RELIAS DYSRHYTHMIA BASIC TEST STUDY
GUIDE AND EXAM BANK (BASIC A) 2026-2027
This comprehensive question practice exam serves as the
ultimate study companion for passing the Relias Basic A
Dysrhythmia competency assessment on your very first
attempt. Every objective multiple-choice question is paired
with direct answers and detailed, authoritative rationales
mapping out exact grid measurements, interval timings, and
clinical interventions. Master complex heart blocks,
pacemaker malfunctions, and lethal ventricular rhythms
using this premium, high-yield document designed to
guarantee clinical verification success.
Question 1
A patient's ECG rhythm strip shows a regular rhythm, a
heart rate of 72 bpm, upright P waves preceding every QRS
complex, a PR interval of 0.16 seconds, and a QRS duration
of 0.08 seconds. How should the nurse interpret this
rhythm?
A) Sinus Bradycardia
B) Normal Sinus Rhythm
C) First-Degree AV Block
D) Junctional Rhythm
Answer: B
Rationale: Normal Sinus Rhythm is characterized by a
,regular rhythm, a heart rate between 60–100 bpm, uniform
upright P waves before every QRS complex, a normal PR
interval (0.12–0.20 seconds), and a narrow QRS complex
(<0.12 seconds). All measurements for this patient fall
perfectly within these standard physiological benchmarks.
Question 2
The nurse notes pacemaker spikes on a patient's monitor,
but these spikes are not followed by a QRS complex or a P
wave. Which pacemaker malfunction does this indicate?
A) Failure to Pace
B) Failure to Sense
C) Failure to Capture
D) Oversensing
Answer: C
Rationale: Failure to capture occurs when the pacemaker
fires an electrical impulse (visible as a spike), but the
myocardium fails to depolarize in response. Visually, this is
seen as pacemaker spikes that are completely uncoupled
from a following P wave or QRS complex, indicating the
chamber did not respond to the stimulus.
Question 3
An ECG rhythm strip reveals a regular rhythm with a heart
rate of 142 bpm. The P waves are upright, identical, and
precede every QRS complex. The PR interval is 0.14
seconds and the QRS complex is 0.06 seconds. Which
,rhythm is present?
A) Supraventricular Tachycardia
B) Ventricular Tachycardia
C) Sinus Tachycardia
D) Atrial Flutter
Answer: C
Rationale: Sinus Tachycardia meets all the baseline criteria
for normal sinus rhythm except that the sinoatrial (SA) node
fires at an accelerated rate between 101 and 150 bpm.
Because normal, upright P waves are clearly distinguishable
before every narrow QRS complex, it is classified as sinus
tachycardia rather than SVT.
Question 4
A telemetry strip demonstrates a rhythm where the PR
interval progressively lengthens with each subsequent
heartbeat until a QRS complex is entirely dropped. After the
dropped beat, the cycle repeats. What is this dysrhythmia?
A) First-Degree AV Block
B) Second-Degree AV Block, Type I (Wenckebach)
C) Second-Degree AV Block, Type II (Mobitz II)
D) Third-Degree AV Block
Answer: B
Rationale: Second-Degree AV Block Type I (Wenckebach) is
defined by a progressive structural delay at the AV node.
This creates a PR interval that grows longer beat by beat
until an atrial impulse is blocked entirely, resulting in a
, dropped QRS. A helpful clinical memory aid is: "longer,
longer, longer, drop, now you have a Wenckebach."
Question 5
The nurse analyzes a rhythm strip and finds an irregularly
irregular ventricular rhythm with no visible P waves. The
baseline appears chaotic and wavy. What is the priority
intervention if the patient is stable?
A) Immediate Defibrillation
B) Administration of Adenosine
C) Rate control medication (e.g., Beta-blocker or Calcium
Channel Blocker)
D) Administration of Atropine
Answer: C
Rationale: The description identifies Atrial Fibrillation (A-
Fib), which features chaotic atrial activity and an irregularly
irregular ventricular response. For a stable patient, the
primary clinical goals are achieving ventricular rate control
(using drugs like Diltiazem or Metoprolol) and assessing the
patient's long-term thromboembolic stroke risk.
Question 6
While reviewing a monitor, the nurse notes three or more
consecutive, wide, and bizarre QRS complexes occurring at
a rapid rate of 160 bpm with no visible P waves. The patient
is awake, alert, and has a strong radial pulse. What is the
immediate treatment?
GUIDE AND EXAM BANK (BASIC A) 2026-2027
This comprehensive question practice exam serves as the
ultimate study companion for passing the Relias Basic A
Dysrhythmia competency assessment on your very first
attempt. Every objective multiple-choice question is paired
with direct answers and detailed, authoritative rationales
mapping out exact grid measurements, interval timings, and
clinical interventions. Master complex heart blocks,
pacemaker malfunctions, and lethal ventricular rhythms
using this premium, high-yield document designed to
guarantee clinical verification success.
Question 1
A patient's ECG rhythm strip shows a regular rhythm, a
heart rate of 72 bpm, upright P waves preceding every QRS
complex, a PR interval of 0.16 seconds, and a QRS duration
of 0.08 seconds. How should the nurse interpret this
rhythm?
A) Sinus Bradycardia
B) Normal Sinus Rhythm
C) First-Degree AV Block
D) Junctional Rhythm
Answer: B
Rationale: Normal Sinus Rhythm is characterized by a
,regular rhythm, a heart rate between 60–100 bpm, uniform
upright P waves before every QRS complex, a normal PR
interval (0.12–0.20 seconds), and a narrow QRS complex
(<0.12 seconds). All measurements for this patient fall
perfectly within these standard physiological benchmarks.
Question 2
The nurse notes pacemaker spikes on a patient's monitor,
but these spikes are not followed by a QRS complex or a P
wave. Which pacemaker malfunction does this indicate?
A) Failure to Pace
B) Failure to Sense
C) Failure to Capture
D) Oversensing
Answer: C
Rationale: Failure to capture occurs when the pacemaker
fires an electrical impulse (visible as a spike), but the
myocardium fails to depolarize in response. Visually, this is
seen as pacemaker spikes that are completely uncoupled
from a following P wave or QRS complex, indicating the
chamber did not respond to the stimulus.
Question 3
An ECG rhythm strip reveals a regular rhythm with a heart
rate of 142 bpm. The P waves are upright, identical, and
precede every QRS complex. The PR interval is 0.14
seconds and the QRS complex is 0.06 seconds. Which
,rhythm is present?
A) Supraventricular Tachycardia
B) Ventricular Tachycardia
C) Sinus Tachycardia
D) Atrial Flutter
Answer: C
Rationale: Sinus Tachycardia meets all the baseline criteria
for normal sinus rhythm except that the sinoatrial (SA) node
fires at an accelerated rate between 101 and 150 bpm.
Because normal, upright P waves are clearly distinguishable
before every narrow QRS complex, it is classified as sinus
tachycardia rather than SVT.
Question 4
A telemetry strip demonstrates a rhythm where the PR
interval progressively lengthens with each subsequent
heartbeat until a QRS complex is entirely dropped. After the
dropped beat, the cycle repeats. What is this dysrhythmia?
A) First-Degree AV Block
B) Second-Degree AV Block, Type I (Wenckebach)
C) Second-Degree AV Block, Type II (Mobitz II)
D) Third-Degree AV Block
Answer: B
Rationale: Second-Degree AV Block Type I (Wenckebach) is
defined by a progressive structural delay at the AV node.
This creates a PR interval that grows longer beat by beat
until an atrial impulse is blocked entirely, resulting in a
, dropped QRS. A helpful clinical memory aid is: "longer,
longer, longer, drop, now you have a Wenckebach."
Question 5
The nurse analyzes a rhythm strip and finds an irregularly
irregular ventricular rhythm with no visible P waves. The
baseline appears chaotic and wavy. What is the priority
intervention if the patient is stable?
A) Immediate Defibrillation
B) Administration of Adenosine
C) Rate control medication (e.g., Beta-blocker or Calcium
Channel Blocker)
D) Administration of Atropine
Answer: C
Rationale: The description identifies Atrial Fibrillation (A-
Fib), which features chaotic atrial activity and an irregularly
irregular ventricular response. For a stable patient, the
primary clinical goals are achieving ventricular rate control
(using drugs like Diltiazem or Metoprolol) and assessing the
patient's long-term thromboembolic stroke risk.
Question 6
While reviewing a monitor, the nurse notes three or more
consecutive, wide, and bizarre QRS complexes occurring at
a rapid rate of 160 bpm with no visible P waves. The patient
is awake, alert, and has a strong radial pulse. What is the
immediate treatment?
