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, Cardiac Monitoring, ECG Rhythm
Interpretation, Dysrhythmias, Medical-Surgical
Nursing, Hemodynamic Monitoring, Pharmacology,
Patient Safety, Critical Care, NCLEX-RN Review,
Detailed Rationales and Complete Revision Material
Question 1: A patient with a history of heart failure is admitted with shortness
of breath and edema. The nurse notes jugular venous distention (JVD) and
crackles in the lung bases. Which laboratory value is most indicative of the
underlying pathophysiological process driving these symptoms?
A. Elevated serum sodium
B. Elevated B-type natriuretic peptide (BNP)
C. Decreased serum potassium
D. Elevated serum creatinine
CORRECT ANSWER: B. Elevated B-type natriuretic peptide (BNP)
Rationale: BNP is a neurohormone released from the ventricles in response to increased
wall tension and volume overload. An elevated BNP is a sensitive and specific marker
for heart failure, directly correlating with the symptoms of JVD, pulmonary crackles, and
edema. Elevated sodium is often diluted in HF; potassium and creatinine are not
primary diagnostic indicators for acute decompensation.
Question 2: During an annual physical, a 55-year-old male is found to have a
blood pressure of 148/92 mmHg. Which finding would indicate to the nurse
that he may have metabolic syndrome, necessitating further assessment?
A. Elevated HDL cholesterol
B. Fasting blood glucose of 115 mg/dL
C. Decreased waist circumference
D. Decreased triglyceride levels
CORRECT ANSWER: B. Fasting blood glucose of 115 mg/dL
Rationale: Metabolic syndrome criteria include elevated fasting glucose (≥100 mg/dL),
hypertension, elevated triglycerides, reduced HDL, and increased waist circumference.
A fasting glucose of 115 mg/dL meets the glycemic criterion, while the other options
represent values that are either normal or protective.
Question 3: The nurse is administering IV heparin to a patient with a
pulmonary embolism. Which laboratory value requires the most immediate
action to prevent a life-threatening complication?
,A. Partial thromboplastin time (PTT) 70 seconds
B. International normalized ratio (INR) 2.5
C. Platelet count 140,000/µL
D. Activated partial thromboplastin time (aPTT) 120 seconds
CORRECT ANSWER: D. Activated partial thromboplastin time (aPTT) 120
seconds
Rationale: The therapeutic range for aPTT on heparin is typically 1.5-2.5 times the
control (roughly 60-80 seconds). An aPTT of 120 seconds indicates a significant
overdose, placing the patient at high risk for hemorrhagic complications. An INR of 2.5
is therapeutic for warfarin, and the platelet count, while slightly low, is not imminently
life-threatening compared to the aPTT.
Question 4: A patient with diabetes mellitus type 2 is prescribed metformin.
The nurse should monitor the patient for which adverse effect, especially if the
patient is scheduled for a procedure involving intravenous contrast dye?
A. Hypoglycemia
B. Lactic acidosis
C. Hepatotoxicity
D. Cardiotoxicity
CORRECT ANSWER: B. Lactic acidosis
Rationale: Metformin carries a risk of lactic acidosis, particularly in conditions that
predispose to its accumulation such as renal insufficiency, hepatic disease, and the
administration of iodinated contrast media. It is often held for 48 hours before and after
contrast studies to prevent acute kidney injury and subsequent lactic acidosis.
Question 5: A 70-year-old patient is brought to the emergency department
with a fever and a productive cough. The nurse notes a respiratory rate of 28
breaths/min, an oxygen saturation of 90% on room air, and auscultates coarse
crackles in the right lower lobe. Which intervention should the nurse
prioritize?
A. Administer oral acetaminophen
B. Obtain a sputum culture
C. Administer supplemental oxygen
D. Initiate IV antibiotics
CORRECT ANSWER: C. Administer supplemental oxygen
Rationale: In the ABCs (Airway, Breathing, Circulation) framework, oxygenation is a
critical priority. The patient is hypoxemic with an SpO2 of 90%, indicating impaired gas
exchange. Immediate oxygen therapy is essential to prevent further hypoxia and organ
damage. Antibiotics and sputum cultures are vital, but oxygen delivery takes
precedence.
,Question 6: A patient is receiving a continuous infusion of dopamine for septic
shock. The nurse assesses the IV site and finds it is cool, pale, and swollen.
What is the most appropriate immediate nursing action?
A. Slow the infusion rate
B. Apply a warm compress to the site
C. Discontinue the infusion and notify the provider
D. Administer phentolamine (Regitine) locally
CORRECT ANSWER: C. Discontinue the infusion and notify the provider
Rationale: The signs (cool, pale, swollen) indicate infiltration and potential extravasation
of the vasopressor. If dopamine infiltrates, it causes severe local vasoconstriction and
tissue necrosis. The infusion must be stopped immediately to prevent further damage.
While phentolamine may be used to treat extravasation, the priority is stopping the
infusion.
Question 7: A patient is 24 hours post-operative from a total knee replacement.
The nurse observes that the patient's urine output is 20 mL/hr for the past 2
hours. Which initial action is most appropriate?
A. Administer a 500 mL fluid bolus
B. Assess the patient's blood pressure and heart rate
C. Notify the healthcare provider immediately
D. Check the placement and patency of the Foley catheter
CORRECT ANSWER: D. Check the placement and patency of the Foley catheter
Rationale: Before initiating invasive or pharmacological interventions for oliguria, the
nurse must perform a focused assessment. Checking for kinks, obstruction, or a
disconnected catheter is the simplest, least invasive, and often identifies the cause of low
urine output. If the catheter is patent, then further assessment for hypovolemia is
warranted.
Question 8: The nurse is preparing to administer 10 units of regular insulin
and 20 units of NPH insulin. Which is the correct order of steps to ensure
proper mixing?
A. Inject air into the NPH vial, inject air into the regular vial, withdraw regular insulin,
withdraw NPH insulin
B. Inject air into the regular vial, inject air into the NPH vial, withdraw NPH insulin,
withdraw regular insulin
C. Withdraw regular insulin, inject air into NPH, withdraw NPH
D. Inject air into the NPH vial, withdraw NPH, inject air into regular, withdraw regular
CORRECT ANSWER: A. Inject air into the NPH vial, inject air into the regular
vial, withdraw regular insulin, withdraw NPH insulin
Rationale: The rule for mixing insulin is "clear to cloudy." Air is injected into the NPH
(cloudy) first to avoid contaminating the regular (clear) insulin. Then, air is injected into
, the regular (clear) vial. Finally, the clear (regular) insulin is drawn first, followed by the
cloudy (NPH) insulin.
Question 9: A patient with a new diagnosis of hypertension is prescribed
lisinopril. Which statement by the patient indicates a need for further
teaching?
A. "I need to change positions slowly to prevent dizziness."
B. "I should avoid salt substitutes while taking this medication."
C. "I can take this medication with ibuprofen for my headaches."
D. "I should report any swelling of my face or tongue."
CORRECT ANSWER: C. "I can take this medication with ibuprofen for my
headaches."
Rationale: Lisinopril is an ACE inhibitor. NSAIDs like ibuprofen can reduce the
antihypertensive effect and increase the risk of renal impairment, especially in patients
with decreased renal blood flow. The other statements are correct: changing positions
slowly prevents orthostatic hypotension, salt substitutes (containing potassium) can
cause hyperkalemia, and facial swelling is a sign of angioedema.
Question 10: A patient with chronic obstructive pulmonary disease (COPD)
has an arterial blood gas (ABG) result: pH 7.31, PaCO2 68 mmHg, HCO3- 32
mEq/L. How does the nurse interpret this ABG?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Mixed metabolic and respiratory acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is low (acidemia). The PaCO2 is elevated (respiratory acidosis). The
HCO3- is also elevated, which is the metabolic compensatory response (renal retention
of bicarbonate) to a chronic respiratory acidosis. However, because the pH is still below
7.35, the compensation is not complete (i.e., it is partially compensated).
Question 11: A nurse is assessing a patient's telemetry strip. The rhythm is
irregular, with no discernible P waves, and the ventricular rate is 88 beats per
minute. What is the most likely rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus arrhythmia
D. Ventricular tachycardia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves (which
are replaced by fibrillatory "f" waves) and an irregularly irregular ventricular rhythm.
Telemetry Updated 2026 | 190+ Questions and
Answers | RELIAS Medical-Surgical Telemetry
Comprehensive Study Guide, Practice Exam, Exam
Prep Test Bank, Cardiac Monitoring, ECG Rhythm
Interpretation, Dysrhythmias, Medical-Surgical
Nursing, Hemodynamic Monitoring, Pharmacology,
Patient Safety, Critical Care, NCLEX-RN Review,
Detailed Rationales and Complete Revision Material
Question 1: A patient with a history of heart failure is admitted with shortness
of breath and edema. The nurse notes jugular venous distention (JVD) and
crackles in the lung bases. Which laboratory value is most indicative of the
underlying pathophysiological process driving these symptoms?
A. Elevated serum sodium
B. Elevated B-type natriuretic peptide (BNP)
C. Decreased serum potassium
D. Elevated serum creatinine
CORRECT ANSWER: B. Elevated B-type natriuretic peptide (BNP)
Rationale: BNP is a neurohormone released from the ventricles in response to increased
wall tension and volume overload. An elevated BNP is a sensitive and specific marker
for heart failure, directly correlating with the symptoms of JVD, pulmonary crackles, and
edema. Elevated sodium is often diluted in HF; potassium and creatinine are not
primary diagnostic indicators for acute decompensation.
Question 2: During an annual physical, a 55-year-old male is found to have a
blood pressure of 148/92 mmHg. Which finding would indicate to the nurse
that he may have metabolic syndrome, necessitating further assessment?
A. Elevated HDL cholesterol
B. Fasting blood glucose of 115 mg/dL
C. Decreased waist circumference
D. Decreased triglyceride levels
CORRECT ANSWER: B. Fasting blood glucose of 115 mg/dL
Rationale: Metabolic syndrome criteria include elevated fasting glucose (≥100 mg/dL),
hypertension, elevated triglycerides, reduced HDL, and increased waist circumference.
A fasting glucose of 115 mg/dL meets the glycemic criterion, while the other options
represent values that are either normal or protective.
Question 3: The nurse is administering IV heparin to a patient with a
pulmonary embolism. Which laboratory value requires the most immediate
action to prevent a life-threatening complication?
,A. Partial thromboplastin time (PTT) 70 seconds
B. International normalized ratio (INR) 2.5
C. Platelet count 140,000/µL
D. Activated partial thromboplastin time (aPTT) 120 seconds
CORRECT ANSWER: D. Activated partial thromboplastin time (aPTT) 120
seconds
Rationale: The therapeutic range for aPTT on heparin is typically 1.5-2.5 times the
control (roughly 60-80 seconds). An aPTT of 120 seconds indicates a significant
overdose, placing the patient at high risk for hemorrhagic complications. An INR of 2.5
is therapeutic for warfarin, and the platelet count, while slightly low, is not imminently
life-threatening compared to the aPTT.
Question 4: A patient with diabetes mellitus type 2 is prescribed metformin.
The nurse should monitor the patient for which adverse effect, especially if the
patient is scheduled for a procedure involving intravenous contrast dye?
A. Hypoglycemia
B. Lactic acidosis
C. Hepatotoxicity
D. Cardiotoxicity
CORRECT ANSWER: B. Lactic acidosis
Rationale: Metformin carries a risk of lactic acidosis, particularly in conditions that
predispose to its accumulation such as renal insufficiency, hepatic disease, and the
administration of iodinated contrast media. It is often held for 48 hours before and after
contrast studies to prevent acute kidney injury and subsequent lactic acidosis.
Question 5: A 70-year-old patient is brought to the emergency department
with a fever and a productive cough. The nurse notes a respiratory rate of 28
breaths/min, an oxygen saturation of 90% on room air, and auscultates coarse
crackles in the right lower lobe. Which intervention should the nurse
prioritize?
A. Administer oral acetaminophen
B. Obtain a sputum culture
C. Administer supplemental oxygen
D. Initiate IV antibiotics
CORRECT ANSWER: C. Administer supplemental oxygen
Rationale: In the ABCs (Airway, Breathing, Circulation) framework, oxygenation is a
critical priority. The patient is hypoxemic with an SpO2 of 90%, indicating impaired gas
exchange. Immediate oxygen therapy is essential to prevent further hypoxia and organ
damage. Antibiotics and sputum cultures are vital, but oxygen delivery takes
precedence.
,Question 6: A patient is receiving a continuous infusion of dopamine for septic
shock. The nurse assesses the IV site and finds it is cool, pale, and swollen.
What is the most appropriate immediate nursing action?
A. Slow the infusion rate
B. Apply a warm compress to the site
C. Discontinue the infusion and notify the provider
D. Administer phentolamine (Regitine) locally
CORRECT ANSWER: C. Discontinue the infusion and notify the provider
Rationale: The signs (cool, pale, swollen) indicate infiltration and potential extravasation
of the vasopressor. If dopamine infiltrates, it causes severe local vasoconstriction and
tissue necrosis. The infusion must be stopped immediately to prevent further damage.
While phentolamine may be used to treat extravasation, the priority is stopping the
infusion.
Question 7: A patient is 24 hours post-operative from a total knee replacement.
The nurse observes that the patient's urine output is 20 mL/hr for the past 2
hours. Which initial action is most appropriate?
A. Administer a 500 mL fluid bolus
B. Assess the patient's blood pressure and heart rate
C. Notify the healthcare provider immediately
D. Check the placement and patency of the Foley catheter
CORRECT ANSWER: D. Check the placement and patency of the Foley catheter
Rationale: Before initiating invasive or pharmacological interventions for oliguria, the
nurse must perform a focused assessment. Checking for kinks, obstruction, or a
disconnected catheter is the simplest, least invasive, and often identifies the cause of low
urine output. If the catheter is patent, then further assessment for hypovolemia is
warranted.
Question 8: The nurse is preparing to administer 10 units of regular insulin
and 20 units of NPH insulin. Which is the correct order of steps to ensure
proper mixing?
A. Inject air into the NPH vial, inject air into the regular vial, withdraw regular insulin,
withdraw NPH insulin
B. Inject air into the regular vial, inject air into the NPH vial, withdraw NPH insulin,
withdraw regular insulin
C. Withdraw regular insulin, inject air into NPH, withdraw NPH
D. Inject air into the NPH vial, withdraw NPH, inject air into regular, withdraw regular
CORRECT ANSWER: A. Inject air into the NPH vial, inject air into the regular
vial, withdraw regular insulin, withdraw NPH insulin
Rationale: The rule for mixing insulin is "clear to cloudy." Air is injected into the NPH
(cloudy) first to avoid contaminating the regular (clear) insulin. Then, air is injected into
, the regular (clear) vial. Finally, the clear (regular) insulin is drawn first, followed by the
cloudy (NPH) insulin.
Question 9: A patient with a new diagnosis of hypertension is prescribed
lisinopril. Which statement by the patient indicates a need for further
teaching?
A. "I need to change positions slowly to prevent dizziness."
B. "I should avoid salt substitutes while taking this medication."
C. "I can take this medication with ibuprofen for my headaches."
D. "I should report any swelling of my face or tongue."
CORRECT ANSWER: C. "I can take this medication with ibuprofen for my
headaches."
Rationale: Lisinopril is an ACE inhibitor. NSAIDs like ibuprofen can reduce the
antihypertensive effect and increase the risk of renal impairment, especially in patients
with decreased renal blood flow. The other statements are correct: changing positions
slowly prevents orthostatic hypotension, salt substitutes (containing potassium) can
cause hyperkalemia, and facial swelling is a sign of angioedema.
Question 10: A patient with chronic obstructive pulmonary disease (COPD)
has an arterial blood gas (ABG) result: pH 7.31, PaCO2 68 mmHg, HCO3- 32
mEq/L. How does the nurse interpret this ABG?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Mixed metabolic and respiratory acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is low (acidemia). The PaCO2 is elevated (respiratory acidosis). The
HCO3- is also elevated, which is the metabolic compensatory response (renal retention
of bicarbonate) to a chronic respiratory acidosis. However, because the pH is still below
7.35, the compensation is not complete (i.e., it is partially compensated).
Question 11: A nurse is assessing a patient's telemetry strip. The rhythm is
irregular, with no discernible P waves, and the ventricular rate is 88 beats per
minute. What is the most likely rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus arrhythmia
D. Ventricular tachycardia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves (which
are replaced by fibrillatory "f" waves) and an irregularly irregular ventricular rhythm.
