RELIAS Medical-Surgical Telemetry Updated 2026 | Comprehensive
Nursing Study Guide, Practice Exam Questions and Answers, Exam Prep
Test Bank, Cardiac Monitoring and ECG Interpretation, Dysrhythmia
Recognition, Medical-Surgical Nursing Concepts, Hemodynamic
Assessment, Patient Safety and Telemetry Monitoring, Cardiovascular
Pharmacology, Clinical Judgment Skills, and Detailed Rationales for Exam
Success
Question 1: A patient with a history of atrial fibrillation is admitted to the telemetry
unit. Which finding would be the most significant indicator of a potential
thromboembolic event?
A. Intermittent episodes of palpitations
B. A sudden onset of severe, sharp chest pain
C. A new onset of hemiparesis and facial droop
D. Shortness of breath during exertion
CORRECT ANSWER: C. A new onset of hemiparesis and facial droop
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrium, which can embolize to the cerebral circulation. A new onset of focal neurologic
deficits, such as hemiparesis and facial droop, is the most significant indicator of an
acute ischemic stroke, a thromboembolic complication.
Question 2: When interpreting a cardiac rhythm strip, a nurse notes a regular
rhythm with a rate of 40 beats per minute and no visible P waves. The QRS complex
is wide and bizarre. This rhythm is best described as:
A. Atrial fibrillation
B. Junctional rhythm
C. Ventricular tachycardia
D. Idioventricular rhythm
CORRECT ANSWER: D. Idioventricular rhythm
Rationale: An idioventricular rhythm is characterized by a slow ventricular rate (20-40
bpm), wide QRS complexes, and the absence of P waves. It occurs when the ventricular
pacemaker takes over due to the failure of higher pacemakers. Ventricular tachycardia
would have a rate over 100 bpm.
Question 3: A nurse is caring for a post-operative patient on a telemetry monitor.
The patient's heart rate suddenly drops from 88 to 42 beats per minute, and the
monitor shows a regular rhythm with a normal QRS complex. The patient is
asymptomatic. What is the nurse's priority action?
,A. Prepare for synchronized cardioversion
B. Administer atropine 0.5 mg IV push
C. Assess the patient's blood pressure and level of consciousness
D. Apply transcutaneous pacemaker pads
CORRECT ANSWER: C. Assess the patient's blood pressure and level of
consciousness
Rationale: The initial step in managing bradycardia is to assess the patient's
hemodynamic stability. Symptoms like hypotension, chest pain, or altered mental
status dictate the need for intervention (e.g., atropine, pacing). As the patient is
asymptomatic, a thorough assessment is the priority before initiating any treatment.
Question 4: A patient with an acute myocardial infarction is exhibiting multifocal
premature ventricular contractions (PVCs) on the telemetry monitor. Which
medication is the priority to administer?
A. Epinephrine
B. Amiodarone
C. Atropine
D. Sodium bicarbonate
CORRECT ANSWER: B. Amiodarone
Rationale: In the context of an acute MI, frequent or multifocal PVCs are considered
warning arrhythmias that can deteriorate into ventricular tachycardia or fibrillation.
Amiodarone is an antiarrhythmic drug indicated for the suppression of these serious
ventricular arrhythmias. Lidocaine is another option, but Amiodarone is often the first-
line agent in this scenario.
Question 5: The nurse is reviewing a patient's telemetry strip and notes that the PR
interval is progressively lengthening until a QRS complex is dropped. This pattern
repeats. This rhythm is identified as:
A. Second-degree atrioventricular (AV) block, Type I (Wenckebach)
B. Second-degree atrioventricular (AV) block, Type II (Mobitz II)
C. Third-degree AV block
D. First-degree AV block
CORRECT ANSWER: A. Second-degree atrioventricular (AV) block, Type I
(Wenckebach)
Rationale: Wenckebach (Mobitz I) is characterized by a progressive prolongation of the
PR interval on successive beats until a P wave is not conducted (dropped QRS). The
cycle then repeats. It is often benign and typically does not progress to more serious
blocks.
,Question 6: A patient on a medical-surgical telemetry unit has an order for
continuous pulse oximetry. The patient’s baseline SpO2 is 96%. The reading drops
to 88% during sleep. What is the nurse’s best initial action?
A. Increase the patient's oxygen flow rate to 4 L/min
B. Wake the patient and encourage deep breathing
C. Assess the placement of the pulse oximeter probe and the patient's respiratory effort
D. Notify the physician immediately of the change
CORRECT ANSWER: C. Assess the placement of the pulse oximeter probe and the
patient's respiratory effort
Rationale: Before implementing any intervention or notification, the nurse must verify
the accuracy of the reading. A false low reading can result from poor probe placement,
movement, or peripheral vasoconstriction. After confirming the reading and assessing
the patient's clinical status, further action can be taken.
Question 7: A post-operative patient’s telemetry monitor shows a rapid, irregular
rhythm with no discernible P waves and an irregularly irregular ventricular
response. The nurse recognizes this as:
A. Atrial flutter
B. Atrial fibrillation
C. Wandering pacemaker
D. Sinus arrhythmia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic, rapid atrial activity with no
distinct P waves and an irregularly irregular ventricular response. This is a common
arrhythmia in post-operative patients, especially those with underlying heart disease.
Question 8: A nurse is preparing a patient for a transesophageal echocardiogram
(TEE). Which of the following is the most critical pre-procedure assessment?
A. Assess for allergy to iodine
B. Assess for a history of diabetes mellitus
C. Assess the patient's ability to lie flat for an extended period
D. Assess the patient's NPO status
CORRECT ANSWER: D. Assess the patient's NPO status
Rationale: A TEE is an invasive procedure involving the insertion of a probe into the
esophagus. The patient must be NPO for at least 6-8 hours prior to the procedure to
reduce the risk of aspiration and to ensure an empty stomach for the procedure.
, Question 9: A patient with chest pain receives a sublingual nitroglycerin tablet.
Which assessment finding indicates the desired therapeutic effect of the
medication?
A. Increase in blood pressure
B. Relief of chest pain
C. Decrease in heart rate
D. Pupillary dilation
CORRECT ANSWER: B. Relief of chest pain
Rationale: Nitroglycerin is a potent vasodilator used to relieve angina. Its primary
therapeutic effect is the reduction of myocardial oxygen demand and the dilation of
coronary arteries, leading to the relief of ischemic chest pain. A drop in blood pressure
is a common side effect, not the desired endpoint.
Question 10: The nurse notes that a patient's cardiac monitor shows a saw-tooth
pattern of atrial activity with a ventricular rate of 150 beats per minute. The nurse
should anticipate which intervention?
A. Immediate defibrillation
B. Administration of digoxin
C. Synchronized cardioversion
D. Administration of atropine
CORRECT ANSWER: C. Synchronized cardioversion
Rationale: The saw-tooth pattern is characteristic of atrial flutter. Atrial flutter with a
rapid ventricular response can compromise cardiac output. Synchronized cardioversion
is a treatment option to restore normal sinus rhythm by delivering a shock that is timed
to the R wave to avoid inducing ventricular fibrillation.
Question 11: A patient is admitted with a diagnosis of heart failure. The nurse on
the telemetry unit should monitor for which early sign of declining cardiac output?
A. Crackles in lung bases
B. Peripheral edema
C. Restlessness and confusion
D. Jugular venous distention
CORRECT ANSWER: C. Restlessness and confusion
Rationale: Restlessness and confusion are early signs of decreased cerebral perfusion
and declining cardiac output. While crackles, edema, and JVD are signs of fluid
Nursing Study Guide, Practice Exam Questions and Answers, Exam Prep
Test Bank, Cardiac Monitoring and ECG Interpretation, Dysrhythmia
Recognition, Medical-Surgical Nursing Concepts, Hemodynamic
Assessment, Patient Safety and Telemetry Monitoring, Cardiovascular
Pharmacology, Clinical Judgment Skills, and Detailed Rationales for Exam
Success
Question 1: A patient with a history of atrial fibrillation is admitted to the telemetry
unit. Which finding would be the most significant indicator of a potential
thromboembolic event?
A. Intermittent episodes of palpitations
B. A sudden onset of severe, sharp chest pain
C. A new onset of hemiparesis and facial droop
D. Shortness of breath during exertion
CORRECT ANSWER: C. A new onset of hemiparesis and facial droop
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrium, which can embolize to the cerebral circulation. A new onset of focal neurologic
deficits, such as hemiparesis and facial droop, is the most significant indicator of an
acute ischemic stroke, a thromboembolic complication.
Question 2: When interpreting a cardiac rhythm strip, a nurse notes a regular
rhythm with a rate of 40 beats per minute and no visible P waves. The QRS complex
is wide and bizarre. This rhythm is best described as:
A. Atrial fibrillation
B. Junctional rhythm
C. Ventricular tachycardia
D. Idioventricular rhythm
CORRECT ANSWER: D. Idioventricular rhythm
Rationale: An idioventricular rhythm is characterized by a slow ventricular rate (20-40
bpm), wide QRS complexes, and the absence of P waves. It occurs when the ventricular
pacemaker takes over due to the failure of higher pacemakers. Ventricular tachycardia
would have a rate over 100 bpm.
Question 3: A nurse is caring for a post-operative patient on a telemetry monitor.
The patient's heart rate suddenly drops from 88 to 42 beats per minute, and the
monitor shows a regular rhythm with a normal QRS complex. The patient is
asymptomatic. What is the nurse's priority action?
,A. Prepare for synchronized cardioversion
B. Administer atropine 0.5 mg IV push
C. Assess the patient's blood pressure and level of consciousness
D. Apply transcutaneous pacemaker pads
CORRECT ANSWER: C. Assess the patient's blood pressure and level of
consciousness
Rationale: The initial step in managing bradycardia is to assess the patient's
hemodynamic stability. Symptoms like hypotension, chest pain, or altered mental
status dictate the need for intervention (e.g., atropine, pacing). As the patient is
asymptomatic, a thorough assessment is the priority before initiating any treatment.
Question 4: A patient with an acute myocardial infarction is exhibiting multifocal
premature ventricular contractions (PVCs) on the telemetry monitor. Which
medication is the priority to administer?
A. Epinephrine
B. Amiodarone
C. Atropine
D. Sodium bicarbonate
CORRECT ANSWER: B. Amiodarone
Rationale: In the context of an acute MI, frequent or multifocal PVCs are considered
warning arrhythmias that can deteriorate into ventricular tachycardia or fibrillation.
Amiodarone is an antiarrhythmic drug indicated for the suppression of these serious
ventricular arrhythmias. Lidocaine is another option, but Amiodarone is often the first-
line agent in this scenario.
Question 5: The nurse is reviewing a patient's telemetry strip and notes that the PR
interval is progressively lengthening until a QRS complex is dropped. This pattern
repeats. This rhythm is identified as:
A. Second-degree atrioventricular (AV) block, Type I (Wenckebach)
B. Second-degree atrioventricular (AV) block, Type II (Mobitz II)
C. Third-degree AV block
D. First-degree AV block
CORRECT ANSWER: A. Second-degree atrioventricular (AV) block, Type I
(Wenckebach)
Rationale: Wenckebach (Mobitz I) is characterized by a progressive prolongation of the
PR interval on successive beats until a P wave is not conducted (dropped QRS). The
cycle then repeats. It is often benign and typically does not progress to more serious
blocks.
,Question 6: A patient on a medical-surgical telemetry unit has an order for
continuous pulse oximetry. The patient’s baseline SpO2 is 96%. The reading drops
to 88% during sleep. What is the nurse’s best initial action?
A. Increase the patient's oxygen flow rate to 4 L/min
B. Wake the patient and encourage deep breathing
C. Assess the placement of the pulse oximeter probe and the patient's respiratory effort
D. Notify the physician immediately of the change
CORRECT ANSWER: C. Assess the placement of the pulse oximeter probe and the
patient's respiratory effort
Rationale: Before implementing any intervention or notification, the nurse must verify
the accuracy of the reading. A false low reading can result from poor probe placement,
movement, or peripheral vasoconstriction. After confirming the reading and assessing
the patient's clinical status, further action can be taken.
Question 7: A post-operative patient’s telemetry monitor shows a rapid, irregular
rhythm with no discernible P waves and an irregularly irregular ventricular
response. The nurse recognizes this as:
A. Atrial flutter
B. Atrial fibrillation
C. Wandering pacemaker
D. Sinus arrhythmia
CORRECT ANSWER: B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic, rapid atrial activity with no
distinct P waves and an irregularly irregular ventricular response. This is a common
arrhythmia in post-operative patients, especially those with underlying heart disease.
Question 8: A nurse is preparing a patient for a transesophageal echocardiogram
(TEE). Which of the following is the most critical pre-procedure assessment?
A. Assess for allergy to iodine
B. Assess for a history of diabetes mellitus
C. Assess the patient's ability to lie flat for an extended period
D. Assess the patient's NPO status
CORRECT ANSWER: D. Assess the patient's NPO status
Rationale: A TEE is an invasive procedure involving the insertion of a probe into the
esophagus. The patient must be NPO for at least 6-8 hours prior to the procedure to
reduce the risk of aspiration and to ensure an empty stomach for the procedure.
, Question 9: A patient with chest pain receives a sublingual nitroglycerin tablet.
Which assessment finding indicates the desired therapeutic effect of the
medication?
A. Increase in blood pressure
B. Relief of chest pain
C. Decrease in heart rate
D. Pupillary dilation
CORRECT ANSWER: B. Relief of chest pain
Rationale: Nitroglycerin is a potent vasodilator used to relieve angina. Its primary
therapeutic effect is the reduction of myocardial oxygen demand and the dilation of
coronary arteries, leading to the relief of ischemic chest pain. A drop in blood pressure
is a common side effect, not the desired endpoint.
Question 10: The nurse notes that a patient's cardiac monitor shows a saw-tooth
pattern of atrial activity with a ventricular rate of 150 beats per minute. The nurse
should anticipate which intervention?
A. Immediate defibrillation
B. Administration of digoxin
C. Synchronized cardioversion
D. Administration of atropine
CORRECT ANSWER: C. Synchronized cardioversion
Rationale: The saw-tooth pattern is characteristic of atrial flutter. Atrial flutter with a
rapid ventricular response can compromise cardiac output. Synchronized cardioversion
is a treatment option to restore normal sinus rhythm by delivering a shock that is timed
to the R wave to avoid inducing ventricular fibrillation.
Question 11: A patient is admitted with a diagnosis of heart failure. The nurse on
the telemetry unit should monitor for which early sign of declining cardiac output?
A. Crackles in lung bases
B. Peripheral edema
C. Restlessness and confusion
D. Jugular venous distention
CORRECT ANSWER: C. Restlessness and confusion
Rationale: Restlessness and confusion are early signs of decreased cerebral perfusion
and declining cardiac output. While crackles, edema, and JVD are signs of fluid
