RELIAS Medical-Surgical Telemetry Updated 2026 | Comprehensive Study Guide,
Practice Exam Questions and Answers, Exam Prep Test Bank, Advanced ECG
Interpretation and Rhythm Analysis, Cardiac Dysrhythmia Recognition and
Management, Telemetry Monitoring Procedures, Cardiovascular Patient
Assessment, Hemodynamic Monitoring Principles, Acute Care Nursing Decision-
Making, and Detailed Rationales for Competency Exam Preparation
Question 1: A patient with a history of heart failure is admitted with acute
shortness of breath and crackles in the lung bases. The nurse notes jugular venous
distention and a 3+ pitting edema in the lower extremities. Which medication, if
ordered, would the nurse question as being potentially contraindicated in this
patient's current state?
A. Furosemide
B. Lisinopril
C. Metoprolol
D. Ibuprofen
CORRECT ANSWER: D. Ibuprofen
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause
sodium and fluid retention, potentially worsening heart failure symptoms. It also can
reduce the effectiveness of diuretics and ACE inhibitors. The patient is showing signs of
fluid overload; therefore, an NSAID would be contraindicated. The other options are
standard therapies for heart failure management in this context.
Question 2: In a patient with a newly inserted permanent pacemaker, which
assessment finding should the nurse report to the healthcare provider
immediately?
A. Mild bruising at the insertion site
B. A paced rhythm of 70 beats per minute on the telemetry monitor
C. Hiccups that occur with every paced beat
D. A small amount of serosanguineous drainage on the dressing
CORRECT ANSWER: C. Hiccups that occur with every paced beat
Rationale: Hiccups that occur with every paced beat can indicate that the pacemaker
lead is stimulating the diaphragm (phrenic nerve stimulation). This is a sign of lead
displacement or perforation and requires immediate notification of the provider for
assessment and potential repositioning. The other findings are common and expected
post-procedure.
Question 3: The nurse is monitoring a patient receiving a continuous IV infusion of
heparin for a pulmonary embolism. The aPTT result is 98 seconds, and the baseline
aPTT is 28 seconds. Which action should the nurse take first?
A. Increase the infusion rate by 2 mL/hour.
B. Document the result in the patient's chart.
,C. Stop the infusion and notify the healthcare provider.
D. Draw blood for a platelet count.
CORRECT ANSWER: C. Stop the infusion and notify the healthcare provider.
Rationale: The therapeutic aPTT for a patient on heparin is typically 1.5 to 2.5 times the
baseline. In this case, 2.5 times the baseline is 70 seconds. An aPTT of 98 seconds is
significantly elevated, placing the patient at high risk for bleeding. The infusion should
be stopped immediately, and the provider should be notified for further orders. This is
the priority action over documentation or further lab draws.
Question 4: A patient is on a telemetry monitor, and the nurse observes a rhythm
with absent P waves, an irregularly irregular ventricular rate, and narrow QRS
complexes. What is the most appropriate initial nursing intervention?
A. Prepare for immediate synchronized cardioversion.
B. Assess the patient's blood pressure and level of consciousness.
C. Administer amiodarone 150 mg IV push.
D. Start a continuous infusion of dopamine.
CORRECT ANSWER: B. Assess the patient's blood pressure and level of
consciousness.
Rationale: The rhythm described is atrial fibrillation. While this is an unstable
dysrhythmia, the immediate priority is to assess the patient's clinical status (ABCs -
airway, breathing, circulation). Unstable atrial fibrillation (with chest pain, hypotension,
or altered mental status) requires immediate cardioversion. If the patient is stable,
medical management (e.g., rate or rhythm control) can be initiated. Therefore,
assessment is the critical first step.
Question 5: A patient is recovering from a right total knee arthroplasty. The nurse
places a sequential compression device (SCD) on the patient's left leg. What is the
primary purpose of this intervention?
A. To prevent skin breakdown on the heel.
B. To reduce postoperative pain.
C. To increase venous return and prevent deep vein thrombosis.
D. To maintain proper alignment of the hip joint.
CORRECT ANSWER: C. To increase venous return and prevent deep vein
thrombosis.
Rationale: The primary purpose of SCDs is to provide intermittent pneumatic
compression to the lower extremities, which mimics the muscle pump of the calf and
enhances venous return. This prevents stasis of blood, which is a key factor in the
development of deep vein thrombosis (DVT). Preventing DVT is especially important in
the postoperative patient.
,Question 6: A patient with type 2 diabetes is prescribed metformin. Which
laboratory value would the nurse be most concerned about before administering
this medication?
A. Hemoglobin A1c of 7.2%
B. Fasting blood glucose of 135 mg/dL
C. Serum creatinine of 1.9 mg/dL
D. Low-density lipoprotein (LDL) of 100 mg/dL
CORRECT ANSWER: C. Serum creatinine of 1.9 mg/dL
Rationale: Metformin is contraindicated in patients with significant renal impairment
because it increases the risk of lactic acidosis, a rare but serious complication. A serum
creatinine of 1.9 mg/dL indicates decreased renal function. The other values (A1c,
glucose, LDL) are not normal but do not present an immediate contraindication to
metformin therapy in the same way as renal impairment does.
Question 7: Which of the following assessment findings in a patient with a chest
tube connected to a water-seal drainage system requires the nurse's immediate
intervention?
A. Constant bubbling in the water-seal chamber.
B. Crepitus noted around the insertion site.
C. Drainage of 75 mL in the first hour.
D. Fluctuation of the fluid level in the water-seal chamber with respirations.
CORRECT ANSWER: A. Constant bubbling in the water-seal chamber.
Rationale: In a chest tube drainage system, intermittent bubbling in the water-seal
chamber is expected as air exits the pleural space. However, constant bubbling
indicates a significant air leak, either from the patient's lung or from the system itself.
This requires immediate intervention to locate and correct the leak. Crepitus
(subcutaneous emphysema) is expected, and drainage of 75 mL in the first hour is
within acceptable limits.
Question 8: The nurse is caring for a patient post-cardiac catheterization via the
femoral approach. Which of the following findings would indicate a possible
complication and require immediate intervention?
A. A small hematoma at the insertion site.
B. The patient reports a pain level of 3/10 at the site.
C. The patient requests to turn from supine to a side-lying position.
D. The patient's toe on the affected extremity is cool and dusky.
CORRECT ANSWER: D. The patient's toe on the affected extremity is cool and
dusky.
Rationale: A cool and dusky extremity on the side of the catheterization indicates a
potential arterial occlusion or compromise to the circulation of that limb. This is a
, serious complication that requires immediate intervention, such as a vascular
assessment and possible consultation with the interventional team. A small
hematoma, mild pain, and position changes are expected or not immediately life-
threatening.
Question 9: A patient is receiving IV amiodarone for ventricular tachycardia. Which
of the following is the most important nursing assessment related to this
medication?
A. Monitoring for signs of hypokalemia.
B. Monitoring the patient's blood pressure.
C. Monitoring for a decrease in heart rate.
D. Monitoring for a prolonged QT interval.
CORRECT ANSWER: D. Monitoring for a prolonged QT interval.
Rationale: Amiodarone is an antiarrhythmic that can prolong the QT interval, which
increases the risk of developing torsades de pointes, a potentially fatal ventricular
arrhythmia. Continuous ECG monitoring for QT prolongation is crucial. While it can
cause hypotension and bradycardia, the most significant and potentially lethal side
effect associated with amiodarone is QT prolongation.
Question 10: When caring for a patient on a telemetry unit, the nurse identifies the
cardiac rhythm as sinus tachycardia. Which of the following is a potential cause for
this rhythm?
A. Hypothermia
B. Pain
C. Hyperkalemia
D. Vagal stimulation
CORRECT ANSWER: B. Pain
Rationale: Sinus tachycardia is a normal response to physiologic stress. Common
causes include fever, pain, anxiety, hypovolemia, and heart failure. Vagal stimulation
and hypothermia would cause bradycardia. Hyperkalemia primarily affects the T-wave
morphology and QRS complex.
Question 11: A patient is 2 hours post-operative from a thyroidectomy. The nurse
should keep which of the following items at the bedside for emergency use?
A. An oral airway
B. A tracheostomy set
C. A cardiac arrest cart
D. A padded tongue blade
CORRECT ANSWER: B. A tracheostomy set
Rationale: A tracheostomy set is kept at the bedside for a patient after a thyroidectomy
in case of laryngeal edema or tracheal compression from a hematoma, which could
Practice Exam Questions and Answers, Exam Prep Test Bank, Advanced ECG
Interpretation and Rhythm Analysis, Cardiac Dysrhythmia Recognition and
Management, Telemetry Monitoring Procedures, Cardiovascular Patient
Assessment, Hemodynamic Monitoring Principles, Acute Care Nursing Decision-
Making, and Detailed Rationales for Competency Exam Preparation
Question 1: A patient with a history of heart failure is admitted with acute
shortness of breath and crackles in the lung bases. The nurse notes jugular venous
distention and a 3+ pitting edema in the lower extremities. Which medication, if
ordered, would the nurse question as being potentially contraindicated in this
patient's current state?
A. Furosemide
B. Lisinopril
C. Metoprolol
D. Ibuprofen
CORRECT ANSWER: D. Ibuprofen
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause
sodium and fluid retention, potentially worsening heart failure symptoms. It also can
reduce the effectiveness of diuretics and ACE inhibitors. The patient is showing signs of
fluid overload; therefore, an NSAID would be contraindicated. The other options are
standard therapies for heart failure management in this context.
Question 2: In a patient with a newly inserted permanent pacemaker, which
assessment finding should the nurse report to the healthcare provider
immediately?
A. Mild bruising at the insertion site
B. A paced rhythm of 70 beats per minute on the telemetry monitor
C. Hiccups that occur with every paced beat
D. A small amount of serosanguineous drainage on the dressing
CORRECT ANSWER: C. Hiccups that occur with every paced beat
Rationale: Hiccups that occur with every paced beat can indicate that the pacemaker
lead is stimulating the diaphragm (phrenic nerve stimulation). This is a sign of lead
displacement or perforation and requires immediate notification of the provider for
assessment and potential repositioning. The other findings are common and expected
post-procedure.
Question 3: The nurse is monitoring a patient receiving a continuous IV infusion of
heparin for a pulmonary embolism. The aPTT result is 98 seconds, and the baseline
aPTT is 28 seconds. Which action should the nurse take first?
A. Increase the infusion rate by 2 mL/hour.
B. Document the result in the patient's chart.
,C. Stop the infusion and notify the healthcare provider.
D. Draw blood for a platelet count.
CORRECT ANSWER: C. Stop the infusion and notify the healthcare provider.
Rationale: The therapeutic aPTT for a patient on heparin is typically 1.5 to 2.5 times the
baseline. In this case, 2.5 times the baseline is 70 seconds. An aPTT of 98 seconds is
significantly elevated, placing the patient at high risk for bleeding. The infusion should
be stopped immediately, and the provider should be notified for further orders. This is
the priority action over documentation or further lab draws.
Question 4: A patient is on a telemetry monitor, and the nurse observes a rhythm
with absent P waves, an irregularly irregular ventricular rate, and narrow QRS
complexes. What is the most appropriate initial nursing intervention?
A. Prepare for immediate synchronized cardioversion.
B. Assess the patient's blood pressure and level of consciousness.
C. Administer amiodarone 150 mg IV push.
D. Start a continuous infusion of dopamine.
CORRECT ANSWER: B. Assess the patient's blood pressure and level of
consciousness.
Rationale: The rhythm described is atrial fibrillation. While this is an unstable
dysrhythmia, the immediate priority is to assess the patient's clinical status (ABCs -
airway, breathing, circulation). Unstable atrial fibrillation (with chest pain, hypotension,
or altered mental status) requires immediate cardioversion. If the patient is stable,
medical management (e.g., rate or rhythm control) can be initiated. Therefore,
assessment is the critical first step.
Question 5: A patient is recovering from a right total knee arthroplasty. The nurse
places a sequential compression device (SCD) on the patient's left leg. What is the
primary purpose of this intervention?
A. To prevent skin breakdown on the heel.
B. To reduce postoperative pain.
C. To increase venous return and prevent deep vein thrombosis.
D. To maintain proper alignment of the hip joint.
CORRECT ANSWER: C. To increase venous return and prevent deep vein
thrombosis.
Rationale: The primary purpose of SCDs is to provide intermittent pneumatic
compression to the lower extremities, which mimics the muscle pump of the calf and
enhances venous return. This prevents stasis of blood, which is a key factor in the
development of deep vein thrombosis (DVT). Preventing DVT is especially important in
the postoperative patient.
,Question 6: A patient with type 2 diabetes is prescribed metformin. Which
laboratory value would the nurse be most concerned about before administering
this medication?
A. Hemoglobin A1c of 7.2%
B. Fasting blood glucose of 135 mg/dL
C. Serum creatinine of 1.9 mg/dL
D. Low-density lipoprotein (LDL) of 100 mg/dL
CORRECT ANSWER: C. Serum creatinine of 1.9 mg/dL
Rationale: Metformin is contraindicated in patients with significant renal impairment
because it increases the risk of lactic acidosis, a rare but serious complication. A serum
creatinine of 1.9 mg/dL indicates decreased renal function. The other values (A1c,
glucose, LDL) are not normal but do not present an immediate contraindication to
metformin therapy in the same way as renal impairment does.
Question 7: Which of the following assessment findings in a patient with a chest
tube connected to a water-seal drainage system requires the nurse's immediate
intervention?
A. Constant bubbling in the water-seal chamber.
B. Crepitus noted around the insertion site.
C. Drainage of 75 mL in the first hour.
D. Fluctuation of the fluid level in the water-seal chamber with respirations.
CORRECT ANSWER: A. Constant bubbling in the water-seal chamber.
Rationale: In a chest tube drainage system, intermittent bubbling in the water-seal
chamber is expected as air exits the pleural space. However, constant bubbling
indicates a significant air leak, either from the patient's lung or from the system itself.
This requires immediate intervention to locate and correct the leak. Crepitus
(subcutaneous emphysema) is expected, and drainage of 75 mL in the first hour is
within acceptable limits.
Question 8: The nurse is caring for a patient post-cardiac catheterization via the
femoral approach. Which of the following findings would indicate a possible
complication and require immediate intervention?
A. A small hematoma at the insertion site.
B. The patient reports a pain level of 3/10 at the site.
C. The patient requests to turn from supine to a side-lying position.
D. The patient's toe on the affected extremity is cool and dusky.
CORRECT ANSWER: D. The patient's toe on the affected extremity is cool and
dusky.
Rationale: A cool and dusky extremity on the side of the catheterization indicates a
potential arterial occlusion or compromise to the circulation of that limb. This is a
, serious complication that requires immediate intervention, such as a vascular
assessment and possible consultation with the interventional team. A small
hematoma, mild pain, and position changes are expected or not immediately life-
threatening.
Question 9: A patient is receiving IV amiodarone for ventricular tachycardia. Which
of the following is the most important nursing assessment related to this
medication?
A. Monitoring for signs of hypokalemia.
B. Monitoring the patient's blood pressure.
C. Monitoring for a decrease in heart rate.
D. Monitoring for a prolonged QT interval.
CORRECT ANSWER: D. Monitoring for a prolonged QT interval.
Rationale: Amiodarone is an antiarrhythmic that can prolong the QT interval, which
increases the risk of developing torsades de pointes, a potentially fatal ventricular
arrhythmia. Continuous ECG monitoring for QT prolongation is crucial. While it can
cause hypotension and bradycardia, the most significant and potentially lethal side
effect associated with amiodarone is QT prolongation.
Question 10: When caring for a patient on a telemetry unit, the nurse identifies the
cardiac rhythm as sinus tachycardia. Which of the following is a potential cause for
this rhythm?
A. Hypothermia
B. Pain
C. Hyperkalemia
D. Vagal stimulation
CORRECT ANSWER: B. Pain
Rationale: Sinus tachycardia is a normal response to physiologic stress. Common
causes include fever, pain, anxiety, hypovolemia, and heart failure. Vagal stimulation
and hypothermia would cause bradycardia. Hyperkalemia primarily affects the T-wave
morphology and QRS complex.
Question 11: A patient is 2 hours post-operative from a thyroidectomy. The nurse
should keep which of the following items at the bedside for emergency use?
A. An oral airway
B. A tracheostomy set
C. A cardiac arrest cart
D. A padded tongue blade
CORRECT ANSWER: B. A tracheostomy set
Rationale: A tracheostomy set is kept at the bedside for a patient after a thyroidectomy
in case of laryngeal edema or tracheal compression from a hematoma, which could
