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ECG ANALYSIS: RHYTHM RECOGNITION (RELIAS) TEST EXAM
COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST EDITION
2026
ECG Analysis: Rhythm Recognition (Relias) Test — Questions
10-Point Summarized Exam Coverage
1. ECG Fundamentals & Measurements: Paper speed, small/large box values, waveform
components (P, QRS, T, U), intervals (PR, QRS, QT), and normal values.
2. Heart Rate Calculation & Rhythm Determination: 6-second method, R-R interval
method, regular vs. irregular rhythms, and systematic rhythm analysis.
3. Sinus Rhythms: Normal sinus rhythm, sinus bradycardia, sinus tachycardia, sinus
arrhythmia, and sinus arrest.
4. Atrial Dysrhythmias: Premature atrial contractions (PACs), atrial fibrillation, atrial flutter,
wandering atrial pacemaker, and multifocal atrial tachycardia.
5. Junctional Rhythms: Junctional rhythm, accelerated junctional rhythm, junctional
tachycardia, and premature junctional contractions (PJCs).
6. Ventricular Dysrhythmias: Premature ventricular contractions (PVCs), ventricular
tachycardia (VT), ventricular fibrillation (VF), idioventricular rhythm, and asystole.
7. Atrioventricular (AV) Blocks: First-degree, second-degree Type I (Wenckebach), second-
degree Type II (Mobitz II), and third-degree (complete) heart block.
8. Pacemaker Rhythms & Malfunctions: Pacing spikes, atrial/ventricular pacing, failure to
pace, failure to capture, and failure to sense.
9. Clinical Response & ACLS Management: Lethal rhythms requiring defibrillation,
symptomatic bradycardia requiring atropine, and unstable tachycardia requiring
cardioversion.
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10. 12-Lead ECG & Ischemia Recognition: ST-segment elevation MI localization, reciprocal
changes, and electrolyte-induced ECG changes.
SECTION 1: ECG FUNDAMENTALS & MEASUREMENTS (Questions 1–40)
Question 1
What does the horizontal axis on a standard ECG tracing measure?
A) Voltage
B) Time
C) Amplitude
D) Resistance
Answer: B
Rationale: The horizontal axis on an ECG measures time, while the vertical axis measures
voltage or amplitude. Each small box represents 0.04 seconds at standard paper speed.
Question 2
How many seconds does one small box represent on standard ECG paper running at 25
mm/sec?
A) 0.04 seconds
B) 0.20 seconds
C) 0.10 seconds
D) 0.01 seconds
Answer: A
Rationale: At the standard paper speed of 25 mm/sec, each small box equals 0.04 seconds. Five
small boxes (one large box) equal 0.20 seconds.
Question 3
Which ECG wave represents atrial depolarization?
A) P wave
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B) QRS complex
C) T wave
D) U wave
Answer: A
Rationale: The P wave reflects the spread of electrical impulse through the atria, causing atrial
contraction.
Question 4
Which ECG component represents ventricular depolarization?
A) P wave
B) PR interval
C) QRS complex
D) QT interval
Answer: C
Rationale: The QRS complex represents the spread of the electrical impulse through the
ventricles, triggering ventricular contraction.
Question 5
What is the normal duration of the PR interval on a standard ECG tracing?
A) 0.04–0.08 seconds
B) 0.12–0.20 seconds
C) 0.20–0.24 seconds
D) 0.24–0.30 seconds
Answer: B
Rationale: The normal PR interval measures 0.12–0.20 seconds (3–5 small boxes), representing
conduction through the atrium and AV node.
Question 6
What is the normal intrinsic firing rate of the sinoatrial (SA) node?
A) 20–40 bpm
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B) 40–60 bpm
C) 60–100 bpm
D) 100–150 bpm
Answer: C
Rationale: The SA node possesses the highest intrinsic firing rate (approximately 60–100 bpm)
and therefore initiates normal cardiac depolarization.
Question 7
Which structure normally functions as the heart's primary pacemaker?
A) Atrioventricular node
B) Bundle of His
C) Sinoatrial node
D) Purkinje fibers
Answer: C
Rationale: The SA node has the highest intrinsic firing rate and initiates normal cardiac
depolarization. The AV node, Bundle of His, and Purkinje fibers act as backup pacemakers.
Question 8
What is the normal heart rate range for sinus rhythm in an adult at rest?
A) 40–60 beats per minute
B) 60–100 beats per minute
C) 100–120 beats per minute
D) 120–140 beats per minute
Answer: B
Rationale: Normal sinus rhythm in resting adults ranges from 60–100 bpm. This is the standard
baseline for cardiac rhythm interpretation.
Question 9
What does the PR interval represent on an ECG?
A) Time from P wave to R wave peak
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ECG ANALYSIS: RHYTHM RECOGNITION (RELIAS) TEST EXAM
COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST EDITION
2026
ECG Analysis: Rhythm Recognition (Relias) Test — Questions
10-Point Summarized Exam Coverage
1. ECG Fundamentals & Measurements: Paper speed, small/large box values, waveform
components (P, QRS, T, U), intervals (PR, QRS, QT), and normal values.
2. Heart Rate Calculation & Rhythm Determination: 6-second method, R-R interval
method, regular vs. irregular rhythms, and systematic rhythm analysis.
3. Sinus Rhythms: Normal sinus rhythm, sinus bradycardia, sinus tachycardia, sinus
arrhythmia, and sinus arrest.
4. Atrial Dysrhythmias: Premature atrial contractions (PACs), atrial fibrillation, atrial flutter,
wandering atrial pacemaker, and multifocal atrial tachycardia.
5. Junctional Rhythms: Junctional rhythm, accelerated junctional rhythm, junctional
tachycardia, and premature junctional contractions (PJCs).
6. Ventricular Dysrhythmias: Premature ventricular contractions (PVCs), ventricular
tachycardia (VT), ventricular fibrillation (VF), idioventricular rhythm, and asystole.
7. Atrioventricular (AV) Blocks: First-degree, second-degree Type I (Wenckebach), second-
degree Type II (Mobitz II), and third-degree (complete) heart block.
8. Pacemaker Rhythms & Malfunctions: Pacing spikes, atrial/ventricular pacing, failure to
pace, failure to capture, and failure to sense.
9. Clinical Response & ACLS Management: Lethal rhythms requiring defibrillation,
symptomatic bradycardia requiring atropine, and unstable tachycardia requiring
cardioversion.
1|Page
,Page 2 of 101
10. 12-Lead ECG & Ischemia Recognition: ST-segment elevation MI localization, reciprocal
changes, and electrolyte-induced ECG changes.
SECTION 1: ECG FUNDAMENTALS & MEASUREMENTS (Questions 1–40)
Question 1
What does the horizontal axis on a standard ECG tracing measure?
A) Voltage
B) Time
C) Amplitude
D) Resistance
Answer: B
Rationale: The horizontal axis on an ECG measures time, while the vertical axis measures
voltage or amplitude. Each small box represents 0.04 seconds at standard paper speed.
Question 2
How many seconds does one small box represent on standard ECG paper running at 25
mm/sec?
A) 0.04 seconds
B) 0.20 seconds
C) 0.10 seconds
D) 0.01 seconds
Answer: A
Rationale: At the standard paper speed of 25 mm/sec, each small box equals 0.04 seconds. Five
small boxes (one large box) equal 0.20 seconds.
Question 3
Which ECG wave represents atrial depolarization?
A) P wave
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B) QRS complex
C) T wave
D) U wave
Answer: A
Rationale: The P wave reflects the spread of electrical impulse through the atria, causing atrial
contraction.
Question 4
Which ECG component represents ventricular depolarization?
A) P wave
B) PR interval
C) QRS complex
D) QT interval
Answer: C
Rationale: The QRS complex represents the spread of the electrical impulse through the
ventricles, triggering ventricular contraction.
Question 5
What is the normal duration of the PR interval on a standard ECG tracing?
A) 0.04–0.08 seconds
B) 0.12–0.20 seconds
C) 0.20–0.24 seconds
D) 0.24–0.30 seconds
Answer: B
Rationale: The normal PR interval measures 0.12–0.20 seconds (3–5 small boxes), representing
conduction through the atrium and AV node.
Question 6
What is the normal intrinsic firing rate of the sinoatrial (SA) node?
A) 20–40 bpm
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B) 40–60 bpm
C) 60–100 bpm
D) 100–150 bpm
Answer: C
Rationale: The SA node possesses the highest intrinsic firing rate (approximately 60–100 bpm)
and therefore initiates normal cardiac depolarization.
Question 7
Which structure normally functions as the heart's primary pacemaker?
A) Atrioventricular node
B) Bundle of His
C) Sinoatrial node
D) Purkinje fibers
Answer: C
Rationale: The SA node has the highest intrinsic firing rate and initiates normal cardiac
depolarization. The AV node, Bundle of His, and Purkinje fibers act as backup pacemakers.
Question 8
What is the normal heart rate range for sinus rhythm in an adult at rest?
A) 40–60 beats per minute
B) 60–100 beats per minute
C) 100–120 beats per minute
D) 120–140 beats per minute
Answer: B
Rationale: Normal sinus rhythm in resting adults ranges from 60–100 bpm. This is the standard
baseline for cardiac rhythm interpretation.
Question 9
What does the PR interval represent on an ECG?
A) Time from P wave to R wave peak
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