RELIAS Medical-Surgical Telemetry Exam Practice Test Updated 2026 | Complete Study Guide
with Verified Questions and Detailed Rationales | Cardiac Monitoring, ECG Interpretation,
Dysrhythmia Recognition, Telemetry Strips Analysis, Patient Assessment, Cardiovascular
Disorders, Medication Management, Critical Care Concepts, and Nursing Interventions for
RELIAS Telemetry Exam Success
Question 1: A telemetry nurse observes a rhythm strip showing regular P waves at
70 bpm, regular QRS complexes at 35 bpm, and no relationship between P waves
and QRS complexes. Which dysrhythmia is the nurse interpreting?
A. First-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. Second-degree atrioventricular block type II
D. Third-degree atrioventricular block
CORRECT ANSWER: D. Third-degree atrioventricular block
RATIONALE: Third-degree (complete) heart block is characterized by complete
dissociation between atrial and ventricular activity, with P waves and QRS complexes
occurring independently at different rates. The atrial rate is typically faster than the
ventricular escape rate, and there is no consistent PR interval. This differs from first-
degree block (prolonged but consistent PR interval) and second-degree blocks
(intermittent non-conducted P waves with specific patterns).
produsasmtsa01.blob.core.windows.net
Question 2: Which ECG finding is most indicative of acute myocardial ischemia in a
patient being monitored on telemetry?
A. Peaked T waves
B. ST-segment elevation of 2 mm in two contiguous leads
C. Prolonged QT interval of 480 ms
D. Inverted P waves in lead II
CORRECT ANSWER: B. ST-segment elevation of 2 mm in two contiguous leads
RATIONALE: ST-segment elevation of ≥1 mm (≥2 mm in precordial leads) in two or more
contiguous leads is a hallmark ECG finding of acute myocardial injury or infarction,
requiring immediate intervention. Peaked T waves may indicate hyperkalemia,
prolonged QT interval increases risk for torsades de pointes, and inverted P waves in
lead II suggest ectopic atrial rhythm, none of which are primary indicators of acute
ischemia.
www.ahajournals.org
Question 3: A patient on telemetry develops sudden-onset palpitations. The
rhythm strip shows an irregularly irregular rhythm with no discernible P waves and
a ventricular rate of 140 bpm. What is the priority nursing intervention?
A. Administer adenosine 6 mg IV push
B. Prepare for synchronized cardioversion
,C. Assess the patient's hemodynamic stability
D. Increase the telemetry alarm sensitivity
CORRECT ANSWER: C. Assess the patient's hemodynamic stability
RATIONALE: The rhythm described is atrial fibrillation with rapid ventricular response.
The priority nursing action is always to assess hemodynamic stability (blood pressure,
level of consciousness, chest pain, dyspnea) before initiating treatment. Unstable
patients require immediate synchronized cardioversion, while stable patients may
receive rate-control medications. Adenosine is used for stable SVT, not atrial fibrillation.
www.rch.org.au
Question 4: Which electrolyte imbalance is most commonly associated with the
development of torsades de pointes on telemetry monitoring?
A. Hyperkalemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hypernatremia
CORRECT ANSWER: C. Hypomagnesemia
RATIONALE: Hypomagnesemia prolongs the QT interval and significantly increases the
risk for torsades de pointes, a polymorphic ventricular tachycardia. While hypokalemia
and hypocalcemia can also prolong QT, magnesium deficiency is most directly linked to
this life-threatening arrhythmia. Treatment includes IV magnesium sulfate and
correction of concurrent electrolyte abnormalities.
美国卫生与公共服务部NIH
Question 5: When applying telemetry electrodes to a female patient, which action
by the nurse best ensures accurate rhythm interpretation and minimizes artifact?
A. Place electrodes directly over breast tissue for better adhesion
B. Shave excessive chest hair and clean skin with alcohol before application
C. Position the V1 electrode in the fifth intercostal space at the midclavicular line
D. Use hypoallergenic tape to secure leads after placement
CORRECT ANSWER: B. Shave excessive chest hair and clean skin with alcohol
before application
RATIONALE: Proper skin preparation, including removing hair and cleansing with
alcohol to reduce oils and debris, is critical for optimal electrode adhesion and signal
conduction, minimizing artifact that can lead to misinterpretation. Electrodes should be
placed on bony prominences when possible, not over breast tissue. V1 is placed in the
fourth intercostal space at the right sternal border.
bhrs.com
,Question 6: A telemetry patient with a history of heart failure is prescribed
metoprolol succinate. Which assessment finding should the nurse report before
administering the medication?
A. Apical heart rate of 58 bpm
B. Blood pressure of 138/86 mm Hg
C. Respiratory rate of 20 breaths/min
D. Oxygen saturation of 96% on room air
CORRECT ANSWER: A. Apical heart rate of 58 bpm
RATIONALE: Beta-blockers like metoprolol decrease heart rate and contractility. An
apical heart rate below 60 bpm is generally a holding parameter for beta-blocker
administration in most protocols, as further bradycardia could compromise cardiac
output, especially in heart failure patients. Blood pressure, respiratory rate, and oxygen
saturation are within acceptable ranges.
produsasmtsa01.blob.core.windows.net
Question 7: Which statement by a patient newly diagnosed with paroxysmal atrial
fibrillation indicates understanding of discharge teaching regarding
anticoagulation therapy?
A. "I will stop taking my warfarin if I notice any bruising."
B. "I need to have my INR checked regularly to ensure my dose is correct."
C. "I can take ibuprofen for headaches since it doesn't affect my heart medication."
D. "I should avoid all green leafy vegetables to prevent clotting."
CORRECT ANSWER: B. "I need to have my INR checked regularly to ensure my dose
is correct."
RATIONALE: Patients on warfarin require regular INR monitoring to maintain therapeutic
anticoagulation (typically INR 2-3 for atrial fibrillation) and reduce stroke risk while
minimizing bleeding complications. Patients should not abruptly stop anticoagulants,
should avoid NSAIDs like ibuprofen due to increased bleeding risk, and should maintain
consistent (not eliminated) vitamin K intake rather than avoiding green vegetables
entirely.
produsasmtsa01.blob.core.windows.net
Question 8: A telemetry alarm sounds indicating asystole. What is the nurse's first
action?
A. Begin chest compressions immediately
B. Call a code blue and retrieve the crash cart
C. Assess the patient and check lead connections
D. Administer epinephrine 1 mg IV push
CORRECT ANSWER: C. Assess the patient and check lead connections
, RATIONALE: Before initiating resuscitation for an apparent asystole alarm, the nurse
must first assess the patient clinically and verify lead placement, as asystole alarms are
frequently caused by lead dislodgement, poor electrode contact, or artifact. If the
patient is unresponsive and pulseless with confirmed asystole, then activate code and
begin CPR per ACLS protocols.
www.ahajournals.org
Question 9: Which ECG interval represents the time from the beginning of atrial
depolarization to the beginning of ventricular depolarization?
A. QT interval
B. PR interval
C. ST segment
D. QRS duration
CORRECT ANSWER: B. PR interval
RATIONALE: The PR interval measures conduction time from the sinoatrial node
through the atria, AV node, and His-Purkinje system to the onset of ventricular
depolarization. Normal duration is 0.12-0.20 seconds. The QT interval represents total
ventricular activity, the ST segment reflects early ventricular repolarization, and QRS
duration indicates ventricular depolarization time.
www.scribd.com
Question 10: A patient receiving IV amiodarone for ventricular tachycardia
develops a new prolonged QT interval on telemetry. What is the nurse's priority
action?
A. Discontinue the amiodarone infusion immediately
B. Notify the provider and prepare for possible medication adjustment
C. Increase the telemetry monitoring frequency to every 15 minutes
D. Administer IV magnesium sulfate per protocol
CORRECT ANSWER: B. Notify the provider and prepare for possible medication
adjustment
RATIONALE: Amiodarone can prolong the QT interval, increasing risk for torsades de
pointes. The nurse should promptly notify the provider for evaluation and potential dose
adjustment or alternative therapy. Abrupt discontinuation may be harmful if the
arrhythmia is still present. Magnesium is indicated if torsades occurs, not solely for QT
prolongation. Continuous monitoring is already in place with telemetry.
www.stuvia.com
Question 11: Which finding on telemetry is characteristic of a premature
ventricular contraction (PVC)?
with Verified Questions and Detailed Rationales | Cardiac Monitoring, ECG Interpretation,
Dysrhythmia Recognition, Telemetry Strips Analysis, Patient Assessment, Cardiovascular
Disorders, Medication Management, Critical Care Concepts, and Nursing Interventions for
RELIAS Telemetry Exam Success
Question 1: A telemetry nurse observes a rhythm strip showing regular P waves at
70 bpm, regular QRS complexes at 35 bpm, and no relationship between P waves
and QRS complexes. Which dysrhythmia is the nurse interpreting?
A. First-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. Second-degree atrioventricular block type II
D. Third-degree atrioventricular block
CORRECT ANSWER: D. Third-degree atrioventricular block
RATIONALE: Third-degree (complete) heart block is characterized by complete
dissociation between atrial and ventricular activity, with P waves and QRS complexes
occurring independently at different rates. The atrial rate is typically faster than the
ventricular escape rate, and there is no consistent PR interval. This differs from first-
degree block (prolonged but consistent PR interval) and second-degree blocks
(intermittent non-conducted P waves with specific patterns).
produsasmtsa01.blob.core.windows.net
Question 2: Which ECG finding is most indicative of acute myocardial ischemia in a
patient being monitored on telemetry?
A. Peaked T waves
B. ST-segment elevation of 2 mm in two contiguous leads
C. Prolonged QT interval of 480 ms
D. Inverted P waves in lead II
CORRECT ANSWER: B. ST-segment elevation of 2 mm in two contiguous leads
RATIONALE: ST-segment elevation of ≥1 mm (≥2 mm in precordial leads) in two or more
contiguous leads is a hallmark ECG finding of acute myocardial injury or infarction,
requiring immediate intervention. Peaked T waves may indicate hyperkalemia,
prolonged QT interval increases risk for torsades de pointes, and inverted P waves in
lead II suggest ectopic atrial rhythm, none of which are primary indicators of acute
ischemia.
www.ahajournals.org
Question 3: A patient on telemetry develops sudden-onset palpitations. The
rhythm strip shows an irregularly irregular rhythm with no discernible P waves and
a ventricular rate of 140 bpm. What is the priority nursing intervention?
A. Administer adenosine 6 mg IV push
B. Prepare for synchronized cardioversion
,C. Assess the patient's hemodynamic stability
D. Increase the telemetry alarm sensitivity
CORRECT ANSWER: C. Assess the patient's hemodynamic stability
RATIONALE: The rhythm described is atrial fibrillation with rapid ventricular response.
The priority nursing action is always to assess hemodynamic stability (blood pressure,
level of consciousness, chest pain, dyspnea) before initiating treatment. Unstable
patients require immediate synchronized cardioversion, while stable patients may
receive rate-control medications. Adenosine is used for stable SVT, not atrial fibrillation.
www.rch.org.au
Question 4: Which electrolyte imbalance is most commonly associated with the
development of torsades de pointes on telemetry monitoring?
A. Hyperkalemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hypernatremia
CORRECT ANSWER: C. Hypomagnesemia
RATIONALE: Hypomagnesemia prolongs the QT interval and significantly increases the
risk for torsades de pointes, a polymorphic ventricular tachycardia. While hypokalemia
and hypocalcemia can also prolong QT, magnesium deficiency is most directly linked to
this life-threatening arrhythmia. Treatment includes IV magnesium sulfate and
correction of concurrent electrolyte abnormalities.
美国卫生与公共服务部NIH
Question 5: When applying telemetry electrodes to a female patient, which action
by the nurse best ensures accurate rhythm interpretation and minimizes artifact?
A. Place electrodes directly over breast tissue for better adhesion
B. Shave excessive chest hair and clean skin with alcohol before application
C. Position the V1 electrode in the fifth intercostal space at the midclavicular line
D. Use hypoallergenic tape to secure leads after placement
CORRECT ANSWER: B. Shave excessive chest hair and clean skin with alcohol
before application
RATIONALE: Proper skin preparation, including removing hair and cleansing with
alcohol to reduce oils and debris, is critical for optimal electrode adhesion and signal
conduction, minimizing artifact that can lead to misinterpretation. Electrodes should be
placed on bony prominences when possible, not over breast tissue. V1 is placed in the
fourth intercostal space at the right sternal border.
bhrs.com
,Question 6: A telemetry patient with a history of heart failure is prescribed
metoprolol succinate. Which assessment finding should the nurse report before
administering the medication?
A. Apical heart rate of 58 bpm
B. Blood pressure of 138/86 mm Hg
C. Respiratory rate of 20 breaths/min
D. Oxygen saturation of 96% on room air
CORRECT ANSWER: A. Apical heart rate of 58 bpm
RATIONALE: Beta-blockers like metoprolol decrease heart rate and contractility. An
apical heart rate below 60 bpm is generally a holding parameter for beta-blocker
administration in most protocols, as further bradycardia could compromise cardiac
output, especially in heart failure patients. Blood pressure, respiratory rate, and oxygen
saturation are within acceptable ranges.
produsasmtsa01.blob.core.windows.net
Question 7: Which statement by a patient newly diagnosed with paroxysmal atrial
fibrillation indicates understanding of discharge teaching regarding
anticoagulation therapy?
A. "I will stop taking my warfarin if I notice any bruising."
B. "I need to have my INR checked regularly to ensure my dose is correct."
C. "I can take ibuprofen for headaches since it doesn't affect my heart medication."
D. "I should avoid all green leafy vegetables to prevent clotting."
CORRECT ANSWER: B. "I need to have my INR checked regularly to ensure my dose
is correct."
RATIONALE: Patients on warfarin require regular INR monitoring to maintain therapeutic
anticoagulation (typically INR 2-3 for atrial fibrillation) and reduce stroke risk while
minimizing bleeding complications. Patients should not abruptly stop anticoagulants,
should avoid NSAIDs like ibuprofen due to increased bleeding risk, and should maintain
consistent (not eliminated) vitamin K intake rather than avoiding green vegetables
entirely.
produsasmtsa01.blob.core.windows.net
Question 8: A telemetry alarm sounds indicating asystole. What is the nurse's first
action?
A. Begin chest compressions immediately
B. Call a code blue and retrieve the crash cart
C. Assess the patient and check lead connections
D. Administer epinephrine 1 mg IV push
CORRECT ANSWER: C. Assess the patient and check lead connections
, RATIONALE: Before initiating resuscitation for an apparent asystole alarm, the nurse
must first assess the patient clinically and verify lead placement, as asystole alarms are
frequently caused by lead dislodgement, poor electrode contact, or artifact. If the
patient is unresponsive and pulseless with confirmed asystole, then activate code and
begin CPR per ACLS protocols.
www.ahajournals.org
Question 9: Which ECG interval represents the time from the beginning of atrial
depolarization to the beginning of ventricular depolarization?
A. QT interval
B. PR interval
C. ST segment
D. QRS duration
CORRECT ANSWER: B. PR interval
RATIONALE: The PR interval measures conduction time from the sinoatrial node
through the atria, AV node, and His-Purkinje system to the onset of ventricular
depolarization. Normal duration is 0.12-0.20 seconds. The QT interval represents total
ventricular activity, the ST segment reflects early ventricular repolarization, and QRS
duration indicates ventricular depolarization time.
www.scribd.com
Question 10: A patient receiving IV amiodarone for ventricular tachycardia
develops a new prolonged QT interval on telemetry. What is the nurse's priority
action?
A. Discontinue the amiodarone infusion immediately
B. Notify the provider and prepare for possible medication adjustment
C. Increase the telemetry monitoring frequency to every 15 minutes
D. Administer IV magnesium sulfate per protocol
CORRECT ANSWER: B. Notify the provider and prepare for possible medication
adjustment
RATIONALE: Amiodarone can prolong the QT interval, increasing risk for torsades de
pointes. The nurse should promptly notify the provider for evaluation and potential dose
adjustment or alternative therapy. Abrupt discontinuation may be harmful if the
arrhythmia is still present. Magnesium is indicated if torsades occurs, not solely for QT
prolongation. Continuous monitoring is already in place with telemetry.
www.stuvia.com
Question 11: Which finding on telemetry is characteristic of a premature
ventricular contraction (PVC)?
