Relias Learning | Dysrhythmia Basic A Competency Assessment
Relias Dysrhythmia Basic A Examination
2026/2027 | Verified Questions
Relias Learning | Dysrhythmia Basic A Competency | Professional Nursing & Telemetry Candidates
35 Verified Questions | 7 Core Domains | Academic Year 2026/2027
Prepared by
Relias Learning | Dysrhythmia Basic A Competency Assessment
Dysrhythmia Basic A Examination Actual Exam | Academic Year 2026/2027
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
,INTRODUCTION
This document contains 35 original certification-level questions covering the full Relias Dysrhythmia Basic A
assessment. It addresses ECG Fundamentals, Anatomy & Lead Placement; Sinus Rhythms & Sinus Arrhythmias;
Atrial Dysrhythmias; Junctional Rhythms; Ventricular Rhythms & Lethal Dysrhythmias; AV Heart Blocks &
Conduction Abnormalities; and Pacemaker Rhythms & Clinical Intervention. The content reinforces the
Dysrhythmia Basic A Examination objectives for actual exam readiness and rhythm interpretation proficiency,
aligned to the 2026/2027 academic year.
ACTUAL QUESTIONS
Domain 1: ECG Fundamentals, Anatomy & Lead Placement
Question 1. A 62-year-old patient has an ECG strip showing regular rhythm at 80 bpm. Each P
wave is upright in leads I and II and precedes every QRS complex with identical morphology.
Which statement best characterizes the P waves and atrial depolarization pattern?
Diagram: schematic rhythm strip for interpretation.
A. P waves are present and represent organized atrial depolarization originating from the sinoatrial (SA)
node.
B. P waves are absent, indicating atrial fibrillation.
C. P waves are inverted in leads I and II, consistent with an ectopic atrial rhythm.
D. P waves vary in morphology beat-to-beat, consistent with multifocal atrial tachycardia.
Correct Answer: A
Rationale: Upright, identical P waves in leads I and II occurring before each QRS in a regular rhythm indicate
organized atrial depolarization most consistent with sinus rhythm originating from the SA node. Absence,
inversion, or beat-to-beat variability would indicate other atrial arrhythmias.
Question 2. A 28-year-old woman presents with syncope. Telemetry shows a polymorphic wide-
complex tachycardia twisting around the baseline with QTc 560 ms. She is hypotensive and
pulseless. Which intervention is most specific and immediately indicated?
A. IV procainamide infusion as first-line therapy
B. Intravenous magnesium sulfate and immediate unsynchronized defibrillation
C. Synchronized cardioversion at 50 J
D. Increase potassium to high-normal with oral supplementation
Correct Answer: B
Rationale: Torsades de pointes is a polymorphic VT associated with prolonged QTc. In unstable or pulseless
cases, immediate defibrillation is required; IV magnesium sulfate is the drug of choice for torsades even if
serum magnesium is normal. Procainamide can worsen torsades by prolonging QT. Oral potassium is too
slow for immediate management; IV potassium may be used to correct hypokalemia.
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
, Question 3. A patient with a single-chamber ventricular pacemaker has spikes occurring at the
programmed rate but several spikes are not followed by QRS complexes. Blood pressure is
dropping and the monitor shows repetitive non-captured spikes. Which is the most appropriate
immediate action?
A. Administer IV atropine and await device clinic to reprogram later
B. Turn off telemetry and observe patient; noncaptured spikes are benign if regular
C. Verify lead integrity and battery status on the programmer, then increase pacing output (mA) to achieve
capture
D. Immediately place transcutaneous pacing pads and prepare for external pacing only if output increase
fails
Correct Answer: C
Rationale: Failure to capture (pacing spikes without resultant depolarization) requires prompt identification
and correction. The immediate device intervention is to increase pacing output (mA) to regain capture after
confirming lead and battery issues; this can often be done quickly at the bedside or by device
representative/programmer. Atropine addresses bradycardia from intrinsic causes, not capture failure.
Turning off telemetry is inappropriate. While transcutaneous pacing is a backup for unstable patients if
internal reprogramming fails, first corrective step is to adjust output.
Question 4. A 78-year-old man with hypertension presents with sudden onset palpitations and
mild dyspnea. ECG rhythm strip (lead II) shows an irregularly irregular rhythm, absent distinct
P waves, baseline fibrillatory waves, and a ventricular rate of 130 bpm. Which is the most
appropriate immediate management for rate control in this hemodynamically stable patient?
A. IV diltiazem loading dose 0.25 mg/kg over 2 minutes
B. Immediate synchronized cardioversion at 200 J
C. IV bolus of amiodarone 150 mg over 10 minutes
D. IV epinephrine infusion
Correct Answer: A
Rationale: Atrial fibrillation with rapid ventricular response in a hemodynamically stable patient is best
initially managed with rate control using a beta blocker or a nondihydropyridine calcium-channel blocker
such as IV diltiazem (0.25 mg/kg over 2 min). Synchronized cardioversion is indicated if the patient is
unstable. Amiodarone can be used for rate or rhythm control but is not first-line immediate rate control in
stable patients. Epinephrine would increase heart rate and is inappropriate.
Question 5. A 55-year-old patient on a telemetry floor has an otherwise normal sinus rhythm
with occasional early P waves that have a different morphology and a preceding PR interval of
0.16 seconds; the QRS complexes are narrow and occur earlier than the next expected sinus
beat. The patient is asymptomatic. What is the most appropriate immediate action?
A. Administer IV magnesium and prepare for electrical cardioversion
B. Document as premature atrial contractions and continue monitoring without specific therapy
C. Start IV lidocaine infusion to suppress ectopy
D. Initiate transcutaneous pacing
Correct Answer: B
Rationale: Premature atrial contractions (PACs) are early P waves with different morphology, normal PR or
slightly altered PR, and narrow QRS unless aberrantly conducted. Asymptomatic PACs in a stable patient
generally require no acute therapy; monitoring and addressing reversible causes (electrolytes, stimulants) is
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
Relias Dysrhythmia Basic A Examination
2026/2027 | Verified Questions
Relias Learning | Dysrhythmia Basic A Competency | Professional Nursing & Telemetry Candidates
35 Verified Questions | 7 Core Domains | Academic Year 2026/2027
Prepared by
Relias Learning | Dysrhythmia Basic A Competency Assessment
Dysrhythmia Basic A Examination Actual Exam | Academic Year 2026/2027
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
,INTRODUCTION
This document contains 35 original certification-level questions covering the full Relias Dysrhythmia Basic A
assessment. It addresses ECG Fundamentals, Anatomy & Lead Placement; Sinus Rhythms & Sinus Arrhythmias;
Atrial Dysrhythmias; Junctional Rhythms; Ventricular Rhythms & Lethal Dysrhythmias; AV Heart Blocks &
Conduction Abnormalities; and Pacemaker Rhythms & Clinical Intervention. The content reinforces the
Dysrhythmia Basic A Examination objectives for actual exam readiness and rhythm interpretation proficiency,
aligned to the 2026/2027 academic year.
ACTUAL QUESTIONS
Domain 1: ECG Fundamentals, Anatomy & Lead Placement
Question 1. A 62-year-old patient has an ECG strip showing regular rhythm at 80 bpm. Each P
wave is upright in leads I and II and precedes every QRS complex with identical morphology.
Which statement best characterizes the P waves and atrial depolarization pattern?
Diagram: schematic rhythm strip for interpretation.
A. P waves are present and represent organized atrial depolarization originating from the sinoatrial (SA)
node.
B. P waves are absent, indicating atrial fibrillation.
C. P waves are inverted in leads I and II, consistent with an ectopic atrial rhythm.
D. P waves vary in morphology beat-to-beat, consistent with multifocal atrial tachycardia.
Correct Answer: A
Rationale: Upright, identical P waves in leads I and II occurring before each QRS in a regular rhythm indicate
organized atrial depolarization most consistent with sinus rhythm originating from the SA node. Absence,
inversion, or beat-to-beat variability would indicate other atrial arrhythmias.
Question 2. A 28-year-old woman presents with syncope. Telemetry shows a polymorphic wide-
complex tachycardia twisting around the baseline with QTc 560 ms. She is hypotensive and
pulseless. Which intervention is most specific and immediately indicated?
A. IV procainamide infusion as first-line therapy
B. Intravenous magnesium sulfate and immediate unsynchronized defibrillation
C. Synchronized cardioversion at 50 J
D. Increase potassium to high-normal with oral supplementation
Correct Answer: B
Rationale: Torsades de pointes is a polymorphic VT associated with prolonged QTc. In unstable or pulseless
cases, immediate defibrillation is required; IV magnesium sulfate is the drug of choice for torsades even if
serum magnesium is normal. Procainamide can worsen torsades by prolonging QT. Oral potassium is too
slow for immediate management; IV potassium may be used to correct hypokalemia.
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
, Question 3. A patient with a single-chamber ventricular pacemaker has spikes occurring at the
programmed rate but several spikes are not followed by QRS complexes. Blood pressure is
dropping and the monitor shows repetitive non-captured spikes. Which is the most appropriate
immediate action?
A. Administer IV atropine and await device clinic to reprogram later
B. Turn off telemetry and observe patient; noncaptured spikes are benign if regular
C. Verify lead integrity and battery status on the programmer, then increase pacing output (mA) to achieve
capture
D. Immediately place transcutaneous pacing pads and prepare for external pacing only if output increase
fails
Correct Answer: C
Rationale: Failure to capture (pacing spikes without resultant depolarization) requires prompt identification
and correction. The immediate device intervention is to increase pacing output (mA) to regain capture after
confirming lead and battery issues; this can often be done quickly at the bedside or by device
representative/programmer. Atropine addresses bradycardia from intrinsic causes, not capture failure.
Turning off telemetry is inappropriate. While transcutaneous pacing is a backup for unstable patients if
internal reprogramming fails, first corrective step is to adjust output.
Question 4. A 78-year-old man with hypertension presents with sudden onset palpitations and
mild dyspnea. ECG rhythm strip (lead II) shows an irregularly irregular rhythm, absent distinct
P waves, baseline fibrillatory waves, and a ventricular rate of 130 bpm. Which is the most
appropriate immediate management for rate control in this hemodynamically stable patient?
A. IV diltiazem loading dose 0.25 mg/kg over 2 minutes
B. Immediate synchronized cardioversion at 200 J
C. IV bolus of amiodarone 150 mg over 10 minutes
D. IV epinephrine infusion
Correct Answer: A
Rationale: Atrial fibrillation with rapid ventricular response in a hemodynamically stable patient is best
initially managed with rate control using a beta blocker or a nondihydropyridine calcium-channel blocker
such as IV diltiazem (0.25 mg/kg over 2 min). Synchronized cardioversion is indicated if the patient is
unstable. Amiodarone can be used for rate or rhythm control but is not first-line immediate rate control in
stable patients. Epinephrine would increase heart rate and is inappropriate.
Question 5. A 55-year-old patient on a telemetry floor has an otherwise normal sinus rhythm
with occasional early P waves that have a different morphology and a preceding PR interval of
0.16 seconds; the QRS complexes are narrow and occur earlier than the next expected sinus
beat. The patient is asymptomatic. What is the most appropriate immediate action?
A. Administer IV magnesium and prepare for electrical cardioversion
B. Document as premature atrial contractions and continue monitoring without specific therapy
C. Start IV lidocaine infusion to suppress ectopy
D. Initiate transcutaneous pacing
Correct Answer: B
Rationale: Premature atrial contractions (PACs) are early P waves with different morphology, normal PR or
slightly altered PR, and narrow QRS unless aberrantly conducted. Asymptomatic PACs in a stable patient
generally require no acute therapy; monitoring and addressing reversible causes (electrolytes, stimulants) is
Relias Dysrhythmia Basic A Examination 2026/2027 | Verified Questions
