RELIAS Medical-Surgical Telemetry Updated 2026 | Comprehensive Study
Guide, Practice Exam Questions and Answers, Exam Prep Test Bank,
Advanced ECG Interpretation, Telemetry Monitoring and Rhythm Analysis,
Cardiac Dysrhythmia Recognition and Treatment Priorities,
Cardiovascular Assessment Skills, Hemodynamic Monitoring Concepts,
Acute Care Nursing Decision-Making, and Detailed Rationales for
Competency Exam Preparation
Question 1: A patient on a telemetry unit exhibits a heart rate of 220 bpm with no
discernible P waves and a chaotic, irregular baseline. What is the most appropriate
immediate nursing intervention?
A. Prepare for synchronized cardioversion
B. Administer intravenous Amiodarone
C. Defibrillate the patient immediately
D. Assess the patient's blood pressure and level of consciousness
CORRECT ANSWER: D. Assess the patient's blood pressure and level of
consciousness
Rationale: The rhythm described is Ventricular Fibrillation (V-Fib). While defibrillation is
the definitive treatment, the immediate nursing action is to assess the patient's
hemodynamic stability and level of consciousness to determine if they are pulseless. If
the patient is pulseless, CPR and defibrillation are initiated immediately.
Question 2: A patient is prescribed a continuous infusion of Heparin for a
pulmonary embolism. Which laboratory value is the primary target for monitoring
the therapeutic effect of this medication?
A. Platelet count
B. Activated Partial Thromboplastin Time (aPTT)
C. Prothrombin Time (PT)
D. International Normalized Ratio (INR)
CORRECT ANSWER: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin affects the intrinsic pathway of the coagulation cascade, which is
measured by the aPTT. The therapeutic goal is typically an aPTT 1.5 to 2.5 times the
normal control value. PT and INR monitor the extrinsic pathway, which is affected by
Warfarin.
Question 3: During a blood transfusion, a patient develops chills, fever, and a
headache approximately 30 minutes after the infusion started. The nurse's initial
action should be to:
A. Slow the transfusion rate and monitor for improvement
B. Administer an antihistamine as a pre-medication
C. Stop the transfusion and hang normal saline
D. Flush the IV line to ensure patency
,CORRECT ANSWER: C. Stop the transfusion and hang normal saline
Rationale: These symptoms indicate a possible febrile non-hemolytic or hemolytic
transfusion reaction. The immediate priority is to stop the transfusion to prevent further
complications and maintain IV access with normal saline. The blood bag and tubing
should be sent to the blood bank for analysis.
Question 4: A patient with Congestive Heart Failure (CHF) is receiving IV Lasix
(Furosemide). Which assessment finding indicates that the medication is having
the desired therapeutic effect?
A. Increased urine output and weight loss
B. Increased blood pressure and heart rate
C. Decreased urine output and peripheral edema
D. Presence of crackles in the lung bases
CORRECT ANSWER: A. Increased urine output and weight loss
Rationale: Lasix is a loop diuretic used to reduce fluid volume overload in CHF. The
therapeutic effect is evidenced by increased urine output, which leads to a decrease in
total body fluid, resulting in weight loss, reduced edema, and decreased pulmonary
congestion (less crackles).
Question 5: What is the leading preventable cause of death in hospitalized
patients, prompting the need for prophylactic measures in medical-surgical
patients?
A. Sepsis
B. Myocardial Infarction
C. Pulmonary Embolism (from Venous Thromboembolism)
D. Adverse drug reactions
CORRECT ANSWER: C. Pulmonary Embolism (from Venous Thromboembolism)
Rationale: Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and
pulmonary embolism (PE), is the leading preventable cause of hospital death.
Prophylaxis such as anticoagulants, compression stockings, and early mobilization are
critical.
Question 6: A nurse is caring for a patient with a nasogastric (NG) tube set to
continuous low suction. Which finding indicates a potential complication of this
therapy?
A. The patient reports a dry mouth
B. The pH of the gastric aspirate is 4.0
C. The patient reports nausea and vomiting
D. Serum potassium level is 3.0 mEq/L
CORRECT ANSWER: D. Serum potassium level is 3.0 mEq/L
,Rationale: Continuous NG suction removes gastric fluids rich in electrolytes,
particularly potassium and hydrogen ions. This can lead to metabolic alkalosis and
hypokalemia. A potassium level of 3.0 mEq/L is below the normal range (3.5-5.0 mEq/L)
and indicates a complication.
Question 7: A patient with a history of COPD is admitted with pneumonia. The nurse
notes that the patient's oxygen saturation is 88% on room air. What is the most
appropriate initial oxygen delivery method?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 24% FiO2
CORRECT ANSWER: B. Nasal cannula at 2 L/min
Rationale: For patients with COPD, oxygen should be administered cautiously to avoid
suppressing the hypoxic drive. The initial therapy is typically low-flow oxygen, such as a
nasal cannula at 1-2 L/min, with close monitoring of the respiratory rate and blood
gases.
Question 8: A patient is scheduled for a cardiac catheterization via the femoral
artery. Which nursing action is a priority immediately following the procedure?
A. Keep the patient's head of bed elevated to 90 degrees
B. Encourage the patient to flex and extend the knee frequently
C. Maintain the affected leg straight and immobilized
D. Assess the distal pulses on the contralateral leg
CORRECT ANSWER: C. Maintain the affected leg straight and immobilized
Rationale: To prevent bleeding or hematoma formation at the arterial puncture site, the
affected leg must be kept straight and immobilized for the prescribed time. The head of
the bed is usually kept flat or at a low angle.
Question 9: A nurse is reviewing the telemetry strip of a patient and notes a rhythm
with a regular rate of 42 bpm, a PR interval of 0.20 seconds, and a QRS complex of
0.08 seconds. How should the nurse interpret this rhythm?
A. Normal Sinus Rhythm
B. Sinus Bradycardia
C. Sinus Tachycardia
D. First-degree AV block
CORRECT ANSWER: B. Sinus Bradycardia
Rationale: The rhythm is regular and has a normal PR interval and QRS duration. The
defining characteristic is the heart rate of 42 bpm, which is below the normal range of
60-100 bpm, indicating Sinus Bradycardia.
, Question 10: Which laboratory test is the most sensitive and specific indicator for
diagnosing a myocardial infarction (MI)?
A. Creatine Kinase (CK)
B. Lactate Dehydrogenase (LDH)
C. Troponin I or T
D. Myoglobin
CORRECT ANSWER: C. Troponin I or T
Rationale: Cardiac troponins are proteins found exclusively in cardiac muscle. They are
highly sensitive and specific for myocardial injury and are the preferred biomarkers for
diagnosing an MI. They rise within 3-4 hours and can remain elevated for up to 2 weeks.
Question 11: A patient is receiving IV antibiotics for a severe infection. The nurse
notes the patient develops a diffuse, erythematous rash and is experiencing
bronchospasm. What is the nurse's priority action?
A. Slow the infusion rate of the antibiotic
B. Apply a topical corticosteroid to the rash
C. Stop the antibiotic infusion immediately
D. Administer an antipyretic for fever
CORRECT ANSWER: C. Stop the antibiotic infusion immediately
Rationale: The patient is exhibiting signs of an anaphylactic reaction (rash and
bronchospasm). The priority is to stop the offending agent (the antibiotic) immediately
and prepare to administer epinephrine, antihistamines, and support the airway.
Question 12: A patient with acute pancreatitis is reporting severe, unrelieved
abdominal pain. What is the priority nursing intervention?
A. Assess the patient's vital signs and pain level
B. Administer morphine sulfate as prescribed
C. Place the patient in a semi-Fowler's position
D. Maintain NPO status and prepare for NG tube insertion
CORRECT ANSWER: A. Assess the patient's vital signs and pain level
Rationale: While pain management is crucial, the priority before any intervention is to
perform a comprehensive assessment, including vital signs and a detailed pain
assessment, to ensure patient safety and evaluate the effectiveness of previous
interventions.
Question 13: A telemetry technician calls the nurse to report that a patient's
monitor shows a rhythm with a sawtooth baseline and a ventricular rate of 110
bpm. What is the most likely rhythm?
A. Atrial Fibrillation
B. Atrial Flutter
Guide, Practice Exam Questions and Answers, Exam Prep Test Bank,
Advanced ECG Interpretation, Telemetry Monitoring and Rhythm Analysis,
Cardiac Dysrhythmia Recognition and Treatment Priorities,
Cardiovascular Assessment Skills, Hemodynamic Monitoring Concepts,
Acute Care Nursing Decision-Making, and Detailed Rationales for
Competency Exam Preparation
Question 1: A patient on a telemetry unit exhibits a heart rate of 220 bpm with no
discernible P waves and a chaotic, irregular baseline. What is the most appropriate
immediate nursing intervention?
A. Prepare for synchronized cardioversion
B. Administer intravenous Amiodarone
C. Defibrillate the patient immediately
D. Assess the patient's blood pressure and level of consciousness
CORRECT ANSWER: D. Assess the patient's blood pressure and level of
consciousness
Rationale: The rhythm described is Ventricular Fibrillation (V-Fib). While defibrillation is
the definitive treatment, the immediate nursing action is to assess the patient's
hemodynamic stability and level of consciousness to determine if they are pulseless. If
the patient is pulseless, CPR and defibrillation are initiated immediately.
Question 2: A patient is prescribed a continuous infusion of Heparin for a
pulmonary embolism. Which laboratory value is the primary target for monitoring
the therapeutic effect of this medication?
A. Platelet count
B. Activated Partial Thromboplastin Time (aPTT)
C. Prothrombin Time (PT)
D. International Normalized Ratio (INR)
CORRECT ANSWER: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin affects the intrinsic pathway of the coagulation cascade, which is
measured by the aPTT. The therapeutic goal is typically an aPTT 1.5 to 2.5 times the
normal control value. PT and INR monitor the extrinsic pathway, which is affected by
Warfarin.
Question 3: During a blood transfusion, a patient develops chills, fever, and a
headache approximately 30 minutes after the infusion started. The nurse's initial
action should be to:
A. Slow the transfusion rate and monitor for improvement
B. Administer an antihistamine as a pre-medication
C. Stop the transfusion and hang normal saline
D. Flush the IV line to ensure patency
,CORRECT ANSWER: C. Stop the transfusion and hang normal saline
Rationale: These symptoms indicate a possible febrile non-hemolytic or hemolytic
transfusion reaction. The immediate priority is to stop the transfusion to prevent further
complications and maintain IV access with normal saline. The blood bag and tubing
should be sent to the blood bank for analysis.
Question 4: A patient with Congestive Heart Failure (CHF) is receiving IV Lasix
(Furosemide). Which assessment finding indicates that the medication is having
the desired therapeutic effect?
A. Increased urine output and weight loss
B. Increased blood pressure and heart rate
C. Decreased urine output and peripheral edema
D. Presence of crackles in the lung bases
CORRECT ANSWER: A. Increased urine output and weight loss
Rationale: Lasix is a loop diuretic used to reduce fluid volume overload in CHF. The
therapeutic effect is evidenced by increased urine output, which leads to a decrease in
total body fluid, resulting in weight loss, reduced edema, and decreased pulmonary
congestion (less crackles).
Question 5: What is the leading preventable cause of death in hospitalized
patients, prompting the need for prophylactic measures in medical-surgical
patients?
A. Sepsis
B. Myocardial Infarction
C. Pulmonary Embolism (from Venous Thromboembolism)
D. Adverse drug reactions
CORRECT ANSWER: C. Pulmonary Embolism (from Venous Thromboembolism)
Rationale: Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and
pulmonary embolism (PE), is the leading preventable cause of hospital death.
Prophylaxis such as anticoagulants, compression stockings, and early mobilization are
critical.
Question 6: A nurse is caring for a patient with a nasogastric (NG) tube set to
continuous low suction. Which finding indicates a potential complication of this
therapy?
A. The patient reports a dry mouth
B. The pH of the gastric aspirate is 4.0
C. The patient reports nausea and vomiting
D. Serum potassium level is 3.0 mEq/L
CORRECT ANSWER: D. Serum potassium level is 3.0 mEq/L
,Rationale: Continuous NG suction removes gastric fluids rich in electrolytes,
particularly potassium and hydrogen ions. This can lead to metabolic alkalosis and
hypokalemia. A potassium level of 3.0 mEq/L is below the normal range (3.5-5.0 mEq/L)
and indicates a complication.
Question 7: A patient with a history of COPD is admitted with pneumonia. The nurse
notes that the patient's oxygen saturation is 88% on room air. What is the most
appropriate initial oxygen delivery method?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 24% FiO2
CORRECT ANSWER: B. Nasal cannula at 2 L/min
Rationale: For patients with COPD, oxygen should be administered cautiously to avoid
suppressing the hypoxic drive. The initial therapy is typically low-flow oxygen, such as a
nasal cannula at 1-2 L/min, with close monitoring of the respiratory rate and blood
gases.
Question 8: A patient is scheduled for a cardiac catheterization via the femoral
artery. Which nursing action is a priority immediately following the procedure?
A. Keep the patient's head of bed elevated to 90 degrees
B. Encourage the patient to flex and extend the knee frequently
C. Maintain the affected leg straight and immobilized
D. Assess the distal pulses on the contralateral leg
CORRECT ANSWER: C. Maintain the affected leg straight and immobilized
Rationale: To prevent bleeding or hematoma formation at the arterial puncture site, the
affected leg must be kept straight and immobilized for the prescribed time. The head of
the bed is usually kept flat or at a low angle.
Question 9: A nurse is reviewing the telemetry strip of a patient and notes a rhythm
with a regular rate of 42 bpm, a PR interval of 0.20 seconds, and a QRS complex of
0.08 seconds. How should the nurse interpret this rhythm?
A. Normal Sinus Rhythm
B. Sinus Bradycardia
C. Sinus Tachycardia
D. First-degree AV block
CORRECT ANSWER: B. Sinus Bradycardia
Rationale: The rhythm is regular and has a normal PR interval and QRS duration. The
defining characteristic is the heart rate of 42 bpm, which is below the normal range of
60-100 bpm, indicating Sinus Bradycardia.
, Question 10: Which laboratory test is the most sensitive and specific indicator for
diagnosing a myocardial infarction (MI)?
A. Creatine Kinase (CK)
B. Lactate Dehydrogenase (LDH)
C. Troponin I or T
D. Myoglobin
CORRECT ANSWER: C. Troponin I or T
Rationale: Cardiac troponins are proteins found exclusively in cardiac muscle. They are
highly sensitive and specific for myocardial injury and are the preferred biomarkers for
diagnosing an MI. They rise within 3-4 hours and can remain elevated for up to 2 weeks.
Question 11: A patient is receiving IV antibiotics for a severe infection. The nurse
notes the patient develops a diffuse, erythematous rash and is experiencing
bronchospasm. What is the nurse's priority action?
A. Slow the infusion rate of the antibiotic
B. Apply a topical corticosteroid to the rash
C. Stop the antibiotic infusion immediately
D. Administer an antipyretic for fever
CORRECT ANSWER: C. Stop the antibiotic infusion immediately
Rationale: The patient is exhibiting signs of an anaphylactic reaction (rash and
bronchospasm). The priority is to stop the offending agent (the antibiotic) immediately
and prepare to administer epinephrine, antihistamines, and support the airway.
Question 12: A patient with acute pancreatitis is reporting severe, unrelieved
abdominal pain. What is the priority nursing intervention?
A. Assess the patient's vital signs and pain level
B. Administer morphine sulfate as prescribed
C. Place the patient in a semi-Fowler's position
D. Maintain NPO status and prepare for NG tube insertion
CORRECT ANSWER: A. Assess the patient's vital signs and pain level
Rationale: While pain management is crucial, the priority before any intervention is to
perform a comprehensive assessment, including vital signs and a detailed pain
assessment, to ensure patient safety and evaluate the effectiveness of previous
interventions.
Question 13: A telemetry technician calls the nurse to report that a patient's
monitor shows a rhythm with a sawtooth baseline and a ventricular rate of 110
bpm. What is the most likely rhythm?
A. Atrial Fibrillation
B. Atrial Flutter
