RELIAS DYSRHYTHMIA BASIC TEST B MASTERY GUIDE 2026 FULL
QUESTION PRACTICE EXAM, ECG RHYTHM INTERPRETATION,
PACEMAKER MALFUNCTIONS, AND ACLS INTERVENTION PROTOCOLS
50 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Differentiate complex dysrhythmias using systematic ECG analysis and clinical context
2 Identify pacemaker malfunction types and apply appropriate troubleshooting algorithms
3 Integrate ACLS pharmacologic and electrical therapies with rhythm-specific protocols
4 Interpret 12-lead ECG findings to localize ischemia and guide reperfusion decisions
5 Relias Dysrhythmia Basic Test B Mastery Guide 2026 Full Question Practice Exam
6 ECG Rhythm Interpretation
7 Pacemaker Malfunctions
8 and ACLS Intervention Protocols for Nurses and Telemetry Technicians
9 Foundations of ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
10 Applied ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
11 Advanced ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
12 ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols Review
ABSTRACT
This study document brings together 50 carefully worded exam questions drawn from Relias
Dysrhythmia Basic Test B Mastery Guide 2026 Full Question Practice Exam, ECG Rhythm
Interpretation, Pacemaker Malfunctions, and ACLS Intervention Protocols for Nurses and
Telemetry Technicians, with the strongest emphasis placed on Differentiate complex dysrhythmias
using systematic ECG analysis and clinical context, Identify pacemaker malfunction types and
apply appropriate troubleshooting algorithms and Integrate ACLS pharmacologic and electrical
therapies with rhythm-specific protocols. Every item follows the wording style and level of
reasoning you meet in the real paper, and each one is paired with a clear rationale so the correct
choice is never a guess. Work through the set at your own pace, mark the questions that slow you
down, then come back to them until the reasoning feels automatic. Learners who revise this way
walk into the exam room recognising the pattern behind the questions instead of meeting them for
the first time. Keep going - steady, honest practice is what turns a difficult paper into a comfortable
pass.
Page 1
,Q1 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A telemetry strip shows a narrow-complex tachycardia at 180 bpm with no visible
P waves. The patient is hemodynamically stable. Which maneuver is most likely to
unmask the underlying rhythm and guide management?
A. Vagal stimulation via carotid sinus massage
B. Administration of intravenous adenosine 6 mg CORRECT
C. Synchronized cardioversion at 100 J
D. Amiodarone 150 mg IV bolus
RATIONALE: Adenosine transiently blocks the AV node, unmasking atrial activity (e.g., flutter
waves or ectopic P waves) and terminating AV nodal reentrant tachycardia. Carotid massage is
less reliable and carries risk; cardioversion is for instability; amiodarone is not first-line for stable
narrow-complex tachycardia.
Q2 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A 12-lead ECG shows ST elevation in leads II, III, and aVF with reciprocal ST
depression in I and aVL. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery CORRECT
D. Left main coronary artery
RATIONALE: ST elevation in inferior leads (II, III, aVF) localizes to the inferior wall, typically
supplied by the right coronary artery (RCA) in a right-dominant circulation. LAD causes anterior
changes; circumflex causes lateral changes; left main causes widespread changes.
Page 2
, Q3 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A patient with a dual-chamber pacemaker set to DDD mode at 60-120 bpm has a
programmed AV delay of 200 ms. The ECG shows pacing spikes before every QRS
but no preceding atrial spikes. What is the most likely explanation?
A. Atrial lead dislodgement
B. Pacemaker syndrome
C. Ventricular safety pacing
D. Atrial undersensing CORRECT
RATIONALE: Atrial undersensing occurs when the pacemaker fails to detect intrinsic atrial
activity, leading to asynchronous atrial pacing (often with spikes). Atrial lead dislodgement would
cause failure to capture; pacemaker syndrome is a clinical diagnosis; ventricular safety pacing is
a specific feature to avoid R-on-T.
Q4 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
During ACLS, a patient in pulseless ventricular tachycardia has received one
shock and one dose of epinephrine. The rhythm remains unchanged. According to
current guidelines, which antiarrhythmic is indicated next?
A. Lidocaine 1-1.5 mg/kg IV push
B. Amiodarone 300 mg IV bolus CORRECT
C. Magnesium sulfate 1-2 g IV
D. Sodium bicarbonate 1 mEq/kg IV
RATIONALE: Amiodarone 300 mg IV bolus is the preferred antiarrhythmic for shock-refractory
VF/pVT. Lidocaine is an alternative; magnesium is for torsades; bicarbonate is not routinely
recommended.
Page 3
QUESTION PRACTICE EXAM, ECG RHYTHM INTERPRETATION,
PACEMAKER MALFUNCTIONS, AND ACLS INTERVENTION PROTOCOLS
50 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Differentiate complex dysrhythmias using systematic ECG analysis and clinical context
2 Identify pacemaker malfunction types and apply appropriate troubleshooting algorithms
3 Integrate ACLS pharmacologic and electrical therapies with rhythm-specific protocols
4 Interpret 12-lead ECG findings to localize ischemia and guide reperfusion decisions
5 Relias Dysrhythmia Basic Test B Mastery Guide 2026 Full Question Practice Exam
6 ECG Rhythm Interpretation
7 Pacemaker Malfunctions
8 and ACLS Intervention Protocols for Nurses and Telemetry Technicians
9 Foundations of ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
10 Applied ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
11 Advanced ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols
12 ECG Rhythm Interpretation, Pacemaker Malfunctions, ACLS Intervention Protocols Review
ABSTRACT
This study document brings together 50 carefully worded exam questions drawn from Relias
Dysrhythmia Basic Test B Mastery Guide 2026 Full Question Practice Exam, ECG Rhythm
Interpretation, Pacemaker Malfunctions, and ACLS Intervention Protocols for Nurses and
Telemetry Technicians, with the strongest emphasis placed on Differentiate complex dysrhythmias
using systematic ECG analysis and clinical context, Identify pacemaker malfunction types and
apply appropriate troubleshooting algorithms and Integrate ACLS pharmacologic and electrical
therapies with rhythm-specific protocols. Every item follows the wording style and level of
reasoning you meet in the real paper, and each one is paired with a clear rationale so the correct
choice is never a guess. Work through the set at your own pace, mark the questions that slow you
down, then come back to them until the reasoning feels automatic. Learners who revise this way
walk into the exam room recognising the pattern behind the questions instead of meeting them for
the first time. Keep going - steady, honest practice is what turns a difficult paper into a comfortable
pass.
Page 1
,Q1 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A telemetry strip shows a narrow-complex tachycardia at 180 bpm with no visible
P waves. The patient is hemodynamically stable. Which maneuver is most likely to
unmask the underlying rhythm and guide management?
A. Vagal stimulation via carotid sinus massage
B. Administration of intravenous adenosine 6 mg CORRECT
C. Synchronized cardioversion at 100 J
D. Amiodarone 150 mg IV bolus
RATIONALE: Adenosine transiently blocks the AV node, unmasking atrial activity (e.g., flutter
waves or ectopic P waves) and terminating AV nodal reentrant tachycardia. Carotid massage is
less reliable and carries risk; cardioversion is for instability; amiodarone is not first-line for stable
narrow-complex tachycardia.
Q2 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A 12-lead ECG shows ST elevation in leads II, III, and aVF with reciprocal ST
depression in I and aVL. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery CORRECT
D. Left main coronary artery
RATIONALE: ST elevation in inferior leads (II, III, aVF) localizes to the inferior wall, typically
supplied by the right coronary artery (RCA) in a right-dominant circulation. LAD causes anterior
changes; circumflex causes lateral changes; left main causes widespread changes.
Page 2
, Q3 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
A patient with a dual-chamber pacemaker set to DDD mode at 60-120 bpm has a
programmed AV delay of 200 ms. The ECG shows pacing spikes before every QRS
but no preceding atrial spikes. What is the most likely explanation?
A. Atrial lead dislodgement
B. Pacemaker syndrome
C. Ventricular safety pacing
D. Atrial undersensing CORRECT
RATIONALE: Atrial undersensing occurs when the pacemaker fails to detect intrinsic atrial
activity, leading to asynchronous atrial pacing (often with spikes). Atrial lead dislodgement would
cause failure to capture; pacemaker syndrome is a clinical diagnosis; ventricular safety pacing is
a specific feature to avoid R-on-T.
Q4 DIFFERENTIATE COMPLEX DYSRHYTHMIAS USING SYSTEMATIC ECG ANALYSIS AND
CLINICAL CONTEXT
During ACLS, a patient in pulseless ventricular tachycardia has received one
shock and one dose of epinephrine. The rhythm remains unchanged. According to
current guidelines, which antiarrhythmic is indicated next?
A. Lidocaine 1-1.5 mg/kg IV push
B. Amiodarone 300 mg IV bolus CORRECT
C. Magnesium sulfate 1-2 g IV
D. Sodium bicarbonate 1 mEq/kg IV
RATIONALE: Amiodarone 300 mg IV bolus is the preferred antiarrhythmic for shock-refractory
VF/pVT. Lidocaine is an alternative; magnesium is for torsades; bicarbonate is not routinely
recommended.
Page 3
