Unit 2: EKG Equipment and Patient Preparation

• Topic 01

  EKG Machine Components — Leads, Electrodes, and Paper

  45 questions
• Topic 02

  ECG Paper Speed, Amplitude, and Grid Measurement

  45 questions
• Topic 03

  Electrode Types — Limb, Precordial, and Disposable vs Reusable

  45 questions
• Topic 04

  Skin Preparation — Shaving, Cleaning, and Abrasion Technique

  45 questions
• Topic 05

  Patient Positioning and Reassurance

  45 questions
• Topic 06

  12-Lead Electrode Placement — Standard Positions and Common Errors

  42 questions
• Topic 07

  Continuous Monitoring — Telemetry and Bedside Monitor Lead Configurations

  45 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. The Joint Commission National Patient Safety Goal NPSG.06.01.01 requires healthcare organisations to improve the safety of clinical alarm systems. How does this specifically apply to the role of EKG technicians managing telemetry?

   • A
     Technicians must install updated alarm software monthly and report installation to the Joint Commission
   • B
     Technicians must ensure alarms are appropriately set and responded to in a timely manner, avoiding both alarm fatigue from excessive nuisance alarms and delayed response to critical rhythm changes
     Correct answer
   • C
     Technicians must reset all alarm thresholds to factory defaults at the start of each shift to ensure standardisation
   • D
     Technicians are exempted from NPSG.06.01.01 because it applies only to nursing staff and biomedical engineers
   Explanation

   NPSG.06.01.01 requires that clinical alarm systems be managed to ensure timely response to critical alerts while avoiding alarm fatigue. For EKG technicians, this means appropriately setting alarm thresholds to the patient's clinical condition, responding promptly to alarms, and escalating genuine rhythm changes immediately. Over-alarming (too-sensitive thresholds) contributes to alarm fatigue; under-alarming (too-permissive thresholds) may delay detection. Key takeaway: NPSG.06.01.01 requires technicians to balance appropriate alarm threshold setting with timely response to genuine critical alarms.

2. What is Holter monitoring and how does it differ from telemetry?

   • A
     Holter monitoring is a continuous 24–48-hour outpatient recording stored on a device; telemetry provides real-time wireless transmission to hospital staff for immediate monitoring
     Correct answer
   • B
     Holter monitoring uses a 12-lead ECG recorded every hour; telemetry uses continuous 3-lead monitoring
   • C
     Holter monitoring is another name for telemetry; both terms describe the same wireless monitoring system
   • D
     Holter monitoring is used only in the ICU; telemetry is used exclusively for outpatient clinic patients
   Explanation

   A Holter monitor is worn by ambulatory outpatients for 24–48 hours (or longer) to capture intermittent arrhythmias; the data is stored and reviewed retrospectively. Telemetry provides real-time wireless ECG transmission to a central monitoring station for immediate clinical response. They are complementary but distinctly different technologies. Key takeaway: Holter = retrospective outpatient recording; telemetry = real-time hospital monitoring.

3. What OSHA standard applies to electrode handling when the patient's skin is broken, and what precautions are required?

   • A
     OSHA 29 CFR 1910.132 (Personal Protective Equipment) applies; the technician must wear a full face shield and gown when handling any ECG electrode
   • B
     OSHA Bloodborne Pathogen Standard (29 CFR 1910.1030) applies; the technician must wear gloves when handling electrodes contacting broken skin, and used electrodes must be disposed of as potentially contaminated waste
     Correct answer
   • C
     OSHA General Industry Standard (29 CFR 1910.303) applies; the main precaution is to avoid touching the metal conductive element of the electrode with bare hands
   • D
     OSHA 29 CFR 1910.1200 (Hazard Communication) applies; electrodes must be labelled with the patient's blood type before handling
   Explanation

   OSHA 29 CFR 1910.1030 (Bloodborne Pathogen Standard) requires that workers take precautions when handling items that may be contaminated with blood or other potentially infectious materials (OPIM). When applying or removing electrodes from skin that is broken, abraded, or bleeding, gloves must be worn. Used electrodes from patients with broken skin must be disposed of per biohazard waste protocols. Key takeaway: OSHA 29 CFR 1910.1030 = bloodborne pathogen standard; wear gloves when electrodes contact broken skin; dispose of contaminated electrodes as biohazard waste.