Relias Medical-Surgical Telemetry Exam
Prep 2026 | Practice Questions & Detailed
Answer Explanations | Complete Study
Guide for Nursing Success
• This 200-question practice exam mirrors the Relias Medical-Surgical Telemetry
exam format, covering all core tested domains to help you identify strengths and
target weak areas before your actual assessment.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer with bold formatting, and a detailed EXPERT RATIONALE — study by
attempting each question first, then reviewing the explanation to reinforce clinical
reasoning.
RELIAS MEDICAL-SURGICAL TELEMETRY EXAM PREP 2026 Practice Questions &
Detailed Answer Explanations Complete Study Guide for Nursing Success
1. A patient on telemetry shows a rhythm with no visible P waves, an
irregularly irregular ventricular rate of 110 bpm, and narrow QRS complexes.
Which dysrhythmia does this represent?
A. Atrial flutter
B. Ventricular tachycardia
C. Sinus tachycardia
D. Second-degree AV block Type II
E. Atrial fibrillation
Correct Answer: E. Atrial fibrillation
EXPERT RATIONALE: Atrial fibrillation is characterized by absent P waves,
irregularly irregular rhythm, and narrow QRS complexes (unless aberrant
conduction is present). The chaotic atrial activity at 350–600 impulses per minute
prevents organized atrial depolarization, resulting in the hallmark irregularly
irregular ventricular response.
,2. The nurse observes a rhythm strip showing a regular rate of 150 bpm,
sawtooth-shaped flutter waves, and a consistent 2:1 conduction ratio. What is
the most likely interpretation?
A. Atrial fibrillation
B. Junctional tachycardia
C. Atrial flutter with 2:1 block
D. Sinus tachycardia
E. Wolff-Parkinson-White syndrome
Correct Answer: C. Atrial flutter with 2:1 block
EXPERT RATIONALE: Atrial flutter typically presents with an atrial rate of 250–
350 bpm with characteristic sawtooth flutter waves. A 2:1 conduction ratio means
only every other flutter wave conducts to the ventricles, producing a ventricular
rate of approximately 150 bpm. This is a classic presentation.
3. A patient's ECG shows a prolonged PR interval (0.24 seconds) that remains
constant with all P waves followed by QRS complexes. Which rhythm is this?
A. Second-degree AV block Type I
B. Second-degree AV block Type II
C. Third-degree AV block
D. First-degree AV block
E. Junctional rhythm
Correct Answer: D. First-degree AV block
EXPERT RATIONALE: First-degree AV block is defined by a PR interval greater
than 0.20 seconds that remains constant, with every P wave followed by a QRS
complex. It reflects slowed conduction through the AV node but is not a true block,
as all impulses are conducted.
,4. Which finding on a telemetry strip is most consistent with third-degree
(complete) AV block?
A. Progressive PR interval lengthening until a QRS is dropped
B. Constant PR interval with occasional dropped QRS
C. P waves and QRS complexes with no relationship to each other
D. Absent P waves with narrow QRS
E. Delta waves before each QRS
Correct Answer: C. P waves and QRS complexes with no relationship to
each other
EXPERT RATIONALE: In third-degree (complete) AV block, no atrial impulses
conduct to the ventricles. The atria and ventricles beat independently — AV
dissociation — resulting in P waves and QRS complexes with completely
independent rates and no consistent relationship.
5. A nurse sees wide, bizarre QRS complexes occurring every other beat on the
monitor, with the patient's own narrow QRS between each. What term
describes this pattern?
A. Ventricular bigeminy
B. Ventricular trigeminy
C. Premature ventricular contractions in bigeminy
D. Ventricular tachycardia
E. Ventricular flutter
Correct Answer: C. Premature ventricular contractions in bigeminy
EXPERT RATIONALE: PVC bigeminy is defined as a PVC occurring after every
normal sinus beat — the pattern is normal beat, PVC, normal beat, PVC. Wide,
, bizarre QRS complexes alternating with narrow normal complexes is the hallmark
of this rhythm pattern.
6. The nurse notes a rhythm strip with no P waves, a ventricular rate of 40
bpm, and narrow QRS complexes. Which rhythm is most likely?
A. Sinus bradycardia
B. Idioventricular rhythm
C. Junctional rhythm
D. Third-degree AV block
E. Atrial fibrillation with slow ventricular response
Correct Answer: C. Junctional rhythm
EXPERT RATIONALE: A junctional rhythm originates in the AV node, produces a
rate of 40–60 bpm, and has narrow QRS complexes (since ventricular conduction is
normal). P waves are absent, inverted, or retrograde. The AV node assumes
pacemaker function when the SA node fails.
7. A patient develops monomorphic ventricular tachycardia at 160 bpm and is
hemodynamically stable. What is the priority nursing intervention?
A. Initiate CPR immediately
B. Prepare for transcutaneous pacing
C. Notify the physician and prepare for pharmacological cardioversion with
amiodarone
D. Administer atropine IV push
E. Perform synchronized cardioversion immediately without physician order
Correct Answer: C. Notify the physician and prepare for pharmacological
cardioversion with amiodarone
Prep 2026 | Practice Questions & Detailed
Answer Explanations | Complete Study
Guide for Nursing Success
• This 200-question practice exam mirrors the Relias Medical-Surgical Telemetry
exam format, covering all core tested domains to help you identify strengths and
target weak areas before your actual assessment.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer with bold formatting, and a detailed EXPERT RATIONALE — study by
attempting each question first, then reviewing the explanation to reinforce clinical
reasoning.
RELIAS MEDICAL-SURGICAL TELEMETRY EXAM PREP 2026 Practice Questions &
Detailed Answer Explanations Complete Study Guide for Nursing Success
1. A patient on telemetry shows a rhythm with no visible P waves, an
irregularly irregular ventricular rate of 110 bpm, and narrow QRS complexes.
Which dysrhythmia does this represent?
A. Atrial flutter
B. Ventricular tachycardia
C. Sinus tachycardia
D. Second-degree AV block Type II
E. Atrial fibrillation
Correct Answer: E. Atrial fibrillation
EXPERT RATIONALE: Atrial fibrillation is characterized by absent P waves,
irregularly irregular rhythm, and narrow QRS complexes (unless aberrant
conduction is present). The chaotic atrial activity at 350–600 impulses per minute
prevents organized atrial depolarization, resulting in the hallmark irregularly
irregular ventricular response.
,2. The nurse observes a rhythm strip showing a regular rate of 150 bpm,
sawtooth-shaped flutter waves, and a consistent 2:1 conduction ratio. What is
the most likely interpretation?
A. Atrial fibrillation
B. Junctional tachycardia
C. Atrial flutter with 2:1 block
D. Sinus tachycardia
E. Wolff-Parkinson-White syndrome
Correct Answer: C. Atrial flutter with 2:1 block
EXPERT RATIONALE: Atrial flutter typically presents with an atrial rate of 250–
350 bpm with characteristic sawtooth flutter waves. A 2:1 conduction ratio means
only every other flutter wave conducts to the ventricles, producing a ventricular
rate of approximately 150 bpm. This is a classic presentation.
3. A patient's ECG shows a prolonged PR interval (0.24 seconds) that remains
constant with all P waves followed by QRS complexes. Which rhythm is this?
A. Second-degree AV block Type I
B. Second-degree AV block Type II
C. Third-degree AV block
D. First-degree AV block
E. Junctional rhythm
Correct Answer: D. First-degree AV block
EXPERT RATIONALE: First-degree AV block is defined by a PR interval greater
than 0.20 seconds that remains constant, with every P wave followed by a QRS
complex. It reflects slowed conduction through the AV node but is not a true block,
as all impulses are conducted.
,4. Which finding on a telemetry strip is most consistent with third-degree
(complete) AV block?
A. Progressive PR interval lengthening until a QRS is dropped
B. Constant PR interval with occasional dropped QRS
C. P waves and QRS complexes with no relationship to each other
D. Absent P waves with narrow QRS
E. Delta waves before each QRS
Correct Answer: C. P waves and QRS complexes with no relationship to
each other
EXPERT RATIONALE: In third-degree (complete) AV block, no atrial impulses
conduct to the ventricles. The atria and ventricles beat independently — AV
dissociation — resulting in P waves and QRS complexes with completely
independent rates and no consistent relationship.
5. A nurse sees wide, bizarre QRS complexes occurring every other beat on the
monitor, with the patient's own narrow QRS between each. What term
describes this pattern?
A. Ventricular bigeminy
B. Ventricular trigeminy
C. Premature ventricular contractions in bigeminy
D. Ventricular tachycardia
E. Ventricular flutter
Correct Answer: C. Premature ventricular contractions in bigeminy
EXPERT RATIONALE: PVC bigeminy is defined as a PVC occurring after every
normal sinus beat — the pattern is normal beat, PVC, normal beat, PVC. Wide,
, bizarre QRS complexes alternating with narrow normal complexes is the hallmark
of this rhythm pattern.
6. The nurse notes a rhythm strip with no P waves, a ventricular rate of 40
bpm, and narrow QRS complexes. Which rhythm is most likely?
A. Sinus bradycardia
B. Idioventricular rhythm
C. Junctional rhythm
D. Third-degree AV block
E. Atrial fibrillation with slow ventricular response
Correct Answer: C. Junctional rhythm
EXPERT RATIONALE: A junctional rhythm originates in the AV node, produces a
rate of 40–60 bpm, and has narrow QRS complexes (since ventricular conduction is
normal). P waves are absent, inverted, or retrograde. The AV node assumes
pacemaker function when the SA node fails.
7. A patient develops monomorphic ventricular tachycardia at 160 bpm and is
hemodynamically stable. What is the priority nursing intervention?
A. Initiate CPR immediately
B. Prepare for transcutaneous pacing
C. Notify the physician and prepare for pharmacological cardioversion with
amiodarone
D. Administer atropine IV push
E. Perform synchronized cardioversion immediately without physician order
Correct Answer: C. Notify the physician and prepare for pharmacological
cardioversion with amiodarone
