Fall Semester 2026–2027 RELIAS Medical-Surgical Telemetry Updated
2026 | 190+ Questions and Answers | Medical-Surgical Telemetry Study
Guide, Practice Exam, Comprehensive Review, RELIAS Assessment Prep
Test Bank, ECG Rhythm Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Assessment, Cardiovascular Nursing, Respiratory
Disorders, Clinical Judgment, Patient Safety, Detailed Rationales and
Complete Revision Material
Question 1: A patient on a medical-surgical telemetry unit is exhibiting sinus
tachycardia with a heart rate of 128 bpm. Which of the following is the most
appropriate initial nursing action?
A. Prepare for immediate synchronized cardioversion.
B. Administer a 6 mg bolus of intravenous adenosine.
C. Assess the patient for potential underlying causes such as pain, fever, or
hypovolemia.
D. Document the rhythm and continue to monitor closely as this is a normal variant.
CORRECT ANSWER: C. Assess the patient for potential underlying causes such as
pain, fever, or hypovolemia.
Rationale: Sinus tachycardia is often a physiologic response to an underlying condition.
The initial nursing action should always be to assess the patient to identify and treat the
root cause, such as pain, fever, dehydration, anxiety, or hypoxia. Immediate
cardioversion or adenosine administration is not indicated for sinus tachycardia, as
these are treatments for unstable tachyarrhythmias like atrial fibrillation or
supraventricular tachycardia.
Question 2: A patient on telemetry has a new onset of atrial fibrillation with a rapid
ventricular response of 150 bpm and is hemodynamically stable. Which
medication should the nurse anticipate administering first?
A. Amiodarone 300 mg IV push
B. Digoxin 0.5 mg IV push
C. Continuous infusion of Diltiazem
D. Lidocaine 100 mg IV push
CORRECT ANSWER: C. Continuous infusion of Diltiazem
Rationale: For hemodynamically stable patients with atrial fibrillation and rapid
ventricular response, the priority is rate control. A continuous infusion of diltiazem, a
calcium channel blocker, is often the first-line agent for rate control. Amiodarone is
used for rhythm control or unstable patients. Digoxin has a slower onset and is often a
second-line agent. Lidocaine is used for ventricular arrhythmias and is not effective for
atrial fibrillation.
,Question 3: The telemetry monitor shows a regular rhythm with a rate of 42 bpm, no
visible P waves, and wide QRS complexes. Which of the following is the most likely
interpretation?
A. Atrial fibrillation
B. Sinus bradycardia
C. Ventricular escape rhythm
D. Junctional bradycardia
CORRECT ANSWER: C. Ventricular escape rhythm
Rationale: A ventricular escape rhythm typically presents with a slow rate (20-40 bpm),
wide QRS complexes (>0.12 sec), and absent P waves. This is a failure of higher
pacemakers to initiate an impulse. Sinus bradycardia would have normal narrow QRS
and P waves. Junctional bradycardia would have narrow QRS complexes.
Question 4: A patient who had a myocardial infarction 2 days ago is now
complaining of chest pressure. The nurse notes a heart rate of 110 bpm and a new
onset of multifocal premature ventricular contractions (PVCs). Which parameter is
most important for the nurse to assess first?
A. The patient's blood pressure
B. The patient's last troponin level
C. The patient's potassium level
D. The patient's pain level on a 0-10 scale
CORRECT ANSWER: A. The patient's blood pressure
Rationale: Multifocal PVCs in a post-MI patient can be a warning sign of increased
ventricular irritability and may precede ventricular tachycardia. The nurse must first
assess hemodynamic stability (blood pressure and level of consciousness) to
determine if the arrhythmia is stable or unstable. While potassium levels and pain are
important, hemodynamic status is the priority for immediate intervention.
Question 5: A patient’s telemetry strip reveals a rhythm that is irregularly irregular,
with no distinct P waves, and a ventricular rate of 90 bpm. What is the most
appropriate nursing intervention for this asymptomatic patient?
A. Prepare for immediate electrical cardioversion.
B. Administer 1 mg of atropine IV push.
C. Administer 150 mg of amiodarone IV over 10 minutes.
D. Continue to monitor and document the rhythm, and notify the provider.
CORRECT ANSWER: D. Continue to monitor and document the rhythm, and notify
the provider.
,Rationale: The rhythm described is classic for atrial fibrillation. Since the patient is
asymptomatic and the ventricular rate is controlled (under 100 bpm), immediate
intervention is not required. The nurse should continue monitoring and notify the
provider for further management, which may include anticoagulation or rate-control
medications.
Question 6: Which of the following telemetry findings is MOST concerning in a
patient with a diagnosis of complete heart block (third-degree AV block)?
A. Ventricular rate of 50 bpm with occasional PVCs
B. Presence of "cannon" A waves in the jugular venous pulse
C. A widened QRS complex > 0.12 seconds
D. The patient reports mild dizziness when standing up
CORRECT ANSWER: C. A widened QRS complex > 0.12 seconds
Rationale: In complete heart block, a widened QRS complex (>0.12 seconds) indicates
that the escape rhythm is arising from the ventricles (ventricular escape), which is less
stable and carries a higher risk of progression to asystole compared to a narrow QRS
junctional escape rhythm. Mild dizziness is expected. Cannon A waves are a hallmark
sign but are not as immediately life-threatening.
Question 7: A patient on a continuous heparin drip is being treated for a pulmonary
embolism. The nurse is reviewing the telemetry and notes the patient has
developed a run of sustained ventricular tachycardia (VT) lasting 20 seconds. The
patient is awake and alert with a blood pressure of 110/70 mmHg. What is the
priority action?
A. Immediate defibrillation at 120 Joules biphasic.
B. Administer a 300 mg bolus of intravenous Amiodarone.
C. Perform synchronized cardioversion at 100 Joules.
D. Check the patient's most recent aPTT level.
CORRECT ANSWER: B. Administer a 300 mg bolus of intravenous Amiodarone.
Rationale: Sustained VT with a palpable pulse and stable hemodynamics is treated
pharmacologically with antiarrhythmic agents like amiodarone. Unstable VT requires
immediate synchronized cardioversion. Defibrillation (unsynchronized) is for pulseless
VT/VF. Checking aPTT is important for heparin therapy but is not the immediate priority
for a dysrhythmia.
Question 8: A patient's cardiac monitor shows a pattern of sudden, recurrent
episodes of a wide-complex tachycardia that begin and end abruptly. The patient
, reports palpitations and mild shortness of breath during the episodes. What is the
most likely rhythm?
A. Atrial flutter with variable conduction
B. Ventricular fibrillation
C. Supraventricular tachycardia (SVT) with aberrancy
D. Sinus rhythm with frequent PVCs
CORRECT ANSWER: C. Supraventricular tachycardia (SVT) with aberrancy
Rationale: The description of sudden onset and termination is characteristic of a re-
entrant tachycardia like SVT. A wide QRS complex can occur if the conduction is
aberrant (e.g., bundle branch block). Ventricular fibrillation is chaotic and lethal. Atrial
flutter typically has a "sawtooth" baseline.
Question 9: The primary reason continuous telemetry monitoring is utilized for
patients in a medical-surgical setting is to:
A. Measure the patient's cardiac output accurately.
B. Provide continuous, non-invasive blood pressure monitoring.
C. Allow for early detection and immediate treatment of life-threatening arrhythmias.
D. Determine the patient's eligibility for a pacemaker.
CORRECT ANSWER: C. Allow for early detection and immediate treatment of life-
threatening arrhythmias.
Rationale: The primary purpose of telemetry is to continuously monitor the heart's
electrical activity to detect and treat potentially lethal arrhythmias (e.g., VT, VF, asystole,
severe bradycardia) as early as possible, thereby preventing sudden cardiac death. It
does not measure cardiac output or blood pressure continuously.
Question 10: The nurse is preparing to apply telemetry leads to a patient. To obtain
the most accurate reading for a 5-lead system, where should the nurse place the
brown (or green/black) ground lead?
A. On the right mid-clavicular line, just below the clavicle.
B. On the left mid-clavicular line, just below the clavicle.
C. On the right lower abdomen, below the ribcage.
D. On the lower left chest, anterior axillary line.
CORRECT ANSWER: C. On the right lower abdomen, below the ribcage.
Rationale: In a standard 5-lead telemetry system, the white lead is placed on the right
upper chest, black on the left upper chest, red on the left lower abdomen, and
green/brown (ground) on the right lower abdomen. Proper placement is crucial for
artifact-free monitoring.
2026 | 190+ Questions and Answers | Medical-Surgical Telemetry Study
Guide, Practice Exam, Comprehensive Review, RELIAS Assessment Prep
Test Bank, ECG Rhythm Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Assessment, Cardiovascular Nursing, Respiratory
Disorders, Clinical Judgment, Patient Safety, Detailed Rationales and
Complete Revision Material
Question 1: A patient on a medical-surgical telemetry unit is exhibiting sinus
tachycardia with a heart rate of 128 bpm. Which of the following is the most
appropriate initial nursing action?
A. Prepare for immediate synchronized cardioversion.
B. Administer a 6 mg bolus of intravenous adenosine.
C. Assess the patient for potential underlying causes such as pain, fever, or
hypovolemia.
D. Document the rhythm and continue to monitor closely as this is a normal variant.
CORRECT ANSWER: C. Assess the patient for potential underlying causes such as
pain, fever, or hypovolemia.
Rationale: Sinus tachycardia is often a physiologic response to an underlying condition.
The initial nursing action should always be to assess the patient to identify and treat the
root cause, such as pain, fever, dehydration, anxiety, or hypoxia. Immediate
cardioversion or adenosine administration is not indicated for sinus tachycardia, as
these are treatments for unstable tachyarrhythmias like atrial fibrillation or
supraventricular tachycardia.
Question 2: A patient on telemetry has a new onset of atrial fibrillation with a rapid
ventricular response of 150 bpm and is hemodynamically stable. Which
medication should the nurse anticipate administering first?
A. Amiodarone 300 mg IV push
B. Digoxin 0.5 mg IV push
C. Continuous infusion of Diltiazem
D. Lidocaine 100 mg IV push
CORRECT ANSWER: C. Continuous infusion of Diltiazem
Rationale: For hemodynamically stable patients with atrial fibrillation and rapid
ventricular response, the priority is rate control. A continuous infusion of diltiazem, a
calcium channel blocker, is often the first-line agent for rate control. Amiodarone is
used for rhythm control or unstable patients. Digoxin has a slower onset and is often a
second-line agent. Lidocaine is used for ventricular arrhythmias and is not effective for
atrial fibrillation.
,Question 3: The telemetry monitor shows a regular rhythm with a rate of 42 bpm, no
visible P waves, and wide QRS complexes. Which of the following is the most likely
interpretation?
A. Atrial fibrillation
B. Sinus bradycardia
C. Ventricular escape rhythm
D. Junctional bradycardia
CORRECT ANSWER: C. Ventricular escape rhythm
Rationale: A ventricular escape rhythm typically presents with a slow rate (20-40 bpm),
wide QRS complexes (>0.12 sec), and absent P waves. This is a failure of higher
pacemakers to initiate an impulse. Sinus bradycardia would have normal narrow QRS
and P waves. Junctional bradycardia would have narrow QRS complexes.
Question 4: A patient who had a myocardial infarction 2 days ago is now
complaining of chest pressure. The nurse notes a heart rate of 110 bpm and a new
onset of multifocal premature ventricular contractions (PVCs). Which parameter is
most important for the nurse to assess first?
A. The patient's blood pressure
B. The patient's last troponin level
C. The patient's potassium level
D. The patient's pain level on a 0-10 scale
CORRECT ANSWER: A. The patient's blood pressure
Rationale: Multifocal PVCs in a post-MI patient can be a warning sign of increased
ventricular irritability and may precede ventricular tachycardia. The nurse must first
assess hemodynamic stability (blood pressure and level of consciousness) to
determine if the arrhythmia is stable or unstable. While potassium levels and pain are
important, hemodynamic status is the priority for immediate intervention.
Question 5: A patient’s telemetry strip reveals a rhythm that is irregularly irregular,
with no distinct P waves, and a ventricular rate of 90 bpm. What is the most
appropriate nursing intervention for this asymptomatic patient?
A. Prepare for immediate electrical cardioversion.
B. Administer 1 mg of atropine IV push.
C. Administer 150 mg of amiodarone IV over 10 minutes.
D. Continue to monitor and document the rhythm, and notify the provider.
CORRECT ANSWER: D. Continue to monitor and document the rhythm, and notify
the provider.
,Rationale: The rhythm described is classic for atrial fibrillation. Since the patient is
asymptomatic and the ventricular rate is controlled (under 100 bpm), immediate
intervention is not required. The nurse should continue monitoring and notify the
provider for further management, which may include anticoagulation or rate-control
medications.
Question 6: Which of the following telemetry findings is MOST concerning in a
patient with a diagnosis of complete heart block (third-degree AV block)?
A. Ventricular rate of 50 bpm with occasional PVCs
B. Presence of "cannon" A waves in the jugular venous pulse
C. A widened QRS complex > 0.12 seconds
D. The patient reports mild dizziness when standing up
CORRECT ANSWER: C. A widened QRS complex > 0.12 seconds
Rationale: In complete heart block, a widened QRS complex (>0.12 seconds) indicates
that the escape rhythm is arising from the ventricles (ventricular escape), which is less
stable and carries a higher risk of progression to asystole compared to a narrow QRS
junctional escape rhythm. Mild dizziness is expected. Cannon A waves are a hallmark
sign but are not as immediately life-threatening.
Question 7: A patient on a continuous heparin drip is being treated for a pulmonary
embolism. The nurse is reviewing the telemetry and notes the patient has
developed a run of sustained ventricular tachycardia (VT) lasting 20 seconds. The
patient is awake and alert with a blood pressure of 110/70 mmHg. What is the
priority action?
A. Immediate defibrillation at 120 Joules biphasic.
B. Administer a 300 mg bolus of intravenous Amiodarone.
C. Perform synchronized cardioversion at 100 Joules.
D. Check the patient's most recent aPTT level.
CORRECT ANSWER: B. Administer a 300 mg bolus of intravenous Amiodarone.
Rationale: Sustained VT with a palpable pulse and stable hemodynamics is treated
pharmacologically with antiarrhythmic agents like amiodarone. Unstable VT requires
immediate synchronized cardioversion. Defibrillation (unsynchronized) is for pulseless
VT/VF. Checking aPTT is important for heparin therapy but is not the immediate priority
for a dysrhythmia.
Question 8: A patient's cardiac monitor shows a pattern of sudden, recurrent
episodes of a wide-complex tachycardia that begin and end abruptly. The patient
, reports palpitations and mild shortness of breath during the episodes. What is the
most likely rhythm?
A. Atrial flutter with variable conduction
B. Ventricular fibrillation
C. Supraventricular tachycardia (SVT) with aberrancy
D. Sinus rhythm with frequent PVCs
CORRECT ANSWER: C. Supraventricular tachycardia (SVT) with aberrancy
Rationale: The description of sudden onset and termination is characteristic of a re-
entrant tachycardia like SVT. A wide QRS complex can occur if the conduction is
aberrant (e.g., bundle branch block). Ventricular fibrillation is chaotic and lethal. Atrial
flutter typically has a "sawtooth" baseline.
Question 9: The primary reason continuous telemetry monitoring is utilized for
patients in a medical-surgical setting is to:
A. Measure the patient's cardiac output accurately.
B. Provide continuous, non-invasive blood pressure monitoring.
C. Allow for early detection and immediate treatment of life-threatening arrhythmias.
D. Determine the patient's eligibility for a pacemaker.
CORRECT ANSWER: C. Allow for early detection and immediate treatment of life-
threatening arrhythmias.
Rationale: The primary purpose of telemetry is to continuously monitor the heart's
electrical activity to detect and treat potentially lethal arrhythmias (e.g., VT, VF, asystole,
severe bradycardia) as early as possible, thereby preventing sudden cardiac death. It
does not measure cardiac output or blood pressure continuously.
Question 10: The nurse is preparing to apply telemetry leads to a patient. To obtain
the most accurate reading for a 5-lead system, where should the nurse place the
brown (or green/black) ground lead?
A. On the right mid-clavicular line, just below the clavicle.
B. On the left mid-clavicular line, just below the clavicle.
C. On the right lower abdomen, below the ribcage.
D. On the lower left chest, anterior axillary line.
CORRECT ANSWER: C. On the right lower abdomen, below the ribcage.
Rationale: In a standard 5-lead telemetry system, the white lead is placed on the right
upper chest, black on the left upper chest, red on the left lower abdomen, and
green/brown (ground) on the right lower abdomen. Proper placement is crucial for
artifact-free monitoring.
