Relias Dysrhythmia Basic A Assessment Actual Exam 2026/2027 –
Comprehensive Test with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Normal Sinus Rhythm & Sinus Arrhythmias
Q1: A 45-year-old patient is being monitored on telemetry after elective knee
replacement. The rhythm strip shows a regular rhythm with a rate of 72 bpm, upright P
waves preceding each QRS complex, a PR interval of 0.16 seconds, and narrow QRS
complexes. Which rhythm is present?
A. Sinus bradycardia with first-degree AV block
B. Sinus arrhythmia with ectopic atrial focus
C. Normal sinus rhythm [CORRECT]
D. Accelerated junctional rhythm
Correct Answer: C
Rationale: Normal sinus rhythm is defined by a regular rhythm, rate 60-100 bpm, upright
P waves before each QRS, PR interval 0.12-0.20 seconds, and narrow QRS complexes. A
is incorrect because the rate is normal and the PR interval is within normal limits. B is
incorrect because the rhythm is regular, not irregular. D is incorrect because junctional
rhythms have absent, inverted, or retrograde P waves.
,Q2: During morning rounds, you review a telemetry strip from a 68-year-old patient on
beta-blocker therapy. The rhythm is regular at 52 bpm with upright P waves before each
QRS, PR interval 0.18 seconds, and narrow QRS complexes. The patient is
asymptomatic with blood pressure 118/72 mmHg. What is the priority nursing action?
A. Prepare for transcutaneous pacing immediately
B. Administer atropine 0.5 mg IV push
C. Continue routine monitoring and document the finding [CORRECT]
D. Call the rapid response team for symptomatic bradycardia
Correct Answer: C
Rationale: This is sinus bradycardia in an asymptomatic patient on beta-blockers, which
is an expected medication effect. No intervention is needed when the patient is stable.
A and D are inappropriate for asymptomatic bradycardia. B is incorrect because
atropine is indicated for symptomatic bradycardia, not asymptomatic findings.
Q3: A telemetry strip shows a rhythm with a rate of 110 bpm, regular rhythm, upright P
waves before each QRS, PR interval 0.14 seconds, and narrow QRS complexes. The
patient reports mild anxiety and palpitations. Vital signs are stable. Which rhythm is
most likely present?
A. Supraventricular tachycardia with aberrant conduction
B. Sinus tachycardia [CORRECT]
,C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Correct Answer: B
Rationale: Sinus tachycardia is characterized by a rate >100 bpm with normal P waves,
PR interval, and QRS morphology. The patient's anxiety and stable vitals support a
physiologic sinus response. A is incorrect because aberrant conduction would show
widened QRS. C is incorrect because atrial flutter shows characteristic sawtooth flutter
waves, not normal P waves. D is incorrect because VT has wide QRS complexes and no
preceding P waves.
Q4: You are reviewing a 6-second rhythm strip. There are 10 QRS complexes visible, the
rhythm is slightly irregular, P waves are upright and present before each QRS, PR interval
is 0.16 seconds, and QRS duration is 0.08 seconds. The rate increases slightly with
inspiration and decreases with expiration. Which rhythm is present?
A. Normal sinus rhythm with artifact
B. Sinus arrhythmia [CORRECT]
C. Wandering atrial pacemaker
D. Sinus tachycardia with respiratory compensation
Correct Answer: B
, Rationale: Sinus arrhythmia is characterized by a phasic variation in heart rate (typically
increasing with inspiration, decreasing with expiration) with normal P wave morphology
and normal PR interval. The rate of 100 bpm (10 QRS in 6 seconds) is at the upper limit.
A is incorrect because normal sinus rhythm is regular. C is incorrect because wandering
atrial pacemaker shows varying P wave morphologies. D is incorrect because the
phasic variation is the defining feature of sinus arrhythmia, not tachycardia.
Q5: A 72-year-old patient on telemetry has a rhythm strip showing a rate of 48 bpm,
regular rhythm, upright P waves before each QRS, PR interval 0.20 seconds, and narrow
QRS complexes. The patient reports dizziness when standing. Blood pressure is 92/58
mmHg. What is the priority intervention?
A. Continue monitoring and reassess in 30 minutes
B. Administer atropine 0.5 mg IV and prepare for transcutaneous pacing [CORRECT]
C. Increase the patient's fluid intake orally
D. Apply supplemental oxygen at 2 L/min via nasal cannula
Correct Answer: B
Rationale: This is symptomatic sinus bradycardia (dizziness, hypotension) requiring
immediate intervention per ACLS guidelines. Atropine is the first-line treatment for
symptomatic bradycardia, with pacing readiness. A is dangerous as the patient is
symptomatic. C and D are supportive measures but do not address the bradycardia
directly.
Comprehensive Test with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Normal Sinus Rhythm & Sinus Arrhythmias
Q1: A 45-year-old patient is being monitored on telemetry after elective knee
replacement. The rhythm strip shows a regular rhythm with a rate of 72 bpm, upright P
waves preceding each QRS complex, a PR interval of 0.16 seconds, and narrow QRS
complexes. Which rhythm is present?
A. Sinus bradycardia with first-degree AV block
B. Sinus arrhythmia with ectopic atrial focus
C. Normal sinus rhythm [CORRECT]
D. Accelerated junctional rhythm
Correct Answer: C
Rationale: Normal sinus rhythm is defined by a regular rhythm, rate 60-100 bpm, upright
P waves before each QRS, PR interval 0.12-0.20 seconds, and narrow QRS complexes. A
is incorrect because the rate is normal and the PR interval is within normal limits. B is
incorrect because the rhythm is regular, not irregular. D is incorrect because junctional
rhythms have absent, inverted, or retrograde P waves.
,Q2: During morning rounds, you review a telemetry strip from a 68-year-old patient on
beta-blocker therapy. The rhythm is regular at 52 bpm with upright P waves before each
QRS, PR interval 0.18 seconds, and narrow QRS complexes. The patient is
asymptomatic with blood pressure 118/72 mmHg. What is the priority nursing action?
A. Prepare for transcutaneous pacing immediately
B. Administer atropine 0.5 mg IV push
C. Continue routine monitoring and document the finding [CORRECT]
D. Call the rapid response team for symptomatic bradycardia
Correct Answer: C
Rationale: This is sinus bradycardia in an asymptomatic patient on beta-blockers, which
is an expected medication effect. No intervention is needed when the patient is stable.
A and D are inappropriate for asymptomatic bradycardia. B is incorrect because
atropine is indicated for symptomatic bradycardia, not asymptomatic findings.
Q3: A telemetry strip shows a rhythm with a rate of 110 bpm, regular rhythm, upright P
waves before each QRS, PR interval 0.14 seconds, and narrow QRS complexes. The
patient reports mild anxiety and palpitations. Vital signs are stable. Which rhythm is
most likely present?
A. Supraventricular tachycardia with aberrant conduction
B. Sinus tachycardia [CORRECT]
,C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Correct Answer: B
Rationale: Sinus tachycardia is characterized by a rate >100 bpm with normal P waves,
PR interval, and QRS morphology. The patient's anxiety and stable vitals support a
physiologic sinus response. A is incorrect because aberrant conduction would show
widened QRS. C is incorrect because atrial flutter shows characteristic sawtooth flutter
waves, not normal P waves. D is incorrect because VT has wide QRS complexes and no
preceding P waves.
Q4: You are reviewing a 6-second rhythm strip. There are 10 QRS complexes visible, the
rhythm is slightly irregular, P waves are upright and present before each QRS, PR interval
is 0.16 seconds, and QRS duration is 0.08 seconds. The rate increases slightly with
inspiration and decreases with expiration. Which rhythm is present?
A. Normal sinus rhythm with artifact
B. Sinus arrhythmia [CORRECT]
C. Wandering atrial pacemaker
D. Sinus tachycardia with respiratory compensation
Correct Answer: B
, Rationale: Sinus arrhythmia is characterized by a phasic variation in heart rate (typically
increasing with inspiration, decreasing with expiration) with normal P wave morphology
and normal PR interval. The rate of 100 bpm (10 QRS in 6 seconds) is at the upper limit.
A is incorrect because normal sinus rhythm is regular. C is incorrect because wandering
atrial pacemaker shows varying P wave morphologies. D is incorrect because the
phasic variation is the defining feature of sinus arrhythmia, not tachycardia.
Q5: A 72-year-old patient on telemetry has a rhythm strip showing a rate of 48 bpm,
regular rhythm, upright P waves before each QRS, PR interval 0.20 seconds, and narrow
QRS complexes. The patient reports dizziness when standing. Blood pressure is 92/58
mmHg. What is the priority intervention?
A. Continue monitoring and reassess in 30 minutes
B. Administer atropine 0.5 mg IV and prepare for transcutaneous pacing [CORRECT]
C. Increase the patient's fluid intake orally
D. Apply supplemental oxygen at 2 L/min via nasal cannula
Correct Answer: B
Rationale: This is symptomatic sinus bradycardia (dizziness, hypotension) requiring
immediate intervention per ACLS guidelines. Atropine is the first-line treatment for
symptomatic bradycardia, with pacing readiness. A is dangerous as the patient is
symptomatic. C and D are supportive measures but do not address the bradycardia
directly.
