R ELIA S LEA R NING | CO M P ETENCY A S S ES S M ENT |
20 26/ 20 27 ACA D EM IC YEA R
Dysrhythmia
Basic A
Actual Exam
A complete verified examination aligned with the Relias
Learning Dysrhythmia Basic A competency assessment and
basic EKG interpretation standards. Thirty-five scenario-
driven and recall questions covering cardiac conduction,
sinus rhythms, atrial and ventricular dysrhythmias, AV
blocks, pacemaker function, electrolyte effects, and
emergency response, each with a verified answer and a
detailed rationale.
35 5
Questions with verified answers Sections covering all content domains
Verified
Scenario-based and recall mix Answer key with rationales
QS & A S | V E RI F I E D A NSW E RS | BA SI C E KG I NTE RP RE TATI ON COM P E TE NCY
, Relias Dysrhythmia Basic A Actual Exam
Relias Learning | 2026/2027 Academic Year | Verified Questions and Answers | Basic EKG
Interpretation Competency
35 Questions | 5 Content Sections | Complete Answer Key with Dysrhythmia-Specific Rationales | Aligned with Relias
Learning competency assessment format and testing standards (75% scenario-based with rhythm strip descriptions, 25% direct
recall; cognitive mix: 25% recall, 50% application, 25% analysis) | Settings: medical-surgical, telemetry, and progressive care
Section 1: Cardiac Conduction, EKG Fundamentals, and Questions 1-8
Sinus Rhythms
Q1: Which structure serves as the primary pacemaker of the heart, and what is its intrinsic
firing rate?
A. The sinoatrial (SA) node, with an intrinsic firing rate of 60 to 100 beats per minute
[CORRECT]
B. The atrioventricular (AV) node, with an intrinsic firing rate of 60 to 100 beats per
minute
C. The Bundle of His, with an intrinsic firing rate of 100 to 150 beats per minute
D. The Purkinje fibers, with an intrinsic firing rate of 40 to 60 beats per minute
Correct Answer: A
Rationale: The SA node is the heart's dominant pacemaker and depolarizes at an intrinsic rate of 60 to 100
beats per minute, which is why a rhythm originating here is classified as sinus. Option B misplaces that rate
on the AV node, which is the secondary pacemaker firing at 40 to 60 beats per minute. Option C is wrong
because the Bundle of His belongs to the junctional region at 40 to 60, and option D gives the Purkinje
fibers, the tertiary pacemaker, a rate of 20 to 40 beats per minute. This pacemaker hierarchy explains
overdrive suppression: whenever a faster site fails, a slower escape rhythm emerges, a concept tested
repeatedly on the Relias dysrhythmia assessment.
Relias Dysrhythmia Basic A | Relias Learning Competency Assessment Preparation 1
, Relias Dysrhythmia Basic A Actual Exam - Relias Learning - 2026/2027 Academic Year - Verified Questions and Answers
Q2: Measured from the beginning of the P wave to the beginning of the QRS complex, the
normal PR interval is:
A. 0.06 to 0.10 second
B. 0.12 to 0.20 second [CORRECT]
C. 0.22 to 0.32 second
D. 0.34 to 0.44 second
Correct Answer: B
Rationale: The normal PR interval spans 0.12 to 0.20 second, or 3 to 5 small boxes on standard EKG paper,
representing conduction time from atrial depolarization through the AV node to the onset of ventricular
depolarization. Option A (0.06 to 0.10 second) describes the normal QRS duration, a classic Relias distractor
that confuses the two intervals. A PR interval greater than 0.20 second defines first-degree AV block, while a
PR shorter than 0.12 second with an inverted or absent P wave suggests a junctional origin. Accurate interval
measurement is a core Basic A competency because miscounting small boxes is the most common cause of
rhythm misidentification.
Q3: While reviewing a telemetry strip, a nurse counts 7 QRS complexes within a 6-second strip
(30 large boxes). Using the 6-second method, what is the patient's ventricular rate?
A. 42 beats per minute
B. 77 beats per minute
C. 70 beats per minute [CORRECT]
D. 140 beats per minute
Correct Answer: C
Rationale: The 6-second method is performed by counting the QRS complexes in a 6-second strip (30 large
boxes) and multiplying by 10, so 7 complexes equals a rate of 70 beats per minute. Option B results from
improperly averaging R-R intervals rather than applying the method, and options A and D reflect doubling or
halving counting errors. This method is the preferred rapid technique for irregular rhythms such as atrial
fibrillation because it does not depend on consistent R-R spacing. The 1500 small-box method and the 300
large-box method should be reserved for regular rhythms, where they provide greater precision.
Relias Dysrhythmia Basic A | Relias Learning Competency Assessment Preparation 2
20 26/ 20 27 ACA D EM IC YEA R
Dysrhythmia
Basic A
Actual Exam
A complete verified examination aligned with the Relias
Learning Dysrhythmia Basic A competency assessment and
basic EKG interpretation standards. Thirty-five scenario-
driven and recall questions covering cardiac conduction,
sinus rhythms, atrial and ventricular dysrhythmias, AV
blocks, pacemaker function, electrolyte effects, and
emergency response, each with a verified answer and a
detailed rationale.
35 5
Questions with verified answers Sections covering all content domains
Verified
Scenario-based and recall mix Answer key with rationales
QS & A S | V E RI F I E D A NSW E RS | BA SI C E KG I NTE RP RE TATI ON COM P E TE NCY
, Relias Dysrhythmia Basic A Actual Exam
Relias Learning | 2026/2027 Academic Year | Verified Questions and Answers | Basic EKG
Interpretation Competency
35 Questions | 5 Content Sections | Complete Answer Key with Dysrhythmia-Specific Rationales | Aligned with Relias
Learning competency assessment format and testing standards (75% scenario-based with rhythm strip descriptions, 25% direct
recall; cognitive mix: 25% recall, 50% application, 25% analysis) | Settings: medical-surgical, telemetry, and progressive care
Section 1: Cardiac Conduction, EKG Fundamentals, and Questions 1-8
Sinus Rhythms
Q1: Which structure serves as the primary pacemaker of the heart, and what is its intrinsic
firing rate?
A. The sinoatrial (SA) node, with an intrinsic firing rate of 60 to 100 beats per minute
[CORRECT]
B. The atrioventricular (AV) node, with an intrinsic firing rate of 60 to 100 beats per
minute
C. The Bundle of His, with an intrinsic firing rate of 100 to 150 beats per minute
D. The Purkinje fibers, with an intrinsic firing rate of 40 to 60 beats per minute
Correct Answer: A
Rationale: The SA node is the heart's dominant pacemaker and depolarizes at an intrinsic rate of 60 to 100
beats per minute, which is why a rhythm originating here is classified as sinus. Option B misplaces that rate
on the AV node, which is the secondary pacemaker firing at 40 to 60 beats per minute. Option C is wrong
because the Bundle of His belongs to the junctional region at 40 to 60, and option D gives the Purkinje
fibers, the tertiary pacemaker, a rate of 20 to 40 beats per minute. This pacemaker hierarchy explains
overdrive suppression: whenever a faster site fails, a slower escape rhythm emerges, a concept tested
repeatedly on the Relias dysrhythmia assessment.
Relias Dysrhythmia Basic A | Relias Learning Competency Assessment Preparation 1
, Relias Dysrhythmia Basic A Actual Exam - Relias Learning - 2026/2027 Academic Year - Verified Questions and Answers
Q2: Measured from the beginning of the P wave to the beginning of the QRS complex, the
normal PR interval is:
A. 0.06 to 0.10 second
B. 0.12 to 0.20 second [CORRECT]
C. 0.22 to 0.32 second
D. 0.34 to 0.44 second
Correct Answer: B
Rationale: The normal PR interval spans 0.12 to 0.20 second, or 3 to 5 small boxes on standard EKG paper,
representing conduction time from atrial depolarization through the AV node to the onset of ventricular
depolarization. Option A (0.06 to 0.10 second) describes the normal QRS duration, a classic Relias distractor
that confuses the two intervals. A PR interval greater than 0.20 second defines first-degree AV block, while a
PR shorter than 0.12 second with an inverted or absent P wave suggests a junctional origin. Accurate interval
measurement is a core Basic A competency because miscounting small boxes is the most common cause of
rhythm misidentification.
Q3: While reviewing a telemetry strip, a nurse counts 7 QRS complexes within a 6-second strip
(30 large boxes). Using the 6-second method, what is the patient's ventricular rate?
A. 42 beats per minute
B. 77 beats per minute
C. 70 beats per minute [CORRECT]
D. 140 beats per minute
Correct Answer: C
Rationale: The 6-second method is performed by counting the QRS complexes in a 6-second strip (30 large
boxes) and multiplying by 10, so 7 complexes equals a rate of 70 beats per minute. Option B results from
improperly averaging R-R intervals rather than applying the method, and options A and D reflect doubling or
halving counting errors. This method is the preferred rapid technique for irregular rhythms such as atrial
fibrillation because it does not depend on consistent R-R spacing. The 1500 small-box method and the 300
large-box method should be reserved for regular rhythms, where they provide greater precision.
Relias Dysrhythmia Basic A | Relias Learning Competency Assessment Preparation 2
