RELIAS MED-SURG CLINICAL ASSESSMENT RELIAS
MEDICAL-SURGICAL TELEMETRY PROPHECY RN A EXAM/
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
Question 1
A patient on telemetry suddenly develops a heart rate of 38 bpm. The rhythm strip
shows regular P waves with no relationship to QRS complexes. Blood pressure is
78/40 mmHg, and the patient reports dizziness.
What is the most appropriate initial nursing action?
A. Prepare to administer atropine
B. Begin transcutaneous pacing
C. Notify the provider and continue monitoring
D. Administer IV fluids rapidly
Correct Answer: B
Rationale:
The patient has symptomatic third-degree (complete) heart block with
hypotension. Immediate pacing is indicated. Atropine is often ineffective in
complete heart block. Fluids alone will not correct the electrical problem.
Question 2
A nurse is reviewing telemetry strips for four patients. Which rhythm requires
immediate intervention?
A. Sinus rhythm with occasional PACs
B. Atrial fibrillation with a ventricular rate of 88 bpm
C. Ventricular tachycardia at 160 bpm without a pulse
D. Sinus bradycardia at 54 bpm in a resting patient
Correct Answer: C
,Rationale:
Pulseless ventricular tachycardia is a life-threatening rhythm requiring
immediate defibrillation and CPR. The other rhythms are either stable or
expected.
Question 3
A postoperative patient has a Jackson-Pratt (JP) drain. The nurse notes that the
bulb is fully expanded and not draining.
What should the nurse do first?
A. Strip the tubing aggressively
B. Remove the drain
C. Compress the bulb and re-cap it
D. Irrigate the drain with sterile saline
Correct Answer: C
Rationale:
A JP drain functions by closed suction. The bulb must be compressed to create
negative pressure. Irrigation or stripping is not routine and may cause tissue
damage.
Question 4
A patient receiving a blood transfusion develops chills, back pain, and dark urine
20 minutes after the infusion begins.
What is the nurse’s priority action?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Obtain a new IV access site
Correct Answer: B
,Rationale:
These findings suggest an acute hemolytic transfusion reaction. The transfusion
must be stopped immediately to prevent renal failure and shock.
Question 5
A telemetry patient has the following lab results:
Potassium: 6.1 mEq/L
Creatinine: 3.2 mg/dL
ECG: peaked T waves
Which provider order should the nurse implement first?
A. Sodium polystyrene sulfonate
B. IV regular insulin with dextrose
C. Oral furosemide
D. Dietary potassium restriction
Correct Answer: B
Rationale:
IV insulin with dextrose rapidly shifts potassium intracellularly and is the fastest
method to stabilize cardiac conduction. Other measures act more slowly.
, Question 6
A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. ABGs
reveal:
pH: 7.30
PaCO₂: 60 mmHg
HCO₃⁻: 28 mEq/L
How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory acidosis with partial compensation
C. Respiratory alkalosis
D. Fully compensated metabolic alkalosis
Correct Answer: B
Rationale:
Elevated PaCO₂ with low pH indicates respiratory acidosis. Slightly elevated
bicarbonate shows partial metabolic compensation, common in chronic COPD.
Question 7
A patient on telemetry reports sudden chest pain and dyspnea. Telemetry shows
sinus tachycardia. Oxygen saturation is 86% on room air.
Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Administer oxygen
C. Draw cardiac enzymes
D. Administer nitroglycerin
Correct Answer: B
Rationale:
This patient is hypoxic. Airway and oxygenation are the priority before
diagnostic testing or medications.
MEDICAL-SURGICAL TELEMETRY PROPHECY RN A EXAM/
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
Question 1
A patient on telemetry suddenly develops a heart rate of 38 bpm. The rhythm strip
shows regular P waves with no relationship to QRS complexes. Blood pressure is
78/40 mmHg, and the patient reports dizziness.
What is the most appropriate initial nursing action?
A. Prepare to administer atropine
B. Begin transcutaneous pacing
C. Notify the provider and continue monitoring
D. Administer IV fluids rapidly
Correct Answer: B
Rationale:
The patient has symptomatic third-degree (complete) heart block with
hypotension. Immediate pacing is indicated. Atropine is often ineffective in
complete heart block. Fluids alone will not correct the electrical problem.
Question 2
A nurse is reviewing telemetry strips for four patients. Which rhythm requires
immediate intervention?
A. Sinus rhythm with occasional PACs
B. Atrial fibrillation with a ventricular rate of 88 bpm
C. Ventricular tachycardia at 160 bpm without a pulse
D. Sinus bradycardia at 54 bpm in a resting patient
Correct Answer: C
,Rationale:
Pulseless ventricular tachycardia is a life-threatening rhythm requiring
immediate defibrillation and CPR. The other rhythms are either stable or
expected.
Question 3
A postoperative patient has a Jackson-Pratt (JP) drain. The nurse notes that the
bulb is fully expanded and not draining.
What should the nurse do first?
A. Strip the tubing aggressively
B. Remove the drain
C. Compress the bulb and re-cap it
D. Irrigate the drain with sterile saline
Correct Answer: C
Rationale:
A JP drain functions by closed suction. The bulb must be compressed to create
negative pressure. Irrigation or stripping is not routine and may cause tissue
damage.
Question 4
A patient receiving a blood transfusion develops chills, back pain, and dark urine
20 minutes after the infusion begins.
What is the nurse’s priority action?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Obtain a new IV access site
Correct Answer: B
,Rationale:
These findings suggest an acute hemolytic transfusion reaction. The transfusion
must be stopped immediately to prevent renal failure and shock.
Question 5
A telemetry patient has the following lab results:
Potassium: 6.1 mEq/L
Creatinine: 3.2 mg/dL
ECG: peaked T waves
Which provider order should the nurse implement first?
A. Sodium polystyrene sulfonate
B. IV regular insulin with dextrose
C. Oral furosemide
D. Dietary potassium restriction
Correct Answer: B
Rationale:
IV insulin with dextrose rapidly shifts potassium intracellularly and is the fastest
method to stabilize cardiac conduction. Other measures act more slowly.
, Question 6
A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. ABGs
reveal:
pH: 7.30
PaCO₂: 60 mmHg
HCO₃⁻: 28 mEq/L
How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory acidosis with partial compensation
C. Respiratory alkalosis
D. Fully compensated metabolic alkalosis
Correct Answer: B
Rationale:
Elevated PaCO₂ with low pH indicates respiratory acidosis. Slightly elevated
bicarbonate shows partial metabolic compensation, common in chronic COPD.
Question 7
A patient on telemetry reports sudden chest pain and dyspnea. Telemetry shows
sinus tachycardia. Oxygen saturation is 86% on room air.
Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Administer oxygen
C. Draw cardiac enzymes
D. Administer nitroglycerin
Correct Answer: B
Rationale:
This patient is hypoxic. Airway and oxygenation are the priority before
diagnostic testing or medications.
