles of the precordial electrodes only
   • The positive and negative poles of the limb electrodesCorrect
   • The internal pacing signal of the SA node directly
   • A single reference electrode placed on the chest

   Why: Leads I, II, and III come from comparing the positive and negative poles formed between pairs of limb electrodes, not from the chest electrodes. The precordial electrodes instead generate the six chest leads, V1 through V6, so they are not the source of leads I, II, and III. There is no single reference electrode that alone produces these three leads, and the machine reads electrical potentials at the skin surface rather than tapping the SA node's signal directly. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 3, PDF p. 73.

5. Question 5

   During a standard resting ECG recording, at what speed does the paper move under the recording pen?

   • 5 millimeters per second
   • 10 millimeters per second
   • 25 millimeters per secondCorrect
   • 50 millimeters per second

   Why: The default paper speed for a resting ECG is 25 millimeters per second, which is what the small- and large-box time values are built around. A speed of 50 mm/sec is used only for special situations such as very fast rhythms, not the routine default. Ten and five millimeters per second are far slower than any standard ECG setting and would badly distort the apparent width of every wave. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 4, PDF p. 83.

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7. Question 6

   A technician is asked to identify the wave on a rhythm strip that represents atrial depolarization and normally appears first in each cardiac cycle. Which wave is this?

   • The T wave
   • The QRS complex
   • The U wave
   • The P waveCorrect

   Why: The P wave represents depolarization of the atria and is the first deflection in the cardiac cycle, beginning as the tracing leaves the baseline and ending when it returns to baseline before the PR interval. The T wave instead represents ventricular repolarization and occurs later in the cycle. The QRS complex represents ventricular depolarization, not atrial activity, and the U wave, when present, follows the T wave and is not the first deflection of the cycle. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 9, PDF p. 176. Cross-reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, PDF p. 3.

8. Question 7

   What is the purpose of the filters built into many ECG machines?

   • To translate the tracing into a foreign language on the printout
   • To produce a clearer tracing by blocking outside electrical disturbancesCorrect
   • To recharge the machine's battery while it is in use
   • To warm the paper so the tracing prints faster

   Why: Filters built into many ECG machines work to screen out unwanted electrical disturbances, which helps produce a cleaner tracing for the reader to interpret. Warming the paper is not a function performed by these filters. Recharging the battery is handled by the machine's power system, not by its signal filters. Translating text on the printout has nothing to do with what a filter does on this equipment. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 26, PDF p. 7.

9. Question 8

   Where does the right bundle branch (RBB) terminate?

   • Its own associated Purkinje fibersCorrect
   • At the sinoatrial node
   • In the left anterior fascicle
   • At the AV node

   Why: After supplying the right ventricle and the septum's right face, the right bundle branch ends by handing off to the Purkinje fibers that serve that side of the heart, completing the final leg of ventricular conduction. It does not terminate at the AV node, since the AV node lies far earlier in the conduction sequence. It also has no connection point at the left anterior fascicle, which belongs to the left bundle system, or at the SA node, which is where the entire impulse originates. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 1, PDF p. 52.

10. Question 9

    An ECG tracing suddenly shows a flat, disconnected line partway through the recording. What does this most likely indicate?

    • The patient is exhibiting a normal sinus rhythm
    • The technician correctly entered the patient information
    • A broken electrical connection between an electrode and the machineCorrect
    • The machine has just printed its calibration mark

    Why: An interrupted baseline appears when the electrical connection between an electrode and the machine is broken, such as from a loose wire or a detached electrode, cutting off the signal being recorded. A normal sinus rhythm would still produce a continuous tracing with regular waveforms, not a flat disconnected line. A calibration mark is a brief, expected feature of a properly working recording, not a sign of a broken connection. Correctly entering the patient's information does not affect whether the physical connection to an electrode stays intact. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 26, PDF p. 9.

11. Question 10

    How many electrodes are placed on the patient's body to obtain a standard 12-lead ECG?

    • Twelve
    • TenCorrect
    • Four
    • Six

    Why: Ten electrodes, placed on the two arms, the two legs, and six positions on the chest, are used to record the twelve separate views that make up a standard ECG. Six electrodes alone would not include the limb electrodes needed to generate the standard and augmented leads. Twelve is the number of resulting leads produced, not the number of electrodes attached to the patient. Four electrodes would not be enough to also generate the six chest leads that are part of a standard 12-lead study. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 26, PDF p. 5. Cross-reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, PDF p. 4.

12. Question 11

    When the TP segment is hard to identify because the T and P waves overlap during a tachycardia, what should be used instead to help determine the ECG baseline?

    • The middle of the ST segment itself
    • Clinical judgment together with the PR intervalCorrect
    • The peak of the T wave alone
    • The peak of the QRS complex alone

    Why: Because the baseline is normally measured from TP segment to TP segment, but rapid heart rates can cause the T and P waves to overlap and obscure that segment, the text advises falling back on best judgment together with the PR interval to help locate the baseline instead. Using only the peak of the QRS complex does not substitute for identifying the baseline, since the QRS peak is not on the baseline at all. The middle of the ST segment is exactly the feature being measured against the baseline, so it cannot be used to define that same baseline. The peak of the T wave, like the QRS peak, is a deflection away from the baseline, not a stand-in for locating it. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 14, PDF p. 445.

13. Question 12

    A patient with a permanent pacemaker asks how often the device is likely to need replacement. Based on typical device life, what is the best answer?

    • The whole pulse generator is replaced when its battery wears out, after several yearsCorrect
    • The pulse generator is replaced only if the patient develops a skin allergy
    • The pulse generator never needs to be replaced once implanted
    • The pulse generator is replaced every few months as routine maintenance

    Why: Because the generator's battery has a finite life, the whole unit is swapped out after several years of service, rather than on a short fixed schedule. A device is not maintained every few months, and describing it as never needing replacement ignores that its battery is a consumable part. A skin allergy is not what drives generator replacement; battery depletion is. Primary reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, Chapter 16, PDF p. 7.

14. Question 13

    An EKG technician is about to perform a procedure with a risk of contact with a patient's blood or body fluids. What do OSHA's bloodborne pathogens requirements call for here?

    • No special equipment for a routine, non-surgical procedure
    • Wearing personal protective equipment for the procedureCorrect
    • Wearing PPE only when the patient specifically requests it
    • Wearing PPE only during a surgical operating-room procedure

    Why: Any time a task carries a chance of contact with a patient's blood or other body fluids, the person performing it needs to be wearing PPE, and that obligation does not depend on the patient asking for it. The requirement is not limited to surgical operating-room work, and it does apply to an everyday, routine procedure where that same exposure risk is present. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 4, PDF p. 7.

15. Question 14

    STEMI is typically caused by transmural ischemia and requires what kind of intervention?

    • Observation only, with no active intervention
    • Oral antibiotics to treat the underlying cause
    • Routine outpatient follow-up within a few weeks
    • Emergent reperfusion to salvage myocardial tissueCorrect

    Why: STEMI is described as typically resulting from transmural ischemia or infarction associated with a coronary occlusion, and affected patients require emergent reperfusion therapy to save as much heart muscle as possible. Routine outpatient follow-up in a few weeks does not match the urgency described for a coronary occlusion causing transmural damage. Pure observation without intervention contradicts the described need for emergent treatment. Oral antibiotics treat infection, not an ischemic coronary occlusion, and are not the intervention described here. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 15, PDF p. 562.

16. Question 15

    An ECG tracing shows a wandering baseline that drifts up and down. What is the most likely cause?

    • The machine's calibration mark printing at the end of the tracing
    • Other electrical equipment operating nearby
    • Poor skin preparation or poor electrode attachmentCorrect
    • The ECG paper being loaded correctly into the machine

    Why: A wandering baseline is typically traced back to poor skin preparation or an electrode that is not making solid contact with the skin, both of which allow the recorded line to drift. Nearby electrical equipment causes alternating current interference, a different artifact seen as regular fine spikes rather than a drifting line. Correctly loaded paper is a normal condition and would not cause the baseline itself to drift. A properly printed calibration mark is a routine part of the tracing and is not identified as a cause of baseline artifact. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 26, PDF p. 9.

17. Question 16

    How should a technician handle soiled linen from a patient's room?

    • Sort clean and soiled linen together to save time
    • Leave it on the floor until housekeeping arrives later
    • Shake it out in the hallway to remove loose debris first
    • Bag it inside the patient's room and treat all linen as infectiousCorrect

    Why: Soiled linen should be placed in a laundry bag while still within the patient's room, and all linen should be treated as though it is infectious regardless of how it appears. Shaking linen out in the hallway can release particles into a shared area and is not the described handling method. Sorting clean and soiled linen together disregards the instruction to treat all linen as potentially infectious and risks cross-contaminating clean items. Leaving soiled linen on the floor is not the described disposal method and creates an unnecessary contamination and fall hazard. Primary reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, Chapter 9, PDF p. 7.

18. Question 17

    Which of the 4 Ds of negligence refers to a healthcare professional's legal obligation to the patient?

    • Damage, the legally recognized injury the patient suffers
    • Direct cause, the link between the breach and the injury
    • Dereliction, the breach of that legal obligation
    • Duty of care, the legal obligation owed to the patientCorrect

    Why: Duty of care is the first of the 4 Ds of negligence and refers to the healthcare professional's legal obligation to the patient. Dereliction instead refers to breaching that duty, damage refers to the injury the patient suffers as a result, and direct cause refers to the breach actually causing that injury, each a separate element that must be proven. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 3, PDF p. 5.

19. Question 18

    Where is the atrioventricular (AV) node located?

    • Right atrial wall, beside the coronary sinus opening and tricuspid septal leafletCorrect
    • Tip of the interventricular septum, beside the Purkinje network
    • Left atrial wall, close to the mitral valve annulus
    • Left ventricular free wall, just beneath the endocardium

    Why: The AV node sits in the right atrium beside the opening of the coronary sinus and next to the septal leaflet of the tricuspid valve, positioning it to receive the impulse from the atria before passing it on toward the ventricles. A location in the left ventricular free wall or beneath the endocardium instead describes distal Purkinje tissue, not the AV node. The left atrial wall and the apex of the septum are also not where the AV node sits. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 1, PDF p. 49.

20. Question 19

    The R-R interval is measured between two consecutive QRS complexes. What is it primarily used to evaluate?

    • The width of the ST segment
    • The height of the P wave
    • Rhythm regularityCorrect
    • The direction of the T wave

    Why: By repeatedly measuring the distance between one QRS complex and the next, a consistent R-R interval from beat to beat confirms a regular rhythm, while a changing distance flags irregularity. P wave height is a separate voltage measurement unrelated to the spacing between QRS complexes. The width of the ST segment and the direction of the T wave are likewise separate features of an individual beat, not something the R-R interval, which spans two consecutive beats, is used to assess. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 6, PDF p. 117.

21. Question 20

    Just before starting the ECG recording, what should the technician do after the lead wires are attached?

    • Turn off the machine's power to reset the tracing speed
    • Ask the patient to stand up and walk in place for a minute
    • Enter the patient's information and recheck the electrodes and lead wiresCorrect
    • Remove the electrodes and reapply them in a different order

    Why: After the lead wires are connected, the technician enters the patient's information into the machine and rechecks each electrode and wire before starting the recording, which helps catch a loose connection before it shows up as a problem on the tracing. Removing and reapplying the electrodes in a different order is unnecessary once they are correctly placed. Powering the machine off at this point would undo the setup rather than prepare for the recording. Having the patient walk in place works against the instruction to remain still for the tracing. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 26, PDF p. 8.

22. Question 21

    After using a contaminated needle in a healthcare facility, which action does infection-control policy specifically prohibit?

    • Placing it immediately in a labeled sharps container
    • Using a puncture-resistant container for disposal
    • Recapping the needle by handCorrect
    • Disposing of it without delay after use

    Why: Policy explicitly forbids recapping a used needle by hand, along with bending, breaking, or resheathing it, because those actions create a high risk of an accidental needlestick. Placing a used sharp immediately into a labeled container is the required disposal step, not a forbidden one. Disposing of a sharp without delay after use is likewise the recommended practice rather than a prohibited action. Using a puncture-resistant container is a required safety feature of proper sharps disposal, not something policy forbids. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 19, PDF p. 10.

23. Question 22

    Which age-related vision change specifically increases an older adult's fall risk when walking through a dimly lit hallway?

    • Increased sensitivity to bright daylight only
    • Decreased visual acuity in dim lightCorrect
    • Improved night vision compared to younger adults
    • Enhanced depth perception with age

    Why: Older adults commonly experience decreased visual acuity in dim light, which makes it harder to see obstacles in a dimly lit hallway and increases fall risk. Older adults do not have improved night vision compared to younger adults; visual acuity in low light typically declines with age instead. Increased glare sensitivity in older adults applies broadly to bright light sources, not only to daylight, and does not itself describe a dim-hallway hazard. Depth perception in older adults tends to become altered or reduced, not enhanced, which is itself a separate fall-risk factor. Primary reference: Fundamental Concepts and Skills for the Patient Care Technician, 2nd Edition, Chapter 11, PDF p. 2.

24. Question 23

    In a normally functioning, resting myocardial cell, how do potassium and sodium concentrations compare across the cell membrane?

    • Sodium concentration is higher inside the cell, while potassium concentration is higher outside
    • Both potassium and sodium concentrations are equal on both sides of the membrane
    • Potassium concentration is higher inside the cell, while sodium concentration is higher outsideCorrect
    • Potassium and sodium are both higher outside the cell than inside

    Why: A living, resting myocyte keeps more potassium on the inside of its membrane and more sodium on the outside, and this uneven distribution is exactly what creates the cell's resting electrical potential. If the concentrations were equal on both sides, as in a dead cell, no meaningful electrical potential could exist. The reversed pattern, with more sodium inside than outside, does not describe the resting state. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 2, PDF p. 61.

25. Question 24

    Which ethical principle is summarized by the phrase "to do no harm"?

    • NonmaleficenceCorrect
    • Beneficence
    • Justice
    • Autonomy

    Why: Nonmaleficence is the principle that summarizes the obligation to do no harm to a patient. Beneficence instead means acting for the good or benefit of others, autonomy means respecting a person's freedom to decide, and justice means treating patients fairly, each describing a different ethical obligation than avoiding harm. Primary reference: Kinn's The Medical Assistant, 15th Edition, Chapter 5, PDF p. 4.

26. Question 25

    After leaving the AV node, in what order does the impulse travel before producing the QRS complex?

    • Directly from the AV node to the Purkinje fibers, bypassing the bundle of His
    • Bundle branches, then the Purkinje fibers, then the bundle of His
    • Bundle of His, then the left and right bundle branches, then the Purkinje fibersCorrect
    • Purkinje fibers, then the bundle of His, then the bundle branches

    Why: The described conduction sequence after the AV node goes from the bundle of His, down into the left and right bundle branches, and finally out to the individual Purkinje fibers, which then activate the ventricular muscle to produce the QRS complex on the tracing. Placing the Purkinje fibers before the bundle of His reverses the actual sequence described. Placing the bundle branches ahead of the bundle of His likewise gets the order backward, since the bundle of His comes first. The pathway does not skip the bundle of His; it is described as the very next structure activated after the AV node. Primary reference: 12-Lead ECG: The Art of Interpretation, 2nd Edition, Chapter 10, PDF p. 218.