MEDICAL SURGICAL TELEMETRY B — ORIGINAL PRACTICE
EXAM QUESTIONS WITH RATIONALES
CORE DOMAINS
Cardiac Telemetry Monitoring and Dysrhythmia Interpretation
Heart Failure and Pulmonary Edema Management
Acute Coronary Syndromes and Myocardial Infarction
Cardiovascular Pharmacology and Emergency Medications
Hemodynamic Monitoring and Fluid/Electrolyte Balance
Post-Operative Care and Complication Recognition
Emergency Response and Patient Safety
INTRODUCTION
This original practice examination is designed for registered nurses
preparing for medical-surgical telemetry competency assessments.
Questions cover cardiac monitoring, dysrhythmia recognition, acute
coronary syndromes, heart failure management, cardiovascular
pharmacology, hemodynamic monitoring, and emergency response. Each
question includes a detailed rationale grounded in current clinical
guidelines. These are original questions created for study purposes and are
not derived from any proprietary examination. Emphasis is placed on
clinical judgment, prioritization, and safe nursing practice in telemetry
settings.
SECTION ONE: CARDIAC TELEMETRY AND DYSRHYTHMIA
INTERPRETATION
1. A nurse is reviewing the telemetry monitor and notes a rhythm with
absent P waves, an irregularly irregular ventricular rate, and narrow
QRS complexes. The heart rate is 142 bpm. Which dysrhythmia is the
nurse observing?
A. Atrial flutter
B. Atrial fibrillation
C. Supraventricular tachycardia
D. Ventricular tachycardia
, B. Atrial fibrillation
RATIONALE: Atrial fibrillation is characterized by absent P waves, an
irregularly irregular ventricular response, and narrow QRS complexes when
conduction occurs through the normal His-Purkinje system. The chaotic
atrial activity creates fibrillatory waves rather than organized P waves. Atrial
flutter shows sawtooth flutter waves. Supraventricular tachycardia is
typically regular. Ventricular tachycardia produces wide QRS complexes.
2. A client on telemetry develops a rhythm with a rate of 38 bpm,
regular P waves preceding each QRS complex, and a PR interval of
0.16 seconds. The QRS duration is 0.08 seconds. Which intervention
is most appropriate?
A. Prepare for transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Continue monitoring; this is a normal sinus rhythm
D. Administer adenosine 6 mg rapid IV push
B. Administer atropine 0.5 mg IV
RATIONALE: This rhythm is sinus bradycardia with a rate of 38 bpm.
The presence of regular P waves with a consistent PR interval and narrow
QRS complexes confirms the impulse is originating from the sinus node.
For symptomatic sinus bradycardia, atropine 0.5 mg IV is the first-line
pharmacologic intervention per ACLS guidelines. Transcutaneous pacing is
reserved for unstable bradycardia unresponsive to atropine. Adenosine is
contraindicated as it would further slow the heart rate.
3. A nurse observes the telemetry monitor showing a regular rhythm
at 150 bpm with sawtooth flutter waves visible in leads II, III, and aVF.
The ventricular response is regular. Which treatment should the nurse
anticipate?
A. Immediate defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers and adenosine
D. Amiodarone 150 mg IV bolus
, B. Synchronized cardioversion
RATIONALE: The rhythm described is atrial flutter with a rapid
ventricular response. Synchronized cardioversion is indicated for unstable
atrial flutter or when rate control and anticoagulation have not been
achieved. Defibrillation is used for pulseless rhythms, not organized
tachyarrhythmias with a pulse. Vagal maneuvers and adenosine may
transiently slow the rate but do not convert atrial flutter. Amiodarone may be
used for chemical cardioversion but synchronized cardioversion is more
definitive for unstable patients.
4. A client on telemetry suddenly develops a wide-complex
tachycardia at 188 bpm. The client is awake but reports dizziness and
chest discomfort. Blood pressure is 78/48 mmHg. Which action
should the nurse take first?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Prepare for immediate synchronized cardioversion
C. Begin CPR and call a code blue
D. Administer adenosine 6 mg rapid IV push
B. Prepare for immediate synchronized cardioversion
RATIONALE: This patient has unstable ventricular tachycardia (wide-
complex tachycardia with a pulse, symptomatic with hypotension and chest
discomfort). Synchronized cardioversion is the treatment of choice for
unstable VT with a pulse. Amiodarone is used for stable VT. CPR is
indicated for pulseless VT. Adenosine is for stable, regular narrow-complex
SVT and is contraindicated in unstable patients.
5. A telemetry monitor shows a rhythm with a progressively
lengthening PR interval until a P wave is not conducted, followed by a
reset. Which type of heart block is this?
A. First-degree heart block
B. Second-degree heart block, Type I (Mobitz I/Wenckebach)
C. Second-degree heart block, Type II (Mobitz II)
D. Third-degree heart block
EXAM QUESTIONS WITH RATIONALES
CORE DOMAINS
Cardiac Telemetry Monitoring and Dysrhythmia Interpretation
Heart Failure and Pulmonary Edema Management
Acute Coronary Syndromes and Myocardial Infarction
Cardiovascular Pharmacology and Emergency Medications
Hemodynamic Monitoring and Fluid/Electrolyte Balance
Post-Operative Care and Complication Recognition
Emergency Response and Patient Safety
INTRODUCTION
This original practice examination is designed for registered nurses
preparing for medical-surgical telemetry competency assessments.
Questions cover cardiac monitoring, dysrhythmia recognition, acute
coronary syndromes, heart failure management, cardiovascular
pharmacology, hemodynamic monitoring, and emergency response. Each
question includes a detailed rationale grounded in current clinical
guidelines. These are original questions created for study purposes and are
not derived from any proprietary examination. Emphasis is placed on
clinical judgment, prioritization, and safe nursing practice in telemetry
settings.
SECTION ONE: CARDIAC TELEMETRY AND DYSRHYTHMIA
INTERPRETATION
1. A nurse is reviewing the telemetry monitor and notes a rhythm with
absent P waves, an irregularly irregular ventricular rate, and narrow
QRS complexes. The heart rate is 142 bpm. Which dysrhythmia is the
nurse observing?
A. Atrial flutter
B. Atrial fibrillation
C. Supraventricular tachycardia
D. Ventricular tachycardia
, B. Atrial fibrillation
RATIONALE: Atrial fibrillation is characterized by absent P waves, an
irregularly irregular ventricular response, and narrow QRS complexes when
conduction occurs through the normal His-Purkinje system. The chaotic
atrial activity creates fibrillatory waves rather than organized P waves. Atrial
flutter shows sawtooth flutter waves. Supraventricular tachycardia is
typically regular. Ventricular tachycardia produces wide QRS complexes.
2. A client on telemetry develops a rhythm with a rate of 38 bpm,
regular P waves preceding each QRS complex, and a PR interval of
0.16 seconds. The QRS duration is 0.08 seconds. Which intervention
is most appropriate?
A. Prepare for transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Continue monitoring; this is a normal sinus rhythm
D. Administer adenosine 6 mg rapid IV push
B. Administer atropine 0.5 mg IV
RATIONALE: This rhythm is sinus bradycardia with a rate of 38 bpm.
The presence of regular P waves with a consistent PR interval and narrow
QRS complexes confirms the impulse is originating from the sinus node.
For symptomatic sinus bradycardia, atropine 0.5 mg IV is the first-line
pharmacologic intervention per ACLS guidelines. Transcutaneous pacing is
reserved for unstable bradycardia unresponsive to atropine. Adenosine is
contraindicated as it would further slow the heart rate.
3. A nurse observes the telemetry monitor showing a regular rhythm
at 150 bpm with sawtooth flutter waves visible in leads II, III, and aVF.
The ventricular response is regular. Which treatment should the nurse
anticipate?
A. Immediate defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers and adenosine
D. Amiodarone 150 mg IV bolus
, B. Synchronized cardioversion
RATIONALE: The rhythm described is atrial flutter with a rapid
ventricular response. Synchronized cardioversion is indicated for unstable
atrial flutter or when rate control and anticoagulation have not been
achieved. Defibrillation is used for pulseless rhythms, not organized
tachyarrhythmias with a pulse. Vagal maneuvers and adenosine may
transiently slow the rate but do not convert atrial flutter. Amiodarone may be
used for chemical cardioversion but synchronized cardioversion is more
definitive for unstable patients.
4. A client on telemetry suddenly develops a wide-complex
tachycardia at 188 bpm. The client is awake but reports dizziness and
chest discomfort. Blood pressure is 78/48 mmHg. Which action
should the nurse take first?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Prepare for immediate synchronized cardioversion
C. Begin CPR and call a code blue
D. Administer adenosine 6 mg rapid IV push
B. Prepare for immediate synchronized cardioversion
RATIONALE: This patient has unstable ventricular tachycardia (wide-
complex tachycardia with a pulse, symptomatic with hypotension and chest
discomfort). Synchronized cardioversion is the treatment of choice for
unstable VT with a pulse. Amiodarone is used for stable VT. CPR is
indicated for pulseless VT. Adenosine is for stable, regular narrow-complex
SVT and is contraindicated in unstable patients.
5. A telemetry monitor shows a rhythm with a progressively
lengthening PR interval until a P wave is not conducted, followed by a
reset. Which type of heart block is this?
A. First-degree heart block
B. Second-degree heart block, Type I (Mobitz I/Wenckebach)
C. Second-degree heart block, Type II (Mobitz II)
D. Third-degree heart block
