Relias Advanced Dysrhythmia Exam A | 2025–
2026 Edition Comprehensive 200-Question
EKG Interpretation & Cardiac Rhythm Mastery
Cardiology & Critical Care | 100% Verified | A+
Graded Review
Introduction: This advanced cardiology resource includes 200
comprehensive questions from the Relias Advanced Dysrhythmia Exam,
updated for 2025–2026. Each question features a step-by-step explanation for
interpreting EKG rhythms and selecting the correct intervention or diagnosis.
Ideal for ICU, telemetry, emergency, and cardiac nurses preparing for
certification or clinical validation.
Question 1: A rhythm strip shows a rate of 88 bpm, regular rhythm,
normal P waves, PR interval 0.16 seconds, QRS 0.08 seconds. What is the
rhythm?
• A) Atrial fibrillation
• B) Normal sinus rhythm ✓✓
• C) Sinus tachycardia
• D) Sinus bradycardia
Rationale: Rate 60–100 bpm, regular rhythm, normal P waves, PR 0.12–0.20
s, QRS <0.12 s indicate normal sinus rhythm.
Question 2: A patient has a rhythm with no identifiable P waves,
irregular rhythm, and QRS 0.10 seconds. What is the rhythm?
• A) Atrial fibrillation ✓✓
, • B) Sinus arrhythmia
• C) Junctional rhythm
• D) Ventricular tachycardia
Rationale: Absent P waves and irregular rhythm are hallmarks of atrial
fibrillation; normal QRS rules out ventricular rhythms.
Question 3: A rhythm strip shows a rate of 42 bpm, regular rhythm,
normal P waves, PR 0.18 seconds, QRS 0.10 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus tachycardia
• C) Sinus bradycardia ✓✓
• D) Junctional rhythm
Rationale: Rate <60 bpm with normal P waves and conduction indicates
sinus bradycardia. Rate is 42 bpm, well below the normal 60-100 range.
Question 4: A rhythm strip shows a rate of 115 bpm, regular rhythm,
normal P waves, PR 0.14 seconds, QRS 0.08 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus tachycardia ✓✓
• C) Atrial flutter
• D) Supraventricular tachycardia
Rationale: Rate >100 bpm with normal P waves and conduction indicates
sinus tachycardia. The rate of 115 bpm with normal morphology rules out
other tachyarrhythmias.
Question 5: A rhythm strip shows a rate of 72 bpm, irregular rhythm,
normal P waves, PR 0.18 seconds, QRS 0.08 seconds. What is the rhythm?
, • A) Atrial fibrillation
• B) Sinus arrhythmia ✓✓
• C) Sinus bradycardia
• D) Normal sinus rhythm
Rationale: Rate 60-100 bpm with irregular rhythm and normal P waves
indicates sinus arrhythmia. The irregularity is typically respiratory-related.
Question 6: A patient presents with a rhythm showing sinus P waves at a
rate of 75 bpm, followed by a 2.5-second pause with no P waves. What is
the rhythm?
• A) Sinus arrhythmia
• B) Sinus arrest ✓✓
• C) Atrial fibrillation
• D) Sinus tachycardia
Rationale: Sinus arrest is characterized by a pause with no P waves. The
pause duration >2 seconds is significant and requires evaluation.
Question 7: A rhythm strip shows a rate of 95 bpm, regular rhythm, P
waves with varying morphology, PR 0.14-0.18 seconds, QRS 0.08
seconds. What is the rhythm?
• A) Atrial fibrillation
• B) Wandering atrial pacemaker ✓✓
• C) Multifocal atrial tachycardia
• D) Normal sinus rhythm
Rationale: Wandering atrial pacemaker shows P waves of varying
morphology with rate <100 bpm. The varying P wave morphology indicates
shifting pacemaker site.
, Question 8: A patient with a sinus rhythm of 70 bpm suddenly develops a
3-second pause followed by a P wave and resumption of sinus rhythm.
What is the rhythm?
• A) Sinus arrhythmia
• B) Sinus pause ✓✓
• C) Atrial fibrillation
• D) Sinus exit block
Rationale: Sinus pause is a transient cessation of sinus node activity. The
pause is not a multiple of the underlying cycle length, distinguishing it from
sinus exit block.
Question 9: A rhythm strip shows a rate of 55 bpm, regular rhythm,
normal P waves, PR 0.22 seconds, QRS 0.10 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus bradycardia
• C) Sinus bradycardia with first-degree AV block ✓✓
• D) Junctional rhythm
Rationale: Rate <60 bpm (sinus bradycardia) with PR interval >0.20 seconds
(first-degree AV block). The combination requires recognition of both
abnormalities.
Question 10: A patient's rhythm strip shows sinus P waves at 60 bpm
with occasional non-conducted P waves. What is the rhythm?
• A) Sinus arrhythmia
• B) Sinus arrest
• C) Sinus exit block ✓✓
2026 Edition Comprehensive 200-Question
EKG Interpretation & Cardiac Rhythm Mastery
Cardiology & Critical Care | 100% Verified | A+
Graded Review
Introduction: This advanced cardiology resource includes 200
comprehensive questions from the Relias Advanced Dysrhythmia Exam,
updated for 2025–2026. Each question features a step-by-step explanation for
interpreting EKG rhythms and selecting the correct intervention or diagnosis.
Ideal for ICU, telemetry, emergency, and cardiac nurses preparing for
certification or clinical validation.
Question 1: A rhythm strip shows a rate of 88 bpm, regular rhythm,
normal P waves, PR interval 0.16 seconds, QRS 0.08 seconds. What is the
rhythm?
• A) Atrial fibrillation
• B) Normal sinus rhythm ✓✓
• C) Sinus tachycardia
• D) Sinus bradycardia
Rationale: Rate 60–100 bpm, regular rhythm, normal P waves, PR 0.12–0.20
s, QRS <0.12 s indicate normal sinus rhythm.
Question 2: A patient has a rhythm with no identifiable P waves,
irregular rhythm, and QRS 0.10 seconds. What is the rhythm?
• A) Atrial fibrillation ✓✓
, • B) Sinus arrhythmia
• C) Junctional rhythm
• D) Ventricular tachycardia
Rationale: Absent P waves and irregular rhythm are hallmarks of atrial
fibrillation; normal QRS rules out ventricular rhythms.
Question 3: A rhythm strip shows a rate of 42 bpm, regular rhythm,
normal P waves, PR 0.18 seconds, QRS 0.10 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus tachycardia
• C) Sinus bradycardia ✓✓
• D) Junctional rhythm
Rationale: Rate <60 bpm with normal P waves and conduction indicates
sinus bradycardia. Rate is 42 bpm, well below the normal 60-100 range.
Question 4: A rhythm strip shows a rate of 115 bpm, regular rhythm,
normal P waves, PR 0.14 seconds, QRS 0.08 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus tachycardia ✓✓
• C) Atrial flutter
• D) Supraventricular tachycardia
Rationale: Rate >100 bpm with normal P waves and conduction indicates
sinus tachycardia. The rate of 115 bpm with normal morphology rules out
other tachyarrhythmias.
Question 5: A rhythm strip shows a rate of 72 bpm, irregular rhythm,
normal P waves, PR 0.18 seconds, QRS 0.08 seconds. What is the rhythm?
, • A) Atrial fibrillation
• B) Sinus arrhythmia ✓✓
• C) Sinus bradycardia
• D) Normal sinus rhythm
Rationale: Rate 60-100 bpm with irregular rhythm and normal P waves
indicates sinus arrhythmia. The irregularity is typically respiratory-related.
Question 6: A patient presents with a rhythm showing sinus P waves at a
rate of 75 bpm, followed by a 2.5-second pause with no P waves. What is
the rhythm?
• A) Sinus arrhythmia
• B) Sinus arrest ✓✓
• C) Atrial fibrillation
• D) Sinus tachycardia
Rationale: Sinus arrest is characterized by a pause with no P waves. The
pause duration >2 seconds is significant and requires evaluation.
Question 7: A rhythm strip shows a rate of 95 bpm, regular rhythm, P
waves with varying morphology, PR 0.14-0.18 seconds, QRS 0.08
seconds. What is the rhythm?
• A) Atrial fibrillation
• B) Wandering atrial pacemaker ✓✓
• C) Multifocal atrial tachycardia
• D) Normal sinus rhythm
Rationale: Wandering atrial pacemaker shows P waves of varying
morphology with rate <100 bpm. The varying P wave morphology indicates
shifting pacemaker site.
, Question 8: A patient with a sinus rhythm of 70 bpm suddenly develops a
3-second pause followed by a P wave and resumption of sinus rhythm.
What is the rhythm?
• A) Sinus arrhythmia
• B) Sinus pause ✓✓
• C) Atrial fibrillation
• D) Sinus exit block
Rationale: Sinus pause is a transient cessation of sinus node activity. The
pause is not a multiple of the underlying cycle length, distinguishing it from
sinus exit block.
Question 9: A rhythm strip shows a rate of 55 bpm, regular rhythm,
normal P waves, PR 0.22 seconds, QRS 0.10 seconds. What is the rhythm?
• A) Normal sinus rhythm
• B) Sinus bradycardia
• C) Sinus bradycardia with first-degree AV block ✓✓
• D) Junctional rhythm
Rationale: Rate <60 bpm (sinus bradycardia) with PR interval >0.20 seconds
(first-degree AV block). The combination requires recognition of both
abnormalities.
Question 10: A patient's rhythm strip shows sinus P waves at 60 bpm
with occasional non-conducted P waves. What is the rhythm?
• A) Sinus arrhythmia
• B) Sinus arrest
• C) Sinus exit block ✓✓
