NURSING EDUCATION PRACTICE ASSESSMENT
Relias Dysrhythmia Basic Test
Core Fundamentals Practice Exam
50 original multiple-choice questions
21 original ECG rhythm strips • Detailed rationales for every question
ECG fundamentals, rhythm interpretation, causes, assessment, and emergency response
Name: ______________________________ Date: ________________ Score: ________ / 50
Educational disclaimer
This is an original practice resource written for nursing education. It is not an official Relias examination, is not affiliated
with or endorsed by Relias, and does not contain recalled, confidential, or proprietary assessment questions.
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Examination Instructions
This practice exam contains 50 original multiple-choice questions on foundational cardiac rhythm
interpretation, ECG principles, dysrhythmia recognition, patient assessment, and basic nursing
interventions. Each question has four choices (A–D) and one best answer. Questions progress from
fundamental concepts to more challenging clinical situations.
• Read each question carefully. When an ECG figure is shown, interpret it with a systematic
approach before reviewing the choices.
• The correct answer and a detailed rationale follow each question. To test yourself, cover the
lines below the answer choices until you have decided on your answer.
• ECG figures are 6-second Lead II strips at 25 mm/s and 10 mm/mV. Each small box is 0.04
second and each large box is 0.20 second.
• Choose the response that is best for the patient’s overall condition, not only the rhythm label.
Categories covered
No. Category Questions
1 Category A: ECG and Cardiac Electrophysiology Fundamentals 1–7
2 Category B: Systematic Rhythm Interpretation 8–12
3 Category C: Normal Sinus Rhythm and Sinus Dysrhythmias 13–18
4 Category D: Atrial and Junctional Dysrhythmias 19–26
5 Category E: Ventricular Dysrhythmias 27–33
6 Category F: Atrioventricular Blocks and Conduction Abnormalities 34–39
7 Category G: Causes and Contributing Factors 40–44
8 Category H: Patient Assessment and Nursing Priorities 45–46
9 Category I: Basic Dysrhythmia Management and Emergency Response 47–48
10 Category J: Integrated Clinical Scenarios 49–50
Original practice resource — not an official Relias examination Page 1
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Category A: ECG and Cardiac Electrophysiology Fundamentals
Question 1. Which statement best describes the relationship between the ECG and the mechanical
function of the heart?
A. A normal-appearing ECG rhythm guarantees that cardiac output is adequate.
B. The ECG records electrical activity, which normally precedes contraction, but it does not show
whether the heart is pumping effectively.
C. The height of the QRS complex directly measures the strength of ventricular contraction.
D. Mechanical contraction of the ventricles occurs before electrical depolarization.
Correct Answer: B. The ECG records electrical activity, which normally precedes contraction, but it
does not show whether the heart is pumping effectively.
Rationale: The ECG shows the electrical events (depolarization and repolarization) that normally
trigger contraction. It does not measure pumping. A patient can have an organized rhythm on the
monitor and still have a weak pulse or no pulse, as in pulseless electrical activity, which is why the
nurse must always assess pulse, blood pressure, and perfusion along with the rhythm. QRS height
reflects electrical voltage, not contractile strength, and electrical depolarization precedes, not follows,
mechanical contraction.
Question 2. On a normal ECG, the ST segment lies between the end of the QRS complex and the
beginning of the T wave. What does it represent?
A. Depolarization of the atria
B. The delay of the impulse in the AV node
C. Depolarization of the ventricles
D. The early phase of ventricular repolarization, when the ventricles are depolarized and
recovering, normally at the baseline
Correct Answer: D. The early phase of ventricular repolarization, when the ventricles are depolarized
and recovering, normally at the baseline.
Rationale: The ST segment represents the plateau phase of early ventricular repolarization and is
normally level with the baseline (isoelectric). Atrial depolarization produces the P wave, the AV node
delay is part of the PR interval, and ventricular depolarization produces the QRS complex. New ST-
segment elevation or depression in a patient with chest discomfort can indicate myocardial ischemia
or injury and should prompt a 12-lead ECG and urgent notification of the provider.
Original practice resource — not an official Relias examination Page 2
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Question 3. Standard ECG calibration is 10 mm/mV. A calibration signal of 1 mV should therefore
produce a deflection that is how many millimeters tall?
A. 10 mm (two large boxes)
B. 15 mm
C. 20 mm
D. 25 mm
Correct Answer: A. 10 mm (two large boxes).
Rationale: At standard calibration, each millimeter of vertical height equals 0.1 mV, so a 1-mV signal
is 10 mm tall, which is two large boxes. Confirming the calibration marker before interpreting voltage
is important because a different gain setting makes complexes look taller or smaller than they truly
are. The value 25 is the standard paper speed in mm/s, not the calibration.
Question 4. ECG Figure 1 was recorded at standard settings. The PR interval measures five small boxes.
How should the nurse interpret this PR interval?
ECG Figure 1. Six-second Lead II rhythm strip (25 mm/s, 10 mm/mV).
A. It is abnormally short.
B. It is prolonged and diagnostic of first-degree AV block.
C. It is at the upper limit of normal and is within the normal range.
D. It is prolonged and indicates that the rhythm originates in the AV junction.
Correct Answer: C. It is at the upper limit of normal and is within the normal range.
Rationale: Each small box is 0.04 second, so five small boxes equal 0.20 second. The normal PR
interval is 0.12–0.20 second, so this value is at the upper limit of normal. First-degree AV block
requires a PR interval longer than 0.20 second. A junctional rhythm typically has a PR interval shorter
than 0.12 second or absent or inverted P waves, not a long PR interval. In this tracing every P wave is
followed by a QRS complex, and the PR interval is constant.
Original practice resource — not an official Relias examination Page 3
Relias Dysrhythmia Basic Test
Core Fundamentals Practice Exam
50 original multiple-choice questions
21 original ECG rhythm strips • Detailed rationales for every question
ECG fundamentals, rhythm interpretation, causes, assessment, and emergency response
Name: ______________________________ Date: ________________ Score: ________ / 50
Educational disclaimer
This is an original practice resource written for nursing education. It is not an official Relias examination, is not affiliated
with or endorsed by Relias, and does not contain recalled, confidential, or proprietary assessment questions.
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Examination Instructions
This practice exam contains 50 original multiple-choice questions on foundational cardiac rhythm
interpretation, ECG principles, dysrhythmia recognition, patient assessment, and basic nursing
interventions. Each question has four choices (A–D) and one best answer. Questions progress from
fundamental concepts to more challenging clinical situations.
• Read each question carefully. When an ECG figure is shown, interpret it with a systematic
approach before reviewing the choices.
• The correct answer and a detailed rationale follow each question. To test yourself, cover the
lines below the answer choices until you have decided on your answer.
• ECG figures are 6-second Lead II strips at 25 mm/s and 10 mm/mV. Each small box is 0.04
second and each large box is 0.20 second.
• Choose the response that is best for the patient’s overall condition, not only the rhythm label.
Categories covered
No. Category Questions
1 Category A: ECG and Cardiac Electrophysiology Fundamentals 1–7
2 Category B: Systematic Rhythm Interpretation 8–12
3 Category C: Normal Sinus Rhythm and Sinus Dysrhythmias 13–18
4 Category D: Atrial and Junctional Dysrhythmias 19–26
5 Category E: Ventricular Dysrhythmias 27–33
6 Category F: Atrioventricular Blocks and Conduction Abnormalities 34–39
7 Category G: Causes and Contributing Factors 40–44
8 Category H: Patient Assessment and Nursing Priorities 45–46
9 Category I: Basic Dysrhythmia Management and Emergency Response 47–48
10 Category J: Integrated Clinical Scenarios 49–50
Original practice resource — not an official Relias examination Page 1
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Category A: ECG and Cardiac Electrophysiology Fundamentals
Question 1. Which statement best describes the relationship between the ECG and the mechanical
function of the heart?
A. A normal-appearing ECG rhythm guarantees that cardiac output is adequate.
B. The ECG records electrical activity, which normally precedes contraction, but it does not show
whether the heart is pumping effectively.
C. The height of the QRS complex directly measures the strength of ventricular contraction.
D. Mechanical contraction of the ventricles occurs before electrical depolarization.
Correct Answer: B. The ECG records electrical activity, which normally precedes contraction, but it
does not show whether the heart is pumping effectively.
Rationale: The ECG shows the electrical events (depolarization and repolarization) that normally
trigger contraction. It does not measure pumping. A patient can have an organized rhythm on the
monitor and still have a weak pulse or no pulse, as in pulseless electrical activity, which is why the
nurse must always assess pulse, blood pressure, and perfusion along with the rhythm. QRS height
reflects electrical voltage, not contractile strength, and electrical depolarization precedes, not follows,
mechanical contraction.
Question 2. On a normal ECG, the ST segment lies between the end of the QRS complex and the
beginning of the T wave. What does it represent?
A. Depolarization of the atria
B. The delay of the impulse in the AV node
C. Depolarization of the ventricles
D. The early phase of ventricular repolarization, when the ventricles are depolarized and
recovering, normally at the baseline
Correct Answer: D. The early phase of ventricular repolarization, when the ventricles are depolarized
and recovering, normally at the baseline.
Rationale: The ST segment represents the plateau phase of early ventricular repolarization and is
normally level with the baseline (isoelectric). Atrial depolarization produces the P wave, the AV node
delay is part of the PR interval, and ventricular depolarization produces the QRS complex. New ST-
segment elevation or depression in a patient with chest discomfort can indicate myocardial ischemia
or injury and should prompt a 12-lead ECG and urgent notification of the provider.
Original practice resource — not an official Relias examination Page 2
, Relias Dysrhythmia Basic Test — Core Fundamentals Practice Exam
Question 3. Standard ECG calibration is 10 mm/mV. A calibration signal of 1 mV should therefore
produce a deflection that is how many millimeters tall?
A. 10 mm (two large boxes)
B. 15 mm
C. 20 mm
D. 25 mm
Correct Answer: A. 10 mm (two large boxes).
Rationale: At standard calibration, each millimeter of vertical height equals 0.1 mV, so a 1-mV signal
is 10 mm tall, which is two large boxes. Confirming the calibration marker before interpreting voltage
is important because a different gain setting makes complexes look taller or smaller than they truly
are. The value 25 is the standard paper speed in mm/s, not the calibration.
Question 4. ECG Figure 1 was recorded at standard settings. The PR interval measures five small boxes.
How should the nurse interpret this PR interval?
ECG Figure 1. Six-second Lead II rhythm strip (25 mm/s, 10 mm/mV).
A. It is abnormally short.
B. It is prolonged and diagnostic of first-degree AV block.
C. It is at the upper limit of normal and is within the normal range.
D. It is prolonged and indicates that the rhythm originates in the AV junction.
Correct Answer: C. It is at the upper limit of normal and is within the normal range.
Rationale: Each small box is 0.04 second, so five small boxes equal 0.20 second. The normal PR
interval is 0.12–0.20 second, so this value is at the upper limit of normal. First-degree AV block
requires a PR interval longer than 0.20 second. A junctional rhythm typically has a PR interval shorter
than 0.12 second or absent or inverted P waves, not a long PR interval. In this tracing every P wave is
followed by a QRS complex, and the PR interval is constant.
Original practice resource — not an official Relias examination Page 3
