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Quiz: Ambulatory Cardiac Monitoring: Holter and Event Monitors

By Nancy Kimmel, MSN, FNP / July 2, 2026

Quiz: Ambulatory Cardiac Monitoring: Holter and Event Monitors

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Question 1 of 80

1. Question

A medical assistant is educating a patient about using an event monitor. Which instruction is most critical for ensuring a successful recording?

"Press the event button whenever you feel any symptom, no matter how minor."
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"Only press the button if you are experiencing severe chest pain."
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"Wait at least 10 minutes after a symptom starts before pressing the button."
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"Press the button once a day to make sure the monitor is working."
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Question 2 of 80

2. Question

A medical assistant is preparing a patient for Holter monitor placement. Which of the following is a crucial step in this process?

Shaving the patient's entire chest
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Ensuring the patient has a full bladder
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Cleaning the electrode sites with alcohol and allowing them to dry
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Instructing the patient to avoid all physical activity
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Question 3 of 80

3. Question

A patient is being fitted for a Holter monitor. They express concern about the electrodes causing skin irritation. How should the medical assistant respond?

"The electrodes are hypoallergenic and rarely cause irritation."
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"You can remove the electrodes for a few hours each day to let your skin breathe."
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"We can apply a lotion under the electrodes to prevent irritation."
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"That's a common concern. We will use the smallest possible electrodes."
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Question 4 of 80

4. Question

A patient is scheduled for ambulatory EKG monitoring to evaluate symptoms of dizziness that occur 2-3 times a week. Which type of monitor is most appropriate for this patient?

Standard 12-lead EKG
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Holter monitor
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Event monitor
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Stress test
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Question 5 of 80

5. Question

A patient wearing a Holter monitor calls the office and says they accidentally got the monitor wet in the shower. What is the most appropriate instruction for the medical assistant to provide?

"Continue wearing the monitor; it is waterproof."
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"Remove the monitor and return it to the office immediately."
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"Use a hairdryer to dry the monitor and continue the test."
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"Note the event in your diary and continue wearing the monitor."
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Question 6 of 80

6. Question

A patient’s EKG strip from an event monitor shows a normal sinus rhythm, but the patient’s diary entry at that time notes severe palpitations. What is the most likely interpretation?

The monitor is malfunctioning.
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The patient's symptoms may not be cardiac in origin.
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The patient forgot to activate the monitor.
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The EKG electrodes were placed incorrectly.
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Question 7 of 80

7. Question

A physician orders ambulatory monitoring for a patient who fainted once last month but has had no other symptoms. Which monitor would be the most logical choice to investigate this isolated event?

A 24-hour Holter monitor
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A 48-hour Holter monitor
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A 30-day event monitor
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A 12-lead EKG in the office
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Question 8 of 80

8. Question

What is the CCMA’s responsibility after the patient returns the Holter monitor?

Interpret the EKG findings and provide a diagnosis to the patient.
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Download the data from the monitor and clean the equipment.
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Schedule the patient for a follow-up stress test.
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Bill the patient's insurance for the monitoring service.
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Question 9 of 80

9. Question

What is the primary purpose of the patient diary during Holter monitoring?

To track the patient's diet and exercise
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To correlate the patient's symptoms and activities with the EKG recording
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To record the times the monitor was turned on and off
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To document the patient's medication schedule
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Question 10 of 80

10. Question

Which of the following statements accurately describes a key difference between a Holter monitor and an event monitor?

A Holter monitor records continuously, while an event monitor only records when activated.
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An event monitor is worn for 24-48 hours, while a Holter monitor is worn for up to 30 days.
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A Holter monitor has a button for the patient to press, while an event monitor does not.
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An event monitor is used for frequent symptoms, while a Holter monitor is for infrequent symptoms.
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Question 11 of 80

11. Question

A medical assistant is explaining the function of the heart valves to a patient. Which valve prevents the backflow of blood into the left atrium?

Tricuspid valve
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Aortic valve
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Mitral valve
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Pulmonary valve
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Question 12 of 80

12. Question

A medical assistant observes that a patient’s heart rate increases from 70 bpm to 95 bpm when they seem anxious. This physiological response is primarily caused by the sympathetic nervous system stimulating which cardiac structure?

The aortic valve
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The Purkinje fibers
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The SA node
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The AV node
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Question 13 of 80

13. Question

A patient asks why a past heart attack is relevant to their new EKG. The medical assistant should explain that a prior myocardial infarction can damage the heart muscle and affect:

The size of the atria
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The thickness of the valve leaflets
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The electrical conduction pathway
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The oxygen-carrying capacity of the blood
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Question 14 of 80

14. Question

A patient’s EKG shows a heart rate of 45 bpm, a regular rhythm, but the P waves are not associated with the QRS complexes (AV dissociation). This suggests a complete failure of conduction at which structure?

SA node
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AV node
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Purkinje fibers
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Bundle branches
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Question 15 of 80

15. Question

An EKG tracing shows an abnormally wide QRS complex (>0.12 seconds). This finding suggests a delay or blockage in which part of the conduction system?

Atrial pathways
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SA node firing
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Ventricular conduction (e.g., bundle branch block)
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The T wave repolarization
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Question 16 of 80

16. Question

The brief delay of the electrical impulse at the AV node serves what crucial purpose?

To allow the ventricles to fill completely with blood
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To increase the heart rate during exercise
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To allow the atria to fill with blood from the vena cava
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To give the SA node time to repolarize before the next beat
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Question 17 of 80

17. Question

The P wave on an EKG represents the electrical activity of which part of the cardiac cycle?

Ventricular depolarization
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Ventricular repolarization
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Atrial depolarization
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Atrial repolarization
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Question 18 of 80

18. Question

What is the correct sequence of electrical conduction through the heart?

AV node, SA node, Bundle of His, Purkinje fibers
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SA node, AV node, Bundle of His, Purkinje fibers
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Bundle of His, Purkinje fibers, SA node, AV node
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SA node, Purkinje fibers, AV node, Bundle of His
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Question 19 of 80

19. Question

Which chamber of the heart has the thickest myocardium and is responsible for pumping oxygenated blood to the entire body?

Right atrium
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Right ventricle
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Left atrium
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Left ventricle
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Question 20 of 80

20. Question

Which of the following is known as the heart’s natural pacemaker?

Atrioventricular (AV) node
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Sinoatrial (SA) node
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Purkinje fibers
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Bundle of His
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Question 21 of 80

21. Question

A medical assistant identifies what appears to be ventricular tachycardia on a patient’s EKG. After alerting the provider, what should the MA be prepared to do?

Administer medication as directed.
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Assist with setting up for cardioversion or defibrillation.
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Obtain a STAT blood sample.
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Schedule the patient for a stress test.
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Question 22 of 80

22. Question

A medical assistant is reviewing an EKG strip and notes that the PR interval is consistently longer than 0.20 seconds. This finding suggests a delay in conduction through which part of the heart?

SA node
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AV node
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Bundle branches
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Purkinje fibers
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Question 23 of 80

23. Question

A medical assistant observes an EKG strip with no discernible P waves, a chaotic baseline, and an irregularly irregular rhythm. This is most characteristic of which dysrhythmia?

Atrial flutter
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Atrial fibrillation
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Ventricular tachycardia
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Normal sinus rhythm
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Question 24 of 80

24. Question

A patient with a history of frequent PVCs is scheduled for a Holter monitor. What is the purpose of this test?

To deliver a controlled electrical shock to the heart.
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To record the heart's electrical activity over a 24-48 hour period.
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To measure the heart's response to exercise.
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To create a three-dimensional image of the heart.
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Question 25 of 80

25. Question

A patient’s EKG shows a rhythm that is chaotic, with no identifiable waves, and the patient is unresponsive and pulseless. This is most likely:

Asystole
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Ventricular fibrillation
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Ventricular tachycardia
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Atrial fibrillation
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Question 26 of 80

26. Question

The “sawtooth” pattern of flutter waves between QRS complexes is a hallmark of which dysrhythmia?

Atrial fibrillation
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Supraventricular tachycardia
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Atrial flutter
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Ventricular fibrillation
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Question 27 of 80

27. Question

Which of the following EKG findings would be most consistent with normal sinus rhythm?

Heart rate of 110 bpm, regular rhythm, P wave before each QRS.
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Heart rate of 72 bpm, regular rhythm, P wave before each QRS.
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Heart rate of 50 bpm, irregular rhythm, no clear P waves.
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Heart rate of 88 bpm, regular rhythm, wide QRS complexes.
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Question 28 of 80

28. Question

Which statement best analyzes the clinical significance of frequent PVCs versus V-Tach?

Both are benign rhythms that do not require intervention.
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Frequent PVCs are always a precursor to V-Tach and indicate an impending emergency.
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V-Tach is a sustained, life-threatening rhythm, whereas frequent PVCs are isolated events that may indicate irritability but are not immediately life-threatening on their own.
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PVCs originate in the atria, while V-Tach originates in the ventricles.
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Question 29 of 80

29. Question

While performing an EKG, you notice the patient’s rhythm suddenly changes to a rapid, wide-complex rhythm at a rate of 190 bpm. The patient becomes dizzy and hypotensive. What is the most appropriate initial action?

Continue monitoring to see if the rhythm converts on its own.
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Ask the patient to cough or bear down.
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Immediately notify the licensed provider and prepare for an emergency response.
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Reposition the electrodes to ensure a clear signal.
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Question 30 of 80

30. Question

Why is a patient with chronic atrial fibrillation often prescribed an anticoagulant?

To control the heart rate.
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To prevent the formation of blood clots.
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To lower blood pressure.
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To correct the irregular rhythm.
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Question 31 of 80

31. Question

A CCMA is preparing a patient for an EKG. The patient just applied a thick layer of body lotion. The CCMA should be most concerned about which potential artifact?

AC Interference
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Somatic Tremor
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Wandering Baseline
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Interrupted Baseline
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Question 32 of 80

32. Question

A CCMA notices a thick, uniform, spiked pattern on an EKG tracing, consistent with 60-Hz interference. Which of the following is the most likely cause?

The patient is shivering from being cold.
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A nearby cell phone is turned on.
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An electrode has become detached from the patient's skin.
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The patient has a neurological condition like Parkinson's disease.
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Question 33 of 80

33. Question

A CCMA observes what appears to be atrial flutter on an EKG tracing from an elderly patient. However, the patient is calm, has a regular pulse, and denies any symptoms. Before alerting the physician, the CCMA should first consider the possibility of:

Interrupted baseline from a loose lead.
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Somatic tremor artifact mimicking atrial flutter.
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Wandering baseline due to deep breathing.
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AC interference from the examination bed.
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Question 34 of 80

34. Question

A patient with a severe cough needs an EKG. Which artifact is the CCMA most likely to encounter?

AC Interference
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Interrupted Baseline
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Somatic Tremor
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Wandering Baseline
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Question 35 of 80

35. Question

An EKG tracing appears fuzzy and unreadable. The CCMA has already provided the patient with a blanket and ensured they are still. What is a possible equipment-related cause for this artifact?

A broken lead wire.
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A poorly grounded electrical outlet.
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Tension on the electrode cables.
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A malfunctioning EKG filter.
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Question 36 of 80

36. Question

An EKG tracing shows a baseline that slowly drifts up and down. The CCMA has already confirmed the patient is breathing normally and the lead wires are not pulling. What is the best next step?

Replace the EKG machine.
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Reprep the skin and reapply the electrodes.
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Ask the patient to hold their breath.
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Cover the patient with another blanket.
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Question 37 of 80

37. Question

The mnemonic “STAMP” is used to recall common EKG artifacts. What does the ‘A’ in STAMP stand for?

Arrhythmia
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Artifact
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AC Interference
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Application
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Question 38 of 80

38. Question

To minimize the artifact caused by a patient’s involuntary tremors from Parkinson’s disease, a CCMA should:

Ask the patient to sit on their hands.
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Turn off all non-essential electrical equipment in the room.
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Ensure the skin is free of lotions or oils.
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Increase the temperature in the room.
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Question 39 of 80

39. Question

Which of the following actions is essential for preventing both wandering and interrupted baselines?

Ensuring the patient remains warm.
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Unplugging nearby electronic devices.
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Using a three-pronged outlet for the EKG machine.
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Ensuring secure connection of electrodes and lead wires.
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Question 40 of 80

40. Question

While reviewing an EKG, the CCMA sees a completely flat line on Lead II, while all other leads appear normal. What is the most probable cause?

The patient is experiencing a cardiac arrest.
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The Lead II electrode has come off.
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The entire EKG machine has malfunctioned.
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The room's power has been interrupted.
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Question 41 of 80

41. Question

A CCMA is placing limb leads and remembers the mnemonic “Smoke over Fire.” This refers to the placement of which two leads?

RA and LA
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RA and RL
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LA and LL
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RL and LL
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Question 42 of 80

42. Question

A medical assistant is preparing to perform a 12-lead EKG. How many electrodes will they need to place on the patient?

6
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10
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12
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15
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Question 43 of 80

43. Question

A patient’s EKG tracing shows significant artifact, making the waveform difficult to read. The patient is calm and still. Which of the following is the most likely cause?

Incorrect lead placement
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Patient talking during the procedure
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Poor electrode-to-skin contact
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A true cardiac arrhythmia
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Question 44 of 80

44. Question

A physician suspects a patient may have had a posterior myocardial infarction. Which of the following would be the most likely modification to the standard 12-lead EKG?

Placing leads V7-V9 on the patient's back.
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Moving the limb leads to the torso.
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Using only the precordial leads.
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Reversing the polarity of the limb leads.
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Question 45 of 80

45. Question

Einthoven’s Triangle is formed by which group of leads?

V1, V2, V3
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aVR, aVL, aVF
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I, II, III
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V4, V5, V6
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Question 46 of 80

46. Question

The augmented unipolar limb leads are:

I, II, and III
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V1, V2, and V3
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aVR, aVL, and aVF
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V4, V5, and V6
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Question 47 of 80

47. Question

What is the primary purpose of using a specific, standardized placement for EKG electrodes?

To ensure the patient is comfortable during the procedure.
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To allow for consistent and comparable EKG recordings across different patients and times.
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To make the procedure faster to perform.
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To reduce the amount of conductive gel needed.
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Question 48 of 80

48. Question

Which lead is considered the ground lead in a standard 12-lead EKG?

RA (White)
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LA (Black)
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LL (Red)
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RL (Green)
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Question 49 of 80

49. Question

Which of the following correctly identifies the location for placing the V4 electrode?

Fourth intercostal space, left sternal border
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Fifth intercostal space, mid-clavicular line
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Midway between V2 and V4
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Anterior axillary line, same horizontal level as V4
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Question 50 of 80

50. Question

While performing an EKG, the medical assistant notices that the V1 and V2 electrodes were accidentally swapped. What is the most appropriate action to take?

Continue the EKG and make a note of the error for the physician.
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Stop the EKG, correct the electrode placement, and restart the procedure.
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Ask the patient if they feel any discomfort.
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Reverse the lead wires on the machine to compensate for the error.
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Question 51 of 80

51. Question

A medical assistant has just completed an EKG. Before disconnecting the patient, what is the most important final check to perform?

Ask the patient if they felt any discomfort.
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Check the machine for low paper.
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Review the printed tracing for diagnostic quality and ensure all 12 leads are present.
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Wipe the lead wires with a disinfectant.
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Question 52 of 80

52. Question

A medical assistant is performing an EKG on a patient who is anxious and breathing rapidly. The tracing shows a baseline that slowly rises and falls with the patient’s respirations. This artifact is best described as:

Somatic Tremor
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AC Interference
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Wandering Baseline
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Interrupted Baseline
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Question 53 of 80

53. Question

A medical assistant is preparing to perform a 12-lead EKG. Which of the following is the correct placement for the V4 electrode?

Fourth intercostal space, left sternal border.
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Fifth intercostal space, left midclavicular line.
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Fifth intercostal space, left midaxillary line.
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Midway between V2 and V4.
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Question 54 of 80

54. Question

A patient in a crowded clinic room is having an EKG. The tracing shows a consistent, fine, 60-cycle-per-second artifact. What is the most likely cause and solution?

The patient is shivering; provide a blanket.
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An electrode is loose; re-attach it.
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The patient is talking; ask them to remain quiet.
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There is electrical interference; unplug nearby non-essential devices.
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Question 55 of 80

55. Question

A patient with a dense patch of chest hair requires an EKG. Which of the following actions should the medical assistant take to ensure good electrode contact?

Apply extra conductive gel over the hair.
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Use smaller electrodes to fit between the hair.
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Clip the hair in the areas where electrodes will be placed.
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Place the electrodes on top of the hair and press firmly.
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Question 56 of 80

56. Question

The standard speed for recording an EKG is 25 mm/second. A physician asks the medical assistant to run the EKG at 50 mm/second for a patient with a very fast heart rate. What effect will this change have on the EKG tracing?

The tracing will appear stretched out, making it easier to see individual waves.
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The tracing will appear compressed, making the heart rate seem slower.
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The amplitude of the QRS complexes will be doubled.
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The amplitude of the QRS complexes will be halved.
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Question 57 of 80

57. Question

To find the fourth intercostal space for placing the V1 and V2 electrodes, a medical assistant should first palpate which anatomical landmark?

Xiphoid process
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Clavicle
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Sternal angle (Angle of Louis)
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The 12th rib
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Question 58 of 80

58. Question

When placing precordial leads, what is the correct sequence of placement to ensure accuracy?

V1, V2, V3, V4, V5, V6
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V1, V2, V4, then V3, V5, V6
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V6, V5, V4, V3, V2, V1
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V1, V4, V6, then V2, V3, V5
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Question 59 of 80

59. Question

Which electrode is considered the “ground” in a 12-lead EKG and helps to reduce electrical interference?

RA (Right Arm)
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LA (Left Arm)
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LL (Left Leg)
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RL (Right Leg)
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Question 60 of 80

60. Question

While reviewing an EKG tracing, the medical assistant notices a thick, fuzzy, and erratic baseline, especially in the limb leads. The patient was noted to be shivering slightly. This type of interference is known as:

AC Interference
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Wandering Baseline
Correct Incorrect Correct answer

Somatic Tremor
Correct Incorrect Correct answer

Interrupted Baseline
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Correct

Incorrect
Question 61 of 80

61. Question

A 78-year-old patient with severe osteoarthritis in both knees is scheduled for a cardiac stress test to evaluate chest pain. Which type of stress test should the CCMA anticipate preparing for?

A maximal exercise stress test on a treadmill.
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A submaximal exercise stress test on a stationary bike.
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A pharmacologic stress test with dobutamine.
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A Holter monitor evaluation.
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Question 62 of 80

62. Question

A CCMA is monitoring a patient during a pharmacologic stress test using adenosine. The patient complains of feeling flushed and having a transient tightness in their chest. The CCMA should recognize these symptoms as:

A sign of a severe allergic reaction.
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An indication to immediately stop the infusion.
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A common and expected side effect of the medication.
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A symptom of a myocardial infarction.
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Question 63 of 80

63. Question

A CCMA is preparing a patient for an exercise stress test. Which of the following patient statements indicates a need for further education?

"I will need to avoid coffee and soda for at least three hours before the test."
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"I took my beta-blocker this morning to keep my heart rate steady."
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"I have my comfortable running shoes and sweatpants to wear."
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"I haven't eaten a meal for the past four hours."
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Question 64 of 80

64. Question

A patient finishes an exercise stress test and feels well. What is the most critical post-procedure instruction a CCMA should provide?

"You can leave immediately and drive yourself home."
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"You should rest in the clinic for a short observation period while we monitor your vitals."
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"You can eat a large meal right away."
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"Avoid all physical activity for the next 48 hours."
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Question 65 of 80

65. Question

A patient suddenly collapses in the waiting room. The CCMA rushes to the scene, determines the patient is unresponsive, and shouts for help. What is the absolute next step?

Apply the AED pads to the patient's chest.
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Check for a carotid pulse for no more than 10 seconds.
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Give two rescue breaths using a pocket mask.
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Begin high-quality chest compressions.
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Question 66 of 80

66. Question

Analyzing the CCMA’s role in a cardiac emergency, which of the following actions demonstrates the highest level of critical thinking and preparedness?

Knowing the location of the crash cart and AED.
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Being able to perform 100-120 chest compressions per minute.
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Recognizing subtle EKG changes that precede a major arrhythmia and alerting the provider.
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Documenting the events accurately after the code is over.
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Question 67 of 80

67. Question

During a stress test, a patient on the treadmill reports moderate chest tightness and shortness of breath. The EKG shows 2 mm of ST-segment depression. What is the CCMA’s most appropriate initial action?

Increase the treadmill speed to finish the test quickly.
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Immediately stop the test and notify the provider.
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Tell the patient to push through the discomfort.
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Check the patient's blood pressure and continue the test.
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Question 68 of 80

68. Question

The provider has ordered a stress test to be terminated once the patient reaches 85% of their maximum predicted heart rate. The patient is 50 years old. What is the target heart rate for this test?

145 bpm
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170 bpm
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128 bpm
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100 bpm
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Incorrect
Question 69 of 80

69. Question

What is the primary purpose of lightly abrading the skin before placing EKG electrodes for a stress test?

To sterilize the skin surface.
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To reduce electrical impedance.
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To help the electrodes adhere better.
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To locate the correct anatomical sites.
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Question 70 of 80

70. Question

While using an AED on a patient in cardiac arrest, the machine advises “No Shock Advised.” What is the most appropriate immediate action?

Check for a pulse again.
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Reposition the AED pads.
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Resume chest compressions immediately.
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Wait for the paramedics to arrive.
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Question 71 of 80

71. Question

A medical assistant is reviewing an EKG and is concerned about the QT interval. Why is an abnormally long QT interval a clinical concern?

It indicates a delay in atrial conduction.
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It increases the risk of dangerous ventricular arrhythmias.
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It is a sign of a previous heart attack.
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It suggests the patient's heart rate is too slow.
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Correct

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Question 72 of 80

72. Question

A medical assistant notes a QRS duration of 0.14 seconds on a patient’s EKG. This finding is considered:

Normal
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Abnormally short
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Abnormally wide
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A technical error
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Question 73 of 80

73. Question

A patient is being prepared for an EKG. He asks what the “flat line between the bumpy parts” means. The medical assistant correctly identifies the PR segment and explains that it represents:

The contraction of the ventricles
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The recovery of the atria
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The delay of the impulse at the AV node
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The heart resting between beats
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Correct

Incorrect
Question 74 of 80

74. Question

A patient’s EKG shows a positive, rounded wave before each QRS complex, measuring 0.08 seconds in duration. This wave is most likely the:

T wave
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U wave
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P wave
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R wave
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Correct

Incorrect
Question 75 of 80

75. Question

An EKG tracing shows no identifiable P waves, a rapid heart rate, and an irregularly irregular rhythm with narrow QRS complexes. While this is an arrhythmia, the absence of which specific wave points to a loss of normal atrial depolarization?

R wave
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T wave
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U wave
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P wave
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Correct

Incorrect
Question 76 of 80

76. Question

On an EKG with a standard speed of 25 mm/sec, a PR interval measures 6 small squares. What is the duration of this interval, and is it within normal limits?

0.12 seconds; Normal
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0.24 seconds; Abnormally long
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0.06 seconds; Abnormally short
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0.20 seconds; Normal
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Correct

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Question 77 of 80

77. Question

The T wave on an EKG corresponds to which of the following events in the cardiac cycle?

Atrial depolarization
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Ventricular depolarization
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Atrial repolarization
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Ventricular repolarization
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Incorrect
Question 78 of 80

78. Question

When analyzing an EKG strip, the medical assistant uses the isoelectric line as a baseline. The ST segment is considered elevated if it is:

Below the isoelectric line
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At the same level as the isoelectric line
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Above the isoelectric line
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Inverted or upside down
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Incorrect
Question 79 of 80

79. Question

Which of the following EKG components provides the most direct information about the electrical activity of the ventricular myocardium?

P wave
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PR interval
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QRS complex
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PR segment
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Correct

Incorrect
Question 80 of 80

80. Question

Which part of the EKG tracing represents the time it takes for the electrical impulse to travel from the atria to the ventricles?

QRS complex
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ST segment
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PR interval
Correct Incorrect Correct answer

QT interval
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Correct

Incorrect

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