Page 1 of 74
RELIAS DYSRHYTHMIA BASIC ASSESSMENT 250 QUESTIONS
EXAM LATEST VERSION QUESTIONS AND ANSWERS 2026
EDITION
RELIAS DYSRHYTHMIA BASIC ASSESSMENT
250 Practice Questions with Rationales
EXAMINATION QUESTIONS
NORMAL SINUS RHYTHM & SINUS BRADYCARDIA
1. A patient's cardiac monitor shows a regular rhythm with a rate of 72 bpm, a P
wave before every QRS, a PR interval of 0.16 seconds, and a QRS duration of 0.08
seconds. How should the nurse interpret this rhythm?
A) Sinus tachycardia
B) Normal sinus rhythm
C) Sinus bradycardia
D) First-degree AV block
Correct Answer: B
Rationale: Normal sinus rhythm has a rate of 60-100 bpm, a P wave before each QRS,
consistent PR interval (0.12-0.20 sec), and QRS < 0.12 sec. This rhythm meets all
criteria, making it normal sinus rhythm.
2. A patient's heart rate is 48 bpm. The rhythm is regular, and there is a P wave
before each QRS with a normal PR interval. What is the most likely interpretation?
A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) First-degree AV block
Correct Answer: B
Rationale: Sinus bradycardia is defined as a sinus rhythm with a rate less than 60 bpm.
, Page 2 of 74
All other intervals are normal. This is a common finding in well-conditioned athletes and
can also occur during sleep or with vagal stimulation.
3. A patient on a cardiac monitor has a heart rate of 130 bpm. The rhythm is regular,
and P waves are present before each QRS with normal PR and QRS intervals. What
is the most likely interpretation?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Supraventricular tachycardia
D) Atrial fibrillation
Correct Answer: B
Rationale: Sinus tachycardia is defined as a sinus rhythm with a rate greater than 100
bpm. It is often a physiological response to stress, fever, pain, hypovolemia, or
hyperthyroidism. The rhythm should be regular with normal P waves, PR, and QRS
intervals.
4. A patient has a heart rate of 52 bpm. The ECG shows a normal P wave before each
QRS, a regular rhythm, and a PR interval of 0.18 seconds. Which of the following is
the most appropriate initial nursing action?
A) Prepare for transcutaneous pacing
B) Assess the patient's blood pressure and level of consciousness
C) Administer atropine 0.5 mg IV push
D) Document the rhythm and continue to monitor
Correct Answer: B
Rationale: The priority is to assess the patient's clinical status. If the patient is
asymptomatic, sinus bradycardia requires no immediate intervention. If the patient is
symptomatic (hypotension, chest pain, altered mental status), treatment with atropine
or pacing may be indicated.
5. A patient with sinus bradycardia is symptomatic with a blood pressure of 86/52
mmHg and reports feeling lightheaded. Which medication should the nurse
anticipate administering?
A) Adenosine
B) Atropine
C) Digoxin
D) Metoprolol
Correct Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia. It is an
anticholinergic that blocks the vagal effects on the heart, increasing the sinus rate. The
dose is 0.5 mg IV push, repeated every 3-5 minutes up to a maximum of 3 mg.
, Page 3 of 74
SINUS TACHYCARDIA & ATRIAL ARRHYTHMIAS
6. A patient with a history of heart failure has a heart rate of 140 bpm. The rhythm is
regular with normal P waves. The nurse should FIRST:
A) Administer adenosine 6 mg IV push
B) Assess for underlying causes such as fever, pain, or hypovolemia
C) Prepare for synchronized cardioversion
D) Administer metoprolol 5 mg IV push
Correct Answer: B
Rationale: Sinus tachycardia is usually a compensatory response to an underlying
condition. The priority is to identify and treat the cause rather than simply lowering the
rate. Fever, pain, anxiety, dehydration, and heart failure are common causes.
7. The monitor shows a rhythm that is irregularly irregular with no discernible P
waves. The ventricular rate is 110 bpm. What is the most likely interpretation?
A) Atrial flutter
B) Atrial fibrillation
C) Sinus tachycardia
D) Supraventricular tachycardia
Correct Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, no
discernible P waves, and a chaotic baseline. This is the most common sustained
arrhythmia and is associated with an increased risk of thromboembolism.
8. A patient is in atrial fibrillation with a ventricular rate of 120 bpm. The patient is
stable but symptomatic with palpitations. Which of the following is an appropriate
treatment option?
A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker or calcium channel blocker
C) Administration of amiodarone 150 mg IV push
D) Administration of adenosine 6 mg IV push
Correct Answer: B
Rationale: In stable atrial fibrillation, rate control is typically the first step. Beta-
blockers (metoprolol) or calcium channel blockers (diltiazem) are used to control the
ventricular rate. Cardioversion is reserved for unstable patients or those who fail rate
control.
9. A patient's ECG shows a "sawtooth" pattern of flutter waves at a rate of 300 bpm,
with a ventricular rate of 150 bpm. What is the most likely rhythm?
A) Atrial fibrillation
, Page 4 of 74
B) Atrial flutter with 2:1 conduction
C) Ventricular tachycardia
D) Supraventricular tachycardia
Correct Answer: B
Rationale: Atrial flutter is characterized by a sawtooth (or picket fence) pattern of flutter
waves, typically at a rate of 250-350 bpm. With a 2:1 block, the ventricular rate is
approximately half the atrial rate, which is why the ventricular rate of 150 bpm is classic
for this rhythm.
10. A patient with known atrial fibrillation is on warfarin with a target INR of 2.0-3.0.
Today's INR is 1.6. What is the most appropriate nursing action?
A) Administer vitamin K 10 mg IM
B) Hold the warfarin and notify the provider for dose adjustment
C) Increase the warfarin dose immediately
D) Administer fresh frozen plasma
Correct Answer: B
Rationale: An INR of 1.6 is below the therapeutic range, indicating that the patient is not
adequately anticoagulated and is at increased risk for thromboembolism. The provider
should be notified to adjust the dose. Vitamin K is given for elevated INR with bleeding.
SUPRAVENTRICULAR TACHYCARDIA (SVT)
11. A patient suddenly develops a regular, narrow-complex tachycardia at a rate of
180 bpm. The patient is stable and reports palpitations and mild dizziness. Which
action should the nurse take FIRST?
A) Administer adenosine 6 mg rapid IV push
B) Instruct the patient to perform a Valsalva maneuver
C) Prepare for immediate synchronized cardioversion
D) Obtain a 12-lead ECG
Correct Answer: B
Rationale: Vagal maneuvers (Valsalva, carotid sinus massage) are the first-line
treatment for stable SVT. They can terminate the re-entrant tachycardia. Adenosine is
given if vagal maneuvers fail. Cardioversion is for unstable patients.
12. Adenosine 6 mg IV push is administered to a patient in SVT. The nurse should
anticipate which of the following?
A) A gradual slowing of the heart rate over several minutes
B) A brief period of asystole followed by a return to sinus rhythm
C) The immediate onset of ventricular fibrillation
D) No change in the rhythm
RELIAS DYSRHYTHMIA BASIC ASSESSMENT 250 QUESTIONS
EXAM LATEST VERSION QUESTIONS AND ANSWERS 2026
EDITION
RELIAS DYSRHYTHMIA BASIC ASSESSMENT
250 Practice Questions with Rationales
EXAMINATION QUESTIONS
NORMAL SINUS RHYTHM & SINUS BRADYCARDIA
1. A patient's cardiac monitor shows a regular rhythm with a rate of 72 bpm, a P
wave before every QRS, a PR interval of 0.16 seconds, and a QRS duration of 0.08
seconds. How should the nurse interpret this rhythm?
A) Sinus tachycardia
B) Normal sinus rhythm
C) Sinus bradycardia
D) First-degree AV block
Correct Answer: B
Rationale: Normal sinus rhythm has a rate of 60-100 bpm, a P wave before each QRS,
consistent PR interval (0.12-0.20 sec), and QRS < 0.12 sec. This rhythm meets all
criteria, making it normal sinus rhythm.
2. A patient's heart rate is 48 bpm. The rhythm is regular, and there is a P wave
before each QRS with a normal PR interval. What is the most likely interpretation?
A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) First-degree AV block
Correct Answer: B
Rationale: Sinus bradycardia is defined as a sinus rhythm with a rate less than 60 bpm.
, Page 2 of 74
All other intervals are normal. This is a common finding in well-conditioned athletes and
can also occur during sleep or with vagal stimulation.
3. A patient on a cardiac monitor has a heart rate of 130 bpm. The rhythm is regular,
and P waves are present before each QRS with normal PR and QRS intervals. What
is the most likely interpretation?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Supraventricular tachycardia
D) Atrial fibrillation
Correct Answer: B
Rationale: Sinus tachycardia is defined as a sinus rhythm with a rate greater than 100
bpm. It is often a physiological response to stress, fever, pain, hypovolemia, or
hyperthyroidism. The rhythm should be regular with normal P waves, PR, and QRS
intervals.
4. A patient has a heart rate of 52 bpm. The ECG shows a normal P wave before each
QRS, a regular rhythm, and a PR interval of 0.18 seconds. Which of the following is
the most appropriate initial nursing action?
A) Prepare for transcutaneous pacing
B) Assess the patient's blood pressure and level of consciousness
C) Administer atropine 0.5 mg IV push
D) Document the rhythm and continue to monitor
Correct Answer: B
Rationale: The priority is to assess the patient's clinical status. If the patient is
asymptomatic, sinus bradycardia requires no immediate intervention. If the patient is
symptomatic (hypotension, chest pain, altered mental status), treatment with atropine
or pacing may be indicated.
5. A patient with sinus bradycardia is symptomatic with a blood pressure of 86/52
mmHg and reports feeling lightheaded. Which medication should the nurse
anticipate administering?
A) Adenosine
B) Atropine
C) Digoxin
D) Metoprolol
Correct Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia. It is an
anticholinergic that blocks the vagal effects on the heart, increasing the sinus rate. The
dose is 0.5 mg IV push, repeated every 3-5 minutes up to a maximum of 3 mg.
, Page 3 of 74
SINUS TACHYCARDIA & ATRIAL ARRHYTHMIAS
6. A patient with a history of heart failure has a heart rate of 140 bpm. The rhythm is
regular with normal P waves. The nurse should FIRST:
A) Administer adenosine 6 mg IV push
B) Assess for underlying causes such as fever, pain, or hypovolemia
C) Prepare for synchronized cardioversion
D) Administer metoprolol 5 mg IV push
Correct Answer: B
Rationale: Sinus tachycardia is usually a compensatory response to an underlying
condition. The priority is to identify and treat the cause rather than simply lowering the
rate. Fever, pain, anxiety, dehydration, and heart failure are common causes.
7. The monitor shows a rhythm that is irregularly irregular with no discernible P
waves. The ventricular rate is 110 bpm. What is the most likely interpretation?
A) Atrial flutter
B) Atrial fibrillation
C) Sinus tachycardia
D) Supraventricular tachycardia
Correct Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, no
discernible P waves, and a chaotic baseline. This is the most common sustained
arrhythmia and is associated with an increased risk of thromboembolism.
8. A patient is in atrial fibrillation with a ventricular rate of 120 bpm. The patient is
stable but symptomatic with palpitations. Which of the following is an appropriate
treatment option?
A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker or calcium channel blocker
C) Administration of amiodarone 150 mg IV push
D) Administration of adenosine 6 mg IV push
Correct Answer: B
Rationale: In stable atrial fibrillation, rate control is typically the first step. Beta-
blockers (metoprolol) or calcium channel blockers (diltiazem) are used to control the
ventricular rate. Cardioversion is reserved for unstable patients or those who fail rate
control.
9. A patient's ECG shows a "sawtooth" pattern of flutter waves at a rate of 300 bpm,
with a ventricular rate of 150 bpm. What is the most likely rhythm?
A) Atrial fibrillation
, Page 4 of 74
B) Atrial flutter with 2:1 conduction
C) Ventricular tachycardia
D) Supraventricular tachycardia
Correct Answer: B
Rationale: Atrial flutter is characterized by a sawtooth (or picket fence) pattern of flutter
waves, typically at a rate of 250-350 bpm. With a 2:1 block, the ventricular rate is
approximately half the atrial rate, which is why the ventricular rate of 150 bpm is classic
for this rhythm.
10. A patient with known atrial fibrillation is on warfarin with a target INR of 2.0-3.0.
Today's INR is 1.6. What is the most appropriate nursing action?
A) Administer vitamin K 10 mg IM
B) Hold the warfarin and notify the provider for dose adjustment
C) Increase the warfarin dose immediately
D) Administer fresh frozen plasma
Correct Answer: B
Rationale: An INR of 1.6 is below the therapeutic range, indicating that the patient is not
adequately anticoagulated and is at increased risk for thromboembolism. The provider
should be notified to adjust the dose. Vitamin K is given for elevated INR with bleeding.
SUPRAVENTRICULAR TACHYCARDIA (SVT)
11. A patient suddenly develops a regular, narrow-complex tachycardia at a rate of
180 bpm. The patient is stable and reports palpitations and mild dizziness. Which
action should the nurse take FIRST?
A) Administer adenosine 6 mg rapid IV push
B) Instruct the patient to perform a Valsalva maneuver
C) Prepare for immediate synchronized cardioversion
D) Obtain a 12-lead ECG
Correct Answer: B
Rationale: Vagal maneuvers (Valsalva, carotid sinus massage) are the first-line
treatment for stable SVT. They can terminate the re-entrant tachycardia. Adenosine is
given if vagal maneuvers fail. Cardioversion is for unstable patients.
12. Adenosine 6 mg IV push is administered to a patient in SVT. The nurse should
anticipate which of the following?
A) A gradual slowing of the heart rate over several minutes
B) A brief period of asystole followed by a return to sinus rhythm
C) The immediate onset of ventricular fibrillation
D) No change in the rhythm
