RELIAS DYSRHYTHMIA BASIC EXAM–COMPLETE STUDY GUIDE
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LATEST EXAM 2026-2027
1. A telemetry monitor technician observes a regular heart rhythm with a rate of 74 beats
per minute, upright P waves preceding every narrow QRS complex, and a constant PR
interval of 0.16 seconds. How should the nurse interpret this underlying rhythm?
A. Sinus bradycardia
B. Normal sinus rhythm
C. Sinus tachycardia
D. Atrial flutter
Answer: B
Normal sinus rhythm originates in the sinoatrial node, characterized by a rate between 60 and
100 beats per minute, regular rhythm, upright P waves in lead II before every QRS complex,
and a normal PR interval of 0.12 to 0.20 seconds.
2. A cardiac monitor displays a rhythm with a regular rate of 48 beats per minute, normal
P waves, and narrow QRS complexes. The client is asymptomatic and alert. Which factor is
the most likely cause of this finding in a young, conditioned athlete?
A. Acute myocardial infarction
B. Enhanced vagal tone
C. Digitalis toxicity
D. Severe hyperkalemia
Answer: B
Sinus bradycardia in an asymptomatic, well-conditioned athlete is typically a normal
physiological adaptation resulting from enhanced parasympathetic vagal tone, which lowers
the resting heart rate without causing hemodynamic compromise.
3. A nurse is evaluating a telemetry strip showing a regular rhythm at a rate of 115 beats
per minute with normal P waves and narrow QRS complexes. Which underlying clinical
condition should the nurse investigate first?
A. Intracranial hemorrhage
B. Hypothyroidism
C. Fever and dehydration
D. Complete heart block
,Answer: C
Sinus tachycardia represents an elevated heart rate originating from the SA node, commonly
triggered by compensatory mechanisms such as fever, dehydration, pain, anxiety, or
hypovolemia meeting increased metabolic demands.
4. A telemetry monitor technician notes an irregular rhythm characterized by varying P-P
intervals, where the heart rate speeds up with inspiration and slows down with expiration.
The rate remains between 60 and 100 beats per minute. What is this rhythm?
A. Sinus arrhythmia
B. Wandering atrial pacemaker
C. Premature atrial contraction
D. Junctional escape rhythm
Answer: A
Sinus arrhythmia occurs when the sinus node discharges at varying intervals, frequently
linked to the respiratory cycle, causing the heart rate to increase slightly during inspiration
and decrease during expiration.
5. A nurse observes an otherwise normal sinus rhythm interrupted by a premature beat
that has an abnormal P wave shape and a normal narrow QRS complex, followed by a non-
compensatory pause. How should the nurse document this finding?
A. Premature ventricular contraction
B. Premature atrial contraction
C. Junctional premature beat
D. Third-degree heart block
Answer: B
A premature atrial contraction originates from an ectopic focus in the atria, resulting in a
premature beat with an early, abnormally shaped P wave followed by a narrow QRS complex
and a non-compensatory pause.
6. A telemetry monitor displays a regular atrial rate of 300 beats per minute with a
sawtooth baseline pattern between narrow QRS complexes. No discrete P waves are visible.
What is this dysrhythmia?
A. Atrial fibrillation
B. Atrial flutter
C. Ventricular tachycardia
D. Supraventricular tachycardia
Answer: B
,Atrial flutter is characterized by a rapid, regular atrial rate around 300 beats per minute,
producing characteristic sawtooth flutter waves (F waves) on the electrocardiogram with a
varying ventricular conduction ratio.
7. A cardiac monitor shows an irregularly irregular rhythm with no distinct P waves,
replaced by chaotic, undulating baseline fibrillatory waves. The ventricular response is
uncontrolled at 135 beats per minute. How should the nurse interpret this rhythm?
A. Controlled atrial flutter
B. Atrial fibrillation with rapid ventricular response
C. Multifocal atrial tachycardia
D. Ventricular fibrillation
Answer: B
Atrial fibrillation is marked by completely disorganized atrial electrical activity, resulting in an
irregularly irregular rhythm, absent P waves, and a fast ventricular response rate termed rapid
ventricular response.
8. A nurse is analyzing an ECG strip showing a heart rate of 110 beats per minute with at
least three different P wave morphologies preceding narrow QRS complexes, alongside an
irregular rhythm. What is the correct identification of this dysrhythmia?
A. Wandering atrial pacemaker
B. Multifocal atrial tachycardia
C. Sinus tachycardia with aberrancy
D. Atrial flutter with variable block
Answer: B
Multifocal atrial tachycardia is identified by a heart rate over 100 beats per minute and the
presence of at least three distinct P wave shapes in the same ECG lead, frequently seen in
clients with severe pulmonary disease.
9. A cardiac monitor displays a regular rhythm at a rate of 55 beats per minute with absent
P waves and a narrow QRS complex, accompanied by a short PR interval when a P wave is
falsely simulated. What is this rhythm?
A. Junctional escape rhythm
B. Idioventricular rhythm
C. Sinus bradycardia
D. First-degree AV block
Answer: A
, A junctional escape rhythm originates from the atrioventricular junctional region at a rate of
40 to 60 beats per minute, typically presenting with absent, inverted, or retrograde P waves
either preceding, hidden within, or following narrow QRS complexes.
10. A telemetry monitor reveals a sudden onset of a regular narrow-complex tachycardia at
a rate of 180 beats per minute where individual P waves cannot be distinguished from the T
waves. What is the most likely diagnosis?
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia
C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Answer: B
Paroxysmal supraventricular tachycardia is a rapid, regular rhythm originating above the
ventricles, typically starting and ending abruptly, with a rate usually between 150 and 250
beats per minute where P waves merge with preceding T waves.
11. A nurse notes a normal underlying sinus rhythm interrupted by a premature complex
characterized by a wide, bizarre QRS complex exceeding 0.12 seconds with no preceding P
wave, followed by a full compensatory pause. What is this dysrhythmia?
A. Premature atrial contraction
B. Premature ventricular contraction
C. Junctional escape beat
D. First-degree heart block
Answer: B
A premature ventricular contraction arises from an irritable focus in the ventricles, displaying
a wide, bizarre QRS complex greater than 0.12 seconds, absent P wave, ST segment changes,
and a full compensatory pause.
12. A cardiac monitor displays consecutive premature ventricular contractions occurring
in pairs. How should the nurse document this specific pattern?
A. Bigeminy
B. Trigeminy
C. Couplet
D. Salvo
Answer: C
| PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A telemetry monitor technician observes a regular heart rhythm with a rate of 74 beats
per minute, upright P waves preceding every narrow QRS complex, and a constant PR
interval of 0.16 seconds. How should the nurse interpret this underlying rhythm?
A. Sinus bradycardia
B. Normal sinus rhythm
C. Sinus tachycardia
D. Atrial flutter
Answer: B
Normal sinus rhythm originates in the sinoatrial node, characterized by a rate between 60 and
100 beats per minute, regular rhythm, upright P waves in lead II before every QRS complex,
and a normal PR interval of 0.12 to 0.20 seconds.
2. A cardiac monitor displays a rhythm with a regular rate of 48 beats per minute, normal
P waves, and narrow QRS complexes. The client is asymptomatic and alert. Which factor is
the most likely cause of this finding in a young, conditioned athlete?
A. Acute myocardial infarction
B. Enhanced vagal tone
C. Digitalis toxicity
D. Severe hyperkalemia
Answer: B
Sinus bradycardia in an asymptomatic, well-conditioned athlete is typically a normal
physiological adaptation resulting from enhanced parasympathetic vagal tone, which lowers
the resting heart rate without causing hemodynamic compromise.
3. A nurse is evaluating a telemetry strip showing a regular rhythm at a rate of 115 beats
per minute with normal P waves and narrow QRS complexes. Which underlying clinical
condition should the nurse investigate first?
A. Intracranial hemorrhage
B. Hypothyroidism
C. Fever and dehydration
D. Complete heart block
,Answer: C
Sinus tachycardia represents an elevated heart rate originating from the SA node, commonly
triggered by compensatory mechanisms such as fever, dehydration, pain, anxiety, or
hypovolemia meeting increased metabolic demands.
4. A telemetry monitor technician notes an irregular rhythm characterized by varying P-P
intervals, where the heart rate speeds up with inspiration and slows down with expiration.
The rate remains between 60 and 100 beats per minute. What is this rhythm?
A. Sinus arrhythmia
B. Wandering atrial pacemaker
C. Premature atrial contraction
D. Junctional escape rhythm
Answer: A
Sinus arrhythmia occurs when the sinus node discharges at varying intervals, frequently
linked to the respiratory cycle, causing the heart rate to increase slightly during inspiration
and decrease during expiration.
5. A nurse observes an otherwise normal sinus rhythm interrupted by a premature beat
that has an abnormal P wave shape and a normal narrow QRS complex, followed by a non-
compensatory pause. How should the nurse document this finding?
A. Premature ventricular contraction
B. Premature atrial contraction
C. Junctional premature beat
D. Third-degree heart block
Answer: B
A premature atrial contraction originates from an ectopic focus in the atria, resulting in a
premature beat with an early, abnormally shaped P wave followed by a narrow QRS complex
and a non-compensatory pause.
6. A telemetry monitor displays a regular atrial rate of 300 beats per minute with a
sawtooth baseline pattern between narrow QRS complexes. No discrete P waves are visible.
What is this dysrhythmia?
A. Atrial fibrillation
B. Atrial flutter
C. Ventricular tachycardia
D. Supraventricular tachycardia
Answer: B
,Atrial flutter is characterized by a rapid, regular atrial rate around 300 beats per minute,
producing characteristic sawtooth flutter waves (F waves) on the electrocardiogram with a
varying ventricular conduction ratio.
7. A cardiac monitor shows an irregularly irregular rhythm with no distinct P waves,
replaced by chaotic, undulating baseline fibrillatory waves. The ventricular response is
uncontrolled at 135 beats per minute. How should the nurse interpret this rhythm?
A. Controlled atrial flutter
B. Atrial fibrillation with rapid ventricular response
C. Multifocal atrial tachycardia
D. Ventricular fibrillation
Answer: B
Atrial fibrillation is marked by completely disorganized atrial electrical activity, resulting in an
irregularly irregular rhythm, absent P waves, and a fast ventricular response rate termed rapid
ventricular response.
8. A nurse is analyzing an ECG strip showing a heart rate of 110 beats per minute with at
least three different P wave morphologies preceding narrow QRS complexes, alongside an
irregular rhythm. What is the correct identification of this dysrhythmia?
A. Wandering atrial pacemaker
B. Multifocal atrial tachycardia
C. Sinus tachycardia with aberrancy
D. Atrial flutter with variable block
Answer: B
Multifocal atrial tachycardia is identified by a heart rate over 100 beats per minute and the
presence of at least three distinct P wave shapes in the same ECG lead, frequently seen in
clients with severe pulmonary disease.
9. A cardiac monitor displays a regular rhythm at a rate of 55 beats per minute with absent
P waves and a narrow QRS complex, accompanied by a short PR interval when a P wave is
falsely simulated. What is this rhythm?
A. Junctional escape rhythm
B. Idioventricular rhythm
C. Sinus bradycardia
D. First-degree AV block
Answer: A
, A junctional escape rhythm originates from the atrioventricular junctional region at a rate of
40 to 60 beats per minute, typically presenting with absent, inverted, or retrograde P waves
either preceding, hidden within, or following narrow QRS complexes.
10. A telemetry monitor reveals a sudden onset of a regular narrow-complex tachycardia at
a rate of 180 beats per minute where individual P waves cannot be distinguished from the T
waves. What is the most likely diagnosis?
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia
C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Answer: B
Paroxysmal supraventricular tachycardia is a rapid, regular rhythm originating above the
ventricles, typically starting and ending abruptly, with a rate usually between 150 and 250
beats per minute where P waves merge with preceding T waves.
11. A nurse notes a normal underlying sinus rhythm interrupted by a premature complex
characterized by a wide, bizarre QRS complex exceeding 0.12 seconds with no preceding P
wave, followed by a full compensatory pause. What is this dysrhythmia?
A. Premature atrial contraction
B. Premature ventricular contraction
C. Junctional escape beat
D. First-degree heart block
Answer: B
A premature ventricular contraction arises from an irritable focus in the ventricles, displaying
a wide, bizarre QRS complex greater than 0.12 seconds, absent P wave, ST segment changes,
and a full compensatory pause.
12. A cardiac monitor displays consecutive premature ventricular contractions occurring
in pairs. How should the nurse document this specific pattern?
A. Bigeminy
B. Trigeminy
C. Couplet
D. Salvo
Answer: C
