Relias Dysrhythmia- advanced A Questions
With Complete Solutions
Course
NURS 4572
✅ 1. Question: Ventricular Tachycardia
A patient’s ECG shows a wide QRS complex rhythm at a rate of 150 bpm with no visible P
waves. What is the rhythm?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia
D. Sinus tachycardia
Correct Answer: B. Ventricular tachycardia
Rationale:
A wide-complex tachycardia with no discernible P waves and a regular rhythm suggests
ventricular tachycardia (VT), especially with rates >100 bpm.
✅ 2. Question: Torsades de Pointes
Torsades de Pointes is most often associated with:
A. Narrow QRS complexes
B. Short PR interval
C. Prolonged QT interval
D. Accelerated junctional rhythm
Correct Answer: C. Prolonged QT interval
Rationale:
Torsades de Pointes is a polymorphic VT often caused by QT prolongation, which increases
risk for fatal arrhythmias.
✅ 3. Question: Complete Heart Block (3rd Degree AV Block)
What rhythm is characterized by a complete dissociation between atrial and ventricular activity?
A. First-degree AV block
B. Second-degree AV block Type I
,C. Second-degree AV block Type II
D. Third-degree (complete) AV block
Correct Answer: D. Third-degree (complete) AV block
Rationale:
In complete heart block, atria and ventricles beat independently, with regular but unrelated
P waves and QRS complexes.
✅ 4. Question: Atrial Flutter
A rhythm with sawtooth flutter waves and a regular ventricular response of 150 bpm is
likely:
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. Multifocal atrial tachycardia
Correct Answer: C. Atrial flutter with 2:1 conduction
Rationale:
Atrial flutter often has atrial rates of ~300 bpm. If only every second impulse conducts, the
ventricular rate is ~150 bpm (2:1 block).
✅ 5. Question: Asystole
What is the most appropriate initial action for a patient in asystole?
A. Defibrillation
B. Synchronized cardioversion
C. Start CPR and give epinephrine
D. Administer amiodarone
Correct Answer: C. Start CPR and give epinephrine
Rationale:
Asystole is a non-shockable rhythm. Immediate CPR and epinephrine are the priorities;
defibrillation is not indicated.
✅ 6. Question: Junctional Rhythm
Which of the following is a key ECG finding in junctional rhythm?
,A. P wave after the QRS
B. QRS > 0.12 sec
C. Irregularly irregular rhythm
D. P wave before QRS with PR interval > 0.20 sec
Correct Answer: A. P wave after the QRS
Rationale:
In junctional rhythms, the atrium is activated retrograde, leading to a P wave that is
inverted and may appear after the QRS or be hidden.
✅ 7. Question: Accelerated Idioventricular Rhythm (AIVR)
Which statement about Accelerated Idioventricular Rhythm (AIVR) is true?
A. It always requires pacing
B. It is a wide-complex rhythm at 40–100 bpm
C. It is a narrow-complex rhythm
D. It is a life-threatening arrhythmia
Correct Answer: B. It is a wide-complex rhythm at 40–100 bpm
Rationale:
AIVR is a benign ventricular rhythm with wide QRS and rate between 40–100 bpm, often
seen post-reperfusion.
✅ 8. Question: Supraventricular Tachycardia (SVT)
A patient presents with a narrow-complex tachycardia of 180 bpm. Vagal maneuvers are
ineffective. What is the next step?
A. Defibrillation
B. Amiodarone IV
C. Adenosine IV push
D. Atropine IV
Correct Answer: C. Adenosine IV push
Rationale:
Adenosine is used to treat stable SVT, particularly if vagal maneuvers fail. It slows AV node
conduction, helping to identify or terminate the rhythm.
✅ 9. Question: Paced Rhythm
, Which ECG finding is consistent with a ventricular paced rhythm?
A. Narrow QRS complexes
B. Regular rhythm with no pacing spikes
C. Wide QRS complexes following pacing spikes
D. PR interval > 0.20 sec
Correct Answer: C. Wide QRS complexes following pacing spikes
Rationale:
Ventricular pacing shows visible pacer spikes followed by wide QRS complexes due to
artificial ventricular activation.
✅ 10. Question: Atrial Fibrillation with Rapid Ventricular Response (RVR)
Which is the best initial medication for stable atrial fibrillation with RVR?
A. Epinephrine
B. Amiodarone
C. Diltiazem
D. Atropine
Correct Answer: C. Diltiazem
Rationale:
Diltiazem, a calcium channel blocker, is first-line for rate control in stable AF with RVR. It
slows AV node conduction to reduce heart rate.
✅ 11. Question: Second-Degree AV Block Type I (Wenckebach)
What is the hallmark ECG feature of Second-Degree AV Block Type I?
A. Constant PR interval with dropped beats
B. Progressively lengthening PR interval followed by a dropped QRS
C. Wide QRS complexes with P wave dissociation
D. Irregular rhythm with no visible P waves
Correct Answer: B. Progressively lengthening PR interval followed by a dropped QRS
Rationale:
Type I second-degree AV block (Wenckebach) features a gradually increasing PR interval,
ending in a non-conducted P wave.
✅ 12. Question: Ventricular Fibrillation
With Complete Solutions
Course
NURS 4572
✅ 1. Question: Ventricular Tachycardia
A patient’s ECG shows a wide QRS complex rhythm at a rate of 150 bpm with no visible P
waves. What is the rhythm?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia
D. Sinus tachycardia
Correct Answer: B. Ventricular tachycardia
Rationale:
A wide-complex tachycardia with no discernible P waves and a regular rhythm suggests
ventricular tachycardia (VT), especially with rates >100 bpm.
✅ 2. Question: Torsades de Pointes
Torsades de Pointes is most often associated with:
A. Narrow QRS complexes
B. Short PR interval
C. Prolonged QT interval
D. Accelerated junctional rhythm
Correct Answer: C. Prolonged QT interval
Rationale:
Torsades de Pointes is a polymorphic VT often caused by QT prolongation, which increases
risk for fatal arrhythmias.
✅ 3. Question: Complete Heart Block (3rd Degree AV Block)
What rhythm is characterized by a complete dissociation between atrial and ventricular activity?
A. First-degree AV block
B. Second-degree AV block Type I
,C. Second-degree AV block Type II
D. Third-degree (complete) AV block
Correct Answer: D. Third-degree (complete) AV block
Rationale:
In complete heart block, atria and ventricles beat independently, with regular but unrelated
P waves and QRS complexes.
✅ 4. Question: Atrial Flutter
A rhythm with sawtooth flutter waves and a regular ventricular response of 150 bpm is
likely:
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. Multifocal atrial tachycardia
Correct Answer: C. Atrial flutter with 2:1 conduction
Rationale:
Atrial flutter often has atrial rates of ~300 bpm. If only every second impulse conducts, the
ventricular rate is ~150 bpm (2:1 block).
✅ 5. Question: Asystole
What is the most appropriate initial action for a patient in asystole?
A. Defibrillation
B. Synchronized cardioversion
C. Start CPR and give epinephrine
D. Administer amiodarone
Correct Answer: C. Start CPR and give epinephrine
Rationale:
Asystole is a non-shockable rhythm. Immediate CPR and epinephrine are the priorities;
defibrillation is not indicated.
✅ 6. Question: Junctional Rhythm
Which of the following is a key ECG finding in junctional rhythm?
,A. P wave after the QRS
B. QRS > 0.12 sec
C. Irregularly irregular rhythm
D. P wave before QRS with PR interval > 0.20 sec
Correct Answer: A. P wave after the QRS
Rationale:
In junctional rhythms, the atrium is activated retrograde, leading to a P wave that is
inverted and may appear after the QRS or be hidden.
✅ 7. Question: Accelerated Idioventricular Rhythm (AIVR)
Which statement about Accelerated Idioventricular Rhythm (AIVR) is true?
A. It always requires pacing
B. It is a wide-complex rhythm at 40–100 bpm
C. It is a narrow-complex rhythm
D. It is a life-threatening arrhythmia
Correct Answer: B. It is a wide-complex rhythm at 40–100 bpm
Rationale:
AIVR is a benign ventricular rhythm with wide QRS and rate between 40–100 bpm, often
seen post-reperfusion.
✅ 8. Question: Supraventricular Tachycardia (SVT)
A patient presents with a narrow-complex tachycardia of 180 bpm. Vagal maneuvers are
ineffective. What is the next step?
A. Defibrillation
B. Amiodarone IV
C. Adenosine IV push
D. Atropine IV
Correct Answer: C. Adenosine IV push
Rationale:
Adenosine is used to treat stable SVT, particularly if vagal maneuvers fail. It slows AV node
conduction, helping to identify or terminate the rhythm.
✅ 9. Question: Paced Rhythm
, Which ECG finding is consistent with a ventricular paced rhythm?
A. Narrow QRS complexes
B. Regular rhythm with no pacing spikes
C. Wide QRS complexes following pacing spikes
D. PR interval > 0.20 sec
Correct Answer: C. Wide QRS complexes following pacing spikes
Rationale:
Ventricular pacing shows visible pacer spikes followed by wide QRS complexes due to
artificial ventricular activation.
✅ 10. Question: Atrial Fibrillation with Rapid Ventricular Response (RVR)
Which is the best initial medication for stable atrial fibrillation with RVR?
A. Epinephrine
B. Amiodarone
C. Diltiazem
D. Atropine
Correct Answer: C. Diltiazem
Rationale:
Diltiazem, a calcium channel blocker, is first-line for rate control in stable AF with RVR. It
slows AV node conduction to reduce heart rate.
✅ 11. Question: Second-Degree AV Block Type I (Wenckebach)
What is the hallmark ECG feature of Second-Degree AV Block Type I?
A. Constant PR interval with dropped beats
B. Progressively lengthening PR interval followed by a dropped QRS
C. Wide QRS complexes with P wave dissociation
D. Irregular rhythm with no visible P waves
Correct Answer: B. Progressively lengthening PR interval followed by a dropped QRS
Rationale:
Type I second-degree AV block (Wenckebach) features a gradually increasing PR interval,
ending in a non-conducted P wave.
✅ 12. Question: Ventricular Fibrillation
