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HealthStream Telemetry Version 1 Questions and
Answers – Complete Study Guide and Exam Material
DOMAIN I: LEAD PLACEMENT & MONITORING PRINCIPLES (Questions 1-6)
Q1: A patient's telemetry tracing shows a wandering baseline. Which of the following is the
MOST likely cause?
A. Patient movement or muscle tremor
B. Electrical interference (60-cycle interference)
C. Respiratory movement pulling electrodes
D. Lead wire disconnection
Correct Answer: C (Respiratory movement pulling electrodes)
Rationale: Wandering baseline presents as a slow undulation of the tracing and is typically
caused by chest expansion during respiration pulling on electrodes, or poor electrode contact.
Muscle tremor (A) causes irregular, jagged artifact. Electrical interference (B) causes a thick,
fuzzy baseline. Lead disconnection (D) results in a flatline or "leads off" message.
Q2: Proper skin preparation for electrode placement includes which of the following actions?
A. Cleaning the skin with betadine solution
B. Abrading the skin gently and cleaning with alcohol or soap/water
C. Shaving the chest hair with a razor to ensure direct contact
D. Applying electrodes over the pectoral muscles for better adhesion
Correct Answer: B (Abrading the skin gently and cleaning with alcohol or soap/water)
Rationale: Proper skin prep involves cleaning the site (soap/water or alcohol) to remove oils,
gently abrading the skin to remove dead cells, and drying thoroughly. Betadine (A) dries the skin
and is not recommended. Shaving (C) can cause micro-abrasions leading to artifact and
irritation; clipping is preferred. Electrodes should be placed over bony areas (D), not large
muscles, to minimize artifact.
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Q3: When applying a 5-lead telemetry system, the nurse places the brown (chest) lead in the
4th intercostal space at the right sternal border. Which lead is being monitored?
A. V1
B. V6
C. MCL1
D. II
Correct Answer: A (V1)
Rationale: The V1 position is located in the 4th intercostal space at the right sternal border. This
lead is excellent for visualizing P waves and differentiating ventricular ectopy (morphology). V6
is at the midaxillary line. MCL1 is a modified lead configuration.
Q4: The nurse notes that a patient's telemetry battery is low. What is the correct nursing
intervention?
A. Turn off the monitor to save the remaining battery life
B. Wait for the "low battery" alarm to sound before changing it
C. Replace the battery immediately or plug the unit into the charger
D. Continue monitoring until the end of the shift for convenience
Correct Answer: C (Replace the battery immediately or plug the unit into the charger)
Rationale: Telemetry units require functional batteries to monitor the patient continuously. A
low battery can lead to loss of signal or transmission failure. The nurse should replace the
battery proactively or connect to AC power to ensure continuous monitoring. Never turn off the
monitor (A) or wait for failure (B).
Q5: Which of the following is a critical safety principle regarding cardiac monitor alarms?
A. Turn off alarms if the patient is being directly observed by a nurse
B. Set alarm limits strictly according to the manufacturer's default settings
C. Silence alarms immediately if they are interfering with patient rest
D. Set alarm limits based on the individual patient's baseline condition
, 3
Correct Answer: D (Set alarm limits based on the individual patient's baseline condition)
Rationale: Alarms must be individualized to the patient's condition (e.g., a bradycardia patient
may need a lower heart rate limit). Default settings (B) may not be appropriate. Alarms should
never be turned off (A) or silenced indefinitely (C) as this compromises patient safety and
prevents notification of life-threatening changes.
Q6: To prevent artifact caused by lead wire tension, the nurse should:
A. Clip the lead wires to the patient's bed rail
B. Tape the lead wires directly to the patient's skin
C. Clip the lead wires to the patient's gown
D. Allow the wires to hang freely to relieve tension
Correct Answer: C (Clip the lead wires to the patient's gown)
Rationale: Clipping wires to the gown creates a "strain relief" loop, preventing tension on the
electrode when the patient moves. Clipping to the bed rail (A) causes the wires to pull when the
bed moves or the patient shifts. Wires should not hang freely (D) as they can catch on objects.
DOMAIN II: NORMAL SINUS RHYTHM & SINUS ARRHYTHMIAS (Questions 7-12)
Q7: A patient has a heart rate of 52 bpm, regular rhythm, normal P waves before each QRS, PR
interval 0.16 sec, QRS 0.08 sec. What is the rhythm?
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Junctional rhythm
Correct Answer: B (Sinus bradycardia)
Rationale: Sinus bradycardia is defined by a rate less than 60 bpm with all other NSR criteria met
(normal P waves, regular rhythm, normal PR/QRS). NSR (A) has a rate of 60-100. Sinus
arrhythmia (C) is irregular. Junctional rhythm (D) typically has absent or inverted P waves.
HealthStream Telemetry Version 1 Questions and
Answers – Complete Study Guide and Exam Material
DOMAIN I: LEAD PLACEMENT & MONITORING PRINCIPLES (Questions 1-6)
Q1: A patient's telemetry tracing shows a wandering baseline. Which of the following is the
MOST likely cause?
A. Patient movement or muscle tremor
B. Electrical interference (60-cycle interference)
C. Respiratory movement pulling electrodes
D. Lead wire disconnection
Correct Answer: C (Respiratory movement pulling electrodes)
Rationale: Wandering baseline presents as a slow undulation of the tracing and is typically
caused by chest expansion during respiration pulling on electrodes, or poor electrode contact.
Muscle tremor (A) causes irregular, jagged artifact. Electrical interference (B) causes a thick,
fuzzy baseline. Lead disconnection (D) results in a flatline or "leads off" message.
Q2: Proper skin preparation for electrode placement includes which of the following actions?
A. Cleaning the skin with betadine solution
B. Abrading the skin gently and cleaning with alcohol or soap/water
C. Shaving the chest hair with a razor to ensure direct contact
D. Applying electrodes over the pectoral muscles for better adhesion
Correct Answer: B (Abrading the skin gently and cleaning with alcohol or soap/water)
Rationale: Proper skin prep involves cleaning the site (soap/water or alcohol) to remove oils,
gently abrading the skin to remove dead cells, and drying thoroughly. Betadine (A) dries the skin
and is not recommended. Shaving (C) can cause micro-abrasions leading to artifact and
irritation; clipping is preferred. Electrodes should be placed over bony areas (D), not large
muscles, to minimize artifact.
,2
Q3: When applying a 5-lead telemetry system, the nurse places the brown (chest) lead in the
4th intercostal space at the right sternal border. Which lead is being monitored?
A. V1
B. V6
C. MCL1
D. II
Correct Answer: A (V1)
Rationale: The V1 position is located in the 4th intercostal space at the right sternal border. This
lead is excellent for visualizing P waves and differentiating ventricular ectopy (morphology). V6
is at the midaxillary line. MCL1 is a modified lead configuration.
Q4: The nurse notes that a patient's telemetry battery is low. What is the correct nursing
intervention?
A. Turn off the monitor to save the remaining battery life
B. Wait for the "low battery" alarm to sound before changing it
C. Replace the battery immediately or plug the unit into the charger
D. Continue monitoring until the end of the shift for convenience
Correct Answer: C (Replace the battery immediately or plug the unit into the charger)
Rationale: Telemetry units require functional batteries to monitor the patient continuously. A
low battery can lead to loss of signal or transmission failure. The nurse should replace the
battery proactively or connect to AC power to ensure continuous monitoring. Never turn off the
monitor (A) or wait for failure (B).
Q5: Which of the following is a critical safety principle regarding cardiac monitor alarms?
A. Turn off alarms if the patient is being directly observed by a nurse
B. Set alarm limits strictly according to the manufacturer's default settings
C. Silence alarms immediately if they are interfering with patient rest
D. Set alarm limits based on the individual patient's baseline condition
, 3
Correct Answer: D (Set alarm limits based on the individual patient's baseline condition)
Rationale: Alarms must be individualized to the patient's condition (e.g., a bradycardia patient
may need a lower heart rate limit). Default settings (B) may not be appropriate. Alarms should
never be turned off (A) or silenced indefinitely (C) as this compromises patient safety and
prevents notification of life-threatening changes.
Q6: To prevent artifact caused by lead wire tension, the nurse should:
A. Clip the lead wires to the patient's bed rail
B. Tape the lead wires directly to the patient's skin
C. Clip the lead wires to the patient's gown
D. Allow the wires to hang freely to relieve tension
Correct Answer: C (Clip the lead wires to the patient's gown)
Rationale: Clipping wires to the gown creates a "strain relief" loop, preventing tension on the
electrode when the patient moves. Clipping to the bed rail (A) causes the wires to pull when the
bed moves or the patient shifts. Wires should not hang freely (D) as they can catch on objects.
DOMAIN II: NORMAL SINUS RHYTHM & SINUS ARRHYTHMIAS (Questions 7-12)
Q7: A patient has a heart rate of 52 bpm, regular rhythm, normal P waves before each QRS, PR
interval 0.16 sec, QRS 0.08 sec. What is the rhythm?
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Junctional rhythm
Correct Answer: B (Sinus bradycardia)
Rationale: Sinus bradycardia is defined by a rate less than 60 bpm with all other NSR criteria met
(normal P waves, regular rhythm, normal PR/QRS). NSR (A) has a rate of 60-100. Sinus
arrhythmia (C) is irregular. Junctional rhythm (D) typically has absent or inverted P waves.
