Fall Semester 2026–2027 RELIAS Medical-Surgical Telemetry
Updated 2026 | 190+ Questions and Answers | RELIAS
Medical-Surgical Telemetry Comprehensive Study Guide,
Practice Exam, Exam Prep Test Bank, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Monitoring, Medical-Surgical Nursing,
Cardiovascular Pharmacology, Acute Coronary Syndromes,
Heart Failure, Patient Safety, NCLEX-RN & Next Generation
NCLEX (NGN), Detailed Rationales and Complete Revision
Material
Question 1: A patient with a history of heart failure is admitted with shortness
of breath and peripheral edema. The nurse notes jugular venous distention
(JVD) and hepatomegaly. Which hemodynamic parameter is most consistent
with this clinical presentation?
A. Decreased central venous pressure (CVP)
B. Elevated pulmonary artery wedge pressure (PAWP)
C. Decreased systemic vascular resistance (SVR)
D. Increased cardiac output (CO)
CORRECT ANSWER: B. Elevated pulmonary artery wedge pressure (PAWP)
Rationale: The patient's symptoms of JVD, hepatomegaly, and peripheral edema are
classic signs of right-sided heart failure, which is often a consequence of left-sided
failure. Elevated PAWP indicates increased pressure in the left atrium and pulmonary
vasculature, leading to pulmonary congestion and subsequent right ventricular strain.
Decreased CVP would be seen in hypovolemia, not failure, while decreased SVR and
increased CO are not characteristic of heart failure.
Question 2: A nurse is caring for a patient on a telemetry unit who exhibits a
narrow-complex tachycardia at a rate of 180 bpm. The patient is hypotensive
and reports palpitations. After ensuring the patient has a patent airway, which
intervention should the nurse anticipate?
A. Administration of IV amiodarone
B. Immediate synchronized cardioversion
C. Administration of IV adenosine
D. Vagal maneuvers
CORRECT ANSWER: B. Immediate synchronized cardioversion
Rationale: The patient is presenting with unstable tachycardia (narrow-complex, rate
180 bpm, hypotension). Synchronized cardioversion is the treatment of choice for
unstable tachyarrhythmias. Vagal maneuvers and adenosine are used for stable patients.
Amiodarone can be used, but electrical cardioversion is the priority in unstable patients.
,Question 3: A patient's cardiac rhythm strip shows a regular rhythm with a
rate of 42 bpm. There is a P wave before every QRS complex, but the PR
interval is 0.24 seconds. What is the most appropriate initial nursing action?
A. Prepare for transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Document the rhythm as normal
D. Prepare for immediate defibrillation
CORRECT ANSWER: B. Administer atropine 0.5 mg IV
Rationale: The rhythm is sinus bradycardia with a first-degree AV block (PR interval
>0.20 seconds). In symptomatic bradycardia (rate <60 bpm with symptoms), atropine is
the first-line medication. The patient's description does not indicate immediate
instability requiring pacing, and defibrillation is for pulseless rhythms.
Question 4: Which finding is the earliest sign of decreased cardiac output in a
postoperative patient?
A. Decreased blood pressure
B. Decreased urine output
C. Increased heart rate
D. Cool, clammy skin
CORRECT ANSWER: C. Increased heart rate
Rationale: Increased heart rate (tachycardia) is an early compensatory mechanism to
maintain cardiac output when stroke volume decreases. Decreased urine output,
hypotension, and cool skin are later signs of decreased perfusion.
Question 5: A patient is prescribed metoprolol succinate for heart failure.
Which assessment finding would indicate a therapeutic response to this
medication?
A. Decreased heart rate and decreased blood pressure
B. Increased cardiac output and decreased dyspnea
C. Improved ejection fraction and decreased peripheral edema
D. All of the above
CORRECT ANSWER: D. All of the above
Rationale: Metoprolol, a beta-blocker, improves cardiac function by decreasing heart
rate and blood pressure (reducing myocardial oxygen demand), increasing cardiac
output, and reducing symptoms of failure such as dyspnea and edema over time.
Question 6: The nurse is monitoring a patient with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation (tidaling) of water in the water-seal chamber with respirations
,C. Constant bubbling in the suction control chamber
D. Lack of drainage in the collection chamber for 24 hours
CORRECT ANSWER: B. Fluctuation (tidaling) of water in the water-seal
chamber with respirations
Rationale: Tidaling (fluctuation) in the water-seal chamber is a normal finding and
indicates that the chest tube is patent. Continuous bubbling in the water-seal chamber
indicates an air leak. Constant bubbling in the suction control chamber is normal only if
suction is connected, but it is not an indicator of function of the water-seal mechanism.
Question 7: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse is concerned about
the patient's oxygen saturation dropping below 88% during sleep. What should
the nurse do first?
A. Increase the oxygen to 4 L/min
B. Notify the healthcare provider for a sleep study
C. Assess the patient's respiratory effort and lung sounds
D. Place the patient in a high-Fowler's position
CORRECT ANSWER: C. Assess the patient's respiratory effort and lung sounds
Rationale: Before making any changes, the nurse must assess the patient's respiratory
status to determine if the desaturation is due to airway obstruction, hypoventilation, or
worsening of the underlying disease. Increasing oxygen can lead to carbon dioxide
retention in COPD patients.
Question 8: The cardiac monitor shows a rhythm with no identifiable P waves,
a chaotic baseline, and an irregularly irregular ventricular rate of 110 bpm.
How should the nurse interpret this rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by absence of P waves, a chaotic baseline
(fibrillatory waves), and an irregularly irregular ventricular response. Atrial flutter has
saw-tooth flutter waves.
Question 9: A patient is admitted with acute myocardial infarction (MI) and is
receiving thrombolytic therapy. Which assessment finding is the highest
priority to report to the healthcare provider?
A. Mild chest pain
B. Bleeding from the IV site
, C. Nausea and vomiting
D. A change in the patient's level of consciousness
CORRECT ANSWER: D. A change in the patient's level of consciousness
Rationale: A change in level of consciousness (LOC) is a sign of potential intracranial
hemorrhage, a life-threatening complication of thrombolytic therapy. Bleeding from the
IV site is a common side effect but less critical than a change in LOC.
Question 10: Which serum laboratory value is the most important indicator of
the effectiveness of furosemide (Lasix) in a patient with pulmonary edema?
A. Sodium level
B. Potassium level
C. BUN and creatinine levels
D. Daily weight and intake/output
CORRECT ANSWER: D. Daily weight and intake/output
Rationale: While electrolyte imbalances (Na+, K+) and renal function (BUN/Cr) must be
monitored, the most direct indicator of furosemide's effectiveness in reducing fluid
overload is a decrease in daily weight and monitoring of fluid balance (intake/output).
Question 11: The nurse is preparing to administer a blood transfusion to a
patient. Which intravenous (IV) solution is appropriate to use as a primary
infusion with a blood transfusion?
A. 0.9% Normal Saline
B. 0.45% Normal Saline (1/2 NS)
C. 5% Dextrose in Water (D5W)
D. Lactated Ringer's
CORRECT ANSWER: A. 0.9% Normal Saline
Rationale: Normal saline is the only recommended primary IV solution for use with
blood transfusions. Dextrose solutions can cause hemolysis and agglutination, and
Lactated Ringer's contains calcium, which can cause clotting.
Question 12: A patient's arterial blood gas (ABG) results reveal: pH 7.28,
PaCO2 55 mmHg, and HCO3- 24 mEq/L. Which condition does this represent?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Respiratory acidosis
Rationale: The pH is low (acidosis). The PaCO2 is elevated (>45 mmHg), indicating a
respiratory acidotic state. The HCO3- is normal, meaning no renal compensation has
occurred yet.
Updated 2026 | 190+ Questions and Answers | RELIAS
Medical-Surgical Telemetry Comprehensive Study Guide,
Practice Exam, Exam Prep Test Bank, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Monitoring, Medical-Surgical Nursing,
Cardiovascular Pharmacology, Acute Coronary Syndromes,
Heart Failure, Patient Safety, NCLEX-RN & Next Generation
NCLEX (NGN), Detailed Rationales and Complete Revision
Material
Question 1: A patient with a history of heart failure is admitted with shortness
of breath and peripheral edema. The nurse notes jugular venous distention
(JVD) and hepatomegaly. Which hemodynamic parameter is most consistent
with this clinical presentation?
A. Decreased central venous pressure (CVP)
B. Elevated pulmonary artery wedge pressure (PAWP)
C. Decreased systemic vascular resistance (SVR)
D. Increased cardiac output (CO)
CORRECT ANSWER: B. Elevated pulmonary artery wedge pressure (PAWP)
Rationale: The patient's symptoms of JVD, hepatomegaly, and peripheral edema are
classic signs of right-sided heart failure, which is often a consequence of left-sided
failure. Elevated PAWP indicates increased pressure in the left atrium and pulmonary
vasculature, leading to pulmonary congestion and subsequent right ventricular strain.
Decreased CVP would be seen in hypovolemia, not failure, while decreased SVR and
increased CO are not characteristic of heart failure.
Question 2: A nurse is caring for a patient on a telemetry unit who exhibits a
narrow-complex tachycardia at a rate of 180 bpm. The patient is hypotensive
and reports palpitations. After ensuring the patient has a patent airway, which
intervention should the nurse anticipate?
A. Administration of IV amiodarone
B. Immediate synchronized cardioversion
C. Administration of IV adenosine
D. Vagal maneuvers
CORRECT ANSWER: B. Immediate synchronized cardioversion
Rationale: The patient is presenting with unstable tachycardia (narrow-complex, rate
180 bpm, hypotension). Synchronized cardioversion is the treatment of choice for
unstable tachyarrhythmias. Vagal maneuvers and adenosine are used for stable patients.
Amiodarone can be used, but electrical cardioversion is the priority in unstable patients.
,Question 3: A patient's cardiac rhythm strip shows a regular rhythm with a
rate of 42 bpm. There is a P wave before every QRS complex, but the PR
interval is 0.24 seconds. What is the most appropriate initial nursing action?
A. Prepare for transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Document the rhythm as normal
D. Prepare for immediate defibrillation
CORRECT ANSWER: B. Administer atropine 0.5 mg IV
Rationale: The rhythm is sinus bradycardia with a first-degree AV block (PR interval
>0.20 seconds). In symptomatic bradycardia (rate <60 bpm with symptoms), atropine is
the first-line medication. The patient's description does not indicate immediate
instability requiring pacing, and defibrillation is for pulseless rhythms.
Question 4: Which finding is the earliest sign of decreased cardiac output in a
postoperative patient?
A. Decreased blood pressure
B. Decreased urine output
C. Increased heart rate
D. Cool, clammy skin
CORRECT ANSWER: C. Increased heart rate
Rationale: Increased heart rate (tachycardia) is an early compensatory mechanism to
maintain cardiac output when stroke volume decreases. Decreased urine output,
hypotension, and cool skin are later signs of decreased perfusion.
Question 5: A patient is prescribed metoprolol succinate for heart failure.
Which assessment finding would indicate a therapeutic response to this
medication?
A. Decreased heart rate and decreased blood pressure
B. Increased cardiac output and decreased dyspnea
C. Improved ejection fraction and decreased peripheral edema
D. All of the above
CORRECT ANSWER: D. All of the above
Rationale: Metoprolol, a beta-blocker, improves cardiac function by decreasing heart
rate and blood pressure (reducing myocardial oxygen demand), increasing cardiac
output, and reducing symptoms of failure such as dyspnea and edema over time.
Question 6: The nurse is monitoring a patient with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation (tidaling) of water in the water-seal chamber with respirations
,C. Constant bubbling in the suction control chamber
D. Lack of drainage in the collection chamber for 24 hours
CORRECT ANSWER: B. Fluctuation (tidaling) of water in the water-seal
chamber with respirations
Rationale: Tidaling (fluctuation) in the water-seal chamber is a normal finding and
indicates that the chest tube is patent. Continuous bubbling in the water-seal chamber
indicates an air leak. Constant bubbling in the suction control chamber is normal only if
suction is connected, but it is not an indicator of function of the water-seal mechanism.
Question 7: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse is concerned about
the patient's oxygen saturation dropping below 88% during sleep. What should
the nurse do first?
A. Increase the oxygen to 4 L/min
B. Notify the healthcare provider for a sleep study
C. Assess the patient's respiratory effort and lung sounds
D. Place the patient in a high-Fowler's position
CORRECT ANSWER: C. Assess the patient's respiratory effort and lung sounds
Rationale: Before making any changes, the nurse must assess the patient's respiratory
status to determine if the desaturation is due to airway obstruction, hypoventilation, or
worsening of the underlying disease. Increasing oxygen can lead to carbon dioxide
retention in COPD patients.
Question 8: The cardiac monitor shows a rhythm with no identifiable P waves,
a chaotic baseline, and an irregularly irregular ventricular rate of 110 bpm.
How should the nurse interpret this rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by absence of P waves, a chaotic baseline
(fibrillatory waves), and an irregularly irregular ventricular response. Atrial flutter has
saw-tooth flutter waves.
Question 9: A patient is admitted with acute myocardial infarction (MI) and is
receiving thrombolytic therapy. Which assessment finding is the highest
priority to report to the healthcare provider?
A. Mild chest pain
B. Bleeding from the IV site
, C. Nausea and vomiting
D. A change in the patient's level of consciousness
CORRECT ANSWER: D. A change in the patient's level of consciousness
Rationale: A change in level of consciousness (LOC) is a sign of potential intracranial
hemorrhage, a life-threatening complication of thrombolytic therapy. Bleeding from the
IV site is a common side effect but less critical than a change in LOC.
Question 10: Which serum laboratory value is the most important indicator of
the effectiveness of furosemide (Lasix) in a patient with pulmonary edema?
A. Sodium level
B. Potassium level
C. BUN and creatinine levels
D. Daily weight and intake/output
CORRECT ANSWER: D. Daily weight and intake/output
Rationale: While electrolyte imbalances (Na+, K+) and renal function (BUN/Cr) must be
monitored, the most direct indicator of furosemide's effectiveness in reducing fluid
overload is a decrease in daily weight and monitoring of fluid balance (intake/output).
Question 11: The nurse is preparing to administer a blood transfusion to a
patient. Which intravenous (IV) solution is appropriate to use as a primary
infusion with a blood transfusion?
A. 0.9% Normal Saline
B. 0.45% Normal Saline (1/2 NS)
C. 5% Dextrose in Water (D5W)
D. Lactated Ringer's
CORRECT ANSWER: A. 0.9% Normal Saline
Rationale: Normal saline is the only recommended primary IV solution for use with
blood transfusions. Dextrose solutions can cause hemolysis and agglutination, and
Lactated Ringer's contains calcium, which can cause clotting.
Question 12: A patient's arterial blood gas (ABG) results reveal: pH 7.28,
PaCO2 55 mmHg, and HCO3- 24 mEq/L. Which condition does this represent?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Respiratory acidosis
Rationale: The pH is low (acidosis). The PaCO2 is elevated (>45 mmHg), indicating a
respiratory acidotic state. The HCO3- is normal, meaning no renal compensation has
occurred yet.
