Relias Advanced Dysrhythmia Exam B Actual Exam
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular (but MAT can be irregular).
2. Rate: 110-130 bpm (>100 bpm is key for MAT vs WAP).
3. P waves: At least 3 different morphologies - hallmark of MAT or WAP.
4. PR interval: Varies - expected with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Multifocal Atrial Tachycardia - criteria met: irregular, rate >100, ≥3
P morphologies.
7. Clinical Significance: Often seen in COPD patients. Treat underlying cause, not
the rhythm itself.
, Differentiation from WAP: Wandering Atrial Pacemaker has same features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 50 bpm. P waves: Absent. QRS: Narrow
(0.08s). ST/T: Normal.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 50 bpm (40-60 = junctional escape range).
3. P waves: Absent (or may be retrograde, hidden in QRS).
4. PR interval: Not measurable.
5. QRS: Narrow (0.08s) - key differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - regular, narrow QRS, rate 40-60, no visible P
waves.
7. Clinical Action: Assess perfusion, consider atropine if symptomatic.
Q3: EKG Description: Rhythm: Irregular with gradual PP shortening then pause. Rate:
60-80 bpm. P waves: Present, normal morphology. PR interval: Gradually prolongs from
0.20s to 0.32s then drops QRS. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus arrhythmia
B. 2nd degree AV block Type II
,C. 2nd degree AV block Type I (Wenckebach)
D. 1st degree AV block
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with grouped beating and progressive PP shortening.
2. Rate: 60-80 bpm (atrial).
3. P waves: Present, consistent morphology.
4. PR interval: Progressively prolongs until QRS drops - hallmark of Wenckebach.
5. QRS: Narrow (supraventricular origin).
6. Interpretation: Mobitz I (Wenckebach) - benign, often nocturnal in young adults.
7. Clinical Action: Usually asymptomatic, monitor if stable.
Q4: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Sawtooth flutter waves
at 280 bpm. PR interval: Not applicable. QRS: Narrow (0.08s). ST/T: Flutter waves
obscure baseline.
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. SVT with aberrancy
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: Ventricular 140 bpm, atrial 280 bpm (classic 2:1 ratio).
3. P waves: Sawtooth flutter waves at 280 bpm - pathognomonic for atrial flutter.
4. PR interval: Not measurable (flutter waves).
, 5. QRS: Narrow (supraventricular conduction).
6. Interpretation: Atrial flutter with 2:1 conduction - most common presentation.
7. Clinical Action: Rate control with AV nodal blockers, consider rhythm control.
Q5: EKG Description: Rhythm: Irregular. Rate: 90-110 bpm. P waves: Present but 3
different morphologies in single lead. PR interval: Varies. QRS: Narrow (0.08s). ST/T:
Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Sinus arrhythmia
D. Atrial fibrillation
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular.
2. Rate: 90-110 bpm (<100 bpm differentiates from MAT).
3. P waves: ≥3 different morphologies in same lead.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Narrow.
6. Interpretation: Wandering Atrial Pacemaker - benign, often in athletes.
7. Clinical Action: No treatment needed, monitor if asymptomatic.
Q6: EKG Description: Rhythm: Regular. Rate: 160 bpm. P waves: Hidden in preceding T
waves. PR interval: Short (0.10s). QRS: Narrow (0.08s). ST/T: T waves distorted by
hidden P waves.
A. Atrial fibrillation
B. Paroxysmal atrial tachycardia (PAT)
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular (but MAT can be irregular).
2. Rate: 110-130 bpm (>100 bpm is key for MAT vs WAP).
3. P waves: At least 3 different morphologies - hallmark of MAT or WAP.
4. PR interval: Varies - expected with changing pacemaker site.
5. QRS: Normal.
6. Interpretation: Multifocal Atrial Tachycardia - criteria met: irregular, rate >100, ≥3
P morphologies.
7. Clinical Significance: Often seen in COPD patients. Treat underlying cause, not
the rhythm itself.
, Differentiation from WAP: Wandering Atrial Pacemaker has same features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 50 bpm. P waves: Absent. QRS: Narrow
(0.08s). ST/T: Normal.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 50 bpm (40-60 = junctional escape range).
3. P waves: Absent (or may be retrograde, hidden in QRS).
4. PR interval: Not measurable.
5. QRS: Narrow (0.08s) - key differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - regular, narrow QRS, rate 40-60, no visible P
waves.
7. Clinical Action: Assess perfusion, consider atropine if symptomatic.
Q3: EKG Description: Rhythm: Irregular with gradual PP shortening then pause. Rate:
60-80 bpm. P waves: Present, normal morphology. PR interval: Gradually prolongs from
0.20s to 0.32s then drops QRS. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus arrhythmia
B. 2nd degree AV block Type II
,C. 2nd degree AV block Type I (Wenckebach)
D. 1st degree AV block
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with grouped beating and progressive PP shortening.
2. Rate: 60-80 bpm (atrial).
3. P waves: Present, consistent morphology.
4. PR interval: Progressively prolongs until QRS drops - hallmark of Wenckebach.
5. QRS: Narrow (supraventricular origin).
6. Interpretation: Mobitz I (Wenckebach) - benign, often nocturnal in young adults.
7. Clinical Action: Usually asymptomatic, monitor if stable.
Q4: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Sawtooth flutter waves
at 280 bpm. PR interval: Not applicable. QRS: Narrow (0.08s). ST/T: Flutter waves
obscure baseline.
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. SVT with aberrancy
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: Ventricular 140 bpm, atrial 280 bpm (classic 2:1 ratio).
3. P waves: Sawtooth flutter waves at 280 bpm - pathognomonic for atrial flutter.
4. PR interval: Not measurable (flutter waves).
, 5. QRS: Narrow (supraventricular conduction).
6. Interpretation: Atrial flutter with 2:1 conduction - most common presentation.
7. Clinical Action: Rate control with AV nodal blockers, consider rhythm control.
Q5: EKG Description: Rhythm: Irregular. Rate: 90-110 bpm. P waves: Present but 3
different morphologies in single lead. PR interval: Varies. QRS: Narrow (0.08s). ST/T:
Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Sinus arrhythmia
D. Atrial fibrillation
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular.
2. Rate: 90-110 bpm (<100 bpm differentiates from MAT).
3. P waves: ≥3 different morphologies in same lead.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Narrow.
6. Interpretation: Wandering Atrial Pacemaker - benign, often in athletes.
7. Clinical Action: No treatment needed, monitor if asymptomatic.
Q6: EKG Description: Rhythm: Regular. Rate: 160 bpm. P waves: Hidden in preceding T
waves. PR interval: Short (0.10s). QRS: Narrow (0.08s). ST/T: T waves distorted by
hidden P waves.
A. Atrial fibrillation
B. Paroxysmal atrial tachycardia (PAT)
