RELIAS Dysrhythmia - Basic B Exam
35 Questions & Answers | 2026/2027 Competency
Telemetry Rhythm Identification
Instructions
For each question, identify the correct rhythm based on the EKG strip description or
referenced strip characteristics. Select the one best answer from the four options
provided.
Key Assessment Parameters for Each Rhythm:
● Rate: Calculate using 300, 150, 100, 75, 60, 50 method or 6-second strip count
● Regularity: Regular vs. irregular pattern
● P waves: Presence, morphology, relationship to QRS
● PR interval: Duration, consistency
● QRS complex: Width (narrow <0.12 sec vs. wide ≥0.12 sec)
Group 1: Normal Sinus & Basic Intervals (Questions 1-5)
Q1. The rhythm strip shows a regular rhythm at a rate of 72 beats per minute. Upright
P waves precede every QRS complex with a constant PR interval of 0.16 sec. QRS
complexes measure 0.08 sec.
A. Sinus Tachycardia
B. Normal Sinus Rhythm [CORRECT]
C. Sinus Arrhythmia
,D. Junctional Rhythm
Correct Answer: B
Rationale:
● Rate: 72 bpm (within normal 60-100 range)
● Regularity: Regular R-R intervals
● P waves: Present, upright, preceding each QRS (sinus node origin)
● PR interval: Constant 0.16 sec (within normal 0.12-0.20 sec)
● QRS: Narrow 0.08 sec (<0.12 sec, normal ventricular conduction)
This meets all five criteria for Normal Sinus Rhythm. The impulse originates in the SA
node, conducts normally through the AV node, and activates the ventricles via the
His-Purkinje system.
Q2. Strip shows a heart rate of 52 bpm. The rhythm is regular. Each QRS complex is
preceded by an upright P wave with a constant PR interval of 0.18 sec. QRS duration is
0.09 sec. The patient is asymptomatic.
A. Normal Sinus Rhythm
B. Sinus Bradycardia [CORRECT]
C. Junctional Escape Rhythm
D. 1st Degree AV Block
Correct Answer: B
Rationale:
● Rate: 52 bpm (below 60 bpm = bradycardia)
● Regularity: Regular
● P waves: Upright, present before each QRS (sinus origin confirmed)
, ● PR interval: Constant 0.18 sec (normal, not prolonged)
● QRS: Narrow 0.09 sec
This is Sinus Bradycardia—a sinus rhythm with rate <60 bpm. The key discriminator
from junctional rhythm is the upright P wave morphology confirming SA node origin. 1st
Degree AV Block (D) requires PR >0.20 sec. Asymptomatic bradycardia typically requires
monitoring only; symptomatic bradycardia may require atropine or pacing per ACLS.
Q3. Strip shows a rhythm with a variable rate between 50-65 bpm. The rhythm is
slightly irregular, with R-R intervals varying by 0.08-0.12 seconds. This variation
corresponds with the patient's respirations (rate increases with inspiration, decreases
with expiration). P waves are upright and normal in morphology.
A. Sinus Bradycardia
B. Sinus Arrest
C. Sinus Arrhythmia [CORRECT]
D. Wandering Atrial Pacemaker
Correct Answer: C
Rationale:
● Rate: 50-65 bpm (varies cyclically)
● Regularity: Irregular with respiratory variation (phasic)
● P waves: Normal, upright, present (sinus node origin)
● PR interval: Normal and constant
● QRS: Narrow
Sinus Arrhythmia is characterized by phasic variation in heart rate with
respiration—inspiration increases rate, expiration decreases it. This is a normal variant
common in young, healthy individuals and athletes. Distinguish from Wandering Atrial
, Pacemaker (D) by P wave morphology: in sinus arrhythmia, P waves remain uniform; in
WAP, P wave morphology changes as the pacemaker site shifts.
Q4. The rhythm strip demonstrates a regular rhythm at 118 bpm. Upright P waves
precede each QRS complex. PR interval is 0.14 sec and constant. QRS complexes are
narrow at 0.07 sec. The patient is febrile and reports feeling "anxious."
A. Normal Sinus Rhythm
B. Sinus Tachycardia [CORRECT]
C. Supraventricular Tachycardia (SVT)
D. Atrial Flutter
Correct Answer: B
Rationale:
● Rate: 118 bpm (above 100 bpm = tachycardia)
● Regularity: Regular
● P waves: Upright, present, preceding each QRS (sinus origin)
● PR interval: Normal 0.14 sec
● QRS: Narrow 0.07 sec
This is Sinus Tachycardia—a sinus rhythm with rate >100 bpm. The preserved normal P
wave morphology and PR interval distinguish it from SVT (C), which typically has
abnormal or buried P waves. Sinus tachycardia is an appropriate physiological response
to stressors (fever, anxiety, hypovolemia, pain) and resolves when the underlying cause
is treated. No specific rhythm treatment is indicated; address the cause.
35 Questions & Answers | 2026/2027 Competency
Telemetry Rhythm Identification
Instructions
For each question, identify the correct rhythm based on the EKG strip description or
referenced strip characteristics. Select the one best answer from the four options
provided.
Key Assessment Parameters for Each Rhythm:
● Rate: Calculate using 300, 150, 100, 75, 60, 50 method or 6-second strip count
● Regularity: Regular vs. irregular pattern
● P waves: Presence, morphology, relationship to QRS
● PR interval: Duration, consistency
● QRS complex: Width (narrow <0.12 sec vs. wide ≥0.12 sec)
Group 1: Normal Sinus & Basic Intervals (Questions 1-5)
Q1. The rhythm strip shows a regular rhythm at a rate of 72 beats per minute. Upright
P waves precede every QRS complex with a constant PR interval of 0.16 sec. QRS
complexes measure 0.08 sec.
A. Sinus Tachycardia
B. Normal Sinus Rhythm [CORRECT]
C. Sinus Arrhythmia
,D. Junctional Rhythm
Correct Answer: B
Rationale:
● Rate: 72 bpm (within normal 60-100 range)
● Regularity: Regular R-R intervals
● P waves: Present, upright, preceding each QRS (sinus node origin)
● PR interval: Constant 0.16 sec (within normal 0.12-0.20 sec)
● QRS: Narrow 0.08 sec (<0.12 sec, normal ventricular conduction)
This meets all five criteria for Normal Sinus Rhythm. The impulse originates in the SA
node, conducts normally through the AV node, and activates the ventricles via the
His-Purkinje system.
Q2. Strip shows a heart rate of 52 bpm. The rhythm is regular. Each QRS complex is
preceded by an upright P wave with a constant PR interval of 0.18 sec. QRS duration is
0.09 sec. The patient is asymptomatic.
A. Normal Sinus Rhythm
B. Sinus Bradycardia [CORRECT]
C. Junctional Escape Rhythm
D. 1st Degree AV Block
Correct Answer: B
Rationale:
● Rate: 52 bpm (below 60 bpm = bradycardia)
● Regularity: Regular
● P waves: Upright, present before each QRS (sinus origin confirmed)
, ● PR interval: Constant 0.18 sec (normal, not prolonged)
● QRS: Narrow 0.09 sec
This is Sinus Bradycardia—a sinus rhythm with rate <60 bpm. The key discriminator
from junctional rhythm is the upright P wave morphology confirming SA node origin. 1st
Degree AV Block (D) requires PR >0.20 sec. Asymptomatic bradycardia typically requires
monitoring only; symptomatic bradycardia may require atropine or pacing per ACLS.
Q3. Strip shows a rhythm with a variable rate between 50-65 bpm. The rhythm is
slightly irregular, with R-R intervals varying by 0.08-0.12 seconds. This variation
corresponds with the patient's respirations (rate increases with inspiration, decreases
with expiration). P waves are upright and normal in morphology.
A. Sinus Bradycardia
B. Sinus Arrest
C. Sinus Arrhythmia [CORRECT]
D. Wandering Atrial Pacemaker
Correct Answer: C
Rationale:
● Rate: 50-65 bpm (varies cyclically)
● Regularity: Irregular with respiratory variation (phasic)
● P waves: Normal, upright, present (sinus node origin)
● PR interval: Normal and constant
● QRS: Narrow
Sinus Arrhythmia is characterized by phasic variation in heart rate with
respiration—inspiration increases rate, expiration decreases it. This is a normal variant
common in young, healthy individuals and athletes. Distinguish from Wandering Atrial
, Pacemaker (D) by P wave morphology: in sinus arrhythmia, P waves remain uniform; in
WAP, P wave morphology changes as the pacemaker site shifts.
Q4. The rhythm strip demonstrates a regular rhythm at 118 bpm. Upright P waves
precede each QRS complex. PR interval is 0.14 sec and constant. QRS complexes are
narrow at 0.07 sec. The patient is febrile and reports feeling "anxious."
A. Normal Sinus Rhythm
B. Sinus Tachycardia [CORRECT]
C. Supraventricular Tachycardia (SVT)
D. Atrial Flutter
Correct Answer: B
Rationale:
● Rate: 118 bpm (above 100 bpm = tachycardia)
● Regularity: Regular
● P waves: Upright, present, preceding each QRS (sinus origin)
● PR interval: Normal 0.14 sec
● QRS: Narrow 0.07 sec
This is Sinus Tachycardia—a sinus rhythm with rate >100 bpm. The preserved normal P
wave morphology and PR interval distinguish it from SVT (C), which typically has
abnormal or buried P waves. Sinus tachycardia is an appropriate physiological response
to stressors (fever, anxiety, hypovolemia, pain) and resolves when the underlying cause
is treated. No specific rhythm treatment is indicated; address the cause.
