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ECG ANALYSIS: RHYTHM RECOGNITION (RELIAS) TEST
EXAM WITH VERIFIED ANSWERS DETAILED RATIONALES
GRADED A+
ECG Analysis: Rhythm Recognition (Relias) Test
Section 1: Basic ECG Concepts (Questions 1-20)
1. A nurse is analyzing an ECG strip and needs to calculate the heart rate. Which of the
following methods is most accurate for a regular rhythm when using a six-second strip?
A. Count the number of R waves and multiply by 10.
B. Count the number of large boxes between R waves and divide by 300.
C. Count the number of small boxes between R waves and multiply by 1500.
D. Count the number of P waves in the strip and multiply by 6.
Rationale: The six-second method involves counting the number of R waves (QRS complexes) in
a six-second strip and multiplying by 10 to estimate the heart rate per minute. This is a quick
and reliable method for regular rhythms.
2. A nurse is evaluating an ECG tracing and notices that the P wave is upright and precedes
each QRS complex. What does this finding indicate about the origin of the electrical impulse?
A. The impulse is originating from the ventricles.
B. The impulse is originating from the sinoatrial (SA) node.
C. The impulse is originating from the atrioventricular (AV) node.
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D. The impulse is originating from the Purkinje fibers.
Rationale: An upright P wave that precedes each QRS complex indicates that the electrical
impulse is originating from the SA node, the normal pacemaker of the heart, and is being
conducted normally through the atria.
3. When analyzing an ECG strip, a nurse measures the PR interval and finds it is 0.24 seconds.
How should the nurse interpret this finding?
A. The PR interval is within normal limits.
B. The PR interval is shortened, suggesting a junctional rhythm.
C. The PR interval is prolonged, suggesting a first-degree AV block.
D. The PR interval is absent, suggesting atrial fibrillation.
Rationale: The normal PR interval is 0.12 to 0.20 seconds. A PR interval greater than 0.20
seconds is considered prolonged and is characteristic of a first-degree AV block.
4. A nurse is examining an ECG strip and notes that the QRS complex measures 0.14 seconds.
What is the correct interpretation of this finding?
A. The QRS complex is narrow, indicating normal ventricular conduction.
B. The QRS complex is wide, indicating a ventricular origin or bundle branch block.
C. The QRS complex is absent, indicating asystole.
D. The QRS complex is normal, indicating sinus rhythm.
Rationale: A normal QRS complex is less than 0.12 seconds. A QRS duration of 0.12 seconds or
greater is considered wide and suggests that the impulse is originating from the ventricles or
there is a conduction delay (bundle branch block).
5. A nurse is assessing an ECG and needs to determine the presence of atrial activity. Which of
the following waves represents atrial depolarization?
A. The QRS complex
B. The T wave
C. The P wave
D. The U wave
Rationale: The P wave represents depolarization of the atria, which leads to atrial contraction.
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The QRS complex represents ventricular depolarization, and the T wave represents ventricular
repolarization.
6. A nurse is measuring the QT interval on an ECG strip and finds it is 0.50 seconds. What is
the clinical significance of this finding?
A. It is a normal finding and requires no further action.
B. It indicates a prolonged QT interval, which increases the risk of torsades de pointes.
C. It indicates a shortened QT interval, which is a sign of hypercalcemia.
D. It indicates the presence of atrial fibrillation.
Rationale: A normal QT interval is typically 0.36 to 0.44 seconds. A QT interval greater than 0.44
seconds is prolonged and increases the risk of dangerous ventricular arrhythmias, particularly
torsades de pointes.
7. A nurse is analyzing an ECG and notes that the PR interval is 0.10 seconds and the QRS is
0.08 seconds. The rhythm is regular with a rate of 80 beats per minute. What rhythm is this
most consistent with?
A. Normal sinus rhythm
B. Junctional rhythm
C. Atrial flutter
D. Ventricular tachycardia
Rationale: A PR interval of 0.10 seconds is shortened (normal is 0.12-0.20 seconds), which
suggests the impulse is originating from the AV junction rather than the SA node. A junctional
rhythm typically has a short PR interval or no visible P wave.
8. Which of the following best describes the normal duration of the QRS complex on an ECG
tracing?
A. Less than 0.12 seconds
B. Between 0.12 and 0.20 seconds
C. Between 0.20 and 0.36 seconds
D. Greater than 0.36 seconds
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Rationale: The normal QRS complex duration is less than 0.12 seconds (or less than 3 small
boxes on ECG paper). A QRS duration of 0.12 seconds or greater is considered wide.
9. A nurse is evaluating an ECG strip and needs to identify the isoelectric line. What does the
isoelectric line represent on an ECG tracing?
A. The baseline of the ECG where no electrical activity is occurring.
B. The peak of the R wave.
C. The end of the T wave.
D. The beginning of the P wave.
Rationale: The isoelectric line is the flat, baseline portion of the ECG tracing that represents the
period when there is no net electrical activity in the heart. It is used as a reference point for
measuring the height and depth of waves.
10. A nurse is calculating the heart rate using the 1500 method. If there are 20 small boxes
between two consecutive R waves, what is the heart rate?
A. 60 beats per minute
B. 75 beats per minute
C. 100 beats per minute
D. 150 beats per minute
Rationale: The 1500 method involves dividing 1500 by the number of small boxes between R
waves. = 75 beats per minute.
11. A nurse is analyzing an ECG and notices that the T wave is inverted in several leads. What
is the most likely clinical significance of this finding?
A. It is a normal finding in all leads.
B. It may indicate myocardial ischemia or injury.
C. It indicates ventricular hypertrophy.
D. It is a sign of hyperkalemia.
Rationale: Inverted T waves can be a sign of myocardial ischemia, injury, or infarction. They are
abnormal in most leads and require further investigation.
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ECG ANALYSIS: RHYTHM RECOGNITION (RELIAS) TEST
EXAM WITH VERIFIED ANSWERS DETAILED RATIONALES
GRADED A+
ECG Analysis: Rhythm Recognition (Relias) Test
Section 1: Basic ECG Concepts (Questions 1-20)
1. A nurse is analyzing an ECG strip and needs to calculate the heart rate. Which of the
following methods is most accurate for a regular rhythm when using a six-second strip?
A. Count the number of R waves and multiply by 10.
B. Count the number of large boxes between R waves and divide by 300.
C. Count the number of small boxes between R waves and multiply by 1500.
D. Count the number of P waves in the strip and multiply by 6.
Rationale: The six-second method involves counting the number of R waves (QRS complexes) in
a six-second strip and multiplying by 10 to estimate the heart rate per minute. This is a quick
and reliable method for regular rhythms.
2. A nurse is evaluating an ECG tracing and notices that the P wave is upright and precedes
each QRS complex. What does this finding indicate about the origin of the electrical impulse?
A. The impulse is originating from the ventricles.
B. The impulse is originating from the sinoatrial (SA) node.
C. The impulse is originating from the atrioventricular (AV) node.
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D. The impulse is originating from the Purkinje fibers.
Rationale: An upright P wave that precedes each QRS complex indicates that the electrical
impulse is originating from the SA node, the normal pacemaker of the heart, and is being
conducted normally through the atria.
3. When analyzing an ECG strip, a nurse measures the PR interval and finds it is 0.24 seconds.
How should the nurse interpret this finding?
A. The PR interval is within normal limits.
B. The PR interval is shortened, suggesting a junctional rhythm.
C. The PR interval is prolonged, suggesting a first-degree AV block.
D. The PR interval is absent, suggesting atrial fibrillation.
Rationale: The normal PR interval is 0.12 to 0.20 seconds. A PR interval greater than 0.20
seconds is considered prolonged and is characteristic of a first-degree AV block.
4. A nurse is examining an ECG strip and notes that the QRS complex measures 0.14 seconds.
What is the correct interpretation of this finding?
A. The QRS complex is narrow, indicating normal ventricular conduction.
B. The QRS complex is wide, indicating a ventricular origin or bundle branch block.
C. The QRS complex is absent, indicating asystole.
D. The QRS complex is normal, indicating sinus rhythm.
Rationale: A normal QRS complex is less than 0.12 seconds. A QRS duration of 0.12 seconds or
greater is considered wide and suggests that the impulse is originating from the ventricles or
there is a conduction delay (bundle branch block).
5. A nurse is assessing an ECG and needs to determine the presence of atrial activity. Which of
the following waves represents atrial depolarization?
A. The QRS complex
B. The T wave
C. The P wave
D. The U wave
Rationale: The P wave represents depolarization of the atria, which leads to atrial contraction.
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The QRS complex represents ventricular depolarization, and the T wave represents ventricular
repolarization.
6. A nurse is measuring the QT interval on an ECG strip and finds it is 0.50 seconds. What is
the clinical significance of this finding?
A. It is a normal finding and requires no further action.
B. It indicates a prolonged QT interval, which increases the risk of torsades de pointes.
C. It indicates a shortened QT interval, which is a sign of hypercalcemia.
D. It indicates the presence of atrial fibrillation.
Rationale: A normal QT interval is typically 0.36 to 0.44 seconds. A QT interval greater than 0.44
seconds is prolonged and increases the risk of dangerous ventricular arrhythmias, particularly
torsades de pointes.
7. A nurse is analyzing an ECG and notes that the PR interval is 0.10 seconds and the QRS is
0.08 seconds. The rhythm is regular with a rate of 80 beats per minute. What rhythm is this
most consistent with?
A. Normal sinus rhythm
B. Junctional rhythm
C. Atrial flutter
D. Ventricular tachycardia
Rationale: A PR interval of 0.10 seconds is shortened (normal is 0.12-0.20 seconds), which
suggests the impulse is originating from the AV junction rather than the SA node. A junctional
rhythm typically has a short PR interval or no visible P wave.
8. Which of the following best describes the normal duration of the QRS complex on an ECG
tracing?
A. Less than 0.12 seconds
B. Between 0.12 and 0.20 seconds
C. Between 0.20 and 0.36 seconds
D. Greater than 0.36 seconds
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Rationale: The normal QRS complex duration is less than 0.12 seconds (or less than 3 small
boxes on ECG paper). A QRS duration of 0.12 seconds or greater is considered wide.
9. A nurse is evaluating an ECG strip and needs to identify the isoelectric line. What does the
isoelectric line represent on an ECG tracing?
A. The baseline of the ECG where no electrical activity is occurring.
B. The peak of the R wave.
C. The end of the T wave.
D. The beginning of the P wave.
Rationale: The isoelectric line is the flat, baseline portion of the ECG tracing that represents the
period when there is no net electrical activity in the heart. It is used as a reference point for
measuring the height and depth of waves.
10. A nurse is calculating the heart rate using the 1500 method. If there are 20 small boxes
between two consecutive R waves, what is the heart rate?
A. 60 beats per minute
B. 75 beats per minute
C. 100 beats per minute
D. 150 beats per minute
Rationale: The 1500 method involves dividing 1500 by the number of small boxes between R
waves. = 75 beats per minute.
11. A nurse is analyzing an ECG and notices that the T wave is inverted in several leads. What
is the most likely clinical significance of this finding?
A. It is a normal finding in all leads.
B. It may indicate myocardial ischemia or injury.
C. It indicates ventricular hypertrophy.
D. It is a sign of hyperkalemia.
Rationale: Inverted T waves can be a sign of myocardial ischemia, injury, or infarction. They are
abnormal in most leads and require further investigation.
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