Relias Advanced Dysrhythmia Exam B Actual Exam
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular (but MAT can be irregular).
2. Rate: 110-130 bpm (>100 bpm is key for MAT vs WAP).
3. P waves: At least 3 different morphologies - hallmark of MAT or WAP.
4. PR interval: Varies - expected with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Multifocal Atrial Tachycardia - criteria met: irregular, rate >100, ≥3
P morphologies.
7. Clinical Significance: Often seen in COPD patients. Treat underlying cause, not
the rhythm itself.
, Differentiation from WAP: Wandering Atrial Pacemaker has same features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 50 bpm. P waves: Absent. QRS: Narrow
(0.08s). ST/T: Normal.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 50 bpm (40-60 = junctional escape range).
3. P waves: Absent (or may be retrograde, hidden in QRS).
4. PR interval: Not measurable.
5. QRS: Narrow (0.08s) - key differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - regular, narrow QRS, rate 40-60, no visible P
waves.
7. Clinical Action: Assess perfusion, consider atropine if symptomatic.
Q3: EKG Description: Rhythm: Irregular with gradual P-P and R-R shortening then
resetting. Rate: 60-100 bpm. P waves: 3 distinct shapes. PR interval: Varies 0.12-0.20s.
QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus arrhythmia
B. Wandering atrial pacemaker (WAP)
,C. Multifocal atrial tachycardia
D. Sinus rhythm with PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with cyclic pattern.
2. Rate: 60-100 bpm (<100 bpm distinguishes WAP from MAT).
3. P waves: 3 distinct morphologies - hallmark.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Wandering Atrial Pacemaker - benign, often in athletes.
7. Clinical Action: No treatment required.
Q4: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Hidden within preceding
T waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia (PSVT)
C. Atrial flutter
D. Junctional tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 140 bpm (150-250 typical for PSVT).
3. P waves: Hidden in T waves - retrograde conduction.
4. PR interval: Not measurable.
5. QRS: Narrow - supraventricular origin.
, 6. Interpretation: PSVT - sudden onset/offset, narrow complex.
7. Clinical Action: Vagal maneuvers → adenosine if stable.
Q5: EKG Description: Rhythm: Regular sawtooth flutter waves. Rate: Atrial 300 bpm,
ventricular 150 bpm. P waves: Replaced by flutter waves. PR interval: Not applicable.
QRS: Narrow (0.08s). ST/T: Obscured by flutter waves.
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. SVT with aberrancy
D. Junctional tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: Atrial 300, ventricular 150 = 2:1 conduction.
3. P waves: Sawtooth flutter waves at 300 bpm.
4. PR interval: Not measurable.
5. QRS: Narrow.
6. Interpretation: Typical atrial flutter - counterclockwise cavotricuspid isthmus
dependent.
7. Clinical Action: Rate control → consider rhythm control.
Q6: EKG Description: Rhythm: Irregular baseline with no organized atrial activity. Rate:
350-400 bpm fibrillatory waves. Ventricular rate: 120 bpm. P waves: Absent. PR interval:
Not applicable. QRS: Narrow (0.08s). ST/T: Obscured.
A. Atrial flutter
B. Atrial fibrillation
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular (but MAT can be irregular).
2. Rate: 110-130 bpm (>100 bpm is key for MAT vs WAP).
3. P waves: At least 3 different morphologies - hallmark of MAT or WAP.
4. PR interval: Varies - expected with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Multifocal Atrial Tachycardia - criteria met: irregular, rate >100, ≥3
P morphologies.
7. Clinical Significance: Often seen in COPD patients. Treat underlying cause, not
the rhythm itself.
, Differentiation from WAP: Wandering Atrial Pacemaker has same features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 50 bpm. P waves: Absent. QRS: Narrow
(0.08s). ST/T: Normal.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 50 bpm (40-60 = junctional escape range).
3. P waves: Absent (or may be retrograde, hidden in QRS).
4. PR interval: Not measurable.
5. QRS: Narrow (0.08s) - key differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - regular, narrow QRS, rate 40-60, no visible P
waves.
7. Clinical Action: Assess perfusion, consider atropine if symptomatic.
Q3: EKG Description: Rhythm: Irregular with gradual P-P and R-R shortening then
resetting. Rate: 60-100 bpm. P waves: 3 distinct shapes. PR interval: Varies 0.12-0.20s.
QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus arrhythmia
B. Wandering atrial pacemaker (WAP)
,C. Multifocal atrial tachycardia
D. Sinus rhythm with PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with cyclic pattern.
2. Rate: 60-100 bpm (<100 bpm distinguishes WAP from MAT).
3. P waves: 3 distinct morphologies - hallmark.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Wandering Atrial Pacemaker - benign, often in athletes.
7. Clinical Action: No treatment required.
Q4: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Hidden within preceding
T waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia (PSVT)
C. Atrial flutter
D. Junctional tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 140 bpm (150-250 typical for PSVT).
3. P waves: Hidden in T waves - retrograde conduction.
4. PR interval: Not measurable.
5. QRS: Narrow - supraventricular origin.
, 6. Interpretation: PSVT - sudden onset/offset, narrow complex.
7. Clinical Action: Vagal maneuvers → adenosine if stable.
Q5: EKG Description: Rhythm: Regular sawtooth flutter waves. Rate: Atrial 300 bpm,
ventricular 150 bpm. P waves: Replaced by flutter waves. PR interval: Not applicable.
QRS: Narrow (0.08s). ST/T: Obscured by flutter waves.
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. SVT with aberrancy
D. Junctional tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: Atrial 300, ventricular 150 = 2:1 conduction.
3. P waves: Sawtooth flutter waves at 300 bpm.
4. PR interval: Not measurable.
5. QRS: Narrow.
6. Interpretation: Typical atrial flutter - counterclockwise cavotricuspid isthmus
dependent.
7. Clinical Action: Rate control → consider rhythm control.
Q6: EKG Description: Rhythm: Irregular baseline with no organized atrial activity. Rate:
350-400 bpm fibrillatory waves. Ventricular rate: 120 bpm. P waves: Absent. PR interval:
Not applicable. QRS: Narrow (0.08s). ST/T: Obscured.
A. Atrial flutter
B. Atrial fibrillation
