RELIAS MEDICAL-SURGICAL TELEMETRY STUDY GUIDE AND PRACTICE EXAM : 200 EVIDENCE-BASED QUESTIONS WITH RATIONALES COVERING TELEMETRY MONITORING, CARDIOVASCULAR ASSESSMENT, PHARMACOLOGICAL MANAGEMENT, HEMODYNAMIC PARAMETERS, DYSRHYTHMIA RECOGNITION,

RELIAS MEDICAL-SURGICAL TELEMETRY STUDY GUIDE AND PRACTICE EXAM : 200 EVIDENCE-BASED QUESTIONS WITH RATIONALES COVERING TELEMETRY MONITORING, CARDIOVASCULAR ASSESSMENT, PHARMACOLOGICAL MANAGEMENT, HEMODYNAMIC PARAMETERS, DYSRHYTHMIA RECOGNITION, AND CRITICAL CARE NURSING INTERVENTIONS FOR THE MEDICAL-SURGICAL TELEMETRY CERTIFICATION Question 1: A patient on telemetry displays a heart rate of 220 bpm with absent P waves and wide QRS complexes. The patient is conscious but reports chest pressure. What is the priority nursing action? A. Administer adenosine 6 mg rapid IV push. B. Prepare for immediate synchronized cardioversion. C. Obtain a 12-lead EKG and assess hemodynamic stability. D. Administer amiodarone 150 mg IV over 10 minutes. CORRECT ANSWER: C. Obtain a 12-lead EKG and assess hemodynamic stability. Rationale: The rhythm described is likely ventricular tachycardia. While the patient is conscious, the priority is to confirm the rhythm with a 12-lead EKG and assess stability. If unstable, synchronized cardioversion is indicated. Adenosine is not effective for ventricular tachycardia. ________________________________________ Question 2: A patient with a diagnosis of heart failure has a morning weight gain of 3 pounds, increased jugular venous distention, and crackles in the lung bases. Which medication should the nurse anticipate administering? A. Digoxin B. Furosemide C. Metoprolol D. Spironolactone CORRECT ANSWER: B. Furosemide Rationale: The patient is exhibiting signs of fluid overload (weight gain, JVD, crackles). Furosemide is a loop diuretic that will promote fluid excretion and reduce preload. Digoxin improves contractility but does not address fluid overload directly. ________________________________________ Question 3: The nurse is caring for a patient with a chest tube following a pneumothorax. The drainage system has continuous bubbling in the water seal chamber. What is the priority nursing action? A. Document the finding as normal. B. Increase suction pressure. C. Assess the system for an air leak. D. Clamp the chest tube immediately. CORRECT ANSWER: C. Assess the system for an air leak. Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which requires assessment to identify the source (patient, tubing, or system). Clamping the tube could cause tension pneumothorax and should be avoided. ________________________________________ Question 4: A patient's cardiac monitor shows a rhythm with a rate of 150 bpm, regular R-R intervals, and no identifiable P waves. What is the most likely rhythm? A. Atrial fibrillation B. Atrial flutter with variable block C. Supraventricular tachycardia D. Sinus tachycardia CORRECT ANSWER: C. Supraventricular tachycardia Rationale: SVT is characterized by a regular rhythm, rate typically 150-250 bpm, and absent or hidden P waves. Atrial fibrillation is irregularly irregular. Atrial flutter typically has saw-tooth flutter waves. ________________________________________ Question 5: A patient is prescribed enoxaparin 40 mg subcutaneous daily for DVT prophylaxis. Which action is essential prior to administration? A. Check the platelet count. B. Assess the patient's weight. C. Verify the aPTT level. D. Check for signs of bleeding. CORRECT ANSWER: D. Check for signs of bleeding. Rationale: Enoxaparin is an anticoagulant; the nurse must assess for signs of bleeding before administration. Platelet counts should be monitored but are not required before each dose. aPTT is not monitored for enoxaparin. ________________________________________ Question 6: The nurse is caring for a patient 2 hours after cardiac catheterization via the femoral artery. The patient's blood pressure is 90/60 mmHg and heart rate is 110 bpm. The insertion site dressing is dry. What is the nurse's priority action? A. Administer IV fluids as prescribed. B. Assess the pedal pulses bilaterally. C. Notify the healthcare provider immediately. D. Check the patient for retroperitoneal bleeding. CORRECT ANSWER: D. Check the patient for retroperitoneal bleeding. Rationale: Hypotension and tachycardia after femoral catheterization can indicate retroperitoneal bleeding, even with a dry dressing. The nurse should assess for flank pain, back pain, or abdominal distension. Notifying the provider is important but assessment comes first. ________________________________________ Question 7: A patient with a history of COPD has an arterial blood gas showing pH 7.30, PaCO2 55 mmHg, HCO3 26 mEq/L. Which interpretation is correct? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis CORRECT ANSWER: C. Respiratory acidosis Rationale: The low pH (acidosis) with elevated PaCO2 (45 mmHg) indicates respiratory acidosis. The HCO3 is normal, suggesting no metabolic compensation. This is consistent with COPD and CO2 retention. ________________________________________ Question 8: A patient on telemetry has a rhythm with a rate of 40 bpm, no P waves, and wide QRS complexes. What is the most appropriate interpretation? A. Sinus bradycardia B. Junctional bradycardia C. Ventricular escape rhythm D. Complete heart block CORRECT ANSWER: C. Ventricular escape rhythm Rationale: The absence of P waves and wide QRS complexes at a slow rate indicates a ventricular escape rhythm. This occurs when higher pacemakers fail and the ventricles take over at a rate of 20-40 bpm. ________________________________________ Question 9: The nurse is administering IV potassium chloride to a patient with hypokalemia. Which action is most important? A. Administer through a peripheral IV at 30 mEq/hour. B. Monitor the patient's respiratory status. C. Assess the IV site for infiltration. D. Mix the potassium with a solution containing dextrose.