Holter Monitoring and Stress Testing for EKG Techs
Updated October 27, 2026
Besides resting 12-lead EKGs, EKG technicians set up ambulatory monitors and assist with exercise stress tests. Both are part of EKG Acquisition on the NHA CET exam. Here’s what to know, followed by free practice questions. Stress testing questions on the exam follow the American Heart Association’s exercise testing standards; always follow your facility’s protocol and the supervising provider’s direction.
Holter monitoring
A Holter monitor records the heart’s rhythm continuously, usually for 24 to 48 hours, while the patient goes about normal activities.
- Skin prep matters: clean the skin, remove hair where needed and let it dry, so the electrodes stay on for the whole recording.
- Patient diary: the patient writes down activities and symptoms with the time, so the provider can match symptoms to the recording.
- Patient instructions: keep the monitor dry (no bathing or swimming unless the device allows it), keep doing normal activities, and don’t remove the electrodes.
An event monitor is worn for longer periods and records when the patient presses a button during symptoms, or automatically when it detects an abnormal rhythm.
Exercise stress testing
The patient walks on a treadmill (or uses a bike) while the heart rhythm, heart rate and blood pressure are monitored. Many tests use a protocol, such as the Bruce protocol, in which the treadmill’s speed and incline increase in stages, typically every 3 minutes.
The technician’s role usually includes preparing the skin and placing electrodes, taking baseline readings, monitoring the patient and tracing, taking blood pressures during the test, and reporting changes right away.
The test is stopped early if, for example, the patient asks to stop, has symptoms such as significant chest pain, dizziness or severe shortness of breath, or shows dangerous rhythm or blood pressure changes. The supervising provider makes these decisions, following the protocol.
Free practice questions
-
How long does a Holter monitor usually record?Answer: BA Holter monitor typically records continuously for 24 to 48 hours. Longer monitoring usually uses an event monitor.
-
Why does a patient keep a diary while wearing a Holter monitor?Answer: CThe diary lets the provider compare symptoms and activities with the heart rhythm recorded at the same time.
-
In the Bruce protocol, what changes at each stage?Answer: AThe Bruce protocol increases the treadmill's speed and incline in stages, typically every 3 minutes.
-
During a stress test, the patient reports severe chest pain. What should the technician do?Answer: DSignificant chest pain is a reason to stop a stress test. Report it to the supervising provider right away and follow the facility's protocol.
-
What instruction is usually given to a patient wearing a Holter monitor?Answer: BPatients keep the monitor dry unless the device allows otherwise and continue normal activities, so the recording shows their usual heart rhythm.
-
How is an event monitor different from a Holter monitor?Answer: AEvent monitors are worn for longer periods and record when the patient presses a button during symptoms, or automatically when they detect an abnormal rhythm.
Pass your EKG technician exam on the first try
- All 190 questions on safety and compliance, patient care, EKG acquisition and rhythm analysis
- An explanation for every answer, with the AHA recommendation, OSHA rule or guideline behind it
- Unlimited full 100-question practice exams, with each domain in its real share