MEDICAL SURGICAL-TELEMETRY RN A EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
MED-SURG / TELEMETRY RN A — EXAM
1. A client with heart failure is receiving furosemide IV. Which finding
requires the highest priority intervention?
A. 2+ bilateral ankle edema
B. Blood pressure 104/62
C. Potassium 3.0 mEq/L
D. Dyspnea on exertion
Correct Answer: C — Potassium 3.0 mEq/L
Rationale: IV loop diuretics commonly cause potassium loss. A K⁺ of 3.0 places
the patient at high risk for ventricular dysrhythmias — especially dangerous in
telemetry patients. Edema and DOE are expected HF findings; BP 104/62 is stable.
2. A telemetry patient develops new-onset confusion. Which lab abnormality
is most likely the cause?
A. Hemoglobin 12.1 g/dL
B. Sodium 118 mEq/L
C. Platelets 210,000
D. Calcium 9.1 mg/dL
Correct Answer: B — Sodium 118 mEq/L
Rationale: Severe hyponatremia (<120) causes acute neurological changes due to
cerebral swelling. This is an emergency requiring rapid but controlled correction.
,3. You see the following rhythm: irregularly irregular, no P waves, narrow
QRS. What is it?
A. Atrial flutter
B. Atrial fibrillation
C. PVCs
D. Junctional rhythm
Correct Answer: B — Atrial fibrillation
Rationale: Afib = irregularly irregular rhythm with absence of P waves. Telemetry
nurses must identify AF promptly due to stroke risk and rate-control needs.
4. A patient with COPD exacerbation is receiving O₂ via nasal cannula. The
SpO₂ is 88%. What is the priority action?
A. Increase O₂ to maintain SpO₂ 88–92%
B. Switch to a simple face mask
C. Start BiPAP immediately
D. Discontinue O₂ to avoid suppressing drive
Correct Answer: A
Rationale: COPD oxygen goal = 88–92%. Increase slightly (1–2 L/min).
Discontinuing O₂ is unsafe; BiPAP is for severe distress.
5. A patient with DKA is improving. Which finding shows that the therapy is
effective?
A. Kussmaul respirations persist
B. Glucose 520 → 390 mg/dL
C. Bicarbonate increases to 18 mEq/L
D. Urine specific gravity stays high
Correct Answer: C
Rationale: Resolution of metabolic acidosis (HCO₃ rising) indicates improvement.
Glucose alone ↓ is NOT enough to confirm correction of DKA.
,6. A patient with a chest tube for pneumothorax suddenly shows no tidaling.
What do you do first?
A. Clamp the chest tube
B. Check for kinks/obstructions
C. Call rapid response
D. Increase suction
Correct Answer: B
Rationale: No tidaling may mean the tube is kinked or obstructed. Check system
first before assuming lung re-expansion.
7. A telemetry patient on digoxin has nausea and visual halos. What is the
priority?
A. Give the next dose
B. Hold the digoxin and check K⁺
C. Increase IV fluids
D. Apply oxygen
Correct Answer: B
Rationale: Classic digoxin toxicity symptoms: nausea, vomiting, halos,
bradycardia. Toxicity worsens with low potassium.
8. A patient with sepsis has MAP 55. What order do you anticipate?
A. LR bolus
B. 25% albumin
C. Nitroglycerin
D. Beta-blocker IV
Correct Answer: A
Rationale: First-line for septic hypotension is aggressive crystalloid bolus to reach
MAP ≥ 65.
, 9. Which patient is the highest priority to see first?
A. Post-op day 1 with 100.2°F fever
B. CHF patient with 3 lb weight gain
C. DKA patient with K⁺ 5.9
D. Pulmonary embolism patient with new hemoptysis
Correct Answer: D
Rationale: Hemoptysis + known PE = possible worsening embolus or pulmonary
infarction — life threatening.
10. A telemetry patient has this rhythm: wide, regular QRS > 0.12, rate 160.
What is it?
A. VTach
B. SVT
C. First-degree block
D. Sinus tachycardia
Correct Answer: A — Ventricular tachycardia
Rationale: Wide-complex tachycardia = VT until proven otherwise.
11. Priority lab value for a patient receiving heparin drip:
A. INR
B. aPTT
C. Hgb
D. Potassium
Correct Answer: B
Rationale: Heparin is titrated using aPTT values.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
MED-SURG / TELEMETRY RN A — EXAM
1. A client with heart failure is receiving furosemide IV. Which finding
requires the highest priority intervention?
A. 2+ bilateral ankle edema
B. Blood pressure 104/62
C. Potassium 3.0 mEq/L
D. Dyspnea on exertion
Correct Answer: C — Potassium 3.0 mEq/L
Rationale: IV loop diuretics commonly cause potassium loss. A K⁺ of 3.0 places
the patient at high risk for ventricular dysrhythmias — especially dangerous in
telemetry patients. Edema and DOE are expected HF findings; BP 104/62 is stable.
2. A telemetry patient develops new-onset confusion. Which lab abnormality
is most likely the cause?
A. Hemoglobin 12.1 g/dL
B. Sodium 118 mEq/L
C. Platelets 210,000
D. Calcium 9.1 mg/dL
Correct Answer: B — Sodium 118 mEq/L
Rationale: Severe hyponatremia (<120) causes acute neurological changes due to
cerebral swelling. This is an emergency requiring rapid but controlled correction.
,3. You see the following rhythm: irregularly irregular, no P waves, narrow
QRS. What is it?
A. Atrial flutter
B. Atrial fibrillation
C. PVCs
D. Junctional rhythm
Correct Answer: B — Atrial fibrillation
Rationale: Afib = irregularly irregular rhythm with absence of P waves. Telemetry
nurses must identify AF promptly due to stroke risk and rate-control needs.
4. A patient with COPD exacerbation is receiving O₂ via nasal cannula. The
SpO₂ is 88%. What is the priority action?
A. Increase O₂ to maintain SpO₂ 88–92%
B. Switch to a simple face mask
C. Start BiPAP immediately
D. Discontinue O₂ to avoid suppressing drive
Correct Answer: A
Rationale: COPD oxygen goal = 88–92%. Increase slightly (1–2 L/min).
Discontinuing O₂ is unsafe; BiPAP is for severe distress.
5. A patient with DKA is improving. Which finding shows that the therapy is
effective?
A. Kussmaul respirations persist
B. Glucose 520 → 390 mg/dL
C. Bicarbonate increases to 18 mEq/L
D. Urine specific gravity stays high
Correct Answer: C
Rationale: Resolution of metabolic acidosis (HCO₃ rising) indicates improvement.
Glucose alone ↓ is NOT enough to confirm correction of DKA.
,6. A patient with a chest tube for pneumothorax suddenly shows no tidaling.
What do you do first?
A. Clamp the chest tube
B. Check for kinks/obstructions
C. Call rapid response
D. Increase suction
Correct Answer: B
Rationale: No tidaling may mean the tube is kinked or obstructed. Check system
first before assuming lung re-expansion.
7. A telemetry patient on digoxin has nausea and visual halos. What is the
priority?
A. Give the next dose
B. Hold the digoxin and check K⁺
C. Increase IV fluids
D. Apply oxygen
Correct Answer: B
Rationale: Classic digoxin toxicity symptoms: nausea, vomiting, halos,
bradycardia. Toxicity worsens with low potassium.
8. A patient with sepsis has MAP 55. What order do you anticipate?
A. LR bolus
B. 25% albumin
C. Nitroglycerin
D. Beta-blocker IV
Correct Answer: A
Rationale: First-line for septic hypotension is aggressive crystalloid bolus to reach
MAP ≥ 65.
, 9. Which patient is the highest priority to see first?
A. Post-op day 1 with 100.2°F fever
B. CHF patient with 3 lb weight gain
C. DKA patient with K⁺ 5.9
D. Pulmonary embolism patient with new hemoptysis
Correct Answer: D
Rationale: Hemoptysis + known PE = possible worsening embolus or pulmonary
infarction — life threatening.
10. A telemetry patient has this rhythm: wide, regular QRS > 0.12, rate 160.
What is it?
A. VTach
B. SVT
C. First-degree block
D. Sinus tachycardia
Correct Answer: A — Ventricular tachycardia
Rationale: Wide-complex tachycardia = VT until proven otherwise.
11. Priority lab value for a patient receiving heparin drip:
A. INR
B. aPTT
C. Hgb
D. Potassium
Correct Answer: B
Rationale: Heparin is titrated using aPTT values.
