RELIAS Medical-Surgical Telemetry 2026 Updated Questions
and Answers | Complete Telemetry Nursing Competency
Study Guide with Verified Solutions, Detailed Rationales, ECG
Interpretation, Cardiac Rhythm Analysis, Dysrhythmias,
Hemodynamic Monitoring, Oxygenation, Fluid and Electrolyte
Balance, Post-Operative Care, Medication Safety, Emergency
Response and Relias Med-Surg Telemetry Exam Preparation
Question 1: What does the P wave on an ECG represent? A. Atrial depolarization B.
Ventricular depolarization C. Atrial repolarization D. Ventricular repolarization
CORRECT ANSWER: A. Atrial depolarization Rationale: The P wave represents the
electrical depolarization of the atria leading to atrial contraction.
Question 2: What is the normal duration of the PR interval? A. 0.04 to 0.10 seconds
B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. 0.30 to 0.40 seconds CORRECT
ANSWER: B. 0.12 to 0.20 seconds Rationale: The normal PR interval ranges from 0.12
to 0.20 seconds, representing the time from the beginning of atrial depolarization to the
beginning of ventricular depolarization.
Question 3: Which wave represents ventricular repolarization? A. P wave B. QRS
complex C. T wave D. U wave CORRECT ANSWER: C. T wave Rationale: The T wave
represents ventricular repolarization, the recovery phase of the ventricles before the
next contraction.
Question 4: What is the normal duration of the QRS complex? A. Less than 0.12
seconds B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. Greater than 0.30 seconds
CORRECT ANSWER: A. Less than 0.12 seconds Rationale: The normal QRS complex
duration is less than 0.12 seconds, representing the time it takes for ventricular
depolarization.
Question 5: Which ECG lead provides the best view of the inferior wall of the heart?
A. Lead I B. Lead aVL C. Lead II D. Lead V1 CORRECT ANSWER: C. Lead II Rationale:
Leads II, III, and aVF provide the best view of the inferior wall of the heart.
Question 6: What is the normal resting heart rate for an adult? A. 40 to 60 bpm B. 60
to 100 bpm C. 100 to 120 bpm D. 120 to 150 bpm CORRECT ANSWER: B. 60 to 100
bpm Rationale: The normal resting heart rate for a healthy adult is between 60 and 100
beats per minute.
Question 7: Which lead is placed at the fourth intercostal space at the right sternal
border? A. V1 B. V2 C. V3 D. V4 CORRECT ANSWER: A. V1 Rationale: Lead V1 is placed
at the fourth intercostal space at the right sternal border.
Question 8: What rhythm is characterized by a regular rate of 45 bpm and normal P
waves? A. Sinus tachycardia B. Sinus bradycardia C. Junctional rhythm D. Atrial
fibrillation CORRECT ANSWER: B. Sinus bradycardia Rationale: Sinus bradycardia is a
normal sinus rhythm with a rate less than 60 bpm.
,Question 9: Which electrolyte imbalance is most likely to cause peaked T waves?
A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypernatremia CORRECT
ANSWER: B. Hyperkalemia Rationale: Hyperkalemia often presents with tall, peaked T
waves on an ECG due to altered ventricular repolarization.
Question 10: What is the primary pacemaker of the heart? A. AV node B. Bundle of
His C. SA node D. Purkinje fibers CORRECT ANSWER: C. SA node Rationale: The
sinoatrial (SA) node is the primary pacemaker of the heart, normally firing at 60-100
bpm.
Question 11: Which arrhythmia is characterized by an irregularly irregular rhythm
and no distinct P waves? A. Atrial flutter B. Atrial fibrillation C. Sinus arrhythmia D.
Multifocal atrial tachycardia CORRECT ANSWER: B. Atrial fibrillation Rationale: Atrial
fibrillation is characterized by an irregularly irregular ventricular response and chaotic
atrial activity without distinct P waves.
Question 12: What is the intrinsic firing rate of the AV node? A. 20 to 40 bpm B. 40 to
60 bpm C. 60 to 80 bpm D. 80 to 100 bpm CORRECT ANSWER: B. 40 to 60 bpm
Rationale: The AV node has an intrinsic firing rate of 40 to 60 bpm if the SA node fails.
Question 13: Which medication is a beta-blocker commonly used for rate control in
atrial fibrillation? A. Amiodarone B. Metoprolol C. Diltiazem D. Digoxin CORRECT
ANSWER: B. Metoprolol Rationale: Metoprolol is a beta-adrenergic blocker used to
control ventricular rate in atrial fibrillation by slowing AV node conduction.
Question 14: What ECG change is associated with hypocalcemia? A. Shortened QT
interval B. Prolonged QT interval C. ST segment elevation D. Peaked T waves CORRECT
ANSWER: B. Prolonged QT interval Rationale: Hypocalcemia prolongs the ST segment,
leading to a prolonged QT interval on the ECG.
Question 15: Which type of heart block is characterized by a progressively
lengthening PR interval until a QRS complex is dropped? A. First-degree AV block B.
Second-degree AV block Type I (Wenckebach) C. Second-degree AV block Type II D.
Third-degree AV block CORRECT ANSWER: B. Second-degree AV block Type I
(Wenckebach) Rationale: In Wenckebach (Mobitz Type I), the PR interval progressively
lengthens until an atrial impulse is not conducted (dropped QRS).
Question 16: What is the immediate treatment for ventricular fibrillation? A.
Amiodarone IV B. Synchronized cardioversion C. Defibrillation D. CPR for 2 minutes
CORRECT ANSWER: C. Defibrillation Rationale: Ventricular fibrillation is a lethal
arrhythmia requiring immediate unsynchronized defibrillation.
Question 17: Which cardiac biomarker is most specific for myocardial infarction?
A. Creatine kinase (CK) B. Myoglobin C. Troponin I D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I Rationale: Troponin I and T are highly specific and
sensitive biomarkers for myocardial necrosis and infarction.
,Question 18: What is the primary symptom of left-sided heart failure? A. Peripheral
edema B. Jugular venous distention C. Pulmonary crackles D. Hepatomegaly CORRECT
ANSWER: C. Pulmonary crackles Rationale: Left-sided heart failure causes blood to
back up into the lungs, leading to pulmonary congestion and crackles.
Question 19: Which class of medications is contraindicated in patients with
bilateral renal artery stenosis? A. Beta-blockers B. ACE inhibitors C. Calcium channel
blockers D. Diuretics CORRECT ANSWER: B. ACE inhibitors Rationale: ACE inhibitors
can cause acute renal failure in patients with bilateral renal artery stenosis by reducing
glomerular filtration pressure.
Question 20: What is the normal range for the QT interval corrected for heart rate
(QTc)? A. Less than 0.44 seconds B. 0.44 to 0.50 seconds C. 0.50 to 0.60 seconds D.
Greater than 0.60 seconds CORRECT ANSWER: A. Less than 0.44 seconds Rationale:
A normal QTc is generally less than 0.44 seconds in men and 0.46 seconds in women;
prolonged QTc increases the risk of Torsades de Pointes.
Question 21: Which lead is placed at the fifth intercostal space at the midclavicular
line? A. V2 B. V3 C. V4 D. V5 CORRECT ANSWER: C. V4 Rationale: Lead V4 is placed at
the fifth intercostal space at the left midclavicular line.
Question 22: What rhythm has a rate of 160 bpm, regular rhythm, and no visible P
waves? A. Sinus tachycardia B. Atrial flutter C. Supraventricular tachycardia (SVT) D.
Ventricular tachycardia CORRECT ANSWER: C. Supraventricular tachycardia (SVT)
Rationale: SVT typically presents with a regular, narrow-complex tachycardia at a rate of
150-250 bpm, often obscuring P waves.
Question 23: Which medication is an antidote for heparin overdose? A. Vitamin K B.
Protamine sulfate C. Fresh frozen plasma D. Aminocaproic acid CORRECT ANSWER: B.
Protamine sulfate Rationale: Protamine sulfate is the specific antidote used to reverse
the anticoagulant effects of heparin.
Question 24: What is the primary cause of right-sided heart failure? A. Left-sided
heart failure B. Pulmonary embolism C. Chronic hypertension D. Myocardial infarction
CORRECT ANSWER: A. Left-sided heart failure Rationale: Left-sided heart failure is
the most common cause of right-sided heart failure due to increased pulmonary
pressures backing up into the right ventricle.
Question 25: Which ECG finding is characteristic of hyperkalemia? A. U waves B.
Peaked T waves C. ST depression D. Prolonged PR interval CORRECT ANSWER: B.
Peaked T waves Rationale: Early ECG changes in hyperkalemia include tall, peaked T
waves, followed by widened QRS and loss of P waves.
Question 26: What is the term for a premature, wide, bizarre QRS complex? A. PAC
B. PVC C. SVT D. Heart block CORRECT ANSWER: B. PVC Rationale: Premature
ventricular contractions (PVCs) are early, wide, and bizarre QRS complexes originating
from the ventricles.
, Question 27: Which intervention is most appropriate for a patient with
symptomatic sinus bradycardia? A. Adenosine IV B. Atropine IV C. Amiodarone IV D.
Vagal maneuvers CORRECT ANSWER: B. Atropine IV Rationale: Atropine is the first-
line medication for symptomatic sinus bradycardia to increase the heart rate by
blocking vagal stimulation.
Question 28: What does the ST segment represent on an ECG? A. Atrial
depolarization B. Ventricular depolarization C. The period between ventricular
depolarization and repolarization D. Ventricular repolarization CORRECT ANSWER: C.
The period between ventricular depolarization and repolarization Rationale: The ST
segment is the isoelectric period between the end of ventricular depolarization (QRS)
and the beginning of repolarization (T wave).
Question 29: Which type of shock is characterized by a low cardiac output and high
systemic vascular resistance? A. Distributive shock B. Hypovolemic shock C.
Cardiogenic shock D. Anaphylactic shock CORRECT ANSWER: C. Cardiogenic shock
Rationale: Cardiogenic shock results from pump failure, leading to low cardiac output
and compensatory high systemic vascular resistance.
Question 30: What is the primary purpose of a telemetry monitor? A. To measure
blood pressure continuously B. To continuously monitor the patient's cardiac rhythm C.
To measure oxygen saturation D. To assess respiratory rate CORRECT ANSWER: B. To
continuously monitor the patient's cardiac rhythm Rationale: Telemetry is used for
continuous cardiac rhythm monitoring to detect arrhythmias or ischemic changes.
Question 31: Which electrolyte imbalance is associated with the presence of U
waves? A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypomagnesemia
CORRECT ANSWER: B. Hypokalemia Rationale: Hypokalemia often presents with
flattened T waves, ST depression, and prominent U waves on the ECG.
Question 32: What is the recommended compression-to-ventilation ratio for adult
CPR? A. 15:1 B. 15:2 C. 30:1 D. 30:2 CORRECT ANSWER: D. 30:2 Rationale: The current
AHA guidelines recommend a compression-to-ventilation ratio of 30:2 for adult CPR.
Question 33: Which medication is a calcium channel blocker used for angina and
hypertension? A. Lisinopril B. Amlodipine C. Metoprolol D. Furosemide CORRECT
ANSWER: B. Amlodipine Rationale: Amlodipine is a dihydropyridine calcium channel
blocker that causes vasodilation, used for angina and hypertension.
Question 34: What is the primary ECG change in a STEMI? A. ST depression B. T wave
inversion C. ST elevation D. Prolonged QT interval CORRECT ANSWER: C. ST elevation
Rationale: ST-segment elevation in two contiguous leads is the hallmark ECG finding of
a ST-elevation myocardial infarction (STEMI).
Question 35: Which complication is most common after a femoral artery cardiac
catheterization? A. Pneumothorax B. Bleeding or hematoma at the site C. Stroke D.
Myocardial infarction CORRECT ANSWER: B. Bleeding or hematoma at the site
and Answers | Complete Telemetry Nursing Competency
Study Guide with Verified Solutions, Detailed Rationales, ECG
Interpretation, Cardiac Rhythm Analysis, Dysrhythmias,
Hemodynamic Monitoring, Oxygenation, Fluid and Electrolyte
Balance, Post-Operative Care, Medication Safety, Emergency
Response and Relias Med-Surg Telemetry Exam Preparation
Question 1: What does the P wave on an ECG represent? A. Atrial depolarization B.
Ventricular depolarization C. Atrial repolarization D. Ventricular repolarization
CORRECT ANSWER: A. Atrial depolarization Rationale: The P wave represents the
electrical depolarization of the atria leading to atrial contraction.
Question 2: What is the normal duration of the PR interval? A. 0.04 to 0.10 seconds
B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. 0.30 to 0.40 seconds CORRECT
ANSWER: B. 0.12 to 0.20 seconds Rationale: The normal PR interval ranges from 0.12
to 0.20 seconds, representing the time from the beginning of atrial depolarization to the
beginning of ventricular depolarization.
Question 3: Which wave represents ventricular repolarization? A. P wave B. QRS
complex C. T wave D. U wave CORRECT ANSWER: C. T wave Rationale: The T wave
represents ventricular repolarization, the recovery phase of the ventricles before the
next contraction.
Question 4: What is the normal duration of the QRS complex? A. Less than 0.12
seconds B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. Greater than 0.30 seconds
CORRECT ANSWER: A. Less than 0.12 seconds Rationale: The normal QRS complex
duration is less than 0.12 seconds, representing the time it takes for ventricular
depolarization.
Question 5: Which ECG lead provides the best view of the inferior wall of the heart?
A. Lead I B. Lead aVL C. Lead II D. Lead V1 CORRECT ANSWER: C. Lead II Rationale:
Leads II, III, and aVF provide the best view of the inferior wall of the heart.
Question 6: What is the normal resting heart rate for an adult? A. 40 to 60 bpm B. 60
to 100 bpm C. 100 to 120 bpm D. 120 to 150 bpm CORRECT ANSWER: B. 60 to 100
bpm Rationale: The normal resting heart rate for a healthy adult is between 60 and 100
beats per minute.
Question 7: Which lead is placed at the fourth intercostal space at the right sternal
border? A. V1 B. V2 C. V3 D. V4 CORRECT ANSWER: A. V1 Rationale: Lead V1 is placed
at the fourth intercostal space at the right sternal border.
Question 8: What rhythm is characterized by a regular rate of 45 bpm and normal P
waves? A. Sinus tachycardia B. Sinus bradycardia C. Junctional rhythm D. Atrial
fibrillation CORRECT ANSWER: B. Sinus bradycardia Rationale: Sinus bradycardia is a
normal sinus rhythm with a rate less than 60 bpm.
,Question 9: Which electrolyte imbalance is most likely to cause peaked T waves?
A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypernatremia CORRECT
ANSWER: B. Hyperkalemia Rationale: Hyperkalemia often presents with tall, peaked T
waves on an ECG due to altered ventricular repolarization.
Question 10: What is the primary pacemaker of the heart? A. AV node B. Bundle of
His C. SA node D. Purkinje fibers CORRECT ANSWER: C. SA node Rationale: The
sinoatrial (SA) node is the primary pacemaker of the heart, normally firing at 60-100
bpm.
Question 11: Which arrhythmia is characterized by an irregularly irregular rhythm
and no distinct P waves? A. Atrial flutter B. Atrial fibrillation C. Sinus arrhythmia D.
Multifocal atrial tachycardia CORRECT ANSWER: B. Atrial fibrillation Rationale: Atrial
fibrillation is characterized by an irregularly irregular ventricular response and chaotic
atrial activity without distinct P waves.
Question 12: What is the intrinsic firing rate of the AV node? A. 20 to 40 bpm B. 40 to
60 bpm C. 60 to 80 bpm D. 80 to 100 bpm CORRECT ANSWER: B. 40 to 60 bpm
Rationale: The AV node has an intrinsic firing rate of 40 to 60 bpm if the SA node fails.
Question 13: Which medication is a beta-blocker commonly used for rate control in
atrial fibrillation? A. Amiodarone B. Metoprolol C. Diltiazem D. Digoxin CORRECT
ANSWER: B. Metoprolol Rationale: Metoprolol is a beta-adrenergic blocker used to
control ventricular rate in atrial fibrillation by slowing AV node conduction.
Question 14: What ECG change is associated with hypocalcemia? A. Shortened QT
interval B. Prolonged QT interval C. ST segment elevation D. Peaked T waves CORRECT
ANSWER: B. Prolonged QT interval Rationale: Hypocalcemia prolongs the ST segment,
leading to a prolonged QT interval on the ECG.
Question 15: Which type of heart block is characterized by a progressively
lengthening PR interval until a QRS complex is dropped? A. First-degree AV block B.
Second-degree AV block Type I (Wenckebach) C. Second-degree AV block Type II D.
Third-degree AV block CORRECT ANSWER: B. Second-degree AV block Type I
(Wenckebach) Rationale: In Wenckebach (Mobitz Type I), the PR interval progressively
lengthens until an atrial impulse is not conducted (dropped QRS).
Question 16: What is the immediate treatment for ventricular fibrillation? A.
Amiodarone IV B. Synchronized cardioversion C. Defibrillation D. CPR for 2 minutes
CORRECT ANSWER: C. Defibrillation Rationale: Ventricular fibrillation is a lethal
arrhythmia requiring immediate unsynchronized defibrillation.
Question 17: Which cardiac biomarker is most specific for myocardial infarction?
A. Creatine kinase (CK) B. Myoglobin C. Troponin I D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I Rationale: Troponin I and T are highly specific and
sensitive biomarkers for myocardial necrosis and infarction.
,Question 18: What is the primary symptom of left-sided heart failure? A. Peripheral
edema B. Jugular venous distention C. Pulmonary crackles D. Hepatomegaly CORRECT
ANSWER: C. Pulmonary crackles Rationale: Left-sided heart failure causes blood to
back up into the lungs, leading to pulmonary congestion and crackles.
Question 19: Which class of medications is contraindicated in patients with
bilateral renal artery stenosis? A. Beta-blockers B. ACE inhibitors C. Calcium channel
blockers D. Diuretics CORRECT ANSWER: B. ACE inhibitors Rationale: ACE inhibitors
can cause acute renal failure in patients with bilateral renal artery stenosis by reducing
glomerular filtration pressure.
Question 20: What is the normal range for the QT interval corrected for heart rate
(QTc)? A. Less than 0.44 seconds B. 0.44 to 0.50 seconds C. 0.50 to 0.60 seconds D.
Greater than 0.60 seconds CORRECT ANSWER: A. Less than 0.44 seconds Rationale:
A normal QTc is generally less than 0.44 seconds in men and 0.46 seconds in women;
prolonged QTc increases the risk of Torsades de Pointes.
Question 21: Which lead is placed at the fifth intercostal space at the midclavicular
line? A. V2 B. V3 C. V4 D. V5 CORRECT ANSWER: C. V4 Rationale: Lead V4 is placed at
the fifth intercostal space at the left midclavicular line.
Question 22: What rhythm has a rate of 160 bpm, regular rhythm, and no visible P
waves? A. Sinus tachycardia B. Atrial flutter C. Supraventricular tachycardia (SVT) D.
Ventricular tachycardia CORRECT ANSWER: C. Supraventricular tachycardia (SVT)
Rationale: SVT typically presents with a regular, narrow-complex tachycardia at a rate of
150-250 bpm, often obscuring P waves.
Question 23: Which medication is an antidote for heparin overdose? A. Vitamin K B.
Protamine sulfate C. Fresh frozen plasma D. Aminocaproic acid CORRECT ANSWER: B.
Protamine sulfate Rationale: Protamine sulfate is the specific antidote used to reverse
the anticoagulant effects of heparin.
Question 24: What is the primary cause of right-sided heart failure? A. Left-sided
heart failure B. Pulmonary embolism C. Chronic hypertension D. Myocardial infarction
CORRECT ANSWER: A. Left-sided heart failure Rationale: Left-sided heart failure is
the most common cause of right-sided heart failure due to increased pulmonary
pressures backing up into the right ventricle.
Question 25: Which ECG finding is characteristic of hyperkalemia? A. U waves B.
Peaked T waves C. ST depression D. Prolonged PR interval CORRECT ANSWER: B.
Peaked T waves Rationale: Early ECG changes in hyperkalemia include tall, peaked T
waves, followed by widened QRS and loss of P waves.
Question 26: What is the term for a premature, wide, bizarre QRS complex? A. PAC
B. PVC C. SVT D. Heart block CORRECT ANSWER: B. PVC Rationale: Premature
ventricular contractions (PVCs) are early, wide, and bizarre QRS complexes originating
from the ventricles.
, Question 27: Which intervention is most appropriate for a patient with
symptomatic sinus bradycardia? A. Adenosine IV B. Atropine IV C. Amiodarone IV D.
Vagal maneuvers CORRECT ANSWER: B. Atropine IV Rationale: Atropine is the first-
line medication for symptomatic sinus bradycardia to increase the heart rate by
blocking vagal stimulation.
Question 28: What does the ST segment represent on an ECG? A. Atrial
depolarization B. Ventricular depolarization C. The period between ventricular
depolarization and repolarization D. Ventricular repolarization CORRECT ANSWER: C.
The period between ventricular depolarization and repolarization Rationale: The ST
segment is the isoelectric period between the end of ventricular depolarization (QRS)
and the beginning of repolarization (T wave).
Question 29: Which type of shock is characterized by a low cardiac output and high
systemic vascular resistance? A. Distributive shock B. Hypovolemic shock C.
Cardiogenic shock D. Anaphylactic shock CORRECT ANSWER: C. Cardiogenic shock
Rationale: Cardiogenic shock results from pump failure, leading to low cardiac output
and compensatory high systemic vascular resistance.
Question 30: What is the primary purpose of a telemetry monitor? A. To measure
blood pressure continuously B. To continuously monitor the patient's cardiac rhythm C.
To measure oxygen saturation D. To assess respiratory rate CORRECT ANSWER: B. To
continuously monitor the patient's cardiac rhythm Rationale: Telemetry is used for
continuous cardiac rhythm monitoring to detect arrhythmias or ischemic changes.
Question 31: Which electrolyte imbalance is associated with the presence of U
waves? A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypomagnesemia
CORRECT ANSWER: B. Hypokalemia Rationale: Hypokalemia often presents with
flattened T waves, ST depression, and prominent U waves on the ECG.
Question 32: What is the recommended compression-to-ventilation ratio for adult
CPR? A. 15:1 B. 15:2 C. 30:1 D. 30:2 CORRECT ANSWER: D. 30:2 Rationale: The current
AHA guidelines recommend a compression-to-ventilation ratio of 30:2 for adult CPR.
Question 33: Which medication is a calcium channel blocker used for angina and
hypertension? A. Lisinopril B. Amlodipine C. Metoprolol D. Furosemide CORRECT
ANSWER: B. Amlodipine Rationale: Amlodipine is a dihydropyridine calcium channel
blocker that causes vasodilation, used for angina and hypertension.
Question 34: What is the primary ECG change in a STEMI? A. ST depression B. T wave
inversion C. ST elevation D. Prolonged QT interval CORRECT ANSWER: C. ST elevation
Rationale: ST-segment elevation in two contiguous leads is the hallmark ECG finding of
a ST-elevation myocardial infarction (STEMI).
Question 35: Which complication is most common after a femoral artery cardiac
catheterization? A. Pneumothorax B. Bleeding or hematoma at the site C. Stroke D.
Myocardial infarction CORRECT ANSWER: B. Bleeding or hematoma at the site
