RELIAS MEDICAL SURGICAL TELEMETRY EXAM 2025/2026 TEST BANK COMPLETE
90 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
1. A patient's telemetry strip shows a regular rhythm with a rate of 44 beats/min. There is a
P wave before every QRS complex, and the PR interval is constant at 0.18 seconds. The
QRS duration is 0.08 seconds. How should the nurse interpret this rhythm?
A) Sinus bradycardia
B) Junctional rhythm
C) First-degree AV block
D) Complete heart block
Answer: A) Sinus bradycardia
This rhythm meets all the criteria for a normal sinus rhythm (upright P waves, constant
PR interval, normal QRS) except for the rate, which is less than 60 beats/min. This
defines sinus bradycardia. A junctional rhythm (B) would typically have no P wave or an
inverted P wave. A first-degree AV block (C) has a prolonged PR interval (>0.20 sec).
Complete heart block (D) shows no relationship between P waves and QRS complexes.
2. A patient with congestive heart failure is receiving intravenous furosemide. Which
finding is the most accurate indicator of effective diuresis?
A) Decreased blood pressure
B) Increased urine output
C) Resolution of peripheral edema
D) A weight loss of 2 kg in 24 hours
Answer: D) A weight loss of 2 kg in 24 hours
Daily weight is the most sensitive and objective indicator of fluid balance. A loss of 1 kg
of weight is approximately equal to a loss of 1 liter of fluid. While urine output (B) is
important, it can be influenced by other factors like renal function and intake. Blood
pressure (A) and edema (C) are useful assessments but are not as directly quantifiable for
measuring fluid loss as daily weight.
3. A patient's monitor alarms showing a rapid, irregular rhythm with no discernible P waves.
The patient is alert but anxious. The nurse should first :
A) Administer a prescribed PRN dose of IV diltiazem.
B) Prepare the patient for immediate synchronized cardioversion.
, C) Assess the patient's vital signs and level of consciousness.
D) Obtain a stat 12-lead electrocardiogram.
Answer: C) Assess the patient's vital signs and level of consciousness.
The rhythm described is likely atrial fibrillation with a rapid ventricular response (RVR).
The initial nursing action is always to assess the patient to determine hemodynamic
stability. The patient being "alert but anxious" suggests stability, making urgent
cardioversion (B) unnecessary at this moment. While a 12-lead ECG (D) is needed for
confirmation and medication (A) may be indicated, the assessment must come first to
guide all subsequent interventions.
4. A patient recovering from an acute myocardial infarction (MI) suddenly becomes
diaphoretic, tachycardic, and hypotensive. Lung sounds reveal crackles bilaterally. The
nurse suspects cardiogenic shock. What is the primary pathophysiologic problem?
A) Widespread systemic vasodilation
B) Inadequate pumping function of the heart
C) A massive pulmonary embolism
D) A severe systemic infection
Answer: B) Inadequate pumping function of the heart
Cardiogenic shock occurs when the heart muscle is damaged and cannot pump
effectively, leading to low cardiac output. This results in hypotension, tachycardia, and
pulmonary congestion (crackles). Systemic vasodilation (A) is characteristic of septic or
neurogenic shock. A pulmonary embolism (C) would cause obstructive shock, and a
systemic infection (D) leads to septic shock.
5. The nurse is caring for a patient with a temporary transvenous pacemaker. The telemetry
strip shows a pacing spike but no subsequent QRS complex. The patient is awake and has
a pulse. What is this phenomenon called and what is the nurse's priority action?
A) Failure to sense; increase the sensitivity.
B) Failure to capture; increase the milliampere (mA) output.
C) Failure to pace; check all connections.
D) Oversensing; decrease the sensitivity.
Answer: B) Failure to capture; increase the milliampere (mA) output.
Failure to capture is identified by a pacing spike without a subsequent P wave or QRS
complex, meaning the electrical stimulus is not causing myocardial depolarization. Since
, the patient is stable, the nurse's priority action is to troubleshoot by increasing the output
(mA) to deliver a stronger impulse. Failure to sense (A) would show pacing spikes at the
wrong time. Failure to pace (C) would show an absence of pacing spikes when they are
expected.
6. A patient with atrial fibrillation is prescribed apixaban. Which patient statement indicates
a need for further teaching ?
A) "I will use a soft-bristled toothbrush to prevent gum bleeding."
B) "I need to have my blood levels checked every week."
C) "I should avoid activities that have a high risk of injury."
D) "I will report any unusual bruising or bleeding to my doctor."
Answer: B) "I need to have my blood levels checked every week."
Apixaban is a direct oral anticoagulant (DOAC). Unlike warfarin, it does not require
routine monitoring of international normalized ratio (INR) or other blood levels. The
other statements are all correct safety measures for a patient on any anticoagulant therapy.
7. A patient is suspected of having a pulmonary embolism. Which finding on the 12-lead
ECG is most characteristic of this condition?
A) ST-segment elevation in leads II, III, and aVF
B) Pathological Q waves in precordial leads
C) Sinus tachycardia with an S1Q3T3 pattern
D) Tall, tented T waves across the precordium
Answer: C) Sinus tachycardia with an S1Q3T3 pattern
The S1Q3T3 pattern (a deep S wave in lead I, a Q wave in lead III, and an inverted T
wave in lead III) is a classic sign of right ventricular strain caused by a pulmonary
embolism. Sinus tachycardia is also very common. ST elevation (A) suggests an inferior
MI. Pathological Q waves (B) indicate a previous MI. Tall, tented T waves (D) are a sign
of hyperkalemia.
8. A patient's telemetry shows a pattern where every other beat is a premature ventricular
contraction (PVC). This pattern is correctly identified as:
A) Ventricular bigeminy
B) Ventricular trigeminy
C) Couplet
D) Ventricular tachycardia
, 9. Answer: A) Ventricular bigeminy
10. Ventricular bigeminy is a rhythm where a PVC follows every normal sinus beat.
Ventricular trigeminy (B) is a pattern where every third beat is a PVC. A couplet (C) is
two consecutive PVCs. Ventricular tachycardia (D) is three or more consecutive PVCs.
11. During a blood transfusion, a patient develops urticaria and pruritus. The nurse's first
action should be to:
A) Stop the transfusion immediately.
B) Slow the transfusion and administer diphenhydramine.
C) Take the patient's vital signs and notify the physician.
D) Check the blood bag for clerical errors.
Answer: B) Slow the transfusion and administer diphenhydramine.
Urticaria and pruritus are signs of a mild allergic transfusion reaction. The standard
protocol for a mild reaction is to slow the infusion (not stop it) and administer an
antihistamine like diphenhydramine as prescribed. Stopping the transfusion (A) is
reserved for more severe reactions (e.g., fever, chills, respiratory distress, hypotension).
Vital signs (C) should be checked, but the immediate intervention is to slow the infusion
and treat the symptoms.
12. The nurse is reviewing laboratory results for a patient with acute kidney injury. Which
result requires immediate intervention due to its direct effect on cardiac conduction?
A) Sodium 130 mEq/L
B) Calcium 8.0 mg/dL
C) Potassium 6.2 mEq/L
D) BUN 80 mg/dL
Answer: C) Potassium 6.2 mEq/L
Hyperkalemia (elevated potassium) is a medical emergency in renal failure because it can
lead to life-threatening cardiac dysrhythmias, including ventricular fibrillation and
asystole. A potassium level of 6.2 mEq/L requires immediate intervention. Hyponatremia
(A) and hypocalcemia (B) can also cause problems, but they are not as immediately
90 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
1. A patient's telemetry strip shows a regular rhythm with a rate of 44 beats/min. There is a
P wave before every QRS complex, and the PR interval is constant at 0.18 seconds. The
QRS duration is 0.08 seconds. How should the nurse interpret this rhythm?
A) Sinus bradycardia
B) Junctional rhythm
C) First-degree AV block
D) Complete heart block
Answer: A) Sinus bradycardia
This rhythm meets all the criteria for a normal sinus rhythm (upright P waves, constant
PR interval, normal QRS) except for the rate, which is less than 60 beats/min. This
defines sinus bradycardia. A junctional rhythm (B) would typically have no P wave or an
inverted P wave. A first-degree AV block (C) has a prolonged PR interval (>0.20 sec).
Complete heart block (D) shows no relationship between P waves and QRS complexes.
2. A patient with congestive heart failure is receiving intravenous furosemide. Which
finding is the most accurate indicator of effective diuresis?
A) Decreased blood pressure
B) Increased urine output
C) Resolution of peripheral edema
D) A weight loss of 2 kg in 24 hours
Answer: D) A weight loss of 2 kg in 24 hours
Daily weight is the most sensitive and objective indicator of fluid balance. A loss of 1 kg
of weight is approximately equal to a loss of 1 liter of fluid. While urine output (B) is
important, it can be influenced by other factors like renal function and intake. Blood
pressure (A) and edema (C) are useful assessments but are not as directly quantifiable for
measuring fluid loss as daily weight.
3. A patient's monitor alarms showing a rapid, irregular rhythm with no discernible P waves.
The patient is alert but anxious. The nurse should first :
A) Administer a prescribed PRN dose of IV diltiazem.
B) Prepare the patient for immediate synchronized cardioversion.
, C) Assess the patient's vital signs and level of consciousness.
D) Obtain a stat 12-lead electrocardiogram.
Answer: C) Assess the patient's vital signs and level of consciousness.
The rhythm described is likely atrial fibrillation with a rapid ventricular response (RVR).
The initial nursing action is always to assess the patient to determine hemodynamic
stability. The patient being "alert but anxious" suggests stability, making urgent
cardioversion (B) unnecessary at this moment. While a 12-lead ECG (D) is needed for
confirmation and medication (A) may be indicated, the assessment must come first to
guide all subsequent interventions.
4. A patient recovering from an acute myocardial infarction (MI) suddenly becomes
diaphoretic, tachycardic, and hypotensive. Lung sounds reveal crackles bilaterally. The
nurse suspects cardiogenic shock. What is the primary pathophysiologic problem?
A) Widespread systemic vasodilation
B) Inadequate pumping function of the heart
C) A massive pulmonary embolism
D) A severe systemic infection
Answer: B) Inadequate pumping function of the heart
Cardiogenic shock occurs when the heart muscle is damaged and cannot pump
effectively, leading to low cardiac output. This results in hypotension, tachycardia, and
pulmonary congestion (crackles). Systemic vasodilation (A) is characteristic of septic or
neurogenic shock. A pulmonary embolism (C) would cause obstructive shock, and a
systemic infection (D) leads to septic shock.
5. The nurse is caring for a patient with a temporary transvenous pacemaker. The telemetry
strip shows a pacing spike but no subsequent QRS complex. The patient is awake and has
a pulse. What is this phenomenon called and what is the nurse's priority action?
A) Failure to sense; increase the sensitivity.
B) Failure to capture; increase the milliampere (mA) output.
C) Failure to pace; check all connections.
D) Oversensing; decrease the sensitivity.
Answer: B) Failure to capture; increase the milliampere (mA) output.
Failure to capture is identified by a pacing spike without a subsequent P wave or QRS
complex, meaning the electrical stimulus is not causing myocardial depolarization. Since
, the patient is stable, the nurse's priority action is to troubleshoot by increasing the output
(mA) to deliver a stronger impulse. Failure to sense (A) would show pacing spikes at the
wrong time. Failure to pace (C) would show an absence of pacing spikes when they are
expected.
6. A patient with atrial fibrillation is prescribed apixaban. Which patient statement indicates
a need for further teaching ?
A) "I will use a soft-bristled toothbrush to prevent gum bleeding."
B) "I need to have my blood levels checked every week."
C) "I should avoid activities that have a high risk of injury."
D) "I will report any unusual bruising or bleeding to my doctor."
Answer: B) "I need to have my blood levels checked every week."
Apixaban is a direct oral anticoagulant (DOAC). Unlike warfarin, it does not require
routine monitoring of international normalized ratio (INR) or other blood levels. The
other statements are all correct safety measures for a patient on any anticoagulant therapy.
7. A patient is suspected of having a pulmonary embolism. Which finding on the 12-lead
ECG is most characteristic of this condition?
A) ST-segment elevation in leads II, III, and aVF
B) Pathological Q waves in precordial leads
C) Sinus tachycardia with an S1Q3T3 pattern
D) Tall, tented T waves across the precordium
Answer: C) Sinus tachycardia with an S1Q3T3 pattern
The S1Q3T3 pattern (a deep S wave in lead I, a Q wave in lead III, and an inverted T
wave in lead III) is a classic sign of right ventricular strain caused by a pulmonary
embolism. Sinus tachycardia is also very common. ST elevation (A) suggests an inferior
MI. Pathological Q waves (B) indicate a previous MI. Tall, tented T waves (D) are a sign
of hyperkalemia.
8. A patient's telemetry shows a pattern where every other beat is a premature ventricular
contraction (PVC). This pattern is correctly identified as:
A) Ventricular bigeminy
B) Ventricular trigeminy
C) Couplet
D) Ventricular tachycardia
, 9. Answer: A) Ventricular bigeminy
10. Ventricular bigeminy is a rhythm where a PVC follows every normal sinus beat.
Ventricular trigeminy (B) is a pattern where every third beat is a PVC. A couplet (C) is
two consecutive PVCs. Ventricular tachycardia (D) is three or more consecutive PVCs.
11. During a blood transfusion, a patient develops urticaria and pruritus. The nurse's first
action should be to:
A) Stop the transfusion immediately.
B) Slow the transfusion and administer diphenhydramine.
C) Take the patient's vital signs and notify the physician.
D) Check the blood bag for clerical errors.
Answer: B) Slow the transfusion and administer diphenhydramine.
Urticaria and pruritus are signs of a mild allergic transfusion reaction. The standard
protocol for a mild reaction is to slow the infusion (not stop it) and administer an
antihistamine like diphenhydramine as prescribed. Stopping the transfusion (A) is
reserved for more severe reactions (e.g., fever, chills, respiratory distress, hypotension).
Vital signs (C) should be checked, but the immediate intervention is to slow the infusion
and treat the symptoms.
12. The nurse is reviewing laboratory results for a patient with acute kidney injury. Which
result requires immediate intervention due to its direct effect on cardiac conduction?
A) Sodium 130 mEq/L
B) Calcium 8.0 mg/dL
C) Potassium 6.2 mEq/L
D) BUN 80 mg/dL
Answer: C) Potassium 6.2 mEq/L
Hyperkalemia (elevated potassium) is a medical emergency in renal failure because it can
lead to life-threatening cardiac dysrhythmias, including ventricular fibrillation and
asystole. A potassium level of 6.2 mEq/L requires immediate intervention. Hyponatremia
(A) and hypocalcemia (B) can also cause problems, but they are not as immediately
