Latest Version 2026/2027 • Current ACLS Guidelines & EKG Standards
Relias Dysrhythmia
Basic A Test
35 Questions & Answers • Graded A
Comprehensive EKG Interpretation Competency Examination
Sinus Rhythms • Atrial/Junctional • AV Blocks • Ventricular/Lethal • Pacemakers/Electrolytes
EXAM INFORMATION
Total Questions: 35 (Multiple Choice, 4 Options A–D)
Cognitive Mix: 25% Recall • 50% Application • 25% Analysis
Format: 75% Scenario-based with rhythm strip descriptions • 25% Direct recall
Sections: 5 (Conduction/Sinus, Atrial/Junctional, AV Blocks,
Ventricular/Lethal, Pacemaker/Electrolyte/Clinical)
INSTRUCTIONS
1. Select the single best answer for each question (A, B, C, or D).
2. The correct answer is marked [CORRECT] and a rationale is provided.
3. Rationales cite rhythm criteria, clinical significance, and
nursing interventions consistent with Relias competency standards.
4. Use this exam as a self-assessment for telemetry, med-surg, and
progressive care cardiac monitoring competency.
For educational use — aligns with Relias Dysrhythmia Basic A competency assessment standards.
,Relias Dysrhythmia Basic A Test — Latest Version 2026/2027 35 Qs & As • Graded A
Section 1: Cardiac Conduction, EKG Fundamentals, and Sinus
Rhythms
Conduction System, EKG Components, Normal Sinus, Bradycardia, Tachycardia, and Arrhythmia (Q1–Q8)
Q1. A nurse is teaching a patient about the heart's electrical conduction system. Which
sequence correctly lists the normal pathway of electrical impulses through the heart?
A. AV node → SA node → Bundle of His → Purkinje fibers → Bundle branches
B. SA node → AV node → Bundle of His → Bundle branches → Purkinje fibers [CORRECT]
C. Purkinje fibers → Bundle branches → Bundle of His → AV node → SA node
D. SA node → Purkinje fibers → Bundle branches → AV node → Bundle of His
Correct Answer: B
Rationale:
The normal electrical impulse originates in the SA node (sinoatrial node, the heart's natural pacemaker at
60–100 bpm), travels to the AV node (atrioventricular node, where it briefly delays to allow for ventricular
filling), then to the Bundle of His, through the left and right bundle branches, and finally to the Purkinje fibers
for ventricular depolarization. Any disruption in this pathway produces characteristic EKG changes that guide
dysrhythmia identification.
Q2. On a rhythm strip, the nurse identifies a small segment that is the first wave before the
QRS complex. This wave represents which physiological event?
A. Ventricular depolarization
B. Atrial depolarization [CORRECT]
C. Ventricular repolarization
D. AV node conduction delay
Correct Answer: B
Rationale:
The P wave represents atrial depolarization, the electrical activation of the right and left atria that results in
atrial contraction. Ventricular depolarization is represented by the QRS complex, ventricular repolarization by
the T wave, and the AV node conduction delay is reflected in the PR interval. The presence, morphology, and
relationship of P waves to QRS complexes are critical for rhythm interpretation.
Q3. A nurse is calculating heart rate using the 6-second method on a rhythm strip. The strip
contains 8 R-R intervals within a 6-second interval (30 large boxes). What is the heart rate?
A. 60 bpm
B. 80 bpm [CORRECT]
C. 100 bpm
D. 120 bpm
Correct Answer: B
Rationale:
Relias Dysrhythmia Basic A — 35 Questions Page 2
, Relias Dysrhythmia Basic A Test — Latest Version 2026/2027 35 Qs & As • Graded A
The 6-second method counts the number of R-R intervals (or QRS complexes) in a 6-second strip (identified
by the 3-second markers at the top of most EKG paper, totaling 30 large boxes) and multiplies by 10. With 8
R-R intervals, the calculation is 8 × 10 = 80 bpm. This method is most accurate for regular rhythms but is also
used for irregular rhythms where the 1500 method (counting small boxes between R-R) cannot be applied
reliably.
Q4. A nurse is analyzing a rhythm strip and notes the following: regular rhythm, rate 72 bpm,
normal P wave before every QRS, PR interval 0.16 seconds, and QRS width 0.08 seconds.
Which rhythm is this?
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. Sinus tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale:
Normal sinus rhythm criteria include: regular rhythm, rate 60–100 bpm (this is 72), normal P wave before
every QRS with consistent morphology, PR interval 0.12–0.20 seconds (this is 0.16, normal), and QRS width
≤0.12 seconds (this is 0.08, normal). All criteria are met. Sinus bradycardia would be <60 bpm; sinus
tachycardia would be >100 bpm; sinus arrhythmia would have an irregular rhythm (often phasic with
respiration).
Q5. A patient on telemetry has a rhythm strip showing: regular rhythm, rate 48 bpm, normal
P wave before every QRS, PR interval 0.18 seconds, QRS 0.10 seconds. The patient reports
dizziness when ambulating. Which rhythm is this, and what is the priority nursing action?
A. Sinus bradycardia — assess for symptomatic causes, hold beta-blockers/digoxin if
applicable, notify the provider of symptomatic bradycardia for possible atropine or pacing
consideration [CORRECT]
B. Normal sinus rhythm — continue routine monitoring
C. Sinus tachycardia — administer beta-blocker immediately
D. Junctional rhythm — prepare for synchronized cardioversion
Correct Answer: A
Rationale:
This is sinus bradycardia: regular rhythm with SA node origin (normal P waves), rate <60 bpm (48), normal
PR and QRS. Symptomatic bradycardia (dizziness) requires provider notification because the patient may need
atropine, transcutaneous pacing, or evaluation for causes (medications like beta-blockers, digoxin, calcium
channel blockers; ischemia; increased intracranial pressure; vagal stimulation). Continuing routine monitoring
ignores symptoms; administering a beta-blocker would worsen bradycardia; synchronized cardioversion is
inappropriate for stable bradycardia.
Relias Dysrhythmia Basic A — 35 Questions Page 3
Relias Dysrhythmia
Basic A Test
35 Questions & Answers • Graded A
Comprehensive EKG Interpretation Competency Examination
Sinus Rhythms • Atrial/Junctional • AV Blocks • Ventricular/Lethal • Pacemakers/Electrolytes
EXAM INFORMATION
Total Questions: 35 (Multiple Choice, 4 Options A–D)
Cognitive Mix: 25% Recall • 50% Application • 25% Analysis
Format: 75% Scenario-based with rhythm strip descriptions • 25% Direct recall
Sections: 5 (Conduction/Sinus, Atrial/Junctional, AV Blocks,
Ventricular/Lethal, Pacemaker/Electrolyte/Clinical)
INSTRUCTIONS
1. Select the single best answer for each question (A, B, C, or D).
2. The correct answer is marked [CORRECT] and a rationale is provided.
3. Rationales cite rhythm criteria, clinical significance, and
nursing interventions consistent with Relias competency standards.
4. Use this exam as a self-assessment for telemetry, med-surg, and
progressive care cardiac monitoring competency.
For educational use — aligns with Relias Dysrhythmia Basic A competency assessment standards.
,Relias Dysrhythmia Basic A Test — Latest Version 2026/2027 35 Qs & As • Graded A
Section 1: Cardiac Conduction, EKG Fundamentals, and Sinus
Rhythms
Conduction System, EKG Components, Normal Sinus, Bradycardia, Tachycardia, and Arrhythmia (Q1–Q8)
Q1. A nurse is teaching a patient about the heart's electrical conduction system. Which
sequence correctly lists the normal pathway of electrical impulses through the heart?
A. AV node → SA node → Bundle of His → Purkinje fibers → Bundle branches
B. SA node → AV node → Bundle of His → Bundle branches → Purkinje fibers [CORRECT]
C. Purkinje fibers → Bundle branches → Bundle of His → AV node → SA node
D. SA node → Purkinje fibers → Bundle branches → AV node → Bundle of His
Correct Answer: B
Rationale:
The normal electrical impulse originates in the SA node (sinoatrial node, the heart's natural pacemaker at
60–100 bpm), travels to the AV node (atrioventricular node, where it briefly delays to allow for ventricular
filling), then to the Bundle of His, through the left and right bundle branches, and finally to the Purkinje fibers
for ventricular depolarization. Any disruption in this pathway produces characteristic EKG changes that guide
dysrhythmia identification.
Q2. On a rhythm strip, the nurse identifies a small segment that is the first wave before the
QRS complex. This wave represents which physiological event?
A. Ventricular depolarization
B. Atrial depolarization [CORRECT]
C. Ventricular repolarization
D. AV node conduction delay
Correct Answer: B
Rationale:
The P wave represents atrial depolarization, the electrical activation of the right and left atria that results in
atrial contraction. Ventricular depolarization is represented by the QRS complex, ventricular repolarization by
the T wave, and the AV node conduction delay is reflected in the PR interval. The presence, morphology, and
relationship of P waves to QRS complexes are critical for rhythm interpretation.
Q3. A nurse is calculating heart rate using the 6-second method on a rhythm strip. The strip
contains 8 R-R intervals within a 6-second interval (30 large boxes). What is the heart rate?
A. 60 bpm
B. 80 bpm [CORRECT]
C. 100 bpm
D. 120 bpm
Correct Answer: B
Rationale:
Relias Dysrhythmia Basic A — 35 Questions Page 2
, Relias Dysrhythmia Basic A Test — Latest Version 2026/2027 35 Qs & As • Graded A
The 6-second method counts the number of R-R intervals (or QRS complexes) in a 6-second strip (identified
by the 3-second markers at the top of most EKG paper, totaling 30 large boxes) and multiplies by 10. With 8
R-R intervals, the calculation is 8 × 10 = 80 bpm. This method is most accurate for regular rhythms but is also
used for irregular rhythms where the 1500 method (counting small boxes between R-R) cannot be applied
reliably.
Q4. A nurse is analyzing a rhythm strip and notes the following: regular rhythm, rate 72 bpm,
normal P wave before every QRS, PR interval 0.16 seconds, and QRS width 0.08 seconds.
Which rhythm is this?
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. Sinus tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale:
Normal sinus rhythm criteria include: regular rhythm, rate 60–100 bpm (this is 72), normal P wave before
every QRS with consistent morphology, PR interval 0.12–0.20 seconds (this is 0.16, normal), and QRS width
≤0.12 seconds (this is 0.08, normal). All criteria are met. Sinus bradycardia would be <60 bpm; sinus
tachycardia would be >100 bpm; sinus arrhythmia would have an irregular rhythm (often phasic with
respiration).
Q5. A patient on telemetry has a rhythm strip showing: regular rhythm, rate 48 bpm, normal
P wave before every QRS, PR interval 0.18 seconds, QRS 0.10 seconds. The patient reports
dizziness when ambulating. Which rhythm is this, and what is the priority nursing action?
A. Sinus bradycardia — assess for symptomatic causes, hold beta-blockers/digoxin if
applicable, notify the provider of symptomatic bradycardia for possible atropine or pacing
consideration [CORRECT]
B. Normal sinus rhythm — continue routine monitoring
C. Sinus tachycardia — administer beta-blocker immediately
D. Junctional rhythm — prepare for synchronized cardioversion
Correct Answer: A
Rationale:
This is sinus bradycardia: regular rhythm with SA node origin (normal P waves), rate <60 bpm (48), normal
PR and QRS. Symptomatic bradycardia (dizziness) requires provider notification because the patient may need
atropine, transcutaneous pacing, or evaluation for causes (medications like beta-blockers, digoxin, calcium
channel blockers; ischemia; increased intracranial pressure; vagal stimulation). Continuing routine monitoring
ignores symptoms; administering a beta-blocker would worsen bradycardia; synchronized cardioversion is
inappropriate for stable bradycardia.
Relias Dysrhythmia Basic A — 35 Questions Page 3
