RELIAS Medical-Surgical Telemetry Exam |
RELIAS Medical-Surgical Telemetry Study Guide &
Exam Prep 2026/2027 | Medical-Surgical
Telemetry Nursing Review, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Heart Failure, Acute Coronary Syndromes,
Hemodynamic Monitoring, Respiratory Assessment,
Oxygen Therapy, Fluid & Electrolyte Imbalances,
Cardiovascular Pharmacology, Emergency
Response, Patient Safety, Clinical Judgment,
Practice Questions, Answers & Detailed Rationales
Question 1: A patient's telemetry strip shows a sudden onset of a wide-
complex tachycardia at a rate of 180 bpm. The patient is awake, diaphoretic,
and reports chest tightness. What is the nurse's priority action?
A. Prepare for immediate synchronized cardioversion.
B. Administer amiodarone 150 mg IV push.
C. Assess the patient's pulse and blood pressure.
D. Apply oxygen via non-rebreather mask.
CORRECT ANSWER: C. Assess the patient's pulse and blood pressure.
Rationale: Ventricular tachycardia can be either pulseless or with a pulse. The
immediate priority is to assess the patient's hemodynamic stability by checking for a
pulse and blood pressure. If the patient is pulseless, defibrillation is indicated. If the
patient has a pulse but is unstable (e.g., chest pain, hypotension), synchronized
cardioversion is the treatment of choice. For stable VT, antiarrhythmic medications may
be considered. Therefore, assessment of stability is the critical first step .
Question 2: A patient with heart failure is prescribed furosemide (Lasix).
Which laboratory value requires the most immediate nursing intervention?
A. Sodium 135 mEq/L.
B. Potassium 2.8 mEq/L.
C. Calcium 9.2 mg/dL.
D. Magnesium 2.0 mEq/L.
CORRECT ANSWER: B. Potassium 2.8 mEq/L.
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A
potassium level of 2.8 mEq/L is critically low (hypokalemia). This can precipitate life-
threatening cardiac dysrhythmias, especially in a patient with heart failure who may also
be on digoxin, as hypokalemia increases the risk of digoxin toxicity. The other values are
within or near normal limits and are not as immediately life-threatening .
,Question 3: A patient on a telemetry unit is in atrial fibrillation with a
ventricular rate of 145 bpm. The patient is hemodynamically stable. Which
medication should the nurse anticipate administering first for rate control?
A. Lidocaine.
B. Atropine.
C. Amiodarone.
D. Epinephrine.
CORRECT ANSWER: C. Amiodarone.
Rationale: Amiodarone is a class III antiarrhythmic effective for rate control in atrial
fibrillation. It is often the drug of choice for rate control in hemodynamically stable
patients, particularly those with heart failure. Lidocaine is used for ventricular
dysrhythmias, atropine for symptomatic bradycardia, and epinephrine for cardiac arrest
or severe hypotension. Controlling the ventricular rate is the priority to prevent
hemodynamic compromise .
Question 4: A patient is admitted with acute chest pain and ST-segment
elevation in leads V1 through V4 on a 12-lead EKG. What is the priority
nursing intervention?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead EKG.
C. Administer aspirin 324 mg, chewed.
D. Draw cardiac enzymes.
CORRECT ANSWER: C. Administer aspirin 324 mg, chewed.
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior ST-elevation
myocardial infarction (STEMI). Aspirin is a critical first-line intervention because it
inhibits platelet aggregation and reduces mortality. The recommended dose is 324 mg,
chewed for rapid absorption. While nitroglycerin and EKG are important, aspirin is the
priority to prevent further clot formation. Cardiac enzymes are diagnostic but not the
first action .
Question 5: A patient's telemetry monitor displays a flatline (asystole). What is
the nurse's first action?
A. Initiate CPR and call a code.
B. Administer epinephrine IV.
C. Check the patient's leads and connections.
D. Prepare for transcutaneous pacing.
CORRECT ANSWER: C. Check the patient's leads and connections.
Rationale: A flatline on a monitor is most often caused by a technical issue such as a
disconnected lead, loose electrode, or patient movement. The nurse must first assess
the patient and verify the lead connections to confirm if the rhythm is true asystole or an
artifact. Assuming it is a true emergency without a quick assessment can lead to
,unnecessary interventions. If the patient is unresponsive and pulseless, CPR and the
code protocol should be initiated immediately .
Question 6: A patient is being monitored on a telemetry unit. The nurse notes
a regular rhythm with a rate of 40 bpm and no visible P waves. The QRS
complexes are wide and bizarre. This rhythm is best described as:
A. Atrial fibrillation.
B. Junctional rhythm.
C. Ventricular tachycardia.
D. Idioventricular rhythm.
CORRECT ANSWER: D. Idioventricular rhythm.
Rationale: An idioventricular rhythm is characterized by a slow ventricular rate (20-40
bpm), wide QRS complexes, and the absence of P waves. This occurs when the
ventricular pacemaker takes over due to the failure of higher pacemakers. Ventricular
tachycardia would have a rate over 100 bpm, while atrial fibrillation and junctional
rhythms would typically have narrow QRS complexes unless aberrancy is present .
Question 7: A nurse is caring for a post-operative patient on a telemetry
monitor. The patient's heart rate suddenly drops from 88 bpm to 42 bpm. The
rhythm is regular with a normal QRS complex, and the patient is
asymptomatic. What is the nurse's priority action?
A. Prepare for synchronized cardioversion.
B. Administer atropine 0.5 mg IV push.
C. Assess the patient's blood pressure and level of consciousness.
D. Apply transcutaneous pacemaker pads.
CORRECT ANSWER: C. Assess the patient's blood pressure and level of
consciousness.
Rationale: The initial step in managing bradycardia is to assess the patient's
hemodynamic stability. Symptoms like hypotension, chest pain, or altered mental status
dictate the need for intervention (e.g., atropine, pacing). Since the patient is
asymptomatic, a thorough assessment is the priority before initiating any treatment .
Question 8: A patient with an acute myocardial infarction is exhibiting
multifocal premature ventricular contractions (PVCs) on the telemetry
monitor. Which medication is the priority to administer?
A. Epinephrine.
B. Amiodarone.
C. Atropine.
D. Sodium bicarbonate.
CORRECT ANSWER: B. Amiodarone.
, Rationale: In the context of an acute MI, frequent or multifocal PVCs are considered
warning arrhythmias that can deteriorate into ventricular tachycardia or fibrillation.
Amiodarone is an antiarrhythmic drug indicated for the suppression of these serious
ventricular arrhythmias. Lidocaine is another option, but Amiodarone is often the first-
line agent in this scenario .
Question 9: The nurse is reviewing a patient's telemetry strip and notes that
the PR interval is progressively lengthening until a QRS complex is dropped.
This pattern repeats. This rhythm is identified as:
A. Second-degree atrioventricular (AV) block, Type I (Wenckebach).
B. Second-degree atrioventricular (AV) block, Type II (Mobitz II).
C. Third-degree AV block.
D. First-degree AV block.
CORRECT ANSWER: A. Second-degree atrioventricular (AV) block, Type I
(Wenckebach).
Rationale: Wenckebach (Mobitz I) is characterized by a progressive prolongation of the
PR interval on successive beats until a P wave is not conducted (dropped QRS). The
cycle then repeats. It is often benign and typically does not progress to more serious
blocks. Mobitz II is characterized by a constant PR interval with non-conducted P waves,
and third-degree heart block involves complete AV dissociation .
Question 10: A patient has a history of atrial fibrillation and is on
anticoagulation therapy. Which finding would be the most significant indicator
of a potential thromboembolic event?
A. Intermittent episodes of palpitations.
B. A sudden onset of severe, sharp chest pain.
C. A new onset of hemiparesis and facial droop.
D. Shortness of breath during exertion.
CORRECT ANSWER: C. A new onset of hemiparesis and facial droop.
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrium, which can embolize to the cerebral circulation. A new onset of focal neurologic
deficits, such as hemiparesis and facial droop, is the most significant indicator of an
acute ischemic stroke, a major thromboembolic complication .
Question 11: A patient on a telemetry unit has an order for continuous pulse
oximetry. The patient's baseline SpO2 is 96%. Which of the following would be
a sign of early hypoxia that a nurse should assess for?
A. Cyanosis.
B. Restlessness.
C. Bradycardia.
D. Hypotension.
CORRECT ANSWER: B. Restlessness.
RELIAS Medical-Surgical Telemetry Study Guide &
Exam Prep 2026/2027 | Medical-Surgical
Telemetry Nursing Review, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Heart Failure, Acute Coronary Syndromes,
Hemodynamic Monitoring, Respiratory Assessment,
Oxygen Therapy, Fluid & Electrolyte Imbalances,
Cardiovascular Pharmacology, Emergency
Response, Patient Safety, Clinical Judgment,
Practice Questions, Answers & Detailed Rationales
Question 1: A patient's telemetry strip shows a sudden onset of a wide-
complex tachycardia at a rate of 180 bpm. The patient is awake, diaphoretic,
and reports chest tightness. What is the nurse's priority action?
A. Prepare for immediate synchronized cardioversion.
B. Administer amiodarone 150 mg IV push.
C. Assess the patient's pulse and blood pressure.
D. Apply oxygen via non-rebreather mask.
CORRECT ANSWER: C. Assess the patient's pulse and blood pressure.
Rationale: Ventricular tachycardia can be either pulseless or with a pulse. The
immediate priority is to assess the patient's hemodynamic stability by checking for a
pulse and blood pressure. If the patient is pulseless, defibrillation is indicated. If the
patient has a pulse but is unstable (e.g., chest pain, hypotension), synchronized
cardioversion is the treatment of choice. For stable VT, antiarrhythmic medications may
be considered. Therefore, assessment of stability is the critical first step .
Question 2: A patient with heart failure is prescribed furosemide (Lasix).
Which laboratory value requires the most immediate nursing intervention?
A. Sodium 135 mEq/L.
B. Potassium 2.8 mEq/L.
C. Calcium 9.2 mg/dL.
D. Magnesium 2.0 mEq/L.
CORRECT ANSWER: B. Potassium 2.8 mEq/L.
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A
potassium level of 2.8 mEq/L is critically low (hypokalemia). This can precipitate life-
threatening cardiac dysrhythmias, especially in a patient with heart failure who may also
be on digoxin, as hypokalemia increases the risk of digoxin toxicity. The other values are
within or near normal limits and are not as immediately life-threatening .
,Question 3: A patient on a telemetry unit is in atrial fibrillation with a
ventricular rate of 145 bpm. The patient is hemodynamically stable. Which
medication should the nurse anticipate administering first for rate control?
A. Lidocaine.
B. Atropine.
C. Amiodarone.
D. Epinephrine.
CORRECT ANSWER: C. Amiodarone.
Rationale: Amiodarone is a class III antiarrhythmic effective for rate control in atrial
fibrillation. It is often the drug of choice for rate control in hemodynamically stable
patients, particularly those with heart failure. Lidocaine is used for ventricular
dysrhythmias, atropine for symptomatic bradycardia, and epinephrine for cardiac arrest
or severe hypotension. Controlling the ventricular rate is the priority to prevent
hemodynamic compromise .
Question 4: A patient is admitted with acute chest pain and ST-segment
elevation in leads V1 through V4 on a 12-lead EKG. What is the priority
nursing intervention?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead EKG.
C. Administer aspirin 324 mg, chewed.
D. Draw cardiac enzymes.
CORRECT ANSWER: C. Administer aspirin 324 mg, chewed.
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior ST-elevation
myocardial infarction (STEMI). Aspirin is a critical first-line intervention because it
inhibits platelet aggregation and reduces mortality. The recommended dose is 324 mg,
chewed for rapid absorption. While nitroglycerin and EKG are important, aspirin is the
priority to prevent further clot formation. Cardiac enzymes are diagnostic but not the
first action .
Question 5: A patient's telemetry monitor displays a flatline (asystole). What is
the nurse's first action?
A. Initiate CPR and call a code.
B. Administer epinephrine IV.
C. Check the patient's leads and connections.
D. Prepare for transcutaneous pacing.
CORRECT ANSWER: C. Check the patient's leads and connections.
Rationale: A flatline on a monitor is most often caused by a technical issue such as a
disconnected lead, loose electrode, or patient movement. The nurse must first assess
the patient and verify the lead connections to confirm if the rhythm is true asystole or an
artifact. Assuming it is a true emergency without a quick assessment can lead to
,unnecessary interventions. If the patient is unresponsive and pulseless, CPR and the
code protocol should be initiated immediately .
Question 6: A patient is being monitored on a telemetry unit. The nurse notes
a regular rhythm with a rate of 40 bpm and no visible P waves. The QRS
complexes are wide and bizarre. This rhythm is best described as:
A. Atrial fibrillation.
B. Junctional rhythm.
C. Ventricular tachycardia.
D. Idioventricular rhythm.
CORRECT ANSWER: D. Idioventricular rhythm.
Rationale: An idioventricular rhythm is characterized by a slow ventricular rate (20-40
bpm), wide QRS complexes, and the absence of P waves. This occurs when the
ventricular pacemaker takes over due to the failure of higher pacemakers. Ventricular
tachycardia would have a rate over 100 bpm, while atrial fibrillation and junctional
rhythms would typically have narrow QRS complexes unless aberrancy is present .
Question 7: A nurse is caring for a post-operative patient on a telemetry
monitor. The patient's heart rate suddenly drops from 88 bpm to 42 bpm. The
rhythm is regular with a normal QRS complex, and the patient is
asymptomatic. What is the nurse's priority action?
A. Prepare for synchronized cardioversion.
B. Administer atropine 0.5 mg IV push.
C. Assess the patient's blood pressure and level of consciousness.
D. Apply transcutaneous pacemaker pads.
CORRECT ANSWER: C. Assess the patient's blood pressure and level of
consciousness.
Rationale: The initial step in managing bradycardia is to assess the patient's
hemodynamic stability. Symptoms like hypotension, chest pain, or altered mental status
dictate the need for intervention (e.g., atropine, pacing). Since the patient is
asymptomatic, a thorough assessment is the priority before initiating any treatment .
Question 8: A patient with an acute myocardial infarction is exhibiting
multifocal premature ventricular contractions (PVCs) on the telemetry
monitor. Which medication is the priority to administer?
A. Epinephrine.
B. Amiodarone.
C. Atropine.
D. Sodium bicarbonate.
CORRECT ANSWER: B. Amiodarone.
, Rationale: In the context of an acute MI, frequent or multifocal PVCs are considered
warning arrhythmias that can deteriorate into ventricular tachycardia or fibrillation.
Amiodarone is an antiarrhythmic drug indicated for the suppression of these serious
ventricular arrhythmias. Lidocaine is another option, but Amiodarone is often the first-
line agent in this scenario .
Question 9: The nurse is reviewing a patient's telemetry strip and notes that
the PR interval is progressively lengthening until a QRS complex is dropped.
This pattern repeats. This rhythm is identified as:
A. Second-degree atrioventricular (AV) block, Type I (Wenckebach).
B. Second-degree atrioventricular (AV) block, Type II (Mobitz II).
C. Third-degree AV block.
D. First-degree AV block.
CORRECT ANSWER: A. Second-degree atrioventricular (AV) block, Type I
(Wenckebach).
Rationale: Wenckebach (Mobitz I) is characterized by a progressive prolongation of the
PR interval on successive beats until a P wave is not conducted (dropped QRS). The
cycle then repeats. It is often benign and typically does not progress to more serious
blocks. Mobitz II is characterized by a constant PR interval with non-conducted P waves,
and third-degree heart block involves complete AV dissociation .
Question 10: A patient has a history of atrial fibrillation and is on
anticoagulation therapy. Which finding would be the most significant indicator
of a potential thromboembolic event?
A. Intermittent episodes of palpitations.
B. A sudden onset of severe, sharp chest pain.
C. A new onset of hemiparesis and facial droop.
D. Shortness of breath during exertion.
CORRECT ANSWER: C. A new onset of hemiparesis and facial droop.
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrium, which can embolize to the cerebral circulation. A new onset of focal neurologic
deficits, such as hemiparesis and facial droop, is the most significant indicator of an
acute ischemic stroke, a major thromboembolic complication .
Question 11: A patient on a telemetry unit has an order for continuous pulse
oximetry. The patient's baseline SpO2 is 96%. Which of the following would be
a sign of early hypoxia that a nurse should assess for?
A. Cyanosis.
B. Restlessness.
C. Bradycardia.
D. Hypotension.
CORRECT ANSWER: B. Restlessness.
