4–6 Week Preparation Guide

Certifying Body: National Healthcareer Association (NHA)

Exam Code: CET

Format: 100 scored questions + 10 pretest questions (110 total), 2 hours

Passing Score: Scaled score of 390 (on a 200–500 scale)

Prerequisites: High school diploma/GED + completion of training program OR 1 year supervised work experience

Cost: ~$117 (as of 2024; verify at nhanow.com)

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About the Exam

The CET validates competency in electrocardiography — performing EKGs, recognizing cardiac rhythms, and understanding cardiovascular anatomy. EKG technicians work in hospitals, clinics, cardiac rehabilitation centers, and diagnostic laboratories.

Exam Content Domains (per NHA Content Outline)

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Week-by-Week Study Plan

Week 1: Cardiac Anatomy & Physiology

Goal: Build strong cardiovascular foundation

Key Topics:

• •Heart anatomy: 4 chambers (RA, LA, RV, LV), 4 valves (tricuspid, pulmonary, mitral/aortic), septum, pericardium
• •Coronary circulation: LAD (left anterior descending), LCx (left circumflex), RCA (right coronary artery)
• •Cardiac cycle: systole (contraction) and diastole (relaxation)
• •Stroke volume, cardiac output (CO = HR × SV), ejection fraction
• •Electrical conduction system:
• •SA node (60–100 bpm) — “pacemaker of the heart”
• •AV node (40–60 bpm backup)
• •Bundle of His → right and left bundle branches
• •Purkinje fibers (20–40 bpm backup)
• •Autonomic nervous system: sympathetic (increases HR) vs. parasympathetic/vagus (decreases HR)
• •Cardiac action potential phases

Daily Schedule (2–3 hours/day):

• •Days 1–2: Heart anatomy — chambers, valves, blood flow pathway (systemic and pulmonary circulation)
• •Days 3–4: Coronary circulation and cardiac cycle
• •Days 5–6: Conduction system — pathway, timing, backup pacemakers
• •Day 7: Review & practice quiz (40 questions)

Mnemonic — Blood Flow:

IVC/SVC → RA → Tricuspid → RV → Pulmonary valve → Pulmonary arteries → Lungs → Pulmonary veins → LA → Mitral → LV → Aortic valve → Aorta → Body

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Week 2: EKG Fundamentals & Lead Placement

Goal: Master EKG acquisition skills

Key Topics:

• •EKG paper: speed (25 mm/s), small boxes (0.04s, 1mm), large boxes (0.20s, 5mm)
• •Standardization: 1 mV = 10mm (2 large boxes tall)
• •12-lead EKG:
• •Bipolar limb leads: I, II, III (Einthoven’s triangle)
• •Augmented limb leads: aVR, aVL, aVF
• •Precordial (chest) leads: V1–V6
• •Electrode placement:
• •RA: right arm (below clavicle, near right shoulder)
• •LA: left arm (below clavicle, near left shoulder)
• •RL: right leg (lower abdomen, below rib cage)
• •LL: left leg (lower abdomen, below rib cage on left)
• •V1: 4th intercostal space, right of sternum
• •V2: 4th intercostal space, left of sternum
• •V4: 5th intercostal space, mid-clavicular line
• •V3: halfway between V2 and V4
• •V5: anterior axillary line, same horizontal as V4
• •V6: mid-axillary line, same horizontal as V4
• •Skin preparation: cleaning, shaving, electrode gel/pad
• •Artifact types and troubleshooting: muscle tremor, 60Hz interference, wandering baseline, poor electrode contact

Daily Schedule (2–3 hours/day):

• •Days 1–2: EKG paper, calibration, measurements (intervals, segments)
• •Days 3–4: 12-lead system — lead groups, views of the heart
• •Days 5–6: Electrode placement practice (use a study partner or diagram), skin prep, artifact troubleshooting
• •Day 7: Review & practice quiz (40 questions)

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Week 3: Normal EKG Waveform & Intervals

Goal: Recognize normal; foundation for identifying abnormal

Key Topics:

• •P wave: atrial depolarization (normal: ≤0.11s duration, ≤2.5mm amplitude, upright in II)
• •PR interval: beginning of P to beginning of QRS (normal: 0.12–0.20s)
• •QRS complex: ventricular depolarization (normal: 0.06–0.10s)
• •Q wave: first downward deflection (normal: <0.04s, <1/3 R wave height)
• •R wave: first upward deflection
• •S wave: downward deflection after R
• •ST segment: end of QRS to beginning of T (normal: isoelectric, ±1mm)
• •T wave: ventricular repolarization (normal: upright in most leads, <10mm amplitude)
• •QT interval: beginning of QRS to end of T (normal: 0.36–0.44s; varies with HR)
• •U wave: sometimes seen, may represent repolarization of Purkinje fibers
• •Heart rate calculation:
• •Regular: 300 ÷ (# large boxes between R-R)
• •6-second strip method: count R waves × 10
• •Rhythm analysis systematic approach: Rate, Rhythm (regular?), P waves, PR interval, QRS width

Daily Schedule (2–3 hours/day):

• •Days 1–3: Waveform identification — practice measuring each component on sample strips
• •Days 4–5: Interval/segment measurement and significance; rate calculation methods
• •Days 6: Practice systematic rhythm analysis on 20+ strips
• •Day 7: Review & practice quiz (40 questions)

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Week 4: Rhythm Interpretation — Sinus & Atrial Rhythms

Goal: Identify common sinus and atrial dysrhythmias

Key Topics — Sinus Rhythms:

• •Normal Sinus Rhythm (NSR): Rate 60–100, regular, P before every QRS, PR 0.12–0.20, QRS <0.12
• •Sinus Bradycardia: Rate <60, otherwise normal
• •Sinus Tachycardia: Rate 100–150, otherwise normal
• •Sinus Arrhythmia: Rate varies with respiration (phasic), otherwise normal
• •Sinus Arrest/Pause: SA node fails to fire; missing PQRST complex(es)

Key Topics — Atrial Rhythms:

• •Premature Atrial Complex (PAC): early P wave (may differ in shape), normal QRS, compensatory or non-compensatory pause
• •Atrial Tachycardia: rate 150–250, regular, P waves may be abnormal
• •Atrial Flutter: sawtooth F waves, rate typically 150 (2:1 block) or variable, regular or irregular
• •Atrial Fibrillation (AFib): irregularly irregular, no discernible P waves, fibrillatory baseline, rate varies (controlled <100, uncontrolled >100)
• •Supraventricular Tachycardia (SVT): rapid regular rhythm, rate 150–250+, narrow QRS, P waves often hidden

Daily Schedule (2–3 hours/day):

• •Days 1–2: Sinus rhythms — identification, causes, clinical significance
• •Days 3–4: Atrial rhythms — PACs, flutter, fibrillation, SVT
• •Days 5–6: Practice 30+ rhythm strips; flashcard drill
• •Day 7: Review & practice quiz (40 questions)

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Week 5: Rhythm Interpretation — Ventricular Rhythms, Heart Blocks & Professional Skills

Goal: Complete rhythm interpretation knowledge; cover professionalism

Key Topics — Junctional Rhythms:

• •Junctional rhythm: rate 40–60, regular, inverted/absent P waves or P after QRS, narrow QRS
• •Accelerated Junctional: rate 60–100
• •Premature Junctional Complex (PJC): early beat with junctional features

Key Topics — Ventricular Rhythms:

• •Premature Ventricular Complex (PVC): wide QRS (>0.12s), no preceding P wave, compensatory pause, T wave opposite QRS direction
• •Ventricular Tachycardia (V-tach): 3+ consecutive PVCs, rate 100–250, wide QRS, regular
• •Ventricular Fibrillation (V-fib): chaotic, no identifiable waveforms, no pulse — LIFE-THREATENING
• •Asystole: flat line (confirm in 2 leads) — LIFE-THREATENING
• •Ventricular Escape rhythm: rate 20–40, wide QRS, regular

Key Topics — Heart Blocks:

• •1st Degree AV Block: PR >0.20s, constant, every P followed by QRS
• •2nd Degree Type I (Wenckebach/Mobitz I): PR progressively lengthens until QRS is dropped
• •2nd Degree Type II (Mobitz II): PR constant, sudden non-conducted P wave(s)
• •3rd Degree (Complete Heart Block): no relationship between P waves and QRS; atrial and ventricular rates independent

Key Topics — Professional Skills:

• •Patient identification and communication
• •HIPAA compliance
• •Emergency procedures: recognize V-fib/V-tach → notify nurse/MD immediately
• •Scope of practice
• •Quality assurance and documentation

Daily Schedule (2–3 hours/day):

• •Days 1–2: Junctional and ventricular rhythms
• •Days 3–4: Heart blocks — all degrees; practice differentiation
• •Days 5: Professional skills, communication, legal/ethical considerations
• •Days 6: Comprehensive rhythm strip practice (40+ strips)
• •Day 7: Review & practice quiz (40 questions)

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Week 6: Comprehensive Review & Practice Exams

Goal: Achieve test readiness; build confidence

Daily Schedule (1.5–2.5 hours/day):

• •Days 1–2: Full-length practice exam #1; review every incorrect answer in detail
• •Days 3: Targeted review of weakest domain based on practice exam results
• •Day 4: Full-length practice exam #2; review
• •Day 5: Rhythm strip speed drills — identify 50+ strips as quickly as possible
• •Day 6: Light review of mnemonics, normal values, and electrode placement
• •Day 7: REST — no studying. Arrive rested and confident.

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Test-Taking Tips

1. Systematic approach for every strip: Rate → Rhythm (regular?) → P waves → PR interval → QRS width → Interpretation
2. Learn the “looks like” patterns — flutter sawtooth, fib baseline chaos, V-tach wide and fast
3. Wide QRS = ventricular origin until proven otherwise
4. Narrow QRS = supraventricular origin (above the ventricles)
5. Irregularly irregular = think atrial fibrillation first
6. If no pulse is mentioned with a shockable rhythm → defibrillation/CPR
7. Remember backup pacemaker rates: SA (60–100), AV (40–60), Ventricular (20–40)
8. Measure from the beginning of one wave to the beginning of the next for intervals
9. Don’t confuse artifact with rhythm — look for consistent P-QRS-T pattern
10. Know when to escalate — V-fib, V-tach (pulseless), asystole → immediate emergency action

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High-Yield Values to Memorize

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Recommended Resources

Primary:

• •NHA CET Candidate Handbook and Content Outline (free at nhanow.com)
• •NHA CET Practice Exams (available through nhanow.com)
• •EKG Plain and Simple — Karen Ellis (Pearson)
• •ECG Made Easy — John R. Hampton

Supplementary:

• •Rapid Interpretation of EKG’s — Dale Dubin (classic, highly visual)
• •The 12-Lead ECG — Tomas B. Garcia
• •SkillStat EKG simulator (skillstat.com — free practice)

Free Resources:

• •Life in the Fast Lane (LITFL) ECG Library — litfl.com/ecg-library
• •Practical Clinical Skills EKG practice — practicalclinicalskills.com
• •Khan Academy — Heart and Circulation videos
• •YouTube: EKG interpretation playlists by RegisteredNurseRN and Simple Nursing

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Sources

• •National Healthcareer Association (NHA) — nhanow.com
• •NHA CET Certification Exam Content Outline (2024)
• •American Heart Association — ACLS Guidelines
• •Garcia, T.B. 12-Lead ECG: The Art of Interpretation
• •Hampton, J.R. The ECG Made Easy, 9th Edition