RELIAS Medical-Surgical Telemetry Exam Prep | 200+ Practice Questions
with Verified Answers and Detailed Rationales | Cardiac Rhythm
Interpretation, Telemetry Monitoring Techniques, Medical-Surgical
Nursing Care, ECG Analysis, Patient Assessment, Cardiac Emergency
Recognition, and Hospital Telemetry Safety Procedures
Question 1: A patient on telemetry monitoring displays a rhythm with irregularly
irregular R-R intervals, absent P waves, and a ventricular rate of 110 beats per
minute. Which cardiac rhythm is the nurse most likely observing?
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
CORRECT ANSWER: C. Atrial fibrillation
RATIONALE: Atrial fibrillation is characterized by an irregularly irregular rhythm,
absence of distinct P waves (replaced by fibrillatory waves), and variable ventricular
response rates. The rate of 110 bpm indicates uncontrolled AFib. Sinus tachycardia has
regular P waves preceding each QRS. Atrial flutter shows sawtooth flutter waves.
Ventricular tachycardia has wide QRS complexes without visible P waves and is
typically regular.
Question 2: When preparing to apply telemetry electrodes to a patient with
diaphoresis, which nursing action is most important to ensure accurate rhythm
monitoring?
A. Apply electrodes over hairy areas to improve adhesion
B. Clean and dry the skin thoroughly before electrode placement
C. Use extra adhesive tape to secure loose electrodes
D. Place electrodes directly over bony prominences for stability
CORRECT ANSWER: B. Clean and dry the skin thoroughly before electrode
placement
RATIONALE: Proper skin preparation, including cleaning and drying, reduces
impedance and artifact, ensuring accurate telemetry readings. Moisture, oils, or
diaphoresis can interfere with electrical conduction. Electrodes should be placed on
fleshy areas, avoiding hair, bony prominences, or irritated skin. Extra tape does not
correct poor skin contact and may cause skin breakdown.
Question 3: A patient receiving intravenous potassium chloride for hypokalemia
develops peaked T waves on telemetry. What is the nurse's priority action?
A. Continue the infusion and reassess in 30 minutes
B. Stop the infusion and notify the healthcare provider immediately
C. Administer calcium gluconate as a stat order
D. Increase the infusion rate to correct potassium faster
,CORRECT ANSWER: B. Stop the infusion and notify the healthcare provider
immediately
RATIONALE: Peaked T waves are an early ECG sign of hyperkalemia, which can rapidly
progress to life-threatening arrhythmias. Since the patient is receiving IV potassium, the
infusion must be stopped immediately to prevent further potassium administration. The
provider must be notified for further orders, which may include calcium gluconate,
insulin with glucose, or dialysis. Continuing or increasing the infusion could be fatal.
Question 4: Which finding on telemetry monitoring requires immediate
intervention for a patient with a newly placed permanent pacemaker?
A. Occasional premature ventricular contractions
B. Pacing spikes followed by wide QRS complexes
C. Pacing spikes without subsequent QRS complexes
D. Sinus rhythm with a rate of 72 beats per minute
CORRECT ANSWER: C. Pacing spikes without subsequent QRS complexes
RATIONALE: Pacing spikes without captured QRS complexes indicate failure to capture,
meaning the electrical impulse is not depolarizing the myocardium. This is a pacemaker
malfunction requiring immediate assessment and intervention. Occasional PVCs are
common and not emergent. Pacing spikes followed by wide QRS complexes indicate
appropriate ventricular pacing. Sinus rhythm at 72 bpm is normal and does not require
intervention.
Question 5: A patient with heart failure is prescribed metoprolol succinate. Which
telemetry finding indicates the medication is achieving its therapeutic goal?
A. Heart rate decreased from 110 to 78 beats per minute with regular rhythm
B. Blood pressure increased from 90/60 to 130/85 mmHg
C. Development of occasional atrial premature beats
D. QRS complex widening from 80 to 110 milliseconds
CORRECT ANSWER: A. Heart rate decreased from 110 to 78 beats per minute with
regular rhythm
RATIONALE: Beta-blockers like metoprolol reduce heart rate and myocardial oxygen
demand, which is therapeutic in heart failure. A reduction from tachycardic to normal
sinus rhythm indicates effective rate control. Blood pressure changes may occur but are
not the primary telemetry indicator. Premature beats or QRS widening are not
therapeutic goals and may indicate adverse effects.
Question 6: During telemetry monitoring, a patient suddenly develops a rhythm
with no visible P waves, a regular rate of 150 beats per minute, and narrow QRS
complexes. Which intervention should the nurse anticipate?
A. Immediate defibrillation at 200 joules
B. Administration of adenosine 6 mg IV push
,C. Preparation for transcutaneous pacing
D. Application of vagal maneuvers
CORRECT ANSWER: B. Administration of adenosine 6 mg IV push
RATIONALE: The described rhythm is consistent with atrioventricular nodal reentrant
tachycardia (AVNRT), a supraventricular tachycardia (SVT) with narrow QRS complexes.
Adenosine is the first-line medication for stable SVT as it transiently blocks AV node
conduction, often terminating the arrhythmia. Defibrillation is for pulseless VT/VF.
Transcutaneous pacing is for symptomatic bradycardia. Vagal maneuvers may be
attempted first but adenosine is the anticipated pharmacologic intervention.
Question 7: Which electrolyte imbalance is most commonly associated with the
development of torsades de pointes on telemetry?
A. Hypernatremia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyperkalemia
CORRECT ANSWER: C. Hypomagnesemia
RATIONALE: Hypomagnesemia prolongs the QT interval and predisposes patients to
torsades de pointes, a polymorphic ventricular tachycardia. Magnesium sulfate is the
treatment of choice for torsades. While hypokalemia and hypocalcemia can also affect
QT interval, hypomagnesemia has the strongest association. Hypernatremia and
hyperkalemia are not primary risk factors for torsades.
Question 8: A patient with an implantable cardioverter-defibrillator (ICD)
experiences appropriate shock delivery for ventricular fibrillation. What is the
nurse's priority assessment immediately after the shock?
A. Check the ICD interrogation report
B. Assess the patient's level of consciousness and pulse
C. Document the event in the electronic health record
D. Notify the cardiology team for device reprogramming
CORRECT ANSWER: B. Assess the patient's level of consciousness and pulse
RATIONALE: After any ICD shock, the nurse must first assess the patient's clinical
status—consciousness, airway, breathing, and pulse—to determine if the shock was
effective and if the patient is stable. If the patient is pulseless, CPR and ACLS protocols
begin immediately. Device interrogation, documentation, and provider notification are
important but secondary to immediate patient assessment and stabilization.
Question 9: Which telemetry rhythm finding in a post-myocardial infarction patient
requires the most urgent notification of the healthcare provider?
A. Sinus bradycardia at 55 beats per minute
B. New-onset left bundle branch block
, C. Occasional premature atrial contractions
D. First-degree atrioventricular block
CORRECT ANSWER: B. New-onset left bundle branch block
RATIONALE: New-onset left bundle branch block (LBBB) in the setting of acute
myocardial infarction is considered a STEMI equivalent and indicates extensive
coronary artery disease or ongoing ischemia. It requires immediate provider notification
and possible emergent reperfusion therapy. Sinus bradycardia, PACs, and first-degree
AV block are common post-MI findings and typically do not require emergent
intervention unless symptomatic.
Question 10: When educating a patient about home telemetry monitoring, which
statement by the patient indicates understanding of when to seek immediate
medical attention?
A. "I will call my doctor if I notice my heart rate is above 100."
B. "I should go to the ER if I feel dizzy and my monitor shows a fast, irregular rhythm."
C. "I can wait until my next appointment if the monitor beeps occasionally."
D. "I will remove the electrodes if my skin becomes slightly red."
CORRECT ANSWER: B. "I should go to the ER if I feel dizzy and my monitor shows a
fast, irregular rhythm."
RATIONALE: Symptoms like dizziness combined with an abnormal rhythm (e.g., fast
and irregular, suggesting AFib with RVR or VT) indicate potential hemodynamic
instability requiring emergent evaluation. A heart rate above 100 may be normal with
activity. Occasional beeps may indicate artifact but should not be ignored if persistent.
Mild skin redness can be managed with skin care; removal of electrodes without
guidance compromises monitoring.
Question 11: A patient receiving digoxin for atrial fibrillation has a telemetry
reading showing a heart rate of 48 beats per minute with regular rhythm. What is
the nurse's priority action?
A. Administer the next scheduled dose of digoxin
B. Hold the digoxin and assess for signs of toxicity
C. Increase the digoxin dose to achieve rate control
D. Document the finding and continue monitoring
CORRECT ANSWER: B. Hold the digoxin and assess for signs of toxicity
RATIONALE: Digoxin toxicity can cause bradycardia, heart block, and other
arrhythmias. A heart rate below 60 bpm in a patient on digoxin warrants holding the
dose and assessing for other toxicity signs (nausea, vomiting, visual changes,
confusion). Serum digoxin and potassium levels should be checked. Administering or
increasing digoxin could worsen toxicity. Documentation alone is insufficient without
intervention.
with Verified Answers and Detailed Rationales | Cardiac Rhythm
Interpretation, Telemetry Monitoring Techniques, Medical-Surgical
Nursing Care, ECG Analysis, Patient Assessment, Cardiac Emergency
Recognition, and Hospital Telemetry Safety Procedures
Question 1: A patient on telemetry monitoring displays a rhythm with irregularly
irregular R-R intervals, absent P waves, and a ventricular rate of 110 beats per
minute. Which cardiac rhythm is the nurse most likely observing?
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
CORRECT ANSWER: C. Atrial fibrillation
RATIONALE: Atrial fibrillation is characterized by an irregularly irregular rhythm,
absence of distinct P waves (replaced by fibrillatory waves), and variable ventricular
response rates. The rate of 110 bpm indicates uncontrolled AFib. Sinus tachycardia has
regular P waves preceding each QRS. Atrial flutter shows sawtooth flutter waves.
Ventricular tachycardia has wide QRS complexes without visible P waves and is
typically regular.
Question 2: When preparing to apply telemetry electrodes to a patient with
diaphoresis, which nursing action is most important to ensure accurate rhythm
monitoring?
A. Apply electrodes over hairy areas to improve adhesion
B. Clean and dry the skin thoroughly before electrode placement
C. Use extra adhesive tape to secure loose electrodes
D. Place electrodes directly over bony prominences for stability
CORRECT ANSWER: B. Clean and dry the skin thoroughly before electrode
placement
RATIONALE: Proper skin preparation, including cleaning and drying, reduces
impedance and artifact, ensuring accurate telemetry readings. Moisture, oils, or
diaphoresis can interfere with electrical conduction. Electrodes should be placed on
fleshy areas, avoiding hair, bony prominences, or irritated skin. Extra tape does not
correct poor skin contact and may cause skin breakdown.
Question 3: A patient receiving intravenous potassium chloride for hypokalemia
develops peaked T waves on telemetry. What is the nurse's priority action?
A. Continue the infusion and reassess in 30 minutes
B. Stop the infusion and notify the healthcare provider immediately
C. Administer calcium gluconate as a stat order
D. Increase the infusion rate to correct potassium faster
,CORRECT ANSWER: B. Stop the infusion and notify the healthcare provider
immediately
RATIONALE: Peaked T waves are an early ECG sign of hyperkalemia, which can rapidly
progress to life-threatening arrhythmias. Since the patient is receiving IV potassium, the
infusion must be stopped immediately to prevent further potassium administration. The
provider must be notified for further orders, which may include calcium gluconate,
insulin with glucose, or dialysis. Continuing or increasing the infusion could be fatal.
Question 4: Which finding on telemetry monitoring requires immediate
intervention for a patient with a newly placed permanent pacemaker?
A. Occasional premature ventricular contractions
B. Pacing spikes followed by wide QRS complexes
C. Pacing spikes without subsequent QRS complexes
D. Sinus rhythm with a rate of 72 beats per minute
CORRECT ANSWER: C. Pacing spikes without subsequent QRS complexes
RATIONALE: Pacing spikes without captured QRS complexes indicate failure to capture,
meaning the electrical impulse is not depolarizing the myocardium. This is a pacemaker
malfunction requiring immediate assessment and intervention. Occasional PVCs are
common and not emergent. Pacing spikes followed by wide QRS complexes indicate
appropriate ventricular pacing. Sinus rhythm at 72 bpm is normal and does not require
intervention.
Question 5: A patient with heart failure is prescribed metoprolol succinate. Which
telemetry finding indicates the medication is achieving its therapeutic goal?
A. Heart rate decreased from 110 to 78 beats per minute with regular rhythm
B. Blood pressure increased from 90/60 to 130/85 mmHg
C. Development of occasional atrial premature beats
D. QRS complex widening from 80 to 110 milliseconds
CORRECT ANSWER: A. Heart rate decreased from 110 to 78 beats per minute with
regular rhythm
RATIONALE: Beta-blockers like metoprolol reduce heart rate and myocardial oxygen
demand, which is therapeutic in heart failure. A reduction from tachycardic to normal
sinus rhythm indicates effective rate control. Blood pressure changes may occur but are
not the primary telemetry indicator. Premature beats or QRS widening are not
therapeutic goals and may indicate adverse effects.
Question 6: During telemetry monitoring, a patient suddenly develops a rhythm
with no visible P waves, a regular rate of 150 beats per minute, and narrow QRS
complexes. Which intervention should the nurse anticipate?
A. Immediate defibrillation at 200 joules
B. Administration of adenosine 6 mg IV push
,C. Preparation for transcutaneous pacing
D. Application of vagal maneuvers
CORRECT ANSWER: B. Administration of adenosine 6 mg IV push
RATIONALE: The described rhythm is consistent with atrioventricular nodal reentrant
tachycardia (AVNRT), a supraventricular tachycardia (SVT) with narrow QRS complexes.
Adenosine is the first-line medication for stable SVT as it transiently blocks AV node
conduction, often terminating the arrhythmia. Defibrillation is for pulseless VT/VF.
Transcutaneous pacing is for symptomatic bradycardia. Vagal maneuvers may be
attempted first but adenosine is the anticipated pharmacologic intervention.
Question 7: Which electrolyte imbalance is most commonly associated with the
development of torsades de pointes on telemetry?
A. Hypernatremia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyperkalemia
CORRECT ANSWER: C. Hypomagnesemia
RATIONALE: Hypomagnesemia prolongs the QT interval and predisposes patients to
torsades de pointes, a polymorphic ventricular tachycardia. Magnesium sulfate is the
treatment of choice for torsades. While hypokalemia and hypocalcemia can also affect
QT interval, hypomagnesemia has the strongest association. Hypernatremia and
hyperkalemia are not primary risk factors for torsades.
Question 8: A patient with an implantable cardioverter-defibrillator (ICD)
experiences appropriate shock delivery for ventricular fibrillation. What is the
nurse's priority assessment immediately after the shock?
A. Check the ICD interrogation report
B. Assess the patient's level of consciousness and pulse
C. Document the event in the electronic health record
D. Notify the cardiology team for device reprogramming
CORRECT ANSWER: B. Assess the patient's level of consciousness and pulse
RATIONALE: After any ICD shock, the nurse must first assess the patient's clinical
status—consciousness, airway, breathing, and pulse—to determine if the shock was
effective and if the patient is stable. If the patient is pulseless, CPR and ACLS protocols
begin immediately. Device interrogation, documentation, and provider notification are
important but secondary to immediate patient assessment and stabilization.
Question 9: Which telemetry rhythm finding in a post-myocardial infarction patient
requires the most urgent notification of the healthcare provider?
A. Sinus bradycardia at 55 beats per minute
B. New-onset left bundle branch block
, C. Occasional premature atrial contractions
D. First-degree atrioventricular block
CORRECT ANSWER: B. New-onset left bundle branch block
RATIONALE: New-onset left bundle branch block (LBBB) in the setting of acute
myocardial infarction is considered a STEMI equivalent and indicates extensive
coronary artery disease or ongoing ischemia. It requires immediate provider notification
and possible emergent reperfusion therapy. Sinus bradycardia, PACs, and first-degree
AV block are common post-MI findings and typically do not require emergent
intervention unless symptomatic.
Question 10: When educating a patient about home telemetry monitoring, which
statement by the patient indicates understanding of when to seek immediate
medical attention?
A. "I will call my doctor if I notice my heart rate is above 100."
B. "I should go to the ER if I feel dizzy and my monitor shows a fast, irregular rhythm."
C. "I can wait until my next appointment if the monitor beeps occasionally."
D. "I will remove the electrodes if my skin becomes slightly red."
CORRECT ANSWER: B. "I should go to the ER if I feel dizzy and my monitor shows a
fast, irregular rhythm."
RATIONALE: Symptoms like dizziness combined with an abnormal rhythm (e.g., fast
and irregular, suggesting AFib with RVR or VT) indicate potential hemodynamic
instability requiring emergent evaluation. A heart rate above 100 may be normal with
activity. Occasional beeps may indicate artifact but should not be ignored if persistent.
Mild skin redness can be managed with skin care; removal of electrodes without
guidance compromises monitoring.
Question 11: A patient receiving digoxin for atrial fibrillation has a telemetry
reading showing a heart rate of 48 beats per minute with regular rhythm. What is
the nurse's priority action?
A. Administer the next scheduled dose of digoxin
B. Hold the digoxin and assess for signs of toxicity
C. Increase the digoxin dose to achieve rate control
D. Document the finding and continue monitoring
CORRECT ANSWER: B. Hold the digoxin and assess for signs of toxicity
RATIONALE: Digoxin toxicity can cause bradycardia, heart block, and other
arrhythmias. A heart rate below 60 bpm in a patient on digoxin warrants holding the
dose and assessing for other toxicity signs (nausea, vomiting, visual changes,
confusion). Serum digoxin and potassium levels should be checked. Administering or
increasing digoxin could worsen toxicity. Documentation alone is insufficient without
intervention.
