Relias Medical Surgical Telemetry Test Bank Exam 2025/2026 Compete
Questions and Very Accurate Tested Answers with full Elaborations/
Graded A+/ Fully Covered A+
1. A 72-year-old patient on telemetry reports dizziness and fatigue. The strip
shows a sinus rhythm at 38 bpm with occasional pauses. What is the most
appropriate initial nursing action?
Answer: Assess hemodynamic stability and prepare for atropine if symptomatic.
Explanation: Symptomatic bradycardia may compromise perfusion; atropine
increases HR.
2. A patient presents with rapid, irregular heart rate of 160 bpm, blood pressure
120/70 mmHg, and no chest pain. Telemetry shows atrial fibrillation with RVR.
What is the priority intervention?
Answer: Administer IV rate-controlling agent (diltiazem or beta-blocker).
Explanation: Controlling ventricular rate prevents hemodynamic compromise and
reduces risk of ischemia.
3. During routine monitoring, a patient shows frequent PVCs in a trigeminy
pattern but is asymptomatic. Labs reveal mild hypokalemia. What is the most
appropriate action?
Answer: Correct potassium level and continue monitoring.
Explanation: Electrolyte disturbances are common triggers of PVCs; correction
reduces arrhythmia risk.
4. Telemetry shows sustained ventricular tachycardia with no palpable pulse.
What is the immediate next step?
Answer: Start CPR and deliver unsynchronized defibrillation.
Explanation: Pulseless VT is a shockable cardiac arrest rhythm; early
defibrillation is lifesaving.
5. A patient exhibits a narrow complex tachycardia at 180 bpm, unresponsive to
vagal maneuvers. What is the next recommended intervention?
Answer: Administer rapid IV adenosine.
Explanation: Adenosine transiently blocks AV nodal conduction, terminating
AVNRT or AVRT.
6. A patient with chronic kidney disease presents with peaked T waves on
telemetry and muscle weakness. What electrolyte abnormality is most likely?
,Answer: Hyperkalemia.
Explanation: Elevated potassium alters repolarization, producing characteristic
tall, peaked T waves.
7. A patient on loop diuretics develops weakness, flattened T waves, and
prominent U waves on ECG. Which electrolyte abnormality should be
suspected?
Answer: Hypokalemia.
Explanation: Loop diuretics cause potassium loss; hypokalemia increases risk for
ventricular arrhythmias.
8. During morning rounds, a nurse observes new ST elevation in leads II, III,
aVF on telemetry. The patient reports chest pressure. What is the immediate
nursing action?
Answer: Obtain a 12-lead ECG and notify the provider immediately; prepare for
STEMI protocol.
Explanation: ST elevation with symptoms suggests acute MI, requiring urgent
reperfusion.
9. A patient with COPD develops multifocal atrial tachycardia (MAT) with
oxygen saturation of 85%. What is the most appropriate initial intervention?
Answer: Optimize oxygenation and treat underlying pulmonary condition.
Explanation: MAT is often precipitated by hypoxia; addressing the underlying
cause stabilizes rhythm.
10. Telemetry alarms show sudden loss of waveform while the patient is talking.
What is the first action?
Answer: Check electrode placement and lead connections.
Explanation: Artifact from loose electrodes is a common cause of apparent
rhythm changes; always confirm patient status first.
11. A patient with chest pain and new left bundle branch block (LBBB) is on
telemetry. What is the correct interpretation?
Answer: Treat as possible acute MI; obtain urgent 12-lead ECG.
Explanation: New LBBB can mask ST changes; assume ischemia until ruled out.
12. Post-op telemetry shows sinus tachycardia of 130 bpm. The patient reports
mild pain. Which is the priority nursing action?
Answer: Assess and manage pain, check fluid status, and monitor vital signs.
,Explanation: Tachycardia may be compensatory; addressing underlying causes
often resolves arrhythmia.
13. Telemetry shows asystole in a patient. What is the immediate nursing
response?
Answer: Begin CPR and administer epinephrine per ACLS protocol.
Explanation: Asystole is non-shockable; high-quality CPR and prompt medication
support perfusion.
14. Pacemaker spikes are observed without corresponding QRS complexes on
telemetry. What does this indicate?
Answer: Pacemaker failure to capture.
Explanation: Pacing output is not depolarizing the myocardium; assess lead
integrity and device settings.
15. An asymptomatic patient has a single PVC on telemetry. What is the
appropriate action?
Answer: Continue monitoring and assess for reversible causes.
Explanation: Isolated PVCs can be benign; evaluate electrolyte status and
oxygenation.
16. A patient on telemetry develops hypotension and chest pain, with ST
depression noted. What is the priority intervention?
Answer: Notify the provider and prepare for emergent care.
Explanation: ST depression indicates myocardial ischemia; hypotension signals
hemodynamic instability.
17. Atrial flutter with 2:1 conduction and HR of 140 bpm is observed on
telemetry. The patient is stable. What is the next step?
Answer: Administer rate-controlling agent (beta-blocker or diltiazem).
Explanation: Slowing ventricular rate improves perfusion and reduces symptoms.
18. Post-operative patient becomes suddenly hypoxic and tachycardic. Telemetry
is inconclusive. What is the likely diagnosis?
Answer: Pulmonary embolism.
Explanation: Sudden dyspnea, hypoxia, and tachycardia are classic signs; urgent
evaluation required.
19. Telemetry shows torsades de pointes. What is the immediate treatment?
Answer: IV magnesium sulfate and prepare for defibrillation if unstable.
, Explanation: Magnesium stabilizes ventricular myocardium in polymorphic VT
caused by prolonged QT.
20. A patient is on sotalol and develops prolonged QT interval on telemetry.
What is the risk?
Answer: Torsades de pointes.
Explanation: QT prolongation predisposes to life-threatening polymorphic VT.
21. A patient with heart failure exhibits 3+ pitting edema, crackles in lungs, and
dyspnea. What is the priority nursing intervention?
Answer: Assess oxygenation, administer prescribed diuretics, and monitor
hemodynamics.
Explanation: Volume overload impairs gas exchange; diuresis reduces pulmonary
congestion.
22. Potassium is 2.8 mEq/L in a patient with ventricular arrhythmias. What is
the most urgent intervention?
Answer: Administer IV potassium carefully while monitoring telemetry.
Explanation: Hypokalemia increases risk for malignant arrhythmias; rapid
correction is critical.
23. A patient with chronic atrial fibrillation and stable ventricular rate is
asymptomatic. What long-term risk must be addressed?
Answer: Assess for stroke risk and anticoagulation need.
Explanation: AF increases thromboembolic risk; CHADS-VASc score guides
therapy.
24. A patient develops new PVCs alongside chest pain. What is the likely
etiology?
Answer: Myocardial ischemia or infarction.
Explanation: Ischemia increases ventricular irritability, producing ectopic beats.
25. Telemetry alarms for frequent artifact in a mobile patient. What is the
appropriate nursing action?
Answer: Reposition electrodes and ensure proper lead contact.
Explanation: Artifact is often caused by motion; confirm patient status before
treating arrhythmia.
26. Which rhythm is characterized by sawtooth P waves on ECG?
Answer: Atrial flutter.
Questions and Very Accurate Tested Answers with full Elaborations/
Graded A+/ Fully Covered A+
1. A 72-year-old patient on telemetry reports dizziness and fatigue. The strip
shows a sinus rhythm at 38 bpm with occasional pauses. What is the most
appropriate initial nursing action?
Answer: Assess hemodynamic stability and prepare for atropine if symptomatic.
Explanation: Symptomatic bradycardia may compromise perfusion; atropine
increases HR.
2. A patient presents with rapid, irregular heart rate of 160 bpm, blood pressure
120/70 mmHg, and no chest pain. Telemetry shows atrial fibrillation with RVR.
What is the priority intervention?
Answer: Administer IV rate-controlling agent (diltiazem or beta-blocker).
Explanation: Controlling ventricular rate prevents hemodynamic compromise and
reduces risk of ischemia.
3. During routine monitoring, a patient shows frequent PVCs in a trigeminy
pattern but is asymptomatic. Labs reveal mild hypokalemia. What is the most
appropriate action?
Answer: Correct potassium level and continue monitoring.
Explanation: Electrolyte disturbances are common triggers of PVCs; correction
reduces arrhythmia risk.
4. Telemetry shows sustained ventricular tachycardia with no palpable pulse.
What is the immediate next step?
Answer: Start CPR and deliver unsynchronized defibrillation.
Explanation: Pulseless VT is a shockable cardiac arrest rhythm; early
defibrillation is lifesaving.
5. A patient exhibits a narrow complex tachycardia at 180 bpm, unresponsive to
vagal maneuvers. What is the next recommended intervention?
Answer: Administer rapid IV adenosine.
Explanation: Adenosine transiently blocks AV nodal conduction, terminating
AVNRT or AVRT.
6. A patient with chronic kidney disease presents with peaked T waves on
telemetry and muscle weakness. What electrolyte abnormality is most likely?
,Answer: Hyperkalemia.
Explanation: Elevated potassium alters repolarization, producing characteristic
tall, peaked T waves.
7. A patient on loop diuretics develops weakness, flattened T waves, and
prominent U waves on ECG. Which electrolyte abnormality should be
suspected?
Answer: Hypokalemia.
Explanation: Loop diuretics cause potassium loss; hypokalemia increases risk for
ventricular arrhythmias.
8. During morning rounds, a nurse observes new ST elevation in leads II, III,
aVF on telemetry. The patient reports chest pressure. What is the immediate
nursing action?
Answer: Obtain a 12-lead ECG and notify the provider immediately; prepare for
STEMI protocol.
Explanation: ST elevation with symptoms suggests acute MI, requiring urgent
reperfusion.
9. A patient with COPD develops multifocal atrial tachycardia (MAT) with
oxygen saturation of 85%. What is the most appropriate initial intervention?
Answer: Optimize oxygenation and treat underlying pulmonary condition.
Explanation: MAT is often precipitated by hypoxia; addressing the underlying
cause stabilizes rhythm.
10. Telemetry alarms show sudden loss of waveform while the patient is talking.
What is the first action?
Answer: Check electrode placement and lead connections.
Explanation: Artifact from loose electrodes is a common cause of apparent
rhythm changes; always confirm patient status first.
11. A patient with chest pain and new left bundle branch block (LBBB) is on
telemetry. What is the correct interpretation?
Answer: Treat as possible acute MI; obtain urgent 12-lead ECG.
Explanation: New LBBB can mask ST changes; assume ischemia until ruled out.
12. Post-op telemetry shows sinus tachycardia of 130 bpm. The patient reports
mild pain. Which is the priority nursing action?
Answer: Assess and manage pain, check fluid status, and monitor vital signs.
,Explanation: Tachycardia may be compensatory; addressing underlying causes
often resolves arrhythmia.
13. Telemetry shows asystole in a patient. What is the immediate nursing
response?
Answer: Begin CPR and administer epinephrine per ACLS protocol.
Explanation: Asystole is non-shockable; high-quality CPR and prompt medication
support perfusion.
14. Pacemaker spikes are observed without corresponding QRS complexes on
telemetry. What does this indicate?
Answer: Pacemaker failure to capture.
Explanation: Pacing output is not depolarizing the myocardium; assess lead
integrity and device settings.
15. An asymptomatic patient has a single PVC on telemetry. What is the
appropriate action?
Answer: Continue monitoring and assess for reversible causes.
Explanation: Isolated PVCs can be benign; evaluate electrolyte status and
oxygenation.
16. A patient on telemetry develops hypotension and chest pain, with ST
depression noted. What is the priority intervention?
Answer: Notify the provider and prepare for emergent care.
Explanation: ST depression indicates myocardial ischemia; hypotension signals
hemodynamic instability.
17. Atrial flutter with 2:1 conduction and HR of 140 bpm is observed on
telemetry. The patient is stable. What is the next step?
Answer: Administer rate-controlling agent (beta-blocker or diltiazem).
Explanation: Slowing ventricular rate improves perfusion and reduces symptoms.
18. Post-operative patient becomes suddenly hypoxic and tachycardic. Telemetry
is inconclusive. What is the likely diagnosis?
Answer: Pulmonary embolism.
Explanation: Sudden dyspnea, hypoxia, and tachycardia are classic signs; urgent
evaluation required.
19. Telemetry shows torsades de pointes. What is the immediate treatment?
Answer: IV magnesium sulfate and prepare for defibrillation if unstable.
, Explanation: Magnesium stabilizes ventricular myocardium in polymorphic VT
caused by prolonged QT.
20. A patient is on sotalol and develops prolonged QT interval on telemetry.
What is the risk?
Answer: Torsades de pointes.
Explanation: QT prolongation predisposes to life-threatening polymorphic VT.
21. A patient with heart failure exhibits 3+ pitting edema, crackles in lungs, and
dyspnea. What is the priority nursing intervention?
Answer: Assess oxygenation, administer prescribed diuretics, and monitor
hemodynamics.
Explanation: Volume overload impairs gas exchange; diuresis reduces pulmonary
congestion.
22. Potassium is 2.8 mEq/L in a patient with ventricular arrhythmias. What is
the most urgent intervention?
Answer: Administer IV potassium carefully while monitoring telemetry.
Explanation: Hypokalemia increases risk for malignant arrhythmias; rapid
correction is critical.
23. A patient with chronic atrial fibrillation and stable ventricular rate is
asymptomatic. What long-term risk must be addressed?
Answer: Assess for stroke risk and anticoagulation need.
Explanation: AF increases thromboembolic risk; CHADS-VASc score guides
therapy.
24. A patient develops new PVCs alongside chest pain. What is the likely
etiology?
Answer: Myocardial ischemia or infarction.
Explanation: Ischemia increases ventricular irritability, producing ectopic beats.
25. Telemetry alarms for frequent artifact in a mobile patient. What is the
appropriate nursing action?
Answer: Reposition electrodes and ensure proper lead contact.
Explanation: Artifact is often caused by motion; confirm patient status before
treating arrhythmia.
26. Which rhythm is characterized by sawtooth P waves on ECG?
Answer: Atrial flutter.
