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, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Monitoring, Medical-Surgical Nursing,
Cardiovascular Pharmacology, Critical Care, Patient Safety,
NCLEX-RN & Next Generation NCLEX (NGN), Detailed
Rationales and Complete Revision Material
Question 1: A patient's cardiac monitor displays a sudden change from normal
sinus rhythm to a wide-complex tachycardia with a rate of 180 bpm. The
patient is hemodynamically unstable with a blood pressure of 82/54 mmHg.
What is the nurse's priority action?
A. Administer amiodarone 150 mg IV push
B. Perform immediate synchronized cardioversion
C. Administer adenosine 6 mg rapid IV push
D. Prepare for emergent transcutaneous pacing
CORRECT ANSWER: B. Perform immediate synchronized cardioversion
Rationale: Synchronized cardioversion is the treatment of choice for unstable
tachyarrhythmias, including unstable ventricular tachycardia, when there is a pulse but
signs of hemodynamic compromise. Adenosine is used for stable narrow-complex
tachycardia, and amiodarone can be given for stable wide-complex tachycardia.
Transcutaneous pacing is for bradyarrhythmias.
Question 2: A patient's telemetry strip shows a heart rate of 42 bpm with
regular P waves followed by a QRS complex, but with a prolonged PR interval
greater than 0.28 seconds. What is the most appropriate initial nursing
intervention?
A. Prepare for insertion of a temporary pacemaker
B. Administer atropine 0.5 mg IV push
C. Document the finding and monitor the patient closely
D. Administer dopamine infusion at 5 mcg/kg/min
CORRECT ANSWER: C. Document the finding and monitor the patient closely
Rationale: This rhythm is first-degree AV block, which is generally asymptomatic and
does not require immediate intervention. The priority is to document the rhythm,
monitor the patient for any developing symptoms of decreased cardiac output, and
notify the provider. Atropine is for symptomatic bradycardia, and pacing is for severe,
unstable bradycardias.
Question 3: A patient is 24 hours post-operative from an abdominal surgery
and has a new onset of pleuritic chest pain, tachycardia, and mild dyspnea.
Which assessment finding is most concerning for a pulmonary embolism?
,A. A sudden drop in oxygen saturation to 88% on room air
B. A low-grade fever of 100.4°F (38°C)
C. Pain rated 5/10 that is controlled with analgesics
D. The presence of bowel sounds in all four quadrants
CORRECT ANSWER: A. A sudden drop in oxygen saturation to 88% on room air
Rationale: A sudden drop in SpO2 in a post-operative patient with pleuritic pain and
tachycardia is a classic sign of a pulmonary embolism, indicating a ventilation-perfusion
mismatch. This is a critical finding requiring immediate intervention. The other options
are less specific or less acute.
Question 4: Which cardiac enzyme is considered the most specific and
sensitive indicator of myocardial necrosis in the early hours (3-4 hours) after a
suspected MI?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I
D. Lactic Dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I
Rationale: Cardiac troponins (Troponin I and T) are highly specific to cardiac muscle
and are the preferred biomarkers for diagnosing myocardial infarction. They begin to
rise 3-4 hours after injury, making them the gold standard. Myoglobin is sensitive but
not specific. CK-MB rises later and is less specific.
Question 5: A patient on a telemetry unit who had a STEMI 3 days ago is now
complaining of sudden, sharp chest pain that worsens with inspiration and
when lying flat. A pericardial friction rub is audible on auscultation. What
condition does this presentation strongly suggest?
A. A recurrent myocardial infarction
B. Acute pericarditis (Dressler's syndrome)
C. Pulmonary embolism
D. Heart failure exacerbation
CORRECT ANSWER: B. Acute pericarditis (Dressler's syndrome)
Rationale: This patient is presenting with signs of post-myocardial infarction pericarditis
(Dressler's syndrome). The key indicators are the pericardial friction rub, pleuritic chest
pain, and the specific temporal relationship to the MI. Recurrent MI pain is not typically
pleuritic.
Question 6: When assessing a patient in third-degree (complete) heart block,
what is the defining characteristic the nurse would observe on the telemetry
monitor?
,A. A consistent PR interval with a dropped QRS complex
B. A heart rate of 150 bpm with no visible P waves
C. No relationship between the P waves and the QRS complexes
D. A sudden, spontaneous reversion from ventricular tachycardia to a normal rhythm
CORRECT ANSWER: C. No relationship between the P waves and the QRS
complexes
Rationale: In third-degree AV block, the atria and ventricles beat independently of each
other. This results in P waves and QRS complexes that are unrelated (AV dissociation),
often with a ventricular rate that is slower than the atrial rate. Option A describes a
second-degree type I block.
Question 7: A patient is being treated for heart failure with IV furosemide.
Which laboratory value is most important to monitor during this therapy to
prevent a serious complication?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium in the
renal tubules, which can lead to hypokalemia. Hypokalemia is a critical concern because
it can precipitate life-threatening cardiac dysrhythmias, especially in patients with
underlying heart disease and those on digitalis.
Question 8: The nurse is caring for a patient with an arterial line. The
waveform appears dampened. Which action should the nurse take first?
A. Flush the arterial line with 500 mL of normal saline
B. Reposition the patient's wrist
C. Check the pressure bag to ensure it is inflated to 300 mmHg
D. Zero the system to atmospheric pressure
CORRECT ANSWER: B. Reposition the patient's wrist
Rationale: A dampened waveform is often caused by the catheter tip being against the
vessel wall. Repositioning the patient's extremity is the least invasive and safest first step
to restore the waveform. Flushing, checking the pressure bag, and zeroing are all
appropriate but should be performed after ruling out a mechanical positional issue.
Question 9: A patient presents with a blood pressure of 210/120 mmHg, severe
headache, and nausea. The provider orders IV nitroprusside. What is the most
critical adverse effect the nurse must monitor for when administering this
medication?
, A. Reflex tachycardia
B. Cyanide toxicity
C. Bradycardia
D. Hyperkalemia
CORRECT ANSWER: B. Cyanide toxicity
Rationale: Nitroprusside is a potent vasodilator that is rapidly metabolized to cyanide
and thiocyanate. Prolonged use at high doses can lead to cyanide toxicity, which is
characterized by metabolic acidosis and altered mental status. Reflex tachycardia is also
a side effect, but cyanide toxicity is the most life-threatening.
Question 10: In a patient with acute coronary syndrome, which of the
following is the primary goal for the administration of sublingual
nitroglycerin?
A. To increase myocardial contractility
B. To reduce preload and afterload to decrease myocardial oxygen demand
C. To prevent the formation of new blood clots
D. To dissolve the existing thrombus in the coronary artery
CORRECT ANSWER: B. To reduce preload and afterload to decrease
myocardial oxygen demand
Rationale: Nitroglycerin is a venous and arterial vasodilator. Its primary benefit in ACS is
to reduce preload (venous) and afterload (arterial), which decreases the workload on the
heart and reduces myocardial oxygen demand, thereby relieving angina. It does not
affect clotting or contractility.
Question 11: A patient is being managed for atrial fibrillation with a rapid
ventricular response. The provider orders a continuous heparin infusion.
Which laboratory value is most essential to monitor to ensure the heparin is at
a therapeutic level?
A. Prothrombin time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
CORRECT ANSWER: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using the aPTT. The goal is typically 1.5 to 2.5
times the control value. PT and INR are used to monitor warfarin (Coumadin) therapy,
and platelet counts are monitored to detect heparin-induced thrombocytopenia (HIT).
Question 12: What is the primary underlying pathophysiology responsible for
the development of a paradoxical pulse (pulsus paradoxus)?
A. Decreased left ventricular compliance
B. Increased intrathoracic pressure during inspiration reducing left-sided filling
Telemetry Updated 2026 | 190+ Questions and Answers |
RELIAS Medical-Surgical Telemetry Comprehensive Study
Guide, Practice Exam, Exam Prep Test Bank, ECG Rhythm
Interpretation, Cardiac Monitoring, Dysrhythmias,
Hemodynamic Monitoring, Medical-Surgical Nursing,
Cardiovascular Pharmacology, Critical Care, Patient Safety,
NCLEX-RN & Next Generation NCLEX (NGN), Detailed
Rationales and Complete Revision Material
Question 1: A patient's cardiac monitor displays a sudden change from normal
sinus rhythm to a wide-complex tachycardia with a rate of 180 bpm. The
patient is hemodynamically unstable with a blood pressure of 82/54 mmHg.
What is the nurse's priority action?
A. Administer amiodarone 150 mg IV push
B. Perform immediate synchronized cardioversion
C. Administer adenosine 6 mg rapid IV push
D. Prepare for emergent transcutaneous pacing
CORRECT ANSWER: B. Perform immediate synchronized cardioversion
Rationale: Synchronized cardioversion is the treatment of choice for unstable
tachyarrhythmias, including unstable ventricular tachycardia, when there is a pulse but
signs of hemodynamic compromise. Adenosine is used for stable narrow-complex
tachycardia, and amiodarone can be given for stable wide-complex tachycardia.
Transcutaneous pacing is for bradyarrhythmias.
Question 2: A patient's telemetry strip shows a heart rate of 42 bpm with
regular P waves followed by a QRS complex, but with a prolonged PR interval
greater than 0.28 seconds. What is the most appropriate initial nursing
intervention?
A. Prepare for insertion of a temporary pacemaker
B. Administer atropine 0.5 mg IV push
C. Document the finding and monitor the patient closely
D. Administer dopamine infusion at 5 mcg/kg/min
CORRECT ANSWER: C. Document the finding and monitor the patient closely
Rationale: This rhythm is first-degree AV block, which is generally asymptomatic and
does not require immediate intervention. The priority is to document the rhythm,
monitor the patient for any developing symptoms of decreased cardiac output, and
notify the provider. Atropine is for symptomatic bradycardia, and pacing is for severe,
unstable bradycardias.
Question 3: A patient is 24 hours post-operative from an abdominal surgery
and has a new onset of pleuritic chest pain, tachycardia, and mild dyspnea.
Which assessment finding is most concerning for a pulmonary embolism?
,A. A sudden drop in oxygen saturation to 88% on room air
B. A low-grade fever of 100.4°F (38°C)
C. Pain rated 5/10 that is controlled with analgesics
D. The presence of bowel sounds in all four quadrants
CORRECT ANSWER: A. A sudden drop in oxygen saturation to 88% on room air
Rationale: A sudden drop in SpO2 in a post-operative patient with pleuritic pain and
tachycardia is a classic sign of a pulmonary embolism, indicating a ventilation-perfusion
mismatch. This is a critical finding requiring immediate intervention. The other options
are less specific or less acute.
Question 4: Which cardiac enzyme is considered the most specific and
sensitive indicator of myocardial necrosis in the early hours (3-4 hours) after a
suspected MI?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I
D. Lactic Dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I
Rationale: Cardiac troponins (Troponin I and T) are highly specific to cardiac muscle
and are the preferred biomarkers for diagnosing myocardial infarction. They begin to
rise 3-4 hours after injury, making them the gold standard. Myoglobin is sensitive but
not specific. CK-MB rises later and is less specific.
Question 5: A patient on a telemetry unit who had a STEMI 3 days ago is now
complaining of sudden, sharp chest pain that worsens with inspiration and
when lying flat. A pericardial friction rub is audible on auscultation. What
condition does this presentation strongly suggest?
A. A recurrent myocardial infarction
B. Acute pericarditis (Dressler's syndrome)
C. Pulmonary embolism
D. Heart failure exacerbation
CORRECT ANSWER: B. Acute pericarditis (Dressler's syndrome)
Rationale: This patient is presenting with signs of post-myocardial infarction pericarditis
(Dressler's syndrome). The key indicators are the pericardial friction rub, pleuritic chest
pain, and the specific temporal relationship to the MI. Recurrent MI pain is not typically
pleuritic.
Question 6: When assessing a patient in third-degree (complete) heart block,
what is the defining characteristic the nurse would observe on the telemetry
monitor?
,A. A consistent PR interval with a dropped QRS complex
B. A heart rate of 150 bpm with no visible P waves
C. No relationship between the P waves and the QRS complexes
D. A sudden, spontaneous reversion from ventricular tachycardia to a normal rhythm
CORRECT ANSWER: C. No relationship between the P waves and the QRS
complexes
Rationale: In third-degree AV block, the atria and ventricles beat independently of each
other. This results in P waves and QRS complexes that are unrelated (AV dissociation),
often with a ventricular rate that is slower than the atrial rate. Option A describes a
second-degree type I block.
Question 7: A patient is being treated for heart failure with IV furosemide.
Which laboratory value is most important to monitor during this therapy to
prevent a serious complication?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium in the
renal tubules, which can lead to hypokalemia. Hypokalemia is a critical concern because
it can precipitate life-threatening cardiac dysrhythmias, especially in patients with
underlying heart disease and those on digitalis.
Question 8: The nurse is caring for a patient with an arterial line. The
waveform appears dampened. Which action should the nurse take first?
A. Flush the arterial line with 500 mL of normal saline
B. Reposition the patient's wrist
C. Check the pressure bag to ensure it is inflated to 300 mmHg
D. Zero the system to atmospheric pressure
CORRECT ANSWER: B. Reposition the patient's wrist
Rationale: A dampened waveform is often caused by the catheter tip being against the
vessel wall. Repositioning the patient's extremity is the least invasive and safest first step
to restore the waveform. Flushing, checking the pressure bag, and zeroing are all
appropriate but should be performed after ruling out a mechanical positional issue.
Question 9: A patient presents with a blood pressure of 210/120 mmHg, severe
headache, and nausea. The provider orders IV nitroprusside. What is the most
critical adverse effect the nurse must monitor for when administering this
medication?
, A. Reflex tachycardia
B. Cyanide toxicity
C. Bradycardia
D. Hyperkalemia
CORRECT ANSWER: B. Cyanide toxicity
Rationale: Nitroprusside is a potent vasodilator that is rapidly metabolized to cyanide
and thiocyanate. Prolonged use at high doses can lead to cyanide toxicity, which is
characterized by metabolic acidosis and altered mental status. Reflex tachycardia is also
a side effect, but cyanide toxicity is the most life-threatening.
Question 10: In a patient with acute coronary syndrome, which of the
following is the primary goal for the administration of sublingual
nitroglycerin?
A. To increase myocardial contractility
B. To reduce preload and afterload to decrease myocardial oxygen demand
C. To prevent the formation of new blood clots
D. To dissolve the existing thrombus in the coronary artery
CORRECT ANSWER: B. To reduce preload and afterload to decrease
myocardial oxygen demand
Rationale: Nitroglycerin is a venous and arterial vasodilator. Its primary benefit in ACS is
to reduce preload (venous) and afterload (arterial), which decreases the workload on the
heart and reduces myocardial oxygen demand, thereby relieving angina. It does not
affect clotting or contractility.
Question 11: A patient is being managed for atrial fibrillation with a rapid
ventricular response. The provider orders a continuous heparin infusion.
Which laboratory value is most essential to monitor to ensure the heparin is at
a therapeutic level?
A. Prothrombin time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
CORRECT ANSWER: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using the aPTT. The goal is typically 1.5 to 2.5
times the control value. PT and INR are used to monitor warfarin (Coumadin) therapy,
and platelet counts are monitored to detect heparin-induced thrombocytopenia (HIT).
Question 12: What is the primary underlying pathophysiology responsible for
the development of a paradoxical pulse (pulsus paradoxus)?
A. Decreased left ventricular compliance
B. Increased intrathoracic pressure during inspiration reducing left-sided filling
