RELIAS Dysrhythmia Basic Test
Revised Version | 2026/2027
35 Correct Verified Questions and Answers | A+ Graded
Basic Cardiac Rhythm Identification for Healthcare Professionals
Aligned with Current ACLS Guidelines | Systematic Interpretation Method
Section 1: Sinus Rhythms and Arrhythmias (Questions 1-8)
Q1. A telemetry strip shows a regular rhythm with a rate of 82 bpm using the 6-second method (8 R-R intervals in 6
seconds). Each P wave is upright, uniform, and precedes each QRS complex. The PR interval measures 0.16 seconds and
the QRS duration is 0.08 seconds. Which rhythm is this?
A. Sinus bradycardia with first-degree AV block
B. Normal sinus rhythm [CORRECT]
C. Sinus arrhythmia with normal conduction
D. Sinus tachycardia
Correct Answer: B
Rationale: Systematic analysis: Rate is 82 bpm (normal range 60-100 bpm). Rhythm is regular with consistent R-R intervals. P waves are upright, uniform,
and precede every QRS (normal sinus origin from SA node). PR interval is 0.16 seconds (within normal 0.12-0.20 seconds). QRS is 0.08 seconds (narrow,
less than 0.12 seconds). All parameters fall within normal limits, confirming normal sinus rhythm. Sinus bradycardia requires a rate below 60 bpm. Sinus
arrhythmia shows a regularly irregular pattern with phasic rate variation. Sinus tachycardia requires a rate above 100 bpm.
Q2. A patient's telemetry monitor displays a regular rhythm at a rate of 48 bpm. P waves are upright and precede each
QRS. The PR interval is 0.14 seconds and QRS measures 0.06 seconds. The patient is asymptomatic with a blood pressure
of 118/76 mmHg. What is the correct interpretation and appropriate action?
A. Sinus bradycardia; administer atropine 0.5 mg IV immediately
B. Sinus bradycardia; continue to monitor and assess for hemodynamic stability [CORRECT]
C. Junctional rhythm; prepare for transcutaneous pacing
D. Normal sinus rhythm with vagal tone; no intervention needed
Correct Answer: B
Rationale: Systematic analysis: Rate is 48 bpm (below 60 bpm, meeting bradycardia criteria). Rhythm is regular. Upright P waves precede each QRS,
confirming sinus origin. PR interval is 0.14 seconds (normal). QRS is 0.06 seconds (narrow). This is sinus bradycardia. Because the patient is asymptomatic
and hemodynamically stable (BP 118/76 mmHg), the appropriate action is continued monitoring. Atropine is indicated only for symptomatic bradycardia
with signs of poor perfusion. This is not a junctional rhythm because P waves are present and upright with a normal PR interval. A rate of 48 bpm is not
normal sinus rhythm.
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, RELIAS Dysrhythmia Basic Test - Revised 2026/2027 35 Questions | A+ Graded
Q3. A telemetry strip reveals a regular rhythm at a rate of 128 bpm. P waves are upright and precede each QRS. The PR
interval is 0.14 seconds and the QRS complex is 0.08 seconds. The patient reports anxiety and has been drinking excessive
amounts of coffee. What is this rhythm?
A. Sinus tachycardia [CORRECT]
B. Atrial fibrillation with rapid ventricular response
C. Supraventricular tachycardia
D. Sinus arrhythmia
Correct Answer: A
Rationale: Systematic analysis: Rate is 128 bpm (above 100 bpm). Rhythm is regular. Upright P waves precede each QRS, confirming sinus node origin. PR
interval is 0.14 seconds (normal). QRS is 0.08 seconds (narrow). This meets all criteria for sinus tachycardia: a regular rhythm originating from the SA node
with a rate exceeding 100 bpm. Atrial fibrillation would show an irregularly irregular rhythm with absent P waves and fibrillatory waves. SVT typically
starts and stops abruptly and has a rate of 150-250 bpm with P waves that may be hidden. Sinus arrhythmia shows rate variation with respiration, not a
sustained elevated rate.
Q4. A telemetry strip shows P waves that are upright and uniform, each followed by a QRS complex. The R-R intervals
vary, with the rate increasing during inspiration and decreasing during expiration. The overall rate averages 72 bpm. The
PR interval is 0.16 seconds and the QRS is 0.08 seconds. Which rhythm is displayed?
A. Atrial fibrillation
B. Sinus arrhythmia [CORRECT]
C. Second-degree AV block Type I (Wenckebach)
D. Premature atrial contractions
Correct Answer: B
Rationale: Systematic analysis: Rate averages 72 bpm (normal). Rhythm is regularly irregular, with R-R intervals that vary cyclically with respiration (rate
increases on inspiration, decreases on expiration). P waves are upright, uniform, and precede each QRS, confirming sinus origin. PR interval is 0.16 seconds
(normal and constant). QRS is 0.08 seconds (narrow). The phasic variation in rate with breathing is the hallmark of sinus arrhythmia, a common benign
finding in young, healthy individuals. Atrial fibrillation shows an irregularly irregular pattern without identifiable P waves. Wenckebach shows
progressively prolonging PR intervals. PACs show early beats with different P wave morphology.
Q5. A patient on telemetry has a regular rhythm at 54 bpm. Upright P waves precede each QRS with a PR interval of 0.12
seconds. QRS duration is 0.08 seconds. The patient reports feeling lightheaded. Blood pressure is 88/56 mmHg. What is the
priority nursing intervention?
A. Continue monitoring because the rate is close to normal
B. Administer atropine 0.5 mg IV per ACLS bradycardia protocol [CORRECT]
C. Perform synchronized cardioversion at 50 joules
D. Administer adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: Systematic analysis: The rhythm is sinus bradycardia (rate 54 bpm, regular rhythm, upright P waves, normal PR and QRS). However, the patient
is symptomatic (lightheaded) and hypotensive (BP 88/56 mmHg), indicating inadequate perfusion. Per ACLS guidelines, symptomatic bradycardia with
signs of poor perfusion is a Class I indication for atropine 0.5 mg IV, which may be repeated every 3-5 minutes up to a total dose of 3 mg. Continuing to
monitor alone is inappropriate for an unstable patient. Synchronized cardioversion is not indicated for bradycardia. Adenosine is used for stable SVT, not
bradycardia.
Q6. A nurse is calculating the heart rate on a telemetry strip using the 300 method. The R-R interval spans exactly 5 large
boxes (each 0.20 seconds). What is the calculated heart rate, and what rhythm characteristic does this represent if the rate
is regular with normal P waves and PR interval?
A. 60 bpm; sinus bradycardia [CORRECT]
B. 75 bpm; normal sinus rhythm
C. 50 bpm; junctional rhythm
D. 100 bpm; sinus tachycardia
Correct Answer: A
Page 2
Revised Version | 2026/2027
35 Correct Verified Questions and Answers | A+ Graded
Basic Cardiac Rhythm Identification for Healthcare Professionals
Aligned with Current ACLS Guidelines | Systematic Interpretation Method
Section 1: Sinus Rhythms and Arrhythmias (Questions 1-8)
Q1. A telemetry strip shows a regular rhythm with a rate of 82 bpm using the 6-second method (8 R-R intervals in 6
seconds). Each P wave is upright, uniform, and precedes each QRS complex. The PR interval measures 0.16 seconds and
the QRS duration is 0.08 seconds. Which rhythm is this?
A. Sinus bradycardia with first-degree AV block
B. Normal sinus rhythm [CORRECT]
C. Sinus arrhythmia with normal conduction
D. Sinus tachycardia
Correct Answer: B
Rationale: Systematic analysis: Rate is 82 bpm (normal range 60-100 bpm). Rhythm is regular with consistent R-R intervals. P waves are upright, uniform,
and precede every QRS (normal sinus origin from SA node). PR interval is 0.16 seconds (within normal 0.12-0.20 seconds). QRS is 0.08 seconds (narrow,
less than 0.12 seconds). All parameters fall within normal limits, confirming normal sinus rhythm. Sinus bradycardia requires a rate below 60 bpm. Sinus
arrhythmia shows a regularly irregular pattern with phasic rate variation. Sinus tachycardia requires a rate above 100 bpm.
Q2. A patient's telemetry monitor displays a regular rhythm at a rate of 48 bpm. P waves are upright and precede each
QRS. The PR interval is 0.14 seconds and QRS measures 0.06 seconds. The patient is asymptomatic with a blood pressure
of 118/76 mmHg. What is the correct interpretation and appropriate action?
A. Sinus bradycardia; administer atropine 0.5 mg IV immediately
B. Sinus bradycardia; continue to monitor and assess for hemodynamic stability [CORRECT]
C. Junctional rhythm; prepare for transcutaneous pacing
D. Normal sinus rhythm with vagal tone; no intervention needed
Correct Answer: B
Rationale: Systematic analysis: Rate is 48 bpm (below 60 bpm, meeting bradycardia criteria). Rhythm is regular. Upright P waves precede each QRS,
confirming sinus origin. PR interval is 0.14 seconds (normal). QRS is 0.06 seconds (narrow). This is sinus bradycardia. Because the patient is asymptomatic
and hemodynamically stable (BP 118/76 mmHg), the appropriate action is continued monitoring. Atropine is indicated only for symptomatic bradycardia
with signs of poor perfusion. This is not a junctional rhythm because P waves are present and upright with a normal PR interval. A rate of 48 bpm is not
normal sinus rhythm.
Page 1
, RELIAS Dysrhythmia Basic Test - Revised 2026/2027 35 Questions | A+ Graded
Q3. A telemetry strip reveals a regular rhythm at a rate of 128 bpm. P waves are upright and precede each QRS. The PR
interval is 0.14 seconds and the QRS complex is 0.08 seconds. The patient reports anxiety and has been drinking excessive
amounts of coffee. What is this rhythm?
A. Sinus tachycardia [CORRECT]
B. Atrial fibrillation with rapid ventricular response
C. Supraventricular tachycardia
D. Sinus arrhythmia
Correct Answer: A
Rationale: Systematic analysis: Rate is 128 bpm (above 100 bpm). Rhythm is regular. Upright P waves precede each QRS, confirming sinus node origin. PR
interval is 0.14 seconds (normal). QRS is 0.08 seconds (narrow). This meets all criteria for sinus tachycardia: a regular rhythm originating from the SA node
with a rate exceeding 100 bpm. Atrial fibrillation would show an irregularly irregular rhythm with absent P waves and fibrillatory waves. SVT typically
starts and stops abruptly and has a rate of 150-250 bpm with P waves that may be hidden. Sinus arrhythmia shows rate variation with respiration, not a
sustained elevated rate.
Q4. A telemetry strip shows P waves that are upright and uniform, each followed by a QRS complex. The R-R intervals
vary, with the rate increasing during inspiration and decreasing during expiration. The overall rate averages 72 bpm. The
PR interval is 0.16 seconds and the QRS is 0.08 seconds. Which rhythm is displayed?
A. Atrial fibrillation
B. Sinus arrhythmia [CORRECT]
C. Second-degree AV block Type I (Wenckebach)
D. Premature atrial contractions
Correct Answer: B
Rationale: Systematic analysis: Rate averages 72 bpm (normal). Rhythm is regularly irregular, with R-R intervals that vary cyclically with respiration (rate
increases on inspiration, decreases on expiration). P waves are upright, uniform, and precede each QRS, confirming sinus origin. PR interval is 0.16 seconds
(normal and constant). QRS is 0.08 seconds (narrow). The phasic variation in rate with breathing is the hallmark of sinus arrhythmia, a common benign
finding in young, healthy individuals. Atrial fibrillation shows an irregularly irregular pattern without identifiable P waves. Wenckebach shows
progressively prolonging PR intervals. PACs show early beats with different P wave morphology.
Q5. A patient on telemetry has a regular rhythm at 54 bpm. Upright P waves precede each QRS with a PR interval of 0.12
seconds. QRS duration is 0.08 seconds. The patient reports feeling lightheaded. Blood pressure is 88/56 mmHg. What is the
priority nursing intervention?
A. Continue monitoring because the rate is close to normal
B. Administer atropine 0.5 mg IV per ACLS bradycardia protocol [CORRECT]
C. Perform synchronized cardioversion at 50 joules
D. Administer adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: Systematic analysis: The rhythm is sinus bradycardia (rate 54 bpm, regular rhythm, upright P waves, normal PR and QRS). However, the patient
is symptomatic (lightheaded) and hypotensive (BP 88/56 mmHg), indicating inadequate perfusion. Per ACLS guidelines, symptomatic bradycardia with
signs of poor perfusion is a Class I indication for atropine 0.5 mg IV, which may be repeated every 3-5 minutes up to a total dose of 3 mg. Continuing to
monitor alone is inappropriate for an unstable patient. Synchronized cardioversion is not indicated for bradycardia. Adenosine is used for stable SVT, not
bradycardia.
Q6. A nurse is calculating the heart rate on a telemetry strip using the 300 method. The R-R interval spans exactly 5 large
boxes (each 0.20 seconds). What is the calculated heart rate, and what rhythm characteristic does this represent if the rate
is regular with normal P waves and PR interval?
A. 60 bpm; sinus bradycardia [CORRECT]
B. 75 bpm; normal sinus rhythm
C. 50 bpm; junctional rhythm
D. 100 bpm; sinus tachycardia
Correct Answer: A
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