ECG ANALYSIS: RHYTHM RECOGNITION (RELIAS)
COMPLETE PRACTICE EXAM | QUESTIONS AND
ANSWERS | COMPREHENSIVE STUDY GUIDE |
UPDATED 2026/2027
Examiner/Administrator: Relias Learning
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ECG ANALYSIS: RHYTHM RECOGNITION
2026/2027 EDITION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMPLETE PRACTICE EXAM
100 MULTIPLE-CHOICE QUESTIONS
PASSING SCORE: 80%
TESTING TIME: 120 MINUTES
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
TABLE OF CONTENTS
1. Cardiac Electrophysiology Fundamentals
2. ECG Waveform Interpretation
3. Heart Rate & Rhythm Determination
4. Sinus Rhythms
5. Atrial Dysrhythmias
6. Junctional Rhythms
7. Ventricular Dysrhythmias
8. Atrioventricular Blocks
,9. Pacemaker Recognition
10. Clinical Response & Patient Management
RELIAS LEARNING || ALIGNED WITH CURRENT RHYTHM RECOGNITION
COMPETENCIES || PROFESSIONAL STUDY GUIDE || ORIGINAL PRACTICE QUESTIONS
WITH DETAILED ANSWERS || COMPREHENSIVE EXAM PREPARATION || PREPARED FOR
HEALTHCARE PROFESSIONAL EDUCATION || PROFESSIONAL EXAMINATION USE
</div>
Questions 1–8: Cardiac Electrophysiology Fundamentals
QUESTION 1.
A telemetry technician observes a rhythm strip with upright P waves preceding every
QRS complex, a constant PR interval, and a ventricular rate of 76 beats/minute.
Which rhythm is most consistent with these findings?
A. Sinus rhythm
B. Accelerated junctional rhythm
C. Atrial flutter
D. Ventricular escape rhythm
Correct Answer: B. Sinus rhythm
Explanation: Normal sinus rhythm originates from the sinoatrial (SA) node. Each
impulse produces one upright P wave followed by a narrow QRS complex with a
constant PR interval. The rate of 60–100 bpm supports normal sinus rhythm. Junctional
rhythms usually have absent or inverted P waves. Atrial flutter demonstrates flutter
waves rather than discrete P waves, while ventricular escape rhythms have wide QRS
complexes and much slower rates.
QUESTION 2.
,Which structure normally functions as the heart's primary pacemaker?
A. Atrioventricular node
B. Bundle of His
C. Sinoatrial node
D. Purkinje fibers
Correct Answer: C. Sinoatrial node
Explanation: The SA node possesses the highest intrinsic firing rate (approximately 60–
100 bpm) and therefore initiates normal cardiac depolarization. The AV node, Bundle
of His, and Purkinje fibers act as backup pacemakers if higher pacemakers fail.
QUESTION 3.
A patient develops delayed conduction from the atria to the ventricles while
maintaining one conducted beat for every atrial impulse. Which ECG interval is
primarily affected?
A. QT interval
B. ST segment
C. PR interval
D. RR interval
Correct Answer: C. PR interval
Explanation: The PR interval reflects conduction from atrial depolarization through the
AV node into the ventricles. Prolongation indicates delayed AV conduction. QT
measures ventricular depolarization and repolarization, ST reflects early ventricular
repolarization, and RR measures ventricular cycle length.
, QUESTION 4.
The QRS complex represents:
A. Atrial depolarization
B. Ventricular depolarization
C. Ventricular repolarization
D. Atrial repolarization only
Correct Answer: B. Ventricular depolarization
Explanation: The QRS complex corresponds to ventricular depolarization leading to
ventricular contraction. Although atrial repolarization occurs simultaneously, it is
hidden within the QRS complex and is not separately visible.
QUESTION 5.
An ECG tracing demonstrates regular RR intervals measuring four large boxes apart.
What is the approximate heart rate?
A. 60 bpm
B. 75 bpm
C. 100 bpm
D. 150 bpm
Correct Answer: B. 75 bpm
Explanation: Using the 300 rule: 300 ÷ 4 = 75 bpm. This method is appropriate for
regular rhythms. The other rates correspond to different numbers of large boxes
between R waves.
QUESTION 6.
COMPLETE PRACTICE EXAM | QUESTIONS AND
ANSWERS | COMPREHENSIVE STUDY GUIDE |
UPDATED 2026/2027
Examiner/Administrator: Relias Learning
<div align="center">
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
ECG ANALYSIS: RHYTHM RECOGNITION
2026/2027 EDITION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMPLETE PRACTICE EXAM
100 MULTIPLE-CHOICE QUESTIONS
PASSING SCORE: 80%
TESTING TIME: 120 MINUTES
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
TABLE OF CONTENTS
1. Cardiac Electrophysiology Fundamentals
2. ECG Waveform Interpretation
3. Heart Rate & Rhythm Determination
4. Sinus Rhythms
5. Atrial Dysrhythmias
6. Junctional Rhythms
7. Ventricular Dysrhythmias
8. Atrioventricular Blocks
,9. Pacemaker Recognition
10. Clinical Response & Patient Management
RELIAS LEARNING || ALIGNED WITH CURRENT RHYTHM RECOGNITION
COMPETENCIES || PROFESSIONAL STUDY GUIDE || ORIGINAL PRACTICE QUESTIONS
WITH DETAILED ANSWERS || COMPREHENSIVE EXAM PREPARATION || PREPARED FOR
HEALTHCARE PROFESSIONAL EDUCATION || PROFESSIONAL EXAMINATION USE
</div>
Questions 1–8: Cardiac Electrophysiology Fundamentals
QUESTION 1.
A telemetry technician observes a rhythm strip with upright P waves preceding every
QRS complex, a constant PR interval, and a ventricular rate of 76 beats/minute.
Which rhythm is most consistent with these findings?
A. Sinus rhythm
B. Accelerated junctional rhythm
C. Atrial flutter
D. Ventricular escape rhythm
Correct Answer: B. Sinus rhythm
Explanation: Normal sinus rhythm originates from the sinoatrial (SA) node. Each
impulse produces one upright P wave followed by a narrow QRS complex with a
constant PR interval. The rate of 60–100 bpm supports normal sinus rhythm. Junctional
rhythms usually have absent or inverted P waves. Atrial flutter demonstrates flutter
waves rather than discrete P waves, while ventricular escape rhythms have wide QRS
complexes and much slower rates.
QUESTION 2.
,Which structure normally functions as the heart's primary pacemaker?
A. Atrioventricular node
B. Bundle of His
C. Sinoatrial node
D. Purkinje fibers
Correct Answer: C. Sinoatrial node
Explanation: The SA node possesses the highest intrinsic firing rate (approximately 60–
100 bpm) and therefore initiates normal cardiac depolarization. The AV node, Bundle
of His, and Purkinje fibers act as backup pacemakers if higher pacemakers fail.
QUESTION 3.
A patient develops delayed conduction from the atria to the ventricles while
maintaining one conducted beat for every atrial impulse. Which ECG interval is
primarily affected?
A. QT interval
B. ST segment
C. PR interval
D. RR interval
Correct Answer: C. PR interval
Explanation: The PR interval reflects conduction from atrial depolarization through the
AV node into the ventricles. Prolongation indicates delayed AV conduction. QT
measures ventricular depolarization and repolarization, ST reflects early ventricular
repolarization, and RR measures ventricular cycle length.
, QUESTION 4.
The QRS complex represents:
A. Atrial depolarization
B. Ventricular depolarization
C. Ventricular repolarization
D. Atrial repolarization only
Correct Answer: B. Ventricular depolarization
Explanation: The QRS complex corresponds to ventricular depolarization leading to
ventricular contraction. Although atrial repolarization occurs simultaneously, it is
hidden within the QRS complex and is not separately visible.
QUESTION 5.
An ECG tracing demonstrates regular RR intervals measuring four large boxes apart.
What is the approximate heart rate?
A. 60 bpm
B. 75 bpm
C. 100 bpm
D. 150 bpm
Correct Answer: B. 75 bpm
Explanation: Using the 300 rule: 300 ÷ 4 = 75 bpm. This method is appropriate for
regular rhythms. The other rates correspond to different numbers of large boxes
between R waves.
QUESTION 6.
