300 ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST UPDATE ALREADY
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This comprehensive RELIAS Medical-Surgical Telemetry Exam guide contains
300 unique practice questions organized into 28 sections covering the full exam
scope. The questions address ECG rhythm interpretation, cardiac monitoring,
medical-surgical nursing assessment, cardiovascular and respiratory disorders,
fluid and electrolyte imbalances, pharmacology, emergency care, infection control,
and professional nursing practice. Each question includes four multiple-choice
options, the correct answer, and a detailed rationale explaining the underlying
clinical concept. The guide covers critical topics including arrhythmia
identification, ACLS algorithms, medication administration, patient safety, and
evidence-based interventions for common medical-surgical conditions encountered
in telemetry settings.
Section 1: ECG Rhythm Interpretation Fundamentals
Question 1: What is the normal PR interval duration?
A) 0.04 - 0.10 seconds
B) 0.12 - 0.20 seconds
C) 0.20 - 0.30 seconds
D) 0.30 - 0.40 seconds
Answer: B) 0.12 - 0.20 seconds
Rationale: The normal PR interval measures 0.12 to 0.20 seconds (3-5 small
boxes). A PR interval greater than 0.20 seconds indicates first-degree AV block .
Question 2: What is the normal QRS duration?
A) Less than 0.04 seconds
B) Less than 0.12 seconds
C) 0.12 - 0.20 seconds
D) Greater than 0.20 seconds
,Answer: B) Less than 0.12 seconds
Rationale: The normal QRS duration is less than 0.12 seconds (less than 3 small
boxes). A widened QRS (≥0.12 seconds) indicates a bundle branch block or
ventricular origin of the rhythm .
Question 3: What is the normal heart rate for sinus rhythm?
A) 40-60 beats per minute
B) 60-100 beats per minute
C) 100-150 beats per minute
D) 150-200 beats per minute
Answer: B) 60-100 beats per minute
Rationale: Normal sinus rhythm has a rate of 60-100 beats per minute with a
regular rhythm, normal P waves, and normal PR and QRS intervals .
Question 4: Which method should be used to determine heart rate for irregular
rhythms?
A) Count large boxes between R waves
B) Count small boxes between R waves
C) 6-second method
D) Rate chart method
Answer: C) 6-second method
Rationale: The 6-second method is the preferred technique for irregular rhythms.
Count the number of R waves in a 6-second strip and multiply by 10. For regular
rhythms, counting the number of small boxes between R waves is more accurate .
Question 5: Which step is first in systematically analyzing an ECG strip?
A) Examine the P wave
B) Measure the PR interval
C) Determine the rate
D) Assess QRS morphology
Answer: C) Determine the rate
,Rationale: The systematic approach to ECG interpretation should follow this order:
1) Determine the rate, 2) Assess regularity, 3) Examine P waves, 4) Measure PR
interval, 5) Evaluate QRS morphology. This stepwise approach prevents errors .
Question 6: What does absence of P waves with an irregularly irregular rhythm
most likely indicate?
A) Normal sinus rhythm
B) Atrial fibrillation
C) Junctional rhythm
D) First-degree AV block
Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by no distinguishable P waves, an
irregularly irregular rhythm, and variable atrial activity before each QRS complex .
Question 7: What is the hallmark of a sawtooth "like" pattern on ECG?
A) Atrial fibrillation
B) Atrial flutter
C) Ventricular tachycardia
D) Junctional rhythm
Answer: B) Atrial flutter
Rationale: Atrial flutter presents with a characteristic sawtooth "like" pattern. The
flutter waves may appear more rounded than pointed, and the atrial rate is typically
250-350 beats per minute .
Question 8: What is the rate range for sinus bradycardia?
A) Below 40 beats per minute
B) Below 60 beats per minute
C) 60-100 beats per minute
D) 100-150 beats per minute
Answer: B) Below 60 beats per minute
Rationale: Sinus bradycardia is defined as a heart rate less than 60 beats per minute
with otherwise normal sinus rhythm characteristics .
Question 9: What is the rate range for sinus tachycardia?
, A) 60-100 beats per minute
B) 100-150 beats per minute
C) 150-250 beats per minute
D) Greater than 250 beats per minute
Answer: B) 100-150 beats per minute
Rationale: Sinus tachycardia is defined as a heart rate greater than 100 beats per
minute, typically 100-150 bpm, with normal P waves preceding each QRS .
Question 10: What is the characteristic rate for junctional rhythm?
A) Less than 40 beats per minute
B) 40-60 beats per minute
C) 61-100 beats per minute
D) Greater than 100 beats per minute
Answer: B) 40-60 beats per minute
Rationale: Junctional rhythm has a rate of 40-60 beats per minute with absent or
inverted P waves. If P waves are present, the PR interval will be short (<0.12
seconds) .
Question 11: What is the rate range for accelerated junctional rhythm?
A) Less than 40 beats per minute
B) 40-60 beats per minute
C) 61-100 beats per minute
D) Greater than 101 beats per minute
Answer: C) 61-100 beats per minute
Rationale: Accelerated junctional rhythm has a rate of 61-100 beats per minute,
with absent or inverted P waves. It is faster than junctional rhythm but slower than
junctional tachycardia .
Question 12: What is the rate range for junctional tachycardia?
A) 40-60 beats per minute
B) 61-100 beats per minute
C) Greater than 101 beats per minute
D) Less than 40 beats per minute