RELIAS MEDICAL-SURGICAL TELEMETRY EXAM 2026/2027 – PRACTICE QUESTIONS & ANSWERS | 200+ VERIFIED Q&A WITH DETAILED RATIONALES | NCLEX-LEVEL CARDIAC & MED-SURG PREP

RELIAS MEDICAL-SURGICAL TELEMETRY EXAM
2026/2027 – PRACTICE QUESTIONS & ANSWERS |
200+ VERIFIED Q&A WITH DETAILED
RATIONALES | NCLEX-LEVEL CARDIAC & MED-
SURG PREP
• This 200-question practice bank replicates the Relias Medical-Surgical Telemetry
Exam format with NCLEX-level difficulty, featuring verified correct answers and
detailed clinical EXPERT RATIONALE for every question.

• Work through each question independently before checking the answer and
EXPERT RATIONALE — this active recall approach significantly strengthens
retention and prepares you for real exam conditions.

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SECTION 1: CARDIAC RHYTHM INTERPRETATION & TELEMETRY

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1. A patient on telemetry displays a rhythm with no visible P waves, an
irregularly irregular ventricular response, and a rate of 110 bpm. Which
dysrhythmia does the nurse identify?

A. Sinus tachycardia

B. Atrial flutter with variable block

C. Junctional tachycardia

D. Atrial fibrillation

E. Supraventricular tachycardia

Correct Answer: D. Atrial fibrillation

EXPERT RATIONALE: Atrial fibrillation is characterized by the absence of distinct
P waves replaced by a chaotic fibrillatory baseline, and an irregularly irregular
ventricular response. No two R-R intervals are equal. Sinus tachycardia has
identifiable P waves; atrial flutter shows a sawtooth pattern; SVT is typically regular.

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,2. The telemetry monitor shows a sawtooth wave pattern at an atrial rate of
300 bpm with a ventricular rate of 150 bpm and regular QRS complexes. The
nurse recognizes this rhythm as:

A. Atrial fibrillation

B. Ventricular flutter

C. Atrial flutter with 2:1 conduction

D. Sinus tachycardia

E. Accelerated junctional rhythm

Correct Answer: C. Atrial flutter with 2:1 conduction

EXPERT RATIONALE: Atrial flutter produces a characteristic sawtooth pattern at
an atrial rate of 250–350 bpm. With 2:1 conduction, every other flutter wave
conducts to the ventricles, producing a regular ventricular rate of approximately
150 bpm. The sawtooth pattern differentiates it from AFib.

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3. A patient's telemetry shows a PR interval of 0.28 seconds, regular P waves,
and normal QRS complexes. The nurse interprets this as:

A. Second-degree AV block Type I

B. Third-degree AV block

C. First-degree AV block

D. Normal sinus rhythm

E. Junctional rhythm

Correct Answer: C. First-degree AV block

EXPERT RATIONALE: First-degree AV block is defined by a PR interval greater
than 0.20 seconds (0.28 sec here) that is consistent with every beat. All P waves
conduct to the ventricles, producing normal QRS complexes. It is not a true block —
it represents delayed conduction through the AV node.

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4. A patient's ECG shows progressive lengthening of the PR interval followed
by a dropped QRS complex, then the pattern repeats. This rhythm is:

A. Third-degree AV block

B. Second-degree AV block Type II (Mobitz II)

C. Second-degree AV block Type I (Wenckebach)

D. First-degree AV block

E. Sinus arrest

Correct Answer: C. Second-degree AV block Type I (Wenckebach)

EXPERT RATIONALE: Wenckebach (Mobitz Type I) is characterized by
progressive PR interval lengthening with each beat until a QRS is dropped (non-
conducted P wave), after which the cycle restarts. It is generally considered a
benign block occurring at the AV node level.

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5. A telemetry strip shows regular P waves, a constant PR interval, but
occasional absent QRS complexes with no warning. Which rhythm does this
represent?

A. Mobitz Type I (Wenckebach)

B. Third-degree heart block

C. Sinus arrest

D. Mobitz Type II second-degree AV block

E. Junctional escape rhythm

Correct Answer: D. Mobitz Type II second-degree AV block

EXPERT RATIONALE: Mobitz Type II is characterized by a constant PR interval
with sudden unexpected dropped QRS complexes. There is no progressive PR

, lengthening before the dropped beat. This rhythm is more dangerous than Type I
and often requires pacemaker implantation due to risk of complete heart block.

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6. A patient's ECG shows P waves and QRS complexes that have no
relationship to each other. The atrial rate is 80 bpm and the ventricular rate is
38 bpm. The nurse identifies this as:

A. Second-degree AV block Type II

B. Accelerated idioventricular rhythm

C. Complete (third-degree) heart block

D. Junctional bradycardia

E. Sinus bradycardia with PVCs

Correct Answer: C. Complete (third-degree) heart block

EXPERT RATIONALE: Third-degree (complete) heart block occurs when no atrial
impulses conduct to the ventricles. The atria and ventricles beat independently —
atrial rate is faster than ventricular. The ventricular rate is maintained by an escape
pacemaker (junctional or ventricular). This requires immediate intervention, often
temporary or permanent pacing.

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7. The nurse observes wide, bizarre QRS complexes that occur early and are
not preceded by a P wave, followed by a compensatory pause. These are:

A. Junctional escape beats

B. Aberrantly conducted PACs

C. Premature ventricular contractions (PVCs)

D. Sinus pauses

E. Accelerated junctional beats