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RELIAS DYSRHYTHMIA ASSESSMENTS ACTUAL
2026/2027 | Complete Solutions | Verified
Certification Exam | Basic & Advanced | Pass
Guaranteed - A+ Graded
Section 1: Normal Sinus Rhythm & Sinus Dysrhythmias (Q1-12)
Question 1 A nurse is reviewing the ECG of a 42-year-old patient at rest. The rhythm
strip shows a regular R-R interval, upright P wave before each QRS complex, PR
interval of 0.16 seconds, narrow QRS duration of 0.08 seconds, and a ventricular rate
of 72 beats per minute. Which rhythm is present? A. Sinus bradycardia B. Normal
sinus rhythm C. Sinus tachycardia D. Junctional rhythm
B. Normal sinus rhythm [CORRECT]
Rationale: Normal sinus rhythm is defined by a regular rhythm, rate 60-100 bpm,
upright P wave before each QRS, PR interval 0.12-0.20 seconds, and narrow QRS
<0.12 seconds. The rate of 72 bpm and all other criteria confirm this as normal sinus
rhythm rather than a dysrhythmia.
Correct Answer: B
Question 2 Using the 1500 method, a nurse counts 25 small boxes between
consecutive R waves on an ECG strip. What is the calculated heart rate? A. 50 beats
per minute B. 60 beats per minute C. 72 beats per minute D. 80 beats per minute
B. 60 beats per minute [CORRECT]
Rationale: The 1500 method divides 1500 by the number of small boxes between R
waves. 1500 ÷ 25 = 60 beats per minute. This method is most accurate for regular
rhythms when the exact number of small boxes can be counted.
Correct Answer: B
Question 3 A 68-year-old patient on beta-blocker therapy has an ECG showing a
regular rhythm, rate 52 bpm, normal upright P waves, PR interval 0.18 seconds, and
narrow QRS complexes. Which dysrhythmia is present? A. First-degree AV block B.
Sinus bradycardia C. Junctional escape rhythm D. Second-degree AV block Type I
,2
B. Sinus bradycardia [CORRECT]
Rationale: Sinus bradycardia is characterized by a sinus rhythm with a rate below 60
bpm, maintaining normal P wave morphology, consistent PR interval within normal
limits, and narrow QRS complexes. The rhythm originates from the SA node but at a
slow rate, which is common with beta-blocker therapy.
Correct Answer: B
Question 4 During a 6-second ECG strip analysis, a nurse counts 14 QRS complexes.
What is the estimated ventricular rate? A. 70 beats per minute B. 84 beats per minute
C. 140 beats per minute D. 112 beats per minute
C. 140 beats per minute [CORRECT]
Rationale: The 6-second method multiplies the number of QRS complexes in a 6-
second strip by 10. 14 × 10 = 140 beats per minute. This method is useful for both
regular and irregular rhythms when exact measurement is difficult.
Correct Answer: C
Question 5 A rhythm strip shows a gradual shortening and lengthening of the R-R
interval corresponding with the respiratory cycle. The rate varies between 68-88 bpm,
with normal upright P waves and constant PR intervals. This finding is consistent with:
A. Sinus arrest B. Sinus arrhythmia C. Atrial fibrillation D. Wandering atrial pacemaker
B. Sinus arrhythmia [CORRECT]
Rationale: Sinus arrhythmia demonstrates phasic variation in the R-R interval typically
related to respiration, with normal P wave morphology and consistent PR intervals.
The rate increases with inspiration and decreases with expiration, distinguishing it
from the irregularly irregular pattern of atrial fibrillation or the changing P waves of
wandering atrial pacemaker.
Correct Answer: B
Question 6 A nurse observes an ECG strip with a rate of 110 bpm, regular rhythm,
upright P waves preceding each QRS, PR interval 0.14 seconds, and narrow QRS
duration. The patient is febrile and reports chest discomfort. Which rhythm is most
likely present? A. Supraventricular tachycardia B. Sinus tachycardia C. Atrial flutter D.
Junctional tachycardia
,3
B. Sinus tachycardia [CORRECT]
Rationale: Sinus tachycardia presents with a rate >100 bpm originating from the
sinus node, evidenced by upright P waves before each QRS, normal PR interval, and
narrow QRS complexes. The clinical context of fever and the gradual onset of
elevated rate support sinus tachycardia over paroxysmal supraventricular tachycardia,
which typically has a more abrupt onset and rates often exceeding 150 bpm.
Correct Answer: B
Question 7 On a continuous cardiac monitor, a nurse notices a pause in the rhythm
where an entire cardiac cycle is absent. The pause duration is not a multiple of the
underlying R-R interval, and the preceding P-QRS-T sequence appears normal. This
pattern indicates: A. Second-degree AV block Type I B. Sinus arrest (sinus pause) C.
Premature atrial complex D. Sinus exit block
B. Sinus arrest (sinus pause) [CORRECT]
Rationale: Sinus arrest occurs when the SA node fails to generate an impulse,
resulting in a pause that is not a multiple of the underlying cycle length. Unlike sinus
exit block where the pause is typically a multiple of the normal R-R interval, sinus
arrest represents a failure of impulse formation rather than conduction.
Correct Answer: B
Question 8 A patient with sinus bradycardia at 48 bpm is asymptomatic and
hemodynamically stable. Which nursing intervention is most appropriate according
to current AACN guidelines? A. Prepare for immediate transcutaneous pacing B.
Administer atropine 0.5 mg IV push C. Continue monitoring and assess for symptoms
D. Initiate cardiopulmonary resuscitation
C. Continue monitoring and assess for symptoms [CORRECT]
Rationale: Asymptomatic sinus bradycardia does not require immediate
pharmacologic or electrical intervention. AACN guidelines emphasize that treatment
is indicated only when bradycardia produces signs of hemodynamic compromise
such as hypotension, altered mental status, or signs of shock.
Correct Answer: C
, 4
Question 9 When analyzing a rhythm strip using the 8-step systematic method,
which parameter is assessed third in the standard sequence? A. Rate calculation B.
Rhythm regularity C. P wave analysis D. PR interval measurement
C. P wave analysis [CORRECT]
Rationale: The standard 8-step systematic approach follows this sequence: (1) rate,
(2) rhythm regularity, (3) P wave analysis, (4) PR interval, (5) QRS duration, (6) ST
segment, (7) T wave, and (8) QT interval. P wave analysis follows rate and rhythm
assessment to determine atrial activity and origin.
Correct Answer: C
Question 10 A marathon runner presents with a resting ECG showing a rate of 54
bpm, regular rhythm, normal P waves, PR interval 0.16 seconds, and narrow QRS
complexes. The patient denies dizziness or syncope. This rhythm is best classified as:
A. Pathologic sinus bradycardia requiring pacemaker insertion B. Physiologic sinus
bradycardia from increased vagal tone C. Junctional escape rhythm with retrograde
conduction D. First-degree AV block with slow ventricular response
B. Physiologic sinus bradycardia from increased vagal tone [CORRECT]
Rationale: Well-conditioned athletes often develop physiologic sinus bradycardia due
to increased vagal tone and enhanced stroke volume. The presence of normal sinus P
waves, normal PR interval, narrow QRS, and absence of symptoms distinguishes this
benign finding from pathologic bradycardia requiring intervention.
Correct Answer: B
Question 11 A nurse is evaluating an ECG strip where the R-R interval measures
exactly 4 large boxes. Using the 300 method, what is the calculated heart rate? A. 65
beats per minute B. 75 beats per minute C. 85 beats per minute D. 95 beats per
minute
B. 75 beats per minute [CORRECT]
Rationale: The 300 method divides 300 by the number of large boxes between R
waves. 300 ÷ 4 = 75 beats per minute. This rapid calculation method is commonly
used for regular rhythms in emergency and clinical settings.
Correct Answer: B
RELIAS DYSRHYTHMIA ASSESSMENTS ACTUAL
2026/2027 | Complete Solutions | Verified
Certification Exam | Basic & Advanced | Pass
Guaranteed - A+ Graded
Section 1: Normal Sinus Rhythm & Sinus Dysrhythmias (Q1-12)
Question 1 A nurse is reviewing the ECG of a 42-year-old patient at rest. The rhythm
strip shows a regular R-R interval, upright P wave before each QRS complex, PR
interval of 0.16 seconds, narrow QRS duration of 0.08 seconds, and a ventricular rate
of 72 beats per minute. Which rhythm is present? A. Sinus bradycardia B. Normal
sinus rhythm C. Sinus tachycardia D. Junctional rhythm
B. Normal sinus rhythm [CORRECT]
Rationale: Normal sinus rhythm is defined by a regular rhythm, rate 60-100 bpm,
upright P wave before each QRS, PR interval 0.12-0.20 seconds, and narrow QRS
<0.12 seconds. The rate of 72 bpm and all other criteria confirm this as normal sinus
rhythm rather than a dysrhythmia.
Correct Answer: B
Question 2 Using the 1500 method, a nurse counts 25 small boxes between
consecutive R waves on an ECG strip. What is the calculated heart rate? A. 50 beats
per minute B. 60 beats per minute C. 72 beats per minute D. 80 beats per minute
B. 60 beats per minute [CORRECT]
Rationale: The 1500 method divides 1500 by the number of small boxes between R
waves. 1500 ÷ 25 = 60 beats per minute. This method is most accurate for regular
rhythms when the exact number of small boxes can be counted.
Correct Answer: B
Question 3 A 68-year-old patient on beta-blocker therapy has an ECG showing a
regular rhythm, rate 52 bpm, normal upright P waves, PR interval 0.18 seconds, and
narrow QRS complexes. Which dysrhythmia is present? A. First-degree AV block B.
Sinus bradycardia C. Junctional escape rhythm D. Second-degree AV block Type I
,2
B. Sinus bradycardia [CORRECT]
Rationale: Sinus bradycardia is characterized by a sinus rhythm with a rate below 60
bpm, maintaining normal P wave morphology, consistent PR interval within normal
limits, and narrow QRS complexes. The rhythm originates from the SA node but at a
slow rate, which is common with beta-blocker therapy.
Correct Answer: B
Question 4 During a 6-second ECG strip analysis, a nurse counts 14 QRS complexes.
What is the estimated ventricular rate? A. 70 beats per minute B. 84 beats per minute
C. 140 beats per minute D. 112 beats per minute
C. 140 beats per minute [CORRECT]
Rationale: The 6-second method multiplies the number of QRS complexes in a 6-
second strip by 10. 14 × 10 = 140 beats per minute. This method is useful for both
regular and irregular rhythms when exact measurement is difficult.
Correct Answer: C
Question 5 A rhythm strip shows a gradual shortening and lengthening of the R-R
interval corresponding with the respiratory cycle. The rate varies between 68-88 bpm,
with normal upright P waves and constant PR intervals. This finding is consistent with:
A. Sinus arrest B. Sinus arrhythmia C. Atrial fibrillation D. Wandering atrial pacemaker
B. Sinus arrhythmia [CORRECT]
Rationale: Sinus arrhythmia demonstrates phasic variation in the R-R interval typically
related to respiration, with normal P wave morphology and consistent PR intervals.
The rate increases with inspiration and decreases with expiration, distinguishing it
from the irregularly irregular pattern of atrial fibrillation or the changing P waves of
wandering atrial pacemaker.
Correct Answer: B
Question 6 A nurse observes an ECG strip with a rate of 110 bpm, regular rhythm,
upright P waves preceding each QRS, PR interval 0.14 seconds, and narrow QRS
duration. The patient is febrile and reports chest discomfort. Which rhythm is most
likely present? A. Supraventricular tachycardia B. Sinus tachycardia C. Atrial flutter D.
Junctional tachycardia
,3
B. Sinus tachycardia [CORRECT]
Rationale: Sinus tachycardia presents with a rate >100 bpm originating from the
sinus node, evidenced by upright P waves before each QRS, normal PR interval, and
narrow QRS complexes. The clinical context of fever and the gradual onset of
elevated rate support sinus tachycardia over paroxysmal supraventricular tachycardia,
which typically has a more abrupt onset and rates often exceeding 150 bpm.
Correct Answer: B
Question 7 On a continuous cardiac monitor, a nurse notices a pause in the rhythm
where an entire cardiac cycle is absent. The pause duration is not a multiple of the
underlying R-R interval, and the preceding P-QRS-T sequence appears normal. This
pattern indicates: A. Second-degree AV block Type I B. Sinus arrest (sinus pause) C.
Premature atrial complex D. Sinus exit block
B. Sinus arrest (sinus pause) [CORRECT]
Rationale: Sinus arrest occurs when the SA node fails to generate an impulse,
resulting in a pause that is not a multiple of the underlying cycle length. Unlike sinus
exit block where the pause is typically a multiple of the normal R-R interval, sinus
arrest represents a failure of impulse formation rather than conduction.
Correct Answer: B
Question 8 A patient with sinus bradycardia at 48 bpm is asymptomatic and
hemodynamically stable. Which nursing intervention is most appropriate according
to current AACN guidelines? A. Prepare for immediate transcutaneous pacing B.
Administer atropine 0.5 mg IV push C. Continue monitoring and assess for symptoms
D. Initiate cardiopulmonary resuscitation
C. Continue monitoring and assess for symptoms [CORRECT]
Rationale: Asymptomatic sinus bradycardia does not require immediate
pharmacologic or electrical intervention. AACN guidelines emphasize that treatment
is indicated only when bradycardia produces signs of hemodynamic compromise
such as hypotension, altered mental status, or signs of shock.
Correct Answer: C
, 4
Question 9 When analyzing a rhythm strip using the 8-step systematic method,
which parameter is assessed third in the standard sequence? A. Rate calculation B.
Rhythm regularity C. P wave analysis D. PR interval measurement
C. P wave analysis [CORRECT]
Rationale: The standard 8-step systematic approach follows this sequence: (1) rate,
(2) rhythm regularity, (3) P wave analysis, (4) PR interval, (5) QRS duration, (6) ST
segment, (7) T wave, and (8) QT interval. P wave analysis follows rate and rhythm
assessment to determine atrial activity and origin.
Correct Answer: C
Question 10 A marathon runner presents with a resting ECG showing a rate of 54
bpm, regular rhythm, normal P waves, PR interval 0.16 seconds, and narrow QRS
complexes. The patient denies dizziness or syncope. This rhythm is best classified as:
A. Pathologic sinus bradycardia requiring pacemaker insertion B. Physiologic sinus
bradycardia from increased vagal tone C. Junctional escape rhythm with retrograde
conduction D. First-degree AV block with slow ventricular response
B. Physiologic sinus bradycardia from increased vagal tone [CORRECT]
Rationale: Well-conditioned athletes often develop physiologic sinus bradycardia due
to increased vagal tone and enhanced stroke volume. The presence of normal sinus P
waves, normal PR interval, narrow QRS, and absence of symptoms distinguishes this
benign finding from pathologic bradycardia requiring intervention.
Correct Answer: B
Question 11 A nurse is evaluating an ECG strip where the R-R interval measures
exactly 4 large boxes. Using the 300 method, what is the calculated heart rate? A. 65
beats per minute B. 75 beats per minute C. 85 beats per minute D. 95 beats per
minute
B. 75 beats per minute [CORRECT]
Rationale: The 300 method divides 300 by the number of large boxes between R
waves. 300 ÷ 4 = 75 beats per minute. This rapid calculation method is commonly
used for regular rhythms in emergency and clinical settings.
Correct Answer: B
