Relias Dysrhythmia Basic B Assessment
Verified Q&A with Rationales — Complete Study
Pack
Competency Cycle
Relias Learning | Basic Dysrhythmia Assessment B | Competency Evaluation
Core Domains: Cardiac Electrical Conduction System · ECG Waveform Identification (P Wave, QRS Complex,
T Wave) · Rhythm Strip Analysis & Interpretation · Sinus Rhythms & Variations · Atrial Dysrhythmias (AFib,
AFlutter, PACs) · Junctional & Ventricular Rhythms · Heart Blocks (1st, 2nd Type I/II, 3rd Degree) ·
Pacemaker Rhythm Recognition · Clinical Correlations & Patient Assessment · Emergency Intervention
Priorities
Healthcare Professional Competency Focus | Multiple-Choice, Rhythm Strip Identification &
Clinical Application Format
Assessment length 35 questions
Time limit 60 minutes
Item formats Multiple-choice · multiple-select · rhythm strip identification · clinical scenario
Blueprint alignment Relias Learning cardiac dysrhythmia competency objectives and AHA ACLS
foundational standards
Clinical baseline 2025 AHA Guidelines for CPR and ECC (released October 2025), including the
revised Adult Bradycardia, Tachycardia and Cardiac Arrest algorithms
Rhythm strips All strips rendered at standard 25 mm/sec and 10 mm/mV on calibrated ECG
graph paper
Items in this pack 35 items with verified answers, rationales and 10 labelled ECG and concept figures
How to Use This Pack
Each of the 35 items is presented in assessment form, followed immediately by the verified answer
and a rationale. Correct answers are rendered in bold green so the answer key can be located at a
glance; rationales are set in italic and cite the controlling guideline or reference. Rhythm-
identification items reference a figure — study the strip before reading the options, and force
yourself through the eight-step method in Figure 10 every time. The single most common cause of a
wrong answer on this assessment is naming the rhythm on first impression instead of measuring it.
Answer format legend: Correct Answer (bold, green) · Rationale and analysis (italic) ·
References (citation line)
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 1
,Introduction
This Relias Dysrhythmia Basic B guide for the 2026/2027 update prepares healthcare professionals
on the accurate identification and clinical interpretation of cardiac rhythms. The content emphasises
ECG waveform analysis, rhythm classification, rate calculation methods, and patient-centred
intervention strategies aligned with AHA ACLS guidelines, Relias Learning competency objectives,
and current cardiac care standards, ensuring learners can accurately interpret rhythm strips,
prioritise clinical responses, and demonstrate the competency in foundational dysrhythmia
recognition required for safe patient monitoring.
Dysrhythmia interpretation rewards a disciplined method far more than pattern memorisation.
Nearly every rhythm on this assessment can be named from four measurements — rate, regularity,
P-wave relationship and QRS width — and the candidates who struggle are almost always those who
glance at a strip and guess rather than working the steps. Three discriminators in particular decide
the majority of items. QRS WIDTH separates supraventricular from ventricular origin: narrow
means the impulse used the normal conduction system, wide means it did not. REGULARITY
separates atrial flutter from atrial fibrillation, the most commonly confused pair on the whole
assessment. And the PR INTERVAL PATTERN — long and constant, lengthening, constant with
dropped beats, or unrelated — distinguishes all four AV blocks from one another.
The final theme is clinical rather than technical. Rhythm recognition exists to drive a decision about
a patient, and the assessment tests that link directly. Two questions convert a rhythm name into an
action: does the patient have a PULSE, and is the patient STABLE? Pulseless VT and VF are
shockable; asystole and PEA are not. Unstable tachycardia with a pulse receives synchronized
cardioversion, never defibrillation. Symptomatic bradycardia receives atropine and prompt
escalation to pacing. When an item offers a technically plausible intervention and a patient-
assessment step, assess the patient first.
Domain Coverage
Domain Focus area Items Figures
Domain 1 Cardiac Electrical Conduction System 1–4 (4) 2
Domain 2 ECG Waveform Identification and Measurement 5–9 (5) 1
Domain 3 Rhythm Strip Analysis and Rate Calculation 10–13 (4) 3, 10
Domain 4 Sinus Rhythms and Variations 14–17 (4) 4
Domain 5 Atrial Dysrhythmias 18–22 (5) 5
Domain 6 Junctional and Ventricular Rhythms 23–27 (5) 6, 8
Domain 7 Atrioventricular Heart Blocks 28–31 (4) 7
Domain 8 Pacemaker Rhythm Recognition 32–33 (2) 9
Domain 9 Clinical Correlation and Patient Assessment 34–34 (1) —
Domain 10 Emergency Intervention Priorities 35–35 (1) 8
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 2
,Part I — Foundations: Waveforms, Conduction and Method
The ten figures in this pack are examinable in their own right. Rhythm-identification items present a
strip and ask you to name it, so study each figure until you can reproduce the diagnostic criteria from
memory and recognise the morphology at a glance.
Figure 1. The normal PQRST complex with all intervals labelled. At 25 mm/sec one small box is 0.04 s and one
large box is 0.20 s; at 10 mm/mV one small box is 0.1 mV.
Memorise the three normal intervals: PR 0.12–0.20 second (three to five small boxes), QRS less than
0.12 second (under three small boxes), and QT 0.36–0.44 second, roughly less than half the R-R
interval at normal rates. Nearly every item in Domains 2 and 7 turns on one of these measurements.
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 3
, Figure 2. The cardiac conduction system, the intrinsic rate of each pacemaker site, and the escape hierarchy that
determines which site controls the heart.
The fastest site controls the heart. Any lower pacemaker takes over only when the site above it fails,
slows or is blocked — that is an ESCAPE rhythm, and its rate tells you where it originated: 40–60
with a narrow QRS is junctional, 20–40 with a wide QRS is ventricular.
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 4
Verified Q&A with Rationales — Complete Study
Pack
Competency Cycle
Relias Learning | Basic Dysrhythmia Assessment B | Competency Evaluation
Core Domains: Cardiac Electrical Conduction System · ECG Waveform Identification (P Wave, QRS Complex,
T Wave) · Rhythm Strip Analysis & Interpretation · Sinus Rhythms & Variations · Atrial Dysrhythmias (AFib,
AFlutter, PACs) · Junctional & Ventricular Rhythms · Heart Blocks (1st, 2nd Type I/II, 3rd Degree) ·
Pacemaker Rhythm Recognition · Clinical Correlations & Patient Assessment · Emergency Intervention
Priorities
Healthcare Professional Competency Focus | Multiple-Choice, Rhythm Strip Identification &
Clinical Application Format
Assessment length 35 questions
Time limit 60 minutes
Item formats Multiple-choice · multiple-select · rhythm strip identification · clinical scenario
Blueprint alignment Relias Learning cardiac dysrhythmia competency objectives and AHA ACLS
foundational standards
Clinical baseline 2025 AHA Guidelines for CPR and ECC (released October 2025), including the
revised Adult Bradycardia, Tachycardia and Cardiac Arrest algorithms
Rhythm strips All strips rendered at standard 25 mm/sec and 10 mm/mV on calibrated ECG
graph paper
Items in this pack 35 items with verified answers, rationales and 10 labelled ECG and concept figures
How to Use This Pack
Each of the 35 items is presented in assessment form, followed immediately by the verified answer
and a rationale. Correct answers are rendered in bold green so the answer key can be located at a
glance; rationales are set in italic and cite the controlling guideline or reference. Rhythm-
identification items reference a figure — study the strip before reading the options, and force
yourself through the eight-step method in Figure 10 every time. The single most common cause of a
wrong answer on this assessment is naming the rhythm on first impression instead of measuring it.
Answer format legend: Correct Answer (bold, green) · Rationale and analysis (italic) ·
References (citation line)
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 1
,Introduction
This Relias Dysrhythmia Basic B guide for the 2026/2027 update prepares healthcare professionals
on the accurate identification and clinical interpretation of cardiac rhythms. The content emphasises
ECG waveform analysis, rhythm classification, rate calculation methods, and patient-centred
intervention strategies aligned with AHA ACLS guidelines, Relias Learning competency objectives,
and current cardiac care standards, ensuring learners can accurately interpret rhythm strips,
prioritise clinical responses, and demonstrate the competency in foundational dysrhythmia
recognition required for safe patient monitoring.
Dysrhythmia interpretation rewards a disciplined method far more than pattern memorisation.
Nearly every rhythm on this assessment can be named from four measurements — rate, regularity,
P-wave relationship and QRS width — and the candidates who struggle are almost always those who
glance at a strip and guess rather than working the steps. Three discriminators in particular decide
the majority of items. QRS WIDTH separates supraventricular from ventricular origin: narrow
means the impulse used the normal conduction system, wide means it did not. REGULARITY
separates atrial flutter from atrial fibrillation, the most commonly confused pair on the whole
assessment. And the PR INTERVAL PATTERN — long and constant, lengthening, constant with
dropped beats, or unrelated — distinguishes all four AV blocks from one another.
The final theme is clinical rather than technical. Rhythm recognition exists to drive a decision about
a patient, and the assessment tests that link directly. Two questions convert a rhythm name into an
action: does the patient have a PULSE, and is the patient STABLE? Pulseless VT and VF are
shockable; asystole and PEA are not. Unstable tachycardia with a pulse receives synchronized
cardioversion, never defibrillation. Symptomatic bradycardia receives atropine and prompt
escalation to pacing. When an item offers a technically plausible intervention and a patient-
assessment step, assess the patient first.
Domain Coverage
Domain Focus area Items Figures
Domain 1 Cardiac Electrical Conduction System 1–4 (4) 2
Domain 2 ECG Waveform Identification and Measurement 5–9 (5) 1
Domain 3 Rhythm Strip Analysis and Rate Calculation 10–13 (4) 3, 10
Domain 4 Sinus Rhythms and Variations 14–17 (4) 4
Domain 5 Atrial Dysrhythmias 18–22 (5) 5
Domain 6 Junctional and Ventricular Rhythms 23–27 (5) 6, 8
Domain 7 Atrioventricular Heart Blocks 28–31 (4) 7
Domain 8 Pacemaker Rhythm Recognition 32–33 (2) 9
Domain 9 Clinical Correlation and Patient Assessment 34–34 (1) —
Domain 10 Emergency Intervention Priorities 35–35 (1) 8
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 2
,Part I — Foundations: Waveforms, Conduction and Method
The ten figures in this pack are examinable in their own right. Rhythm-identification items present a
strip and ask you to name it, so study each figure until you can reproduce the diagnostic criteria from
memory and recognise the morphology at a glance.
Figure 1. The normal PQRST complex with all intervals labelled. At 25 mm/sec one small box is 0.04 s and one
large box is 0.20 s; at 10 mm/mV one small box is 0.1 mV.
Memorise the three normal intervals: PR 0.12–0.20 second (three to five small boxes), QRS less than
0.12 second (under three small boxes), and QT 0.36–0.44 second, roughly less than half the R-R
interval at normal rates. Nearly every item in Domains 2 and 7 turns on one of these measurements.
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 3
, Figure 2. The cardiac conduction system, the intrinsic rate of each pacemaker site, and the escape hierarchy that
determines which site controls the heart.
The fastest site controls the heart. Any lower pacemaker takes over only when the site above it fails,
slows or is blocked — that is an ESCAPE rhythm, and its rate tells you where it originated: 40–60
with a narrow QRS is junctional, 20–40 with a wide QRS is ventricular.
Relias Dysrhythmia Basic B Assessment · 2026/2027 · Page 4
