,Relias Dysrhythmia Basic Test -
Advanced Clinical Application400
+Questions with Scenarios,
Diagrams, and Clinical Reasoning
2026-2027
SECTION 1: Sinus Rhythms & Basic Principles (Questions
1-50)
Scenario:
You are caring for a 68-year-old male who is 2 days post-operative from a total hip
replacement. He is awake and alert, but complains of mild dizziness when he
attempts to stand. His vital signs are: BP 102/68, HR 52, RR 16, SpO2 96%. The
monitor shows a regular rhythm with normal P waves preceding each QRS complex.
The PR interval is 0.16 seconds and the QRS duration is 0.08 seconds.
Question 1: What is the most appropriate initial nursing action?
A) Administer atropine 0.5 mg IV push
B) Prepare for transcutaneous pacing
C) Document the rhythm and assist the patient with sitting up slowly [CORRECT]
D) Notify the rapid response team immediately
Rationale: This patient has sinus bradycardia (HR 52) but is hemodynamically stable
with only mild dizziness on standing. The appropriate action is to document the
rhythm, which is common in athletic or elderly patients, and implement fall
precautions. Atropine and pacing are indicated for symptomatic bradycardia with
instability (hypotension, chest pain, altered mental status). The rapid response team is
not needed for a stable patient.
,Table 1: Sinus Rhythm Characteristics
PR QRS
Rhythm Rate Regularity P Wave
Interval Duration
60-100 0.12-
Normal Sinus Regular Upright <0.12 sec
bpm 0.20 sec
Sinus <60 0.12-
Regular Upright <0.12 sec
Bradycardia bpm 0.20 sec
100-
Sinus 0.12-
150 Regular Upright <0.12 sec
Tachycardia 0.20 sec
bpm
Sinus 60-100 Irregular 0.12-
Upright <0.12 sec
Arrhythmia bpm (respiratory) 0.20 sec
Scenario:
A 45-year-old female with no significant medical history presents to the emergency
department with palpitations, anxiety, and a sensation of her heart "racing." She
reports drinking 4 cups of coffee this morning. Her HR is 128 bpm, BP 138/82, RR 18,
SpO2 99%. The monitor shows a regular rhythm with upright P waves before each
QRS. She is anxious but hemodynamically stable.
Question 2: Which intervention should the nurse prioritize first?
A) Administer adenosine 6 mg rapid IV push
B) Prepare for synchronized cardioversion
C) Instruct the patient to perform vagal maneuvers
D) Address potential causes and provide reassurance [CORRECT]
Rationale: The patient has sinus tachycardia likely caused by excessive caffeine. Sinus
tachycardia is a physiologic response to a stimulus and should be treated by addressing
the underlying cause. Adenosine is used for SVT, cardioversion for unstable
tachycardia, and vagal maneuvers are not typically effective for sinus tachycardia. The
priority is to address the cause and provide reassurance while monitoring for
improvement.
, Scenario:
A 72-year-old male with a history of coronary artery disease is admitted with
shortness of breath. His monitor shows a regular rhythm at a rate of 46 bpm with
normal P waves. His blood pressure is 88/54 mmHg, and he is lethargic. He has cool,
clammy skin.
Question 3: What is the most appropriate immediate intervention?
A) Administer oxygen at 2 L/min via nasal cannula
B) Administer atropine 0.5 mg IV push [CORRECT]
C) Start a dopamine infusion
D) Prepare for transcutaneous pacing
Rationale: This patient has symptomatic bradycardia with hypotension and altered
mental status. Atropine 0.5 mg IV push is the first-line treatment for symptomatic
bradycardia. If atropine is ineffective, transcutaneous pacing would be the next step.
Oxygen should be administered but is not the primary intervention. Dopamine is a
second-line option if atropine fails.
Figure 1: ECG Paper Measurement
text
ECG Paper (Standard Speed 25 mm/sec)
ONE LARGE BOX = 0.20 sec (5 mm)
┌─────────────────────────────────────────────────────────┐
│ ┌──────┐ ┌──────┐ ┌──────┐ ┌──────┐ ┌──────┐ │
│ │ │ │ │ │ │ │ │ │ │ │
│ │ 0.04 │ │ 0.04 │ │ 0.04 │ │ 0.04 │ │ 0.04 │ │
│ │ sec │ │ sec │ │ sec │ │ sec │ │ sec │ │
│ │ │ │ │ │ │ │ │ │ │ │
│ └──────┘ └──────┘ └──────┘ └──────┘ └──────┘ │
│←────────────────── 1 SECOND ─────────────────────→│
└─────────────────────────────────────────────────────────┘
300 method for regular rhythms: Rate = 300 / (# of large boxes between R-R)
6-second method for irregular rhythms: Rate = (# of R waves in 6 sec) × 10
Advanced Clinical Application400
+Questions with Scenarios,
Diagrams, and Clinical Reasoning
2026-2027
SECTION 1: Sinus Rhythms & Basic Principles (Questions
1-50)
Scenario:
You are caring for a 68-year-old male who is 2 days post-operative from a total hip
replacement. He is awake and alert, but complains of mild dizziness when he
attempts to stand. His vital signs are: BP 102/68, HR 52, RR 16, SpO2 96%. The
monitor shows a regular rhythm with normal P waves preceding each QRS complex.
The PR interval is 0.16 seconds and the QRS duration is 0.08 seconds.
Question 1: What is the most appropriate initial nursing action?
A) Administer atropine 0.5 mg IV push
B) Prepare for transcutaneous pacing
C) Document the rhythm and assist the patient with sitting up slowly [CORRECT]
D) Notify the rapid response team immediately
Rationale: This patient has sinus bradycardia (HR 52) but is hemodynamically stable
with only mild dizziness on standing. The appropriate action is to document the
rhythm, which is common in athletic or elderly patients, and implement fall
precautions. Atropine and pacing are indicated for symptomatic bradycardia with
instability (hypotension, chest pain, altered mental status). The rapid response team is
not needed for a stable patient.
,Table 1: Sinus Rhythm Characteristics
PR QRS
Rhythm Rate Regularity P Wave
Interval Duration
60-100 0.12-
Normal Sinus Regular Upright <0.12 sec
bpm 0.20 sec
Sinus <60 0.12-
Regular Upright <0.12 sec
Bradycardia bpm 0.20 sec
100-
Sinus 0.12-
150 Regular Upright <0.12 sec
Tachycardia 0.20 sec
bpm
Sinus 60-100 Irregular 0.12-
Upright <0.12 sec
Arrhythmia bpm (respiratory) 0.20 sec
Scenario:
A 45-year-old female with no significant medical history presents to the emergency
department with palpitations, anxiety, and a sensation of her heart "racing." She
reports drinking 4 cups of coffee this morning. Her HR is 128 bpm, BP 138/82, RR 18,
SpO2 99%. The monitor shows a regular rhythm with upright P waves before each
QRS. She is anxious but hemodynamically stable.
Question 2: Which intervention should the nurse prioritize first?
A) Administer adenosine 6 mg rapid IV push
B) Prepare for synchronized cardioversion
C) Instruct the patient to perform vagal maneuvers
D) Address potential causes and provide reassurance [CORRECT]
Rationale: The patient has sinus tachycardia likely caused by excessive caffeine. Sinus
tachycardia is a physiologic response to a stimulus and should be treated by addressing
the underlying cause. Adenosine is used for SVT, cardioversion for unstable
tachycardia, and vagal maneuvers are not typically effective for sinus tachycardia. The
priority is to address the cause and provide reassurance while monitoring for
improvement.
, Scenario:
A 72-year-old male with a history of coronary artery disease is admitted with
shortness of breath. His monitor shows a regular rhythm at a rate of 46 bpm with
normal P waves. His blood pressure is 88/54 mmHg, and he is lethargic. He has cool,
clammy skin.
Question 3: What is the most appropriate immediate intervention?
A) Administer oxygen at 2 L/min via nasal cannula
B) Administer atropine 0.5 mg IV push [CORRECT]
C) Start a dopamine infusion
D) Prepare for transcutaneous pacing
Rationale: This patient has symptomatic bradycardia with hypotension and altered
mental status. Atropine 0.5 mg IV push is the first-line treatment for symptomatic
bradycardia. If atropine is ineffective, transcutaneous pacing would be the next step.
Oxygen should be administered but is not the primary intervention. Dopamine is a
second-line option if atropine fails.
Figure 1: ECG Paper Measurement
text
ECG Paper (Standard Speed 25 mm/sec)
ONE LARGE BOX = 0.20 sec (5 mm)
┌─────────────────────────────────────────────────────────┐
│ ┌──────┐ ┌──────┐ ┌──────┐ ┌──────┐ ┌──────┐ │
│ │ │ │ │ │ │ │ │ │ │ │
│ │ 0.04 │ │ 0.04 │ │ 0.04 │ │ 0.04 │ │ 0.04 │ │
│ │ sec │ │ sec │ │ sec │ │ sec │ │ sec │ │
│ │ │ │ │ │ │ │ │ │ │ │
│ └──────┘ └──────┘ └──────┘ └──────┘ └──────┘ │
│←────────────────── 1 SECOND ─────────────────────→│
└─────────────────────────────────────────────────────────┘
300 method for regular rhythms: Rate = 300 / (# of large boxes between R-R)
6-second method for irregular rhythms: Rate = (# of R waves in 6 sec) × 10
