Relias Dysrhythmia Basic Test - Basic A | 2026/2027 Edition 35 Verified Questions and 100% Correct Answers
Relias Dysrhythmia Basic Test - Basic A
35 Verified Questions and 100% Correct Answers | 2026/2027 Edition
Total Questions 35 multiple-choice questions, each with 4 options and exactly one correct answer
Cognitive Levels 25% Recall | 50% Application | 25% Analysis
75% Scenario-Based with Rhythm Strip Descriptions | 25% Direct Recall and Concept
Question Style
Identification
Relias Competency Assessment format with current ACLS guidelines and EKG standards
Standards Alignment
(2026/2027 update)
Practice Settings Medical-Surgical, Telemetry, and Progressive Care
Section 1: Cardiac Conduction, EKG Fundamentals, and Sinus Rhythms
Questions 1-8 - Conduction System, EKG Waveform Components, Rate Calculation Methods, Normal Sinus Rhythm, Sinus
Bradycardia, Sinus Tachycardia, and Sinus Arrhythmia
Q1: Which structure serves as the primary pacemaker of the heart by initiating electrical impulses at an
intrinsic rate of 60 to 100 beats per minute?
A. Atrioventricular (AV) node
B. Sinoatrial (SA) node [CORRECT]
C. Bundle of His
D. Left bundle branch and Purkinje fibers
Correct Answer: B
Rationale: The SA node, located in the upper wall of the right atrium, is the dominant pacemaker of the heart and
fires at an intrinsic rate of 60 to 100 beats per minute, which defines normal sinus rhythm. The AV node (Option
A) serves as the gatekeeper of AV conduction with an intrinsic rate of only 40 to 60 beats per minute and assumes
pacemaker control only if the SA node fails. The Bundle of His (Option C) and the bundle branches with Purkinje
fibers (Option D) have progressively slower intrinsic rates of 20 to 40 beats per minute and function as backup
escape pacemakers rather than the primary pacemaker.
Cardiac Monitoring Certification Preparation 1
,Relias Dysrhythmia Basic Test - Basic A | 2026/2027 Edition 35 Verified Questions and 100% Correct Answers
Q2: A nurse is measuring EKG intervals on a patient's rhythm strip. Which PR interval value falls within the
normal adult range?
A. 0.06 second
B. 0.10 second
C. 0.26 second
D. 0.16 second [CORRECT]
Correct Answer: D
Rationale: The normal PR interval in adults measures 0.12 to 0.20 seconds (3 to 5 small boxes) and represents the
time required for the impulse to travel from the SA node through the atria, the AV node, and the His-Purkinje
system into the ventricles. A PR interval of 0.16 second falls comfortably within this range and indicates normal
AV conduction. Values of 0.06 and 0.10 second (Options A and B) are abnormally short and may suggest
pre-excitation such as Wolff-Parkinson-White syndrome, while a PR interval of 0.26 second (Option C) exceeds
0.20 second and indicates first-degree AV block.
Q3: A telemetry monitor prints a 6-second rhythm strip containing 8 QRS complexes. Using the 6-second
method, which ventricular rate should the nurse document?
A. 48 beats per minute
B. 60 beats per minute
C. 80 beats per minute [CORRECT]
D. 96 beats per minute
Correct Answer: C
Rationale: The 6-second method calculates rate by counting the QRS complexes within a 6-second strip (30 large
boxes) and multiplying that number by 10, so 8 complexes yield a ventricular rate of 80 beats per minute. This
quick method is reliable even for irregular rhythms, although the 1500 small-box method provides greater
precision for regular rhythms. A result of 48 (Option A) or 60 (Option B) reflects miscounting complexes or
mixing up the 1500 and 300 methods, and 96 (Option D) results from doubling rather than multiplying by 10, a
common calculation error that misclassifies a normal rate as tachycardia.
Q4: A nurse reviews a rhythm strip showing a regular rhythm at a rate of 74 beats per minute with one
upright, round P wave preceding every QRS complex, a PR interval of 0.16 second, and a QRS duration of
0.08 second. How should the nurse interpret this rhythm?
A. Normal sinus rhythm [CORRECT]
B. Sinus bradycardia
C. First-degree AV block
D. Sinus arrhythmia
Correct Answer: A
Rationale: Every criterion of normal sinus rhythm is met on this strip: a single upright P wave before every QRS,
a regular R-R interval, a rate between 60 and 100 beats per minute, a PR interval of 0.12 to 0.20 second, and a
QRS duration under 0.12 second. Sinus bradycardia (Option B) requires a rate below 60 beats per minute, and
first-degree AV block (Option C) requires a PR interval greater than 0.20 second. Sinus arrhythmia (Option D)
requires an irregular R-R interval that typically varies with respiration, which is not present on this strip.
Cardiac Monitoring Certification Preparation 2
, Relias Dysrhythmia Basic Test - Basic A | 2026/2027 Edition 35 Verified Questions and 100% Correct Answers
Q5: A patient's monitor shows a regular sinus rhythm at a rate of 42 beats per minute with normal P-QRS-T
sequences. The patient reports dizziness, is pale and diaphoretic, and has a blood pressure of 86/50 mm Hg.
Which action should the nurse take first?
A. Document the finding and continue routine monitoring
B. Increase the low-rate alarm limit to 35 beats per minute
C. Encourage the patient to cough deeply and recheck the rate
D. Administer atropine as prescribed under the symptomatic bradycardia protocol [CORRECT]
Correct Answer: D
Rationale: Sinus bradycardia originates in the SA node at a rate below 60 beats per minute and becomes clinically
significant when the slow rate compromises cardiac output, producing hypotension, dizziness, pallor, and
diaphoresis as seen in this patient. The nurse should implement the symptomatic bradycardia protocol,
administering atropine as prescribed while preparing transcutaneous pacing in case the response is inadequate.
Routine documentation (Option A) delays necessary treatment, adjusting alarm limits (Option B) merely silences
the warning without treating the patient, and forceful coughing (Option C) is not an intervention for symptomatic
bradycardia.
Q6: A postoperative patient has a regular sinus tachycardia at 118 beats per minute, a temperature of 101.8
degrees F, and reports incisional pain rated 8 on a 0 to 10 scale. Which intervention should the nurse
anticipate?
A. Immediate synchronized cardioversion
B. Defibrillation at 200 joules
C. Treating the underlying causes of pain and fever [CORRECT]
D. Preparing for transcutaneous pacing
Correct Answer: C
Rationale: Sinus tachycardia originates in the SA node at a rate greater than 100 beats per minute and is almost
always a compensatory response to an identifiable physiologic demand such as pain, fever, hypovolemia, anxiety,
or medication effects. The correct intervention is to identify and treat the underlying causes, here pain and fever,
rather than applying electrical therapy to a rhythm that is protecting the patient's perfusion. Synchronized
cardioversion (Option A) and defibrillation (Option B) are reserved for unstable tachyarrhythmias and pulseless
rhythms and are never indicated for sinus tachycardia, while transcutaneous pacing (Option D) treats symptomatic
bradycardia, the opposite rate disturbance.
Cardiac Monitoring Certification Preparation 3
Relias Dysrhythmia Basic Test - Basic A
35 Verified Questions and 100% Correct Answers | 2026/2027 Edition
Total Questions 35 multiple-choice questions, each with 4 options and exactly one correct answer
Cognitive Levels 25% Recall | 50% Application | 25% Analysis
75% Scenario-Based with Rhythm Strip Descriptions | 25% Direct Recall and Concept
Question Style
Identification
Relias Competency Assessment format with current ACLS guidelines and EKG standards
Standards Alignment
(2026/2027 update)
Practice Settings Medical-Surgical, Telemetry, and Progressive Care
Section 1: Cardiac Conduction, EKG Fundamentals, and Sinus Rhythms
Questions 1-8 - Conduction System, EKG Waveform Components, Rate Calculation Methods, Normal Sinus Rhythm, Sinus
Bradycardia, Sinus Tachycardia, and Sinus Arrhythmia
Q1: Which structure serves as the primary pacemaker of the heart by initiating electrical impulses at an
intrinsic rate of 60 to 100 beats per minute?
A. Atrioventricular (AV) node
B. Sinoatrial (SA) node [CORRECT]
C. Bundle of His
D. Left bundle branch and Purkinje fibers
Correct Answer: B
Rationale: The SA node, located in the upper wall of the right atrium, is the dominant pacemaker of the heart and
fires at an intrinsic rate of 60 to 100 beats per minute, which defines normal sinus rhythm. The AV node (Option
A) serves as the gatekeeper of AV conduction with an intrinsic rate of only 40 to 60 beats per minute and assumes
pacemaker control only if the SA node fails. The Bundle of His (Option C) and the bundle branches with Purkinje
fibers (Option D) have progressively slower intrinsic rates of 20 to 40 beats per minute and function as backup
escape pacemakers rather than the primary pacemaker.
Cardiac Monitoring Certification Preparation 1
,Relias Dysrhythmia Basic Test - Basic A | 2026/2027 Edition 35 Verified Questions and 100% Correct Answers
Q2: A nurse is measuring EKG intervals on a patient's rhythm strip. Which PR interval value falls within the
normal adult range?
A. 0.06 second
B. 0.10 second
C. 0.26 second
D. 0.16 second [CORRECT]
Correct Answer: D
Rationale: The normal PR interval in adults measures 0.12 to 0.20 seconds (3 to 5 small boxes) and represents the
time required for the impulse to travel from the SA node through the atria, the AV node, and the His-Purkinje
system into the ventricles. A PR interval of 0.16 second falls comfortably within this range and indicates normal
AV conduction. Values of 0.06 and 0.10 second (Options A and B) are abnormally short and may suggest
pre-excitation such as Wolff-Parkinson-White syndrome, while a PR interval of 0.26 second (Option C) exceeds
0.20 second and indicates first-degree AV block.
Q3: A telemetry monitor prints a 6-second rhythm strip containing 8 QRS complexes. Using the 6-second
method, which ventricular rate should the nurse document?
A. 48 beats per minute
B. 60 beats per minute
C. 80 beats per minute [CORRECT]
D. 96 beats per minute
Correct Answer: C
Rationale: The 6-second method calculates rate by counting the QRS complexes within a 6-second strip (30 large
boxes) and multiplying that number by 10, so 8 complexes yield a ventricular rate of 80 beats per minute. This
quick method is reliable even for irregular rhythms, although the 1500 small-box method provides greater
precision for regular rhythms. A result of 48 (Option A) or 60 (Option B) reflects miscounting complexes or
mixing up the 1500 and 300 methods, and 96 (Option D) results from doubling rather than multiplying by 10, a
common calculation error that misclassifies a normal rate as tachycardia.
Q4: A nurse reviews a rhythm strip showing a regular rhythm at a rate of 74 beats per minute with one
upright, round P wave preceding every QRS complex, a PR interval of 0.16 second, and a QRS duration of
0.08 second. How should the nurse interpret this rhythm?
A. Normal sinus rhythm [CORRECT]
B. Sinus bradycardia
C. First-degree AV block
D. Sinus arrhythmia
Correct Answer: A
Rationale: Every criterion of normal sinus rhythm is met on this strip: a single upright P wave before every QRS,
a regular R-R interval, a rate between 60 and 100 beats per minute, a PR interval of 0.12 to 0.20 second, and a
QRS duration under 0.12 second. Sinus bradycardia (Option B) requires a rate below 60 beats per minute, and
first-degree AV block (Option C) requires a PR interval greater than 0.20 second. Sinus arrhythmia (Option D)
requires an irregular R-R interval that typically varies with respiration, which is not present on this strip.
Cardiac Monitoring Certification Preparation 2
, Relias Dysrhythmia Basic Test - Basic A | 2026/2027 Edition 35 Verified Questions and 100% Correct Answers
Q5: A patient's monitor shows a regular sinus rhythm at a rate of 42 beats per minute with normal P-QRS-T
sequences. The patient reports dizziness, is pale and diaphoretic, and has a blood pressure of 86/50 mm Hg.
Which action should the nurse take first?
A. Document the finding and continue routine monitoring
B. Increase the low-rate alarm limit to 35 beats per minute
C. Encourage the patient to cough deeply and recheck the rate
D. Administer atropine as prescribed under the symptomatic bradycardia protocol [CORRECT]
Correct Answer: D
Rationale: Sinus bradycardia originates in the SA node at a rate below 60 beats per minute and becomes clinically
significant when the slow rate compromises cardiac output, producing hypotension, dizziness, pallor, and
diaphoresis as seen in this patient. The nurse should implement the symptomatic bradycardia protocol,
administering atropine as prescribed while preparing transcutaneous pacing in case the response is inadequate.
Routine documentation (Option A) delays necessary treatment, adjusting alarm limits (Option B) merely silences
the warning without treating the patient, and forceful coughing (Option C) is not an intervention for symptomatic
bradycardia.
Q6: A postoperative patient has a regular sinus tachycardia at 118 beats per minute, a temperature of 101.8
degrees F, and reports incisional pain rated 8 on a 0 to 10 scale. Which intervention should the nurse
anticipate?
A. Immediate synchronized cardioversion
B. Defibrillation at 200 joules
C. Treating the underlying causes of pain and fever [CORRECT]
D. Preparing for transcutaneous pacing
Correct Answer: C
Rationale: Sinus tachycardia originates in the SA node at a rate greater than 100 beats per minute and is almost
always a compensatory response to an identifiable physiologic demand such as pain, fever, hypovolemia, anxiety,
or medication effects. The correct intervention is to identify and treat the underlying causes, here pain and fever,
rather than applying electrical therapy to a rhythm that is protecting the patient's perfusion. Synchronized
cardioversion (Option A) and defibrillation (Option B) are reserved for unstable tachyarrhythmias and pulseless
rhythms and are never indicated for sinus tachycardia, while transcutaneous pacing (Option D) treats symptomatic
bradycardia, the opposite rate disturbance.
Cardiac Monitoring Certification Preparation 3
