NURSING EDUCATION PRACTICE ASSESSMENT
Relias Dysrhythmia Basic Test
Comprehensive Practice Exam
50 original multiple-choice questions
23 original ECG rhythm strips • Detailed rationales for every question
Basic cardiac rhythm recognition, interpretation, symptoms, and nursing priorities
Name: ______________________________ Date: ________________ Score: ________ / 50
Educational disclaimer
This is an original practice resource written for nursing education. It is not an official Relias examination, is not affiliated
with or endorsed by Relias, and does not contain recalled, confidential, or proprietary assessment questions.
, Relias Dysrhythmia Basic Test — Comprehensive Practice Exam
Instructions
This practice exam contains 50 original multiple-choice questions on basic cardiac rhythm recognition
and interpretation. Each question has four answer choices (A–D) and one best answer.
• Read each question and, when an ECG figure is shown, interpret the strip before you look at the
answer choices.
• The correct answer and a detailed rationale are printed directly below each question. To test
yourself, cover everything under the answer choices with a sheet of paper until you have chosen
your answer.
• Each ECG figure is a 6-second Lead II rhythm strip recorded at 25 mm/s and 10 mm/mV. Use the
grid to measure rate, regularity, and intervals.
• The ECG strips are original educational simulations created for this resource. Each figure has a
neutral label and caption so that the diagnosis is not shown.
Topics covered
No. Section Questions
1 Cardiac Conduction System and ECG Fundamentals 1–6
2 Heart Rate Calculation 7–10
3 Sinus Rhythms 11–15
4 Atrial Dysrhythmias 16–24
5 Junctional Rhythms 25–26
6 Ventricular Dysrhythmias 27–33
7 Cardiac Arrest Rhythms 34–38
8 Atrioventricular (AV) Blocks 39–46
9 Pacemaker Rhythms and Capture 47–49
10 Integrated Rhythm Interpretation and Nursing Priorities 50
Educational disclaimer
This is an original practice resource created for nursing education and is not an official Relias examination.
Rhythm strips are original simulations. Treatment content reflects general ACLS principles; always follow current
American Heart Association guidance, your facility’s policies, and provider orders in clinical practice.
Original practice resource — not an official Relias examination Page 1
, Relias Dysrhythmia Basic Test — Comprehensive Practice Exam
Section 1: Cardiac Conduction System and ECG Fundamentals
Question 1. Which sequence correctly lists the normal pathway of an electrical impulse through the
heart’s conduction system?
A. AV node → SA node → bundle of His → Purkinje fibers → bundle branches
B. SA node → bundle of His → AV node → bundle branches → Purkinje fibers
C. SA node → AV node → bundle of His → bundle branches → Purkinje fibers
D. Purkinje fibers → bundle branches → bundle of His → AV node → SA node
Answer: C. SA node → AV node → bundle of His → bundle branches → Purkinje fibers
Rationale: The impulse normally begins in the SA node, the primary pacemaker, and spreads across
the atria to the AV node. The AV node briefly delays the impulse before it travels through the bundle
of His, the right and left bundle branches, and finally the Purkinje fibers, which depolarize the
ventricular muscle. The other sequences reverse the direction of conduction or place structures in the
wrong order.
Question 2. The SA node fails to fire. Which site has an intrinsic firing rate of about 40–60 beats/min and
typically acts as the backup pacemaker?
A. The AV junction
B. The SA node
C. The Purkinje fibers
D. The left bundle branch
Answer: A. The AV junction
Rationale: The AV junction (the AV node and bundle of His region) has an intrinsic rate of about 40–60
beats/min and is the usual escape pacemaker when the SA node fails. The SA node itself fires at 60–
100 beats/min. The Purkinje fibers and the bundle branches have much slower intrinsic rates of about
20–40 beats/min and take over only when higher pacemakers fail.
Original practice resource — not an official Relias examination Page 2
Relias Dysrhythmia Basic Test
Comprehensive Practice Exam
50 original multiple-choice questions
23 original ECG rhythm strips • Detailed rationales for every question
Basic cardiac rhythm recognition, interpretation, symptoms, and nursing priorities
Name: ______________________________ Date: ________________ Score: ________ / 50
Educational disclaimer
This is an original practice resource written for nursing education. It is not an official Relias examination, is not affiliated
with or endorsed by Relias, and does not contain recalled, confidential, or proprietary assessment questions.
, Relias Dysrhythmia Basic Test — Comprehensive Practice Exam
Instructions
This practice exam contains 50 original multiple-choice questions on basic cardiac rhythm recognition
and interpretation. Each question has four answer choices (A–D) and one best answer.
• Read each question and, when an ECG figure is shown, interpret the strip before you look at the
answer choices.
• The correct answer and a detailed rationale are printed directly below each question. To test
yourself, cover everything under the answer choices with a sheet of paper until you have chosen
your answer.
• Each ECG figure is a 6-second Lead II rhythm strip recorded at 25 mm/s and 10 mm/mV. Use the
grid to measure rate, regularity, and intervals.
• The ECG strips are original educational simulations created for this resource. Each figure has a
neutral label and caption so that the diagnosis is not shown.
Topics covered
No. Section Questions
1 Cardiac Conduction System and ECG Fundamentals 1–6
2 Heart Rate Calculation 7–10
3 Sinus Rhythms 11–15
4 Atrial Dysrhythmias 16–24
5 Junctional Rhythms 25–26
6 Ventricular Dysrhythmias 27–33
7 Cardiac Arrest Rhythms 34–38
8 Atrioventricular (AV) Blocks 39–46
9 Pacemaker Rhythms and Capture 47–49
10 Integrated Rhythm Interpretation and Nursing Priorities 50
Educational disclaimer
This is an original practice resource created for nursing education and is not an official Relias examination.
Rhythm strips are original simulations. Treatment content reflects general ACLS principles; always follow current
American Heart Association guidance, your facility’s policies, and provider orders in clinical practice.
Original practice resource — not an official Relias examination Page 1
, Relias Dysrhythmia Basic Test — Comprehensive Practice Exam
Section 1: Cardiac Conduction System and ECG Fundamentals
Question 1. Which sequence correctly lists the normal pathway of an electrical impulse through the
heart’s conduction system?
A. AV node → SA node → bundle of His → Purkinje fibers → bundle branches
B. SA node → bundle of His → AV node → bundle branches → Purkinje fibers
C. SA node → AV node → bundle of His → bundle branches → Purkinje fibers
D. Purkinje fibers → bundle branches → bundle of His → AV node → SA node
Answer: C. SA node → AV node → bundle of His → bundle branches → Purkinje fibers
Rationale: The impulse normally begins in the SA node, the primary pacemaker, and spreads across
the atria to the AV node. The AV node briefly delays the impulse before it travels through the bundle
of His, the right and left bundle branches, and finally the Purkinje fibers, which depolarize the
ventricular muscle. The other sequences reverse the direction of conduction or place structures in the
wrong order.
Question 2. The SA node fails to fire. Which site has an intrinsic firing rate of about 40–60 beats/min and
typically acts as the backup pacemaker?
A. The AV junction
B. The SA node
C. The Purkinje fibers
D. The left bundle branch
Answer: A. The AV junction
Rationale: The AV junction (the AV node and bundle of His region) has an intrinsic rate of about 40–60
beats/min and is the usual escape pacemaker when the SA node fails. The SA node itself fires at 60–
100 beats/min. The Purkinje fibers and the bundle branches have much slower intrinsic rates of about
20–40 beats/min and take over only when higher pacemakers fail.
Original practice resource — not an official Relias examination Page 2
