Relias Advanced Dysrhythmia Exam A 2025/2026
Relias Advanced Dysrhythmia Exam
A 2025/2026 Complete 52
Questions with Step-by-Step Verified
Answers and Clinical Assessment
Explanations
1 Introduction to Dysrhythmias
Dysrhythmias are abnormal heart rhythms that impact cardiac function. This document
provides a streamlined study guide for the Relias Advanced Dysrhythmia Exam A, with
clear, concise answers and explanations. Complex terminology is simplified for practical
use. The first section addresses 52 core questions, while the second includes 100 additional
questions for comprehensive preparation. Each question offers a step-by-step answer and
clinical assessment guidance.
2 Core 52 Questions from Relias Advanced Dysrhyth-
mia Exam A
Question 1: A rhythm strip displays a rate of 90 bpm, regular rhythm, upright P waves, PR
interval 0.18 seconds, QRS 0.09 seconds. Identify the rhythm.
Answer: Normal sinus rhythm.
Step-by-Step Explanation:
(a) Rate is 90 bpm, within 60–100, normal range.
(b) Rhythm is regular, with consistent beat intervals.
(c) P waves are upright before each QRS, indicating atrial depolarization.
(d) PR interval of 0.18 seconds is within 0.12–0.20 seconds.
(e) QRS duration of 0.09 seconds is under 0.12 seconds, confirming normal con-
duction.
Clinical Assessment: Check pulse, blood pressure, and oxygen saturation. If
asymptomatic, continue monitoring for symptom changes like fatigue or dizziness.
Question 2: A patients rhythm lacks clear P waves, is irregular, and has a QRS of 0.11 seconds.
What is the rhythm?
Answer: Atrial fibrillation.
Step-by-Step Explanation:
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, Relias Advanced Dysrhythmia Exam A 2025/2026
(a) Absence of distinct P waves indicates atrial quiver.
(b) Irregular rhythm shows variable R-R intervals.
(c) QRS of 0.11 seconds is normal, ruling out ventricular origin.
Clinical Assessment: Compare apical and radial pulses for deficits. Assess for
palpitations or shortness of breath; initiate anticoagulation if indicated.
Question 3: A rhythm strip shows 55 bpm, regular rhythm, P waves before QRS, PR interval
0.22 seconds, QRS 0.10 seconds. What is the rhythm?
Answer: First-degree AV block.
Step-by-Step Explanation:
(a) Rate of 55 bpm is slow but regular.
(b) P waves precede QRS, showing atrial-ventricular connection.
(c) PR interval of 0.22 seconds exceeds 0.20 seconds, indicating delayed conduc-
tion.
(d) QRS of 0.10 seconds is normal.
Clinical Assessment: Monitor for symptoms like lethargy. No immediate inter-
vention if stable; schedule cardiology follow-up.
Question 4: A patient with chest pain shows a rhythm with QRS >0.12 seconds, rate 165 bpm,
no P waves. What is the priority action?
Answer: Prepare for synchronized cardioversion.
Step-by-Step Explanation:
(a) Wide QRS (>0.12 seconds) suggests ventricular origin.
(b) Rate of 165 bpm is tachycardic.
(c) No P waves confirm ventricular tachycardia.
(d) Chest pain indicates instability, requiring urgent cardioversion.
Clinical Assessment: Ensure airway patency, provide oxygen, and alert the code
team. Use defibrillator in synchronized mode.
Question 5: A rhythm strip shows QRS dropping after every fourth P wave, with PR intervals
progressively lengthening. What is the rhythm?
Answer: Second-degree AV block Type I (Wenckebach).
Step-by-Step Explanation:
(a) PR intervals lengthen progressively.
(b) QRS drops after the fourth P wave.
(c) Pattern resets, typical of Wenckebach.
Clinical Assessment: Assess pulse and blood pressure. If symptomatic (e.g.,
syncope), prepare for pacing; otherwise, monitor closely.
Question 6: A patient with a pacemaker shows no pacer spikes and an irregular rhythm. What
is the issue?
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, Relias Advanced Dysrhythmia Exam A 2025/2026
Answer: Pacemaker malfunction.
Step-by-Step Explanation:
(a) No pacer spikes indicate device failure to fire.
(b) Irregular rhythm suggests loss of pacing control.
(c) Likely causes include lead displacement or battery failure.
Clinical Assessment: Check for bradycardia or hypotension. Contact cardiology
urgently for device evaluation.
Question 7: A rhythm strip shows 125 bpm, regular rhythm, P waves present, PR interval 0.16
seconds, QRS 0.09 seconds. What is the rhythm?
Answer: Sinus tachycardia.
Step-by-Step Explanation:
(a) Rate of 125 bpm exceeds 100, indicating tachycardia.
(b) Regular rhythm with P waves before QRS.
(c) PR interval (0.16 seconds) and QRS (0.09 seconds) are normal.
Clinical Assessment: Investigate causes like dehydration or pain. Treat under-
lying condition and monitor for angina.
Question 8: A patients rhythm has sawtooth P waves at 145 bpm. What is the rhythm?
Answer: Atrial flutter.
Step-by-Step Explanation:
(a) Sawtooth P waves are characteristic of atrial flutter.
(b) Rate of 145 bpm aligns with typical ventricular response.
(c) Rhythm may be regular or variable based on AV conduction.
Clinical Assessment: Assess for fatigue or palpitations. Administer rate control
medications; consider cardioversion if unstable.
Question 9: A rhythm strip shows no relation between P waves and QRS, rate 38 bpm, QRS
0.15 seconds. What is the rhythm?
Answer: Third-degree AV block.
Step-by-Step Explanation:
(a) P waves and QRS are independent, indicating complete dissociation.
(b) Rate of 38 bpm suggests ventricular escape rhythm.
(c) Wide QRS (0.15 seconds) confirms ventricular origin.
Clinical Assessment: Check for hypotension or altered mental status. Urgent
pacemaker placement is required.
Question 10: A rhythm with wide QRS, 175 bpm, no P waves. What is the rhythm?
Answer: Ventricular tachycardia.
Step-by-Step Explanation:
(a) Wide QRS (>0.12 seconds) indicates ventricular origin.
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, Relias Advanced Dysrhythmia Exam A 2025/2026
(b) Rate of 175 bpm is fast.
(c) No P waves confirm ventricular tachycardia.
Clinical Assessment: If pulseless, defibrillate; if stable, use amiodarone.
Question 11: A stable patient with atrial fibrillation and rapid ventricular response. What is the
first-line treatment?
Answer: Beta-blockers for rate control.
Step-by-Step Explanation:
(a) Confirm hemodynamic stability (normal BP, no distress).
(b) Beta-blockers (e.g., metoprolol) slow ventricular rate.
(c) Avoid cardioversion in stable cases initially.
Clinical Assessment: Monitor heart rate and symptoms. Initiate anticoagulation
to prevent thromboembolism.
Question 12: A rhythm strip shows 42 bpm, regular rhythm, P waves present, PR interval 0.19
seconds, QRS 0.10 seconds. What is the rhythm?
Answer: Sinus bradycardia.
Step-by-Step Explanation:
(a) Rate of 42 bpm is below 60, indicating bradycardia.
(b) Regular rhythm with P waves before QRS.
(c) PR interval (0.19 seconds) and QRS (0.10 seconds) are normal.
Clinical Assessment: Evaluate for medication side effects or vagal tone. Treat if
symptomatic with atropine.
Question 13: A patient shows ventricular fibrillation on the monitor. What is the priority action?
Answer: Immediate defibrillation.
Step-by-Step Explanation:
(a) Chaotic rhythm with no QRS complexes.
(b) No palpable pulse confirms cardiac arrest.
(c) Deliver unsynchronized shock (200J biphasic).
Clinical Assessment: Start CPR post-shock; administer epinephrine per ACLS
protocol.
Question 14: A rhythm with inverted P waves, rate 52 bpm. What is the rhythm?
Answer: Junctional rhythm.
Step-by-Step Explanation:
(a) Inverted or absent P waves suggest AV node origin.
(b) Rate of 52 bpm is typical for junctional (40–60 bpm).
(c) QRS is normal, indicating no ventricular conduction issues.
Clinical Assessment: Assess cardiac output; consider pacing if symptomatic.
Page 4 of 32
Relias Advanced Dysrhythmia Exam
A 2025/2026 Complete 52
Questions with Step-by-Step Verified
Answers and Clinical Assessment
Explanations
1 Introduction to Dysrhythmias
Dysrhythmias are abnormal heart rhythms that impact cardiac function. This document
provides a streamlined study guide for the Relias Advanced Dysrhythmia Exam A, with
clear, concise answers and explanations. Complex terminology is simplified for practical
use. The first section addresses 52 core questions, while the second includes 100 additional
questions for comprehensive preparation. Each question offers a step-by-step answer and
clinical assessment guidance.
2 Core 52 Questions from Relias Advanced Dysrhyth-
mia Exam A
Question 1: A rhythm strip displays a rate of 90 bpm, regular rhythm, upright P waves, PR
interval 0.18 seconds, QRS 0.09 seconds. Identify the rhythm.
Answer: Normal sinus rhythm.
Step-by-Step Explanation:
(a) Rate is 90 bpm, within 60–100, normal range.
(b) Rhythm is regular, with consistent beat intervals.
(c) P waves are upright before each QRS, indicating atrial depolarization.
(d) PR interval of 0.18 seconds is within 0.12–0.20 seconds.
(e) QRS duration of 0.09 seconds is under 0.12 seconds, confirming normal con-
duction.
Clinical Assessment: Check pulse, blood pressure, and oxygen saturation. If
asymptomatic, continue monitoring for symptom changes like fatigue or dizziness.
Question 2: A patients rhythm lacks clear P waves, is irregular, and has a QRS of 0.11 seconds.
What is the rhythm?
Answer: Atrial fibrillation.
Step-by-Step Explanation:
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, Relias Advanced Dysrhythmia Exam A 2025/2026
(a) Absence of distinct P waves indicates atrial quiver.
(b) Irregular rhythm shows variable R-R intervals.
(c) QRS of 0.11 seconds is normal, ruling out ventricular origin.
Clinical Assessment: Compare apical and radial pulses for deficits. Assess for
palpitations or shortness of breath; initiate anticoagulation if indicated.
Question 3: A rhythm strip shows 55 bpm, regular rhythm, P waves before QRS, PR interval
0.22 seconds, QRS 0.10 seconds. What is the rhythm?
Answer: First-degree AV block.
Step-by-Step Explanation:
(a) Rate of 55 bpm is slow but regular.
(b) P waves precede QRS, showing atrial-ventricular connection.
(c) PR interval of 0.22 seconds exceeds 0.20 seconds, indicating delayed conduc-
tion.
(d) QRS of 0.10 seconds is normal.
Clinical Assessment: Monitor for symptoms like lethargy. No immediate inter-
vention if stable; schedule cardiology follow-up.
Question 4: A patient with chest pain shows a rhythm with QRS >0.12 seconds, rate 165 bpm,
no P waves. What is the priority action?
Answer: Prepare for synchronized cardioversion.
Step-by-Step Explanation:
(a) Wide QRS (>0.12 seconds) suggests ventricular origin.
(b) Rate of 165 bpm is tachycardic.
(c) No P waves confirm ventricular tachycardia.
(d) Chest pain indicates instability, requiring urgent cardioversion.
Clinical Assessment: Ensure airway patency, provide oxygen, and alert the code
team. Use defibrillator in synchronized mode.
Question 5: A rhythm strip shows QRS dropping after every fourth P wave, with PR intervals
progressively lengthening. What is the rhythm?
Answer: Second-degree AV block Type I (Wenckebach).
Step-by-Step Explanation:
(a) PR intervals lengthen progressively.
(b) QRS drops after the fourth P wave.
(c) Pattern resets, typical of Wenckebach.
Clinical Assessment: Assess pulse and blood pressure. If symptomatic (e.g.,
syncope), prepare for pacing; otherwise, monitor closely.
Question 6: A patient with a pacemaker shows no pacer spikes and an irregular rhythm. What
is the issue?
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, Relias Advanced Dysrhythmia Exam A 2025/2026
Answer: Pacemaker malfunction.
Step-by-Step Explanation:
(a) No pacer spikes indicate device failure to fire.
(b) Irregular rhythm suggests loss of pacing control.
(c) Likely causes include lead displacement or battery failure.
Clinical Assessment: Check for bradycardia or hypotension. Contact cardiology
urgently for device evaluation.
Question 7: A rhythm strip shows 125 bpm, regular rhythm, P waves present, PR interval 0.16
seconds, QRS 0.09 seconds. What is the rhythm?
Answer: Sinus tachycardia.
Step-by-Step Explanation:
(a) Rate of 125 bpm exceeds 100, indicating tachycardia.
(b) Regular rhythm with P waves before QRS.
(c) PR interval (0.16 seconds) and QRS (0.09 seconds) are normal.
Clinical Assessment: Investigate causes like dehydration or pain. Treat under-
lying condition and monitor for angina.
Question 8: A patients rhythm has sawtooth P waves at 145 bpm. What is the rhythm?
Answer: Atrial flutter.
Step-by-Step Explanation:
(a) Sawtooth P waves are characteristic of atrial flutter.
(b) Rate of 145 bpm aligns with typical ventricular response.
(c) Rhythm may be regular or variable based on AV conduction.
Clinical Assessment: Assess for fatigue or palpitations. Administer rate control
medications; consider cardioversion if unstable.
Question 9: A rhythm strip shows no relation between P waves and QRS, rate 38 bpm, QRS
0.15 seconds. What is the rhythm?
Answer: Third-degree AV block.
Step-by-Step Explanation:
(a) P waves and QRS are independent, indicating complete dissociation.
(b) Rate of 38 bpm suggests ventricular escape rhythm.
(c) Wide QRS (0.15 seconds) confirms ventricular origin.
Clinical Assessment: Check for hypotension or altered mental status. Urgent
pacemaker placement is required.
Question 10: A rhythm with wide QRS, 175 bpm, no P waves. What is the rhythm?
Answer: Ventricular tachycardia.
Step-by-Step Explanation:
(a) Wide QRS (>0.12 seconds) indicates ventricular origin.
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, Relias Advanced Dysrhythmia Exam A 2025/2026
(b) Rate of 175 bpm is fast.
(c) No P waves confirm ventricular tachycardia.
Clinical Assessment: If pulseless, defibrillate; if stable, use amiodarone.
Question 11: A stable patient with atrial fibrillation and rapid ventricular response. What is the
first-line treatment?
Answer: Beta-blockers for rate control.
Step-by-Step Explanation:
(a) Confirm hemodynamic stability (normal BP, no distress).
(b) Beta-blockers (e.g., metoprolol) slow ventricular rate.
(c) Avoid cardioversion in stable cases initially.
Clinical Assessment: Monitor heart rate and symptoms. Initiate anticoagulation
to prevent thromboembolism.
Question 12: A rhythm strip shows 42 bpm, regular rhythm, P waves present, PR interval 0.19
seconds, QRS 0.10 seconds. What is the rhythm?
Answer: Sinus bradycardia.
Step-by-Step Explanation:
(a) Rate of 42 bpm is below 60, indicating bradycardia.
(b) Regular rhythm with P waves before QRS.
(c) PR interval (0.19 seconds) and QRS (0.10 seconds) are normal.
Clinical Assessment: Evaluate for medication side effects or vagal tone. Treat if
symptomatic with atropine.
Question 13: A patient shows ventricular fibrillation on the monitor. What is the priority action?
Answer: Immediate defibrillation.
Step-by-Step Explanation:
(a) Chaotic rhythm with no QRS complexes.
(b) No palpable pulse confirms cardiac arrest.
(c) Deliver unsynchronized shock (200J biphasic).
Clinical Assessment: Start CPR post-shock; administer epinephrine per ACLS
protocol.
Question 14: A rhythm with inverted P waves, rate 52 bpm. What is the rhythm?
Answer: Junctional rhythm.
Step-by-Step Explanation:
(a) Inverted or absent P waves suggest AV node origin.
(b) Rate of 52 bpm is typical for junctional (40–60 bpm).
(c) QRS is normal, indicating no ventricular conduction issues.
Clinical Assessment: Assess cardiac output; consider pacing if symptomatic.
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