RELIAS Medical-Surgical Telemetry Updated 2026 | Comprehensive
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, ECG Interpretation and Rhythm Analysis, Cardiac Dysrhythmia
Recognition and Management, Telemetry Monitoring Procedures,
Cardiovascular Nursing Assessment, Hemodynamic Monitoring
Principles, Acute Care Clinical Decision-Making, and Detailed
Rationales for Competency Exam Success
Question 1: Telemetry primarily monitors: A. Blood pressure B. Cardiac rhythm C. O2
saturation D. Urine output CORRECT ANSWER: B. Cardiac rhythm Rationale:
Telemetry continuously tracks cardiac electrical activity to detect arrhythmias.
Question 2: Normal sinus rhythm rate is: A. 40-60 bpm B. 60-100 bpm C. 100-150 bpm
D. 150-200 bpm CORRECT ANSWER: B. 60-100 bpm Rationale: Normal sinus rhythm
originates in the SA node at a normal rate of 60 to 100 beats per minute.
Question 3: Normal PR interval duration is: A. 0.04-0.10 sec B. 0.12-0.20 sec C. 0.20-
0.30 sec D. 0.30-0.44 sec CORRECT ANSWER: B. 0.12-0.20 sec Rationale: The PR
interval represents AV node conduction time and normally lasts 0.12 to 0.20 seconds.
Question 4: Normal QRS complex duration is: A. 0.04-0.10 sec B. 0.12-0.20 sec C.
0.20-0.30 sec D. 0.30-0.44 sec CORRECT ANSWER: A. 0.04-0.10 sec Rationale: The
QRS complex represents ventricular depolarization and normally lasts less than 0.12
seconds.
Question 5: The P wave represents: A. Atrial depolarization B. Ventricular
depolarization C. Atrial repolarization D. Ventricular repolarization CORRECT ANSWER:
A. Atrial depolarization Rationale: The P wave on an ECG indicates the electrical
impulse spreading through the atria.
Question 6: The T wave represents: A. Atrial depolarization B. Ventricular
depolarization C. Atrial repolarization D. Ventricular repolarization CORRECT ANSWER:
D. Ventricular repolarization Rationale: The T wave reflects the recovery phase
(repolarization) of the ventricles.
Question 7: Lead V1 is placed at the: A. 4th intercostal space, right sternal border B.
4th intercostal space, left sternal border C. 5th intercostal space, midclavicular line D.
5th intercostal space, anterior axillary line CORRECT ANSWER: A. 4th intercostal
space, right sternal border Rationale: V1 is correctly positioned at the 4th intercostal
space at the right sternal border.
Question 8: Lead V4 is placed at the: A. 4th intercostal space, right sternal border B.
4th intercostal space, left sternal border C. 5th intercostal space, midclavicular line D.
5th intercostal space, anterior axillary line CORRECT ANSWER: C. 5th intercostal
space, midclavicular line Rationale: V4 is placed in the 5th intercostal space at the left
midclavicular line.
Question 9: Somatic tremor artifact is caused by: A. Patient movement or shivering B.
Loose electrodes C. Electrical interference D. Improper lead placement CORRECT
,ANSWER: A. Patient movement or shivering Rationale: Somatic tremor appears as
irregular, jagged lines due to muscle tremors or patient movement.
Question 10: Wandering baseline artifact is typically caused by: A. Patient
movement or shivering B. Poor electrode contact or dry gel C. Electrical interference D.
Improper lead placement CORRECT ANSWER: B. Poor electrode contact or dry gel
Rationale: A wandering baseline drifts up and down, often due to poor skin prep, dry
electrodes, or patient breathing.
Question 11: First action for asystole is to: A. Defibrillate immediately B. Begin high-
quality CPR C. Administer epinephrine D. Administer atropine CORRECT ANSWER: B.
Begin high-quality CPR Rationale: Asystole is a non-shockable rhythm; high-quality
CPR is the immediate priority.
Question 12: First action for ventricular fibrillation is to: A. Defibrillate immediately
B. Begin high-quality CPR C. Administer epinephrine D. Administer amiodarone
CORRECT ANSWER: A. Defibrillate immediately Rationale: V-fib is a shockable
rhythm, and immediate defibrillation is the most critical intervention.
Question 13: Treatment for pulseless ventricular tachycardia is: A. Synchronized
cardioversion B. Defibrillation C. Vagal maneuvers D. Atropine CORRECT ANSWER: B.
Defibrillation Rationale: Pulseless V-tach is treated identically to V-fib with immediate
unsynchronized defibrillation.
Question 14: Treatment for stable ventricular tachycardia with a pulse is: A.
Defibrillation B. Synchronized cardioversion or antiarrhythmics C. Atropine D.
Transcutaneous pacing CORRECT ANSWER: B. Synchronized cardioversion or
antiarrhythmics Rationale: Stable V-tach with a pulse is managed with antiarrhythmics
like amiodarone or elective synchronized cardioversion.
Question 15: A premature ventricular complex (PVC) originates in the: A. SA node B.
AV node C. Atria D. Ventricles CORRECT ANSWER: D. Ventricles Rationale: PVCs are
early beats originating from an ectopic focus in the ventricles, appearing wide and
bizarre.
Question 16: Atrial fibrillation increases the risk of: A. Pulmonary embolism B. Stroke
C. Myocardial infarction D. Heart block CORRECT ANSWER: B. Stroke Rationale: Blood
pools in the fibrillating atria, increasing the risk of clot formation and subsequent
embolic stroke.
Question 17: Atrial flutter is characterized by: A. Irregularly irregular rhythm B.
Sawtooth-shaped F waves C. Wide QRS complexes D. Absent P waves CORRECT
ANSWER: B. Sawtooth-shaped F waves Rationale: Atrial flutter exhibits distinct, rapid
"sawtooth" flutter waves between QRS complexes.
Question 18: First-degree AV block is identified by: A. Prolonged PR interval B.
Dropped QRS complexes C. Wide QRS complexes D. Irregular rhythm CORRECT
, ANSWER: A. Prolonged PR interval Rationale: First-degree block shows a consistent
PR interval greater than 0.20 seconds with all P waves conducted.
Question 19: Second-degree AV block Type I (Wenckebach) features: A. Constant PR
interval B. Progressively lengthening PR interval C. Wide QRS complexes D. More QRS
than P waves CORRECT ANSWER: B. Progressively lengthening PR interval Rationale:
Wenckebach is characterized by a PR interval that lengthens until a QRS complex is
dropped.
Question 20: Second-degree AV block Type II features: A. Progressively lengthening
PR interval B. Constant PR interval with dropped QRS C. Irregularly irregular rhythm D.
Absent P waves CORRECT ANSWER: B. Constant PR interval with dropped QRS
Rationale: Type II block has a constant PR interval, but occasional P waves are not
conducted to the ventricles.
Question 21: Third-degree AV block is also known as: A. Wenckebach B. Complete
heart block C. Bundle branch block D. Sick sinus syndrome CORRECT ANSWER: B.
Complete heart block Rationale: In third-degree block, no atrial impulses reach the
ventricles, resulting in AV dissociation.
Question 22: ST-segment elevation indicates: A. Myocardial ischemia B. Myocardial
injury/infarction C. Ventricular hypertrophy D. Pericarditis CORRECT ANSWER: B.
Myocardial injury/infarction Rationale: ST elevation is a hallmark of acute transmural
myocardial injury, typically seen in STEMI.
Question 23: Nitroglycerin is administered for angina to: A. Increase heart rate B.
Vasodilate coronary arteries C. Increase blood pressure D. Prevent clot formation
CORRECT ANSWER: B. Vasodilate coronary arteries Rationale: Nitroglycerin dilates
coronary and peripheral vessels, reducing preload and myocardial oxygen demand.
Question 24: Morphine is used in MI primarily to: A. Reduce anxiety and pain B.
Prevent arrhythmias C. Dissolve clots D. Lower blood glucose CORRECT ANSWER: A.
Reduce anxiety and pain Rationale: Morphine relieves severe chest pain and reduces
sympathetic nervous system stimulation.
Question 25: Aspirin is given during an MI to: A. Relieve pain B. Inhibit platelet
aggregation C. Lower blood pressure D. Dilate coronary arteries CORRECT ANSWER: B.
Inhibit platelet aggregation Rationale: Aspirin prevents further thrombus formation by
irreversibly inhibiting platelet cyclooxygenase.
Question 26: Beta-blockers in acute MI are used to: A. Increase heart rate B.
Decrease myocardial oxygen demand C. Dissolve clots D. Increase blood pressure
CORRECT ANSWER: B. Decrease myocardial oxygen demand Rationale: Beta-
blockers lower heart rate and contractility, reducing the heart's workload and oxygen
needs.
Question 27: Elevated troponin levels indicate: A. Heart failure B. Myocardial necrosis
C. Pulmonary embolism D. Renal failure CORRECT ANSWER: B. Myocardial necrosis
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, ECG Interpretation and Rhythm Analysis, Cardiac Dysrhythmia
Recognition and Management, Telemetry Monitoring Procedures,
Cardiovascular Nursing Assessment, Hemodynamic Monitoring
Principles, Acute Care Clinical Decision-Making, and Detailed
Rationales for Competency Exam Success
Question 1: Telemetry primarily monitors: A. Blood pressure B. Cardiac rhythm C. O2
saturation D. Urine output CORRECT ANSWER: B. Cardiac rhythm Rationale:
Telemetry continuously tracks cardiac electrical activity to detect arrhythmias.
Question 2: Normal sinus rhythm rate is: A. 40-60 bpm B. 60-100 bpm C. 100-150 bpm
D. 150-200 bpm CORRECT ANSWER: B. 60-100 bpm Rationale: Normal sinus rhythm
originates in the SA node at a normal rate of 60 to 100 beats per minute.
Question 3: Normal PR interval duration is: A. 0.04-0.10 sec B. 0.12-0.20 sec C. 0.20-
0.30 sec D. 0.30-0.44 sec CORRECT ANSWER: B. 0.12-0.20 sec Rationale: The PR
interval represents AV node conduction time and normally lasts 0.12 to 0.20 seconds.
Question 4: Normal QRS complex duration is: A. 0.04-0.10 sec B. 0.12-0.20 sec C.
0.20-0.30 sec D. 0.30-0.44 sec CORRECT ANSWER: A. 0.04-0.10 sec Rationale: The
QRS complex represents ventricular depolarization and normally lasts less than 0.12
seconds.
Question 5: The P wave represents: A. Atrial depolarization B. Ventricular
depolarization C. Atrial repolarization D. Ventricular repolarization CORRECT ANSWER:
A. Atrial depolarization Rationale: The P wave on an ECG indicates the electrical
impulse spreading through the atria.
Question 6: The T wave represents: A. Atrial depolarization B. Ventricular
depolarization C. Atrial repolarization D. Ventricular repolarization CORRECT ANSWER:
D. Ventricular repolarization Rationale: The T wave reflects the recovery phase
(repolarization) of the ventricles.
Question 7: Lead V1 is placed at the: A. 4th intercostal space, right sternal border B.
4th intercostal space, left sternal border C. 5th intercostal space, midclavicular line D.
5th intercostal space, anterior axillary line CORRECT ANSWER: A. 4th intercostal
space, right sternal border Rationale: V1 is correctly positioned at the 4th intercostal
space at the right sternal border.
Question 8: Lead V4 is placed at the: A. 4th intercostal space, right sternal border B.
4th intercostal space, left sternal border C. 5th intercostal space, midclavicular line D.
5th intercostal space, anterior axillary line CORRECT ANSWER: C. 5th intercostal
space, midclavicular line Rationale: V4 is placed in the 5th intercostal space at the left
midclavicular line.
Question 9: Somatic tremor artifact is caused by: A. Patient movement or shivering B.
Loose electrodes C. Electrical interference D. Improper lead placement CORRECT
,ANSWER: A. Patient movement or shivering Rationale: Somatic tremor appears as
irregular, jagged lines due to muscle tremors or patient movement.
Question 10: Wandering baseline artifact is typically caused by: A. Patient
movement or shivering B. Poor electrode contact or dry gel C. Electrical interference D.
Improper lead placement CORRECT ANSWER: B. Poor electrode contact or dry gel
Rationale: A wandering baseline drifts up and down, often due to poor skin prep, dry
electrodes, or patient breathing.
Question 11: First action for asystole is to: A. Defibrillate immediately B. Begin high-
quality CPR C. Administer epinephrine D. Administer atropine CORRECT ANSWER: B.
Begin high-quality CPR Rationale: Asystole is a non-shockable rhythm; high-quality
CPR is the immediate priority.
Question 12: First action for ventricular fibrillation is to: A. Defibrillate immediately
B. Begin high-quality CPR C. Administer epinephrine D. Administer amiodarone
CORRECT ANSWER: A. Defibrillate immediately Rationale: V-fib is a shockable
rhythm, and immediate defibrillation is the most critical intervention.
Question 13: Treatment for pulseless ventricular tachycardia is: A. Synchronized
cardioversion B. Defibrillation C. Vagal maneuvers D. Atropine CORRECT ANSWER: B.
Defibrillation Rationale: Pulseless V-tach is treated identically to V-fib with immediate
unsynchronized defibrillation.
Question 14: Treatment for stable ventricular tachycardia with a pulse is: A.
Defibrillation B. Synchronized cardioversion or antiarrhythmics C. Atropine D.
Transcutaneous pacing CORRECT ANSWER: B. Synchronized cardioversion or
antiarrhythmics Rationale: Stable V-tach with a pulse is managed with antiarrhythmics
like amiodarone or elective synchronized cardioversion.
Question 15: A premature ventricular complex (PVC) originates in the: A. SA node B.
AV node C. Atria D. Ventricles CORRECT ANSWER: D. Ventricles Rationale: PVCs are
early beats originating from an ectopic focus in the ventricles, appearing wide and
bizarre.
Question 16: Atrial fibrillation increases the risk of: A. Pulmonary embolism B. Stroke
C. Myocardial infarction D. Heart block CORRECT ANSWER: B. Stroke Rationale: Blood
pools in the fibrillating atria, increasing the risk of clot formation and subsequent
embolic stroke.
Question 17: Atrial flutter is characterized by: A. Irregularly irregular rhythm B.
Sawtooth-shaped F waves C. Wide QRS complexes D. Absent P waves CORRECT
ANSWER: B. Sawtooth-shaped F waves Rationale: Atrial flutter exhibits distinct, rapid
"sawtooth" flutter waves between QRS complexes.
Question 18: First-degree AV block is identified by: A. Prolonged PR interval B.
Dropped QRS complexes C. Wide QRS complexes D. Irregular rhythm CORRECT
, ANSWER: A. Prolonged PR interval Rationale: First-degree block shows a consistent
PR interval greater than 0.20 seconds with all P waves conducted.
Question 19: Second-degree AV block Type I (Wenckebach) features: A. Constant PR
interval B. Progressively lengthening PR interval C. Wide QRS complexes D. More QRS
than P waves CORRECT ANSWER: B. Progressively lengthening PR interval Rationale:
Wenckebach is characterized by a PR interval that lengthens until a QRS complex is
dropped.
Question 20: Second-degree AV block Type II features: A. Progressively lengthening
PR interval B. Constant PR interval with dropped QRS C. Irregularly irregular rhythm D.
Absent P waves CORRECT ANSWER: B. Constant PR interval with dropped QRS
Rationale: Type II block has a constant PR interval, but occasional P waves are not
conducted to the ventricles.
Question 21: Third-degree AV block is also known as: A. Wenckebach B. Complete
heart block C. Bundle branch block D. Sick sinus syndrome CORRECT ANSWER: B.
Complete heart block Rationale: In third-degree block, no atrial impulses reach the
ventricles, resulting in AV dissociation.
Question 22: ST-segment elevation indicates: A. Myocardial ischemia B. Myocardial
injury/infarction C. Ventricular hypertrophy D. Pericarditis CORRECT ANSWER: B.
Myocardial injury/infarction Rationale: ST elevation is a hallmark of acute transmural
myocardial injury, typically seen in STEMI.
Question 23: Nitroglycerin is administered for angina to: A. Increase heart rate B.
Vasodilate coronary arteries C. Increase blood pressure D. Prevent clot formation
CORRECT ANSWER: B. Vasodilate coronary arteries Rationale: Nitroglycerin dilates
coronary and peripheral vessels, reducing preload and myocardial oxygen demand.
Question 24: Morphine is used in MI primarily to: A. Reduce anxiety and pain B.
Prevent arrhythmias C. Dissolve clots D. Lower blood glucose CORRECT ANSWER: A.
Reduce anxiety and pain Rationale: Morphine relieves severe chest pain and reduces
sympathetic nervous system stimulation.
Question 25: Aspirin is given during an MI to: A. Relieve pain B. Inhibit platelet
aggregation C. Lower blood pressure D. Dilate coronary arteries CORRECT ANSWER: B.
Inhibit platelet aggregation Rationale: Aspirin prevents further thrombus formation by
irreversibly inhibiting platelet cyclooxygenase.
Question 26: Beta-blockers in acute MI are used to: A. Increase heart rate B.
Decrease myocardial oxygen demand C. Dissolve clots D. Increase blood pressure
CORRECT ANSWER: B. Decrease myocardial oxygen demand Rationale: Beta-
blockers lower heart rate and contractility, reducing the heart's workload and oxygen
needs.
Question 27: Elevated troponin levels indicate: A. Heart failure B. Myocardial necrosis
C. Pulmonary embolism D. Renal failure CORRECT ANSWER: B. Myocardial necrosis
