PROPHECY MEDICAL SURGICAL TELEMETRY EXAM
2026/2027 | Answered & Graded A+ | Updated Test | Pass
Guaranteed - A+ Graded
Cardiac Telemetry Monitoring & Rhythm Interpretation
Q1: When monitoring a patient for myocardial ischemia on telemetry, which two leads
are most commonly used together to detect ST-segment changes indicative of ischemia
or infarction?
A. Lead I and Lead II
B. Lead II and Lead III
C. Lead V1 and Lead V5 [CORRECT]
D. Lead aVR and Lead aVL
Correct Answer: C
Rationale: The best answer is C. Lead V1 is excellent for detecting right ventricular and
septal ischemia, while Lead V5 is highly sensitive for lateral wall ischemia; using both
together provides comprehensive anterior-lateral monitoring. The other lead
combinations are not the standard pairing for ischemia surveillance on a typical
telemetry unit.
Q2: A patient's telemetry strip shows a regular rhythm at a rate of 52 beats per minute
with a normal P wave before each QRS complex and a PR interval of 0.18 seconds. The
patient is alert but reports mild dizziness. Which intervention is most appropriate?
A. Prepare for immediate transcutaneous pacing
B. Administer atropine 0.5 mg IV push if symptomatic [CORRECT]
C. Perform synchronized cardioversion
D. Administer adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: The best answer is B. This is sinus bradycardia with symptoms of dizziness;
atropine is the first-line pharmacologic intervention for symptomatic bradycardia per
,ACLS guidelines. Transcutaneous pacing is reserved for unstable bradycardia
unresponsive to atropine, synchronized cardioversion is for tachyarrhythmias with a
pulse, and adenosine is used for supraventricular tachycardia.
Q3: A patient on telemetry suddenly develops an irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 110. The patient is alert, blood pressure is
128/76, and denies chest pain. What is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Assess the patient's anticoagulation status and stroke risk [CORRECT]
C. Administer adenosine 12 mg rapid IV push
D. Perform defibrillation immediately
Correct Answer: B
Rationale: The best answer is B. This rhythm is atrial fibrillation with rapid ventricular
response; because the patient is hemodynamically stable, the priority is to assess
anticoagulation status and stroke risk rather than performing emergency cardioversion.
Adenosine will not convert atrial fibrillation, and defibrillation is reserved for pulseless
rhythms.
Q4: The telemetry monitor shows a characteristic "sawtooth" baseline pattern with
flutter waves at approximately 300 per minute and a ventricular response of 150. The
patient is asymptomatic. Which rhythm is most likely present?
A. Atrial fibrillation
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: The best answer is B. The sawtooth flutter waves and regular atrial rate
around 300 bpm with a ventricular response that is a fraction of the atrial rate are
classic for atrial flutter. Atrial fibrillation is irregularly irregular without organized atrial
activity, ventricular tachycardia has wide QRS complexes, and sinus tachycardia has
normal P waves.
, Q5: A stable patient on telemetry suddenly converts to a narrow-complex tachycardia at
a rate of 180 with a regular rhythm. The blood pressure is 110/70 and the patient is
alert. What is the first-line intervention?
A. Immediate synchronized cardioversion
B. Vagal maneuvers followed by adenosine if unsuccessful [CORRECT]
C. Defibrillation at 200 joules
D. Amiodarone 300 mg IV push
Correct Answer: B
Rationale: The best answer is B. For stable supraventricular tachycardia, vagal
maneuvers such as the Valsalva maneuver are attempted first, followed by adenosine if
the rhythm persists. Synchronized cardioversion is for unstable patients, defibrillation is
for pulseless rhythms, and amiodarone is not first-line for stable SVT.
Q6: A patient's telemetry strip shows a normal sinus rhythm with every other beat being
a premature ventricular complex. The patient is asymptomatic and vital signs are
stable. Which nursing action is most appropriate?
A. Prepare the crash cart for immediate defibrillation
B. Administer lidocaine 1 mg/kg IV push
C. Check serum potassium and magnesium levels [CORRECT]
D. Perform synchronized cardioversion
Correct Answer: C
Rationale: The best answer is C. PVCs in a pattern of bigeminy often indicate electrolyte
disturbances, particularly hypokalemia or hypomagnesemia; checking and repleting
these is the appropriate first step in a stable patient. Defibrillation, lidocaine, and
cardioversion are not indicated for asymptomatic PVCs.
Q7: A telemetry strip shows three consecutive PVCs occurring at a rate of 160, then the
rhythm spontaneously converts back to normal sinus rhythm. The patient is awake and
talking. How should the nurse document and manage this finding?
A. Pulseless ventricular tachycardia requiring defibrillation
B. Non-sustained ventricular tachycardia; assess patient, check electrolytes, and notify
the provider [CORRECT]
C. Sustained monomorphic ventricular tachycardia requiring cardioversion
D. Normal variant requiring no documentation
Correct Answer: B
2026/2027 | Answered & Graded A+ | Updated Test | Pass
Guaranteed - A+ Graded
Cardiac Telemetry Monitoring & Rhythm Interpretation
Q1: When monitoring a patient for myocardial ischemia on telemetry, which two leads
are most commonly used together to detect ST-segment changes indicative of ischemia
or infarction?
A. Lead I and Lead II
B. Lead II and Lead III
C. Lead V1 and Lead V5 [CORRECT]
D. Lead aVR and Lead aVL
Correct Answer: C
Rationale: The best answer is C. Lead V1 is excellent for detecting right ventricular and
septal ischemia, while Lead V5 is highly sensitive for lateral wall ischemia; using both
together provides comprehensive anterior-lateral monitoring. The other lead
combinations are not the standard pairing for ischemia surveillance on a typical
telemetry unit.
Q2: A patient's telemetry strip shows a regular rhythm at a rate of 52 beats per minute
with a normal P wave before each QRS complex and a PR interval of 0.18 seconds. The
patient is alert but reports mild dizziness. Which intervention is most appropriate?
A. Prepare for immediate transcutaneous pacing
B. Administer atropine 0.5 mg IV push if symptomatic [CORRECT]
C. Perform synchronized cardioversion
D. Administer adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: The best answer is B. This is sinus bradycardia with symptoms of dizziness;
atropine is the first-line pharmacologic intervention for symptomatic bradycardia per
,ACLS guidelines. Transcutaneous pacing is reserved for unstable bradycardia
unresponsive to atropine, synchronized cardioversion is for tachyarrhythmias with a
pulse, and adenosine is used for supraventricular tachycardia.
Q3: A patient on telemetry suddenly develops an irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 110. The patient is alert, blood pressure is
128/76, and denies chest pain. What is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Assess the patient's anticoagulation status and stroke risk [CORRECT]
C. Administer adenosine 12 mg rapid IV push
D. Perform defibrillation immediately
Correct Answer: B
Rationale: The best answer is B. This rhythm is atrial fibrillation with rapid ventricular
response; because the patient is hemodynamically stable, the priority is to assess
anticoagulation status and stroke risk rather than performing emergency cardioversion.
Adenosine will not convert atrial fibrillation, and defibrillation is reserved for pulseless
rhythms.
Q4: The telemetry monitor shows a characteristic "sawtooth" baseline pattern with
flutter waves at approximately 300 per minute and a ventricular response of 150. The
patient is asymptomatic. Which rhythm is most likely present?
A. Atrial fibrillation
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: The best answer is B. The sawtooth flutter waves and regular atrial rate
around 300 bpm with a ventricular response that is a fraction of the atrial rate are
classic for atrial flutter. Atrial fibrillation is irregularly irregular without organized atrial
activity, ventricular tachycardia has wide QRS complexes, and sinus tachycardia has
normal P waves.
, Q5: A stable patient on telemetry suddenly converts to a narrow-complex tachycardia at
a rate of 180 with a regular rhythm. The blood pressure is 110/70 and the patient is
alert. What is the first-line intervention?
A. Immediate synchronized cardioversion
B. Vagal maneuvers followed by adenosine if unsuccessful [CORRECT]
C. Defibrillation at 200 joules
D. Amiodarone 300 mg IV push
Correct Answer: B
Rationale: The best answer is B. For stable supraventricular tachycardia, vagal
maneuvers such as the Valsalva maneuver are attempted first, followed by adenosine if
the rhythm persists. Synchronized cardioversion is for unstable patients, defibrillation is
for pulseless rhythms, and amiodarone is not first-line for stable SVT.
Q6: A patient's telemetry strip shows a normal sinus rhythm with every other beat being
a premature ventricular complex. The patient is asymptomatic and vital signs are
stable. Which nursing action is most appropriate?
A. Prepare the crash cart for immediate defibrillation
B. Administer lidocaine 1 mg/kg IV push
C. Check serum potassium and magnesium levels [CORRECT]
D. Perform synchronized cardioversion
Correct Answer: C
Rationale: The best answer is C. PVCs in a pattern of bigeminy often indicate electrolyte
disturbances, particularly hypokalemia or hypomagnesemia; checking and repleting
these is the appropriate first step in a stable patient. Defibrillation, lidocaine, and
cardioversion are not indicated for asymptomatic PVCs.
Q7: A telemetry strip shows three consecutive PVCs occurring at a rate of 160, then the
rhythm spontaneously converts back to normal sinus rhythm. The patient is awake and
talking. How should the nurse document and manage this finding?
A. Pulseless ventricular tachycardia requiring defibrillation
B. Non-sustained ventricular tachycardia; assess patient, check electrolytes, and notify
the provider [CORRECT]
C. Sustained monomorphic ventricular tachycardia requiring cardioversion
D. Normal variant requiring no documentation
Correct Answer: B
