Academic Year 2026–2027 RELIAS Medical-Surgical Telemetry Updated
2026 | 190+ Exam Questions and Answers | Comprehensive Study Guide,
Practice Exam, Medical-Surgical Telemetry Assessment Test Bank,
Cardiac Monitoring Review, ECG Interpretation, Dysrhythmias,
Hemodynamic Monitoring, Cardiac Care, Respiratory Disorders, Patient
Assessment, Clinical Decision-Making, Detailed Rationales and Exam Prep
Revision Material
Question 1: A patient with a history of heart failure is admitted with pulmonary
edema. The telemetry monitor shows a heart rate of 110 bpm and frequent
premature ventricular contractions (PVCs). Which medication should the nurse
anticipate administering to reduce preload and relieve pulmonary congestion?
A. Digoxin
B. Dobutamine
C. Furosemide
D. Amiodarone
CORRECT ANSWER: C. Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by promoting venous
vasodilation and diuresis, which decreases pulmonary congestion in heart failure.
Digoxin increases contractility but does not acutely reduce preload. Dobutamine is an
inotrope that increases cardiac output but can increase heart rate and arrhythmias.
Amiodarone is an antiarrhythmic used for rhythm control, not first-line for preload
reduction.
Question 2: A patient on a telemetry unit is experiencing chest pain. The ECG
shows ST-segment depression in leads V1-V4. Which condition is most strongly
suggested by this finding?
A. Pericarditis
B. Anterior wall ischemia
C. Inferior wall infarction
D. Pulmonary embolism
CORRECT ANSWER: B. Anterior wall ischemia
Rationale: ST-segment depression in the anterior precordial leads (V1-V4) is indicative
of subendocardial ischemia, often related to left anterior descending artery
compromise. Pericarditis typically presents with diffuse ST-segment elevation. Inferior
wall infarction is seen in leads II, III, and aVF. Pulmonary embolism often shows sinus
tachycardia and right heart strain patterns.
Question 3: A post-operative patient's telemetry shows a narrow-complex
tachycardia at a rate of 180 bpm. The patient is hypotensive and complains of
palpitations. After ensuring the patient is unstable, what is the initial intervention
of choice?
,A. IV adenosine
B. Synchronized cardioversion
C. IV amiodarone
D. Vagal maneuvers
CORRECT ANSWER: B. Synchronized cardioversion
Rationale: For unstable tachycardia with a narrow complex, synchronized
cardioversion is the immediate treatment of choice to restore hemodynamic stability.
Adenosine and vagal maneuvers are used for stable patients. Amiodarone is a second-
line agent for stable or refractory cases.
Question 4: The nurse is caring for a patient with a suspected acute myocardial
infarction. Which cardiac biomarker is most specific and has the highest sensitivity
for diagnosing a recent MI?
A. Creatine kinase (CK)
B. Myoglobin
C. Troponin I
D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I
Rationale: Troponin I is highly specific to cardiac muscle and is the gold-standard
biomarker for diagnosing acute MI due to its high sensitivity and specificity. CK and LDH
are less specific as they are found in skeletal muscle. Myoglobin is early but non-
specific.
Question 5: The telemetry technician notifies the nurse of a patient's rhythm, which
shows a chaotic, irregular pattern with no discernible P waves and an irregularly
irregular ventricular response. What is the most appropriate action?
A. Prepare for synchronized cardioversion
B. Administer amiodarone per protocol
C. Assess the patient's pulse and blood pressure
D. Prepare for immediate defibrillation
CORRECT ANSWER: C. Assess the patient's pulse and blood pressure
Rationale: The rhythm described is atrial fibrillation. The priority is always to assess the
patient's clinical status (ABCs) before intervening. Defibrillation is for pulseless
ventricular rhythms. Synchronized cardioversion is for unstable atrial fibrillation, but
assessment is the first step. Amiodarone is for rhythm control but not the immediate
priority.
Question 6: A patient's telemetry monitor shows a regular rhythm with a rate of 40
bpm, absent P waves, and wide QRS complexes. The patient is lethargic and
hypotensive. Which medication should the nurse prepare to administer?
,A. Epinephrine
B. Atropine
C. Adenosine
D. Amiodarone
CORRECT ANSWER: B. Atropine
Rationale: This rhythm is characteristic of symptomatic bradycardia (likely a junctional
or ventricular escape rhythm). Atropine is the first-line medication for symptomatic
bradycardia by increasing the heart rate via vagolytic action. Epinephrine is a second-
line agent for bradycardia. Adenosine is for tachyarrhythmias. Amiodarone is for
ventricular arrhythmias.
Question 7: Which of the following telemetry findings is most concerning for the
development of torsades de pointes?
A. A prolonged QT interval
B. A shortened PR interval
C. A widened QRS complex
D. ST-segment elevation
CORRECT ANSWER: A. A prolonged QT interval
Rationale: Torsades de pointes is a specific form of polymorphic ventricular
tachycardia that occurs in the setting of a prolonged QT interval. This can be congenital
or acquired (e.g., from medications). A widened QRS suggests a bundle branch block,
and PR interval abnormalities relate to AV conduction.
Question 8: The nurse is caring for a patient 6 hours post-thrombolytic therapy for
an ST-segment elevation MI (STEMI). The patient's telemetry shows a new onset of
ventricular tachycardia. What is the nurse's priority assessment?
A. Check the patient's neurological status
B. Assess the patient's chest pain and hemodynamic status
C. Review the patient's laboratory values for anemia
D. Evaluate the patient's urine output
CORRECT ANSWER: B. Assess the patient's chest pain and hemodynamic status
Rationale: New-onset ventricular tachycardia post-thrombolytic therapy could indicate
reperfusion arrhythmias or re-occlusion. The priority is to assess the patient's chest
pain and hemodynamic stability to determine if the rhythm is stable or unstable and to
guide further intervention.
Question 9: A patient with a permanent pacemaker is on telemetry. The monitor
shows a pacing spike followed by a QRS complex, but the spike does not
consistently appear on the screen. What should the nurse do first?
A. Call the electrophysiologist immediately
B. Prepare for external pacing
, C. Check the patient's pulse and blood pressure
D. Change the telemetry battery
CORRECT ANSWER: C. Check the patient's pulse and blood pressure
Rationale: The first action is to assess the patient. Inconsistent pacing spikes on the
monitor could be a technical issue with telemetry or a true failure to capture. Assessing
the patient's hemodynamic status (pulse and BP) determines the urgency of the
situation.
Question 10: Which ECG finding is considered pathognomonic for pericarditis?
A. ST-segment depression in lead V2
B. ST-segment elevation with a concave upward appearance
C. Pathological Q waves in leads II, III, and aVF
D. Tall, peaked T waves
CORRECT ANSWER: B. ST-segment elevation with a concave upward appearance
Rationale: Diffuse ST-segment elevation with a concave (scooped) upward appearance
is characteristic of acute pericarditis. Pathological Q waves are indicative of MI. Tall,
peaked T waves are seen in hyperkalemia.
Question 11: The nurse is assessing a patient's telemetry strip. The P waves are
upright and uniform, the PR interval is 0.20 seconds, and the QRS complex is 0.08
seconds. The heart rate is 88 bpm. What is the correct interpretation?
A. Atrial fibrillation
B. Normal sinus rhythm
C. First-degree AV block
D. Sinus tachycardia
CORRECT ANSWER: B. Normal sinus rhythm
Rationale: Normal sinus rhythm is characterized by upright, uniform P waves preceding
each QRS, a PR interval of 0.12-0.20 seconds, a QRS duration of <0.12 seconds, and a
rate of 60-100 bpm. This strip meets all criteria.
Question 12: A patient is receiving a continuous infusion of amiodarone. The nurse
should monitor for which of the following adverse effects?
A. Hypokalemia
B. Pulmonary toxicity
C. Hyperglycemia
D. Bradycardia
CORRECT ANSWER: D. Bradycardia
Rationale: Amiodarone is a potent antiarrhythmic that can cause bradycardia, AV
block, and hypotension. While pulmonary toxicity is a serious long-term side effect, it is
2026 | 190+ Exam Questions and Answers | Comprehensive Study Guide,
Practice Exam, Medical-Surgical Telemetry Assessment Test Bank,
Cardiac Monitoring Review, ECG Interpretation, Dysrhythmias,
Hemodynamic Monitoring, Cardiac Care, Respiratory Disorders, Patient
Assessment, Clinical Decision-Making, Detailed Rationales and Exam Prep
Revision Material
Question 1: A patient with a history of heart failure is admitted with pulmonary
edema. The telemetry monitor shows a heart rate of 110 bpm and frequent
premature ventricular contractions (PVCs). Which medication should the nurse
anticipate administering to reduce preload and relieve pulmonary congestion?
A. Digoxin
B. Dobutamine
C. Furosemide
D. Amiodarone
CORRECT ANSWER: C. Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by promoting venous
vasodilation and diuresis, which decreases pulmonary congestion in heart failure.
Digoxin increases contractility but does not acutely reduce preload. Dobutamine is an
inotrope that increases cardiac output but can increase heart rate and arrhythmias.
Amiodarone is an antiarrhythmic used for rhythm control, not first-line for preload
reduction.
Question 2: A patient on a telemetry unit is experiencing chest pain. The ECG
shows ST-segment depression in leads V1-V4. Which condition is most strongly
suggested by this finding?
A. Pericarditis
B. Anterior wall ischemia
C. Inferior wall infarction
D. Pulmonary embolism
CORRECT ANSWER: B. Anterior wall ischemia
Rationale: ST-segment depression in the anterior precordial leads (V1-V4) is indicative
of subendocardial ischemia, often related to left anterior descending artery
compromise. Pericarditis typically presents with diffuse ST-segment elevation. Inferior
wall infarction is seen in leads II, III, and aVF. Pulmonary embolism often shows sinus
tachycardia and right heart strain patterns.
Question 3: A post-operative patient's telemetry shows a narrow-complex
tachycardia at a rate of 180 bpm. The patient is hypotensive and complains of
palpitations. After ensuring the patient is unstable, what is the initial intervention
of choice?
,A. IV adenosine
B. Synchronized cardioversion
C. IV amiodarone
D. Vagal maneuvers
CORRECT ANSWER: B. Synchronized cardioversion
Rationale: For unstable tachycardia with a narrow complex, synchronized
cardioversion is the immediate treatment of choice to restore hemodynamic stability.
Adenosine and vagal maneuvers are used for stable patients. Amiodarone is a second-
line agent for stable or refractory cases.
Question 4: The nurse is caring for a patient with a suspected acute myocardial
infarction. Which cardiac biomarker is most specific and has the highest sensitivity
for diagnosing a recent MI?
A. Creatine kinase (CK)
B. Myoglobin
C. Troponin I
D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Troponin I
Rationale: Troponin I is highly specific to cardiac muscle and is the gold-standard
biomarker for diagnosing acute MI due to its high sensitivity and specificity. CK and LDH
are less specific as they are found in skeletal muscle. Myoglobin is early but non-
specific.
Question 5: The telemetry technician notifies the nurse of a patient's rhythm, which
shows a chaotic, irregular pattern with no discernible P waves and an irregularly
irregular ventricular response. What is the most appropriate action?
A. Prepare for synchronized cardioversion
B. Administer amiodarone per protocol
C. Assess the patient's pulse and blood pressure
D. Prepare for immediate defibrillation
CORRECT ANSWER: C. Assess the patient's pulse and blood pressure
Rationale: The rhythm described is atrial fibrillation. The priority is always to assess the
patient's clinical status (ABCs) before intervening. Defibrillation is for pulseless
ventricular rhythms. Synchronized cardioversion is for unstable atrial fibrillation, but
assessment is the first step. Amiodarone is for rhythm control but not the immediate
priority.
Question 6: A patient's telemetry monitor shows a regular rhythm with a rate of 40
bpm, absent P waves, and wide QRS complexes. The patient is lethargic and
hypotensive. Which medication should the nurse prepare to administer?
,A. Epinephrine
B. Atropine
C. Adenosine
D. Amiodarone
CORRECT ANSWER: B. Atropine
Rationale: This rhythm is characteristic of symptomatic bradycardia (likely a junctional
or ventricular escape rhythm). Atropine is the first-line medication for symptomatic
bradycardia by increasing the heart rate via vagolytic action. Epinephrine is a second-
line agent for bradycardia. Adenosine is for tachyarrhythmias. Amiodarone is for
ventricular arrhythmias.
Question 7: Which of the following telemetry findings is most concerning for the
development of torsades de pointes?
A. A prolonged QT interval
B. A shortened PR interval
C. A widened QRS complex
D. ST-segment elevation
CORRECT ANSWER: A. A prolonged QT interval
Rationale: Torsades de pointes is a specific form of polymorphic ventricular
tachycardia that occurs in the setting of a prolonged QT interval. This can be congenital
or acquired (e.g., from medications). A widened QRS suggests a bundle branch block,
and PR interval abnormalities relate to AV conduction.
Question 8: The nurse is caring for a patient 6 hours post-thrombolytic therapy for
an ST-segment elevation MI (STEMI). The patient's telemetry shows a new onset of
ventricular tachycardia. What is the nurse's priority assessment?
A. Check the patient's neurological status
B. Assess the patient's chest pain and hemodynamic status
C. Review the patient's laboratory values for anemia
D. Evaluate the patient's urine output
CORRECT ANSWER: B. Assess the patient's chest pain and hemodynamic status
Rationale: New-onset ventricular tachycardia post-thrombolytic therapy could indicate
reperfusion arrhythmias or re-occlusion. The priority is to assess the patient's chest
pain and hemodynamic stability to determine if the rhythm is stable or unstable and to
guide further intervention.
Question 9: A patient with a permanent pacemaker is on telemetry. The monitor
shows a pacing spike followed by a QRS complex, but the spike does not
consistently appear on the screen. What should the nurse do first?
A. Call the electrophysiologist immediately
B. Prepare for external pacing
, C. Check the patient's pulse and blood pressure
D. Change the telemetry battery
CORRECT ANSWER: C. Check the patient's pulse and blood pressure
Rationale: The first action is to assess the patient. Inconsistent pacing spikes on the
monitor could be a technical issue with telemetry or a true failure to capture. Assessing
the patient's hemodynamic status (pulse and BP) determines the urgency of the
situation.
Question 10: Which ECG finding is considered pathognomonic for pericarditis?
A. ST-segment depression in lead V2
B. ST-segment elevation with a concave upward appearance
C. Pathological Q waves in leads II, III, and aVF
D. Tall, peaked T waves
CORRECT ANSWER: B. ST-segment elevation with a concave upward appearance
Rationale: Diffuse ST-segment elevation with a concave (scooped) upward appearance
is characteristic of acute pericarditis. Pathological Q waves are indicative of MI. Tall,
peaked T waves are seen in hyperkalemia.
Question 11: The nurse is assessing a patient's telemetry strip. The P waves are
upright and uniform, the PR interval is 0.20 seconds, and the QRS complex is 0.08
seconds. The heart rate is 88 bpm. What is the correct interpretation?
A. Atrial fibrillation
B. Normal sinus rhythm
C. First-degree AV block
D. Sinus tachycardia
CORRECT ANSWER: B. Normal sinus rhythm
Rationale: Normal sinus rhythm is characterized by upright, uniform P waves preceding
each QRS, a PR interval of 0.12-0.20 seconds, a QRS duration of <0.12 seconds, and a
rate of 60-100 bpm. This strip meets all criteria.
Question 12: A patient is receiving a continuous infusion of amiodarone. The nurse
should monitor for which of the following adverse effects?
A. Hypokalemia
B. Pulmonary toxicity
C. Hyperglycemia
D. Bradycardia
CORRECT ANSWER: D. Bradycardia
Rationale: Amiodarone is a potent antiarrhythmic that can cause bradycardia, AV
block, and hypotension. While pulmonary toxicity is a serious long-term side effect, it is
