EKG Practice Test 2026: Free CCMA-Style EKG Questions

Where do the EKG chest leads go?

V1 at the fourth intercostal space right of the sternum, V2 the same space on the left, V4 at the fifth space on the midclavicular line, V3 midway between V2 and V4, and V5 and V6 level with V4 at the anterior and midaxillary lines.

Chest lead placement for a 12-lead EKG
Lead	Placement
V1	Fourth intercostal space, right sternal border
V2	Fourth intercostal space, left sternal border
V3	Midway between V2 and V4
V4	Fifth intercostal space, left midclavicular line
V5	Left anterior axillary line, level with V4
V6	Left midaxillary line, level with V4 and V5

A 12-lead EKG uses 10 electrodes: six on the chest and four on the limbs (right arm, left arm, right leg, left leg). The 12 leads are views computed from them: the limb leads I, II and III, the augmented leads aVR, aVL and aVF, and the chest leads V1 to V6.

To find the fourth intercostal space, feel the sternal angle, slide to the second rib beside it, and count down two spaces. On a patient with breasts, place V3 to V6 under the breast tissue, at the correct landmarks.

CCMA-style question 1 · Lead placement
Where is the V4 electrode placed?
1. AFourth intercostal space, left sternal border
2. BFifth intercostal space, left midclavicular line
3. CLeft midaxillary line, level with V5
4. DFifth intercostal space, right sternal border
Worked answer
B: Fifth intercostal space, left midclavicular line. V4 goes in the fifth intercostal space at the left midclavicular line. V2 is the fourth space at the left sternal border, and V6 the midaxillary line level with V4 and V5.
1. V1 and V2: fourth intercostal space, either side of the sternum.
2. V4: fifth intercostal space, midclavicular line.
3. V3 sits midway between V2 and V4; V5 and V6 continue level with V4.
The trap: Putting V4 in the fourth space. V1 and V2 are in the fourth; V4 drops to the fifth.

How do you read EKG paper?

At the standard 25 mm per second, each small box is 0.04 second and each large box (5 small boxes) is 0.20 second; standard calibration is 10 mm per mV. The P wave is atrial depolarization, the QRS ventricular depolarization, and the T wave ventricular repolarization.

Normal intervals in an adult
Interval	Normal	In small boxes
PR interval	0.12 to 0.20 second	3 to 5
QRS complex	Under 0.12 second (usually 0.06 to 0.10)	Under 3

Interval questions are multiplication: count the small boxes and multiply by 0.04. A PR interval of 6 small boxes is 0.24 second, longer than normal, which the medical assistant reports; the provider interprets it.

How do you calculate heart rate from an EKG?

Three ways: 300 divided by the large boxes between two R waves, 1,500 divided by the small boxes, or the QRS complexes in a 6-second strip times 10. The 6-second method is the one to use when the rhythm is irregular.

The three rate methods
Method	How	Example
300 method	300 ÷ large boxes between R waves	4 large boxes: 300 ÷ 4 = 75
1,500 method	1,500 ÷ small boxes between R waves	20 small boxes: 1,500 ÷ 20 = 75
6-second method	QRS complexes in 6 seconds × 10	8 complexes: 8 × 10 = 80

CCMA-style question 1 · Heart rate
A 6-second rhythm strip shows 7 QRS complexes. What is the approximate heart rate?
1. A42 beats per minute
2. B60 beats per minute
3. C70 beats per minute
4. D76 beats per minute
Worked answer
C: 70 beats per minute. The six-second method multiplies the QRS complexes in 6 seconds by 10: 7 × 10 = 70 beats per minute. It works for regular and irregular rhythms.
1. Count the QRS complexes in 6 seconds: 7.
2. Multiply by 10 (6 seconds × 10 = 1 minute).
3. 7 × 10 = 70.
The trap: Multiplying by 6. The strip is 6 seconds long, so multiply by 10 to reach 60 seconds.

Four EKG drills, new strips each time

Eight full 150-question mocks and four drills per area, with box counts and rates generated fresh in every set.

The CCMA Pass Pack gives you 8 full mocks on the real clock, 28 drills of 12 questions for the sections that cost you points, and a predictor that turns your mocks into the odds of reaching your target. One payment, no subscription, and your free score stays free.

Prep courses for these tests usually cost $19 to $129. The CCMA Pass Pack is US$39 (£29), once.

See the CCMA Pass Pack How our questions are built and checked

8
timed mocks: 28
topic drills: 1
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Which EKG rhythms and artifacts are on the CCMA exam?

The basic rhythms a medical assistant must recognize and report: normal sinus rhythm (60 to 100), sinus bradycardia (under 60), sinus tachycardia (over 100), atrial fibrillation and flutter, and the life-threatening ventricular tachycardia and fibrillation. And the four artifacts and their fixes.

Artifacts and their fixes
Artifact	Looks like	Fix
Somatic tremor	Jagged, irregular baseline	Warm and relax the patient; support the limbs
Wandering baseline	Baseline drifts up and down	Clean and dry the skin (lotion, sweat), fresh electrodes, check the cables are not pulling
60-cycle (AC) interference	Thick, even, regular fuzz	Unplug or move nearby equipment, check grounding, keep wires off cords
Interrupted baseline	Flat gaps or a broken line	Check for a loose electrode or broken lead wire

If a patient becomes unresponsive and the tracing shows a chaotic line with no QRS complexes, that is not an artifact question: call for help and start CPR. On the exam, a dangerous rhythm in an alert patient means stay with the patient and get the provider now.

CCMA-style question 1 · Artifacts
A tracing has a thick, even, fuzzy baseline of tiny regular spikes in every lead. What is the most likely fix?
1. AWarm the patient with a blanket
2. BMove or unplug nearby electrical equipment and check the machine's grounding
3. CReplace the patient's gown
4. DRaise the paper speed to 50 mm per second
Worked answer
B: Move or unplug nearby electrical equipment and check the machine's grounding. Even, regular spikes are 60-cycle (AC) interference from nearby electrical equipment or poor grounding. Unplug or move other devices, keep the lead wires from crossing cords, and check the machine is grounded.
1. Regular, uniform spikes point to electrical interference.
2. Shivering gives irregular, jagged artifact instead.
3. So remove the electrical source and check grounding.
The trap: Warming the patient. That fixes somatic tremor, which looks irregular, not evenly spiked.

What do you need to know about Holter monitors and stress tests?

A Holter monitor records continuously, usually for 24 to 48 hours, while the patient keeps a diary of activities and symptoms and does not shower; an event monitor records when the patient presses the button; a stress test is supervised by the provider and stopped at once for chest pain.

Holter instructions are a favorite: keep a timed diary of activities and symptoms, carry on normal activity, avoid getting the monitor wet, and keep away from things that interfere such as electric blankets. An event monitor suits symptoms that come every few days or weeks.

Practise the whole area in the free drill above, then take the full CCMA practice test. The rest of clinical care is on the CCMA clinical patient care practice test, and more worked questions are on CCMA sample questions.

Frequently asked questions

How many electrodes are on a 12-lead EKG?

10: six on the chest and four on the limbs.

Where does V1 go?

The fourth intercostal space at the right sternal border.

How long is a small box on EKG paper?

0.04 second at the standard 25 mm per second. A large box is 0.20 second.

Is this the same as the EKG technician exam?

No. This covers EKG as it appears on the CCMA exam. NHA's Certified EKG Technician (CET) exam is separate and covers more.

Are these real CCMA questions?

No. They are original CCMA-style questions. LifeScore is not affiliated with NHA.

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