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 shortening of R-R intervals followed
by a pause. Rate: 80-120 bpm. P waves: Present, uniform. PR interval: Gradually
lengthens then drops a QRS. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus tachycardia
B. 2nd degree AV block, Type I (Wenckebach)
C. 2nd degree AV block, Type II
D. Sinus arrhythmia
Correct Answer: B
Rationale: Step-by-Step Analysis:
, 1. Rhythm: Irregular with grouped beating and pauses.
2. Rate: 80-120 bpm (atrial rate slightly faster than ventricular).
3. P waves: Present, uniform morphology.
4. PR interval: Progressive lengthening until a QRS is dropped - hallmark of
Wenckebach.
5. QRS: Narrow (0.08s) indicating supraventricular origin.
6. Interpretation: 2nd degree AV block, Type I - progressive PR prolongation with
dropped QRS.
7. Clinical Significance: Usually benign, may occur post-MI. Monitor for progression.
Q4: EKG Description: Rhythm: Irregular. Rate: 70-90 bpm. P waves: Present, 3 different
morphologies. PR interval: Varies. QRS: Narrow (0.08s). ST/T: Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Atrial fibrillation
D. Sinus rhythm with PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular.
2. Rate: 70-90 bpm (<100 bpm distinguishes WAP from MAT).
3. P waves: 3 different morphologies - hallmark of wandering pacemaker.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Narrow indicating supraventricular origin.
6. Interpretation: Wandering Atrial Pacemaker - same criteria as MAT but rate <100
bpm.
7. Clinical Significance: Often normal variant in athletes, elderly. No treatment
needed.
Q5: EKG Description: Rhythm: Regular. Rate: 150 bpm. P waves: Hidden in preceding T
waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST/T: T waves distorted by
hidden P waves.
A. Sinus tachycardia
, B. Paroxysmal supraventricular tachycardia (PSVT)
C. Atrial flutter
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 150 bpm (typical for PSVT).
3. P waves: Hidden in T waves - retrograde conduction in AVNRT.
4. PR interval: Not measurable due to hidden P waves.
5. QRS: Narrow indicating supraventricular origin.
6. Interpretation: PSVT/AVNRT - sudden onset, regular narrow complex tachycardia.
7. Clinical Action: Vagal maneuvers, adenosine if unstable.
Q6: EKG Description: Rhythm: Irregular baseline with sawtooth pattern. Rate: Atrial 300
bpm, ventricular 150 bpm. P waves: Replaced by flutter waves. PR interval: Not
applicable. QRS: Narrow (0.08s). ST/T: Flutter waves obscure baseline.
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. Sinus tachycardia
D. Multifocal atrial tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular ventricular response.
2. Rate: Atrial 300 bpm, ventricular 150 bpm (2:1 conduction).
3. P waves: Replaced by sawtooth flutter waves at 300 bpm.
4. PR interval: Not measurable.
5. QRS: Narrow indicating supraventricular origin.
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 shortening of R-R intervals followed
by a pause. Rate: 80-120 bpm. P waves: Present, uniform. PR interval: Gradually
lengthens then drops a QRS. QRS: Narrow (0.08s). ST/T: Normal.
A. Sinus tachycardia
B. 2nd degree AV block, Type I (Wenckebach)
C. 2nd degree AV block, Type II
D. Sinus arrhythmia
Correct Answer: B
Rationale: Step-by-Step Analysis:
, 1. Rhythm: Irregular with grouped beating and pauses.
2. Rate: 80-120 bpm (atrial rate slightly faster than ventricular).
3. P waves: Present, uniform morphology.
4. PR interval: Progressive lengthening until a QRS is dropped - hallmark of
Wenckebach.
5. QRS: Narrow (0.08s) indicating supraventricular origin.
6. Interpretation: 2nd degree AV block, Type I - progressive PR prolongation with
dropped QRS.
7. Clinical Significance: Usually benign, may occur post-MI. Monitor for progression.
Q4: EKG Description: Rhythm: Irregular. Rate: 70-90 bpm. P waves: Present, 3 different
morphologies. PR interval: Varies. QRS: Narrow (0.08s). ST/T: Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Atrial fibrillation
D. Sinus rhythm with PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular.
2. Rate: 70-90 bpm (<100 bpm distinguishes WAP from MAT).
3. P waves: 3 different morphologies - hallmark of wandering pacemaker.
4. PR interval: Varies with changing pacemaker site.
5. QRS: Narrow indicating supraventricular origin.
6. Interpretation: Wandering Atrial Pacemaker - same criteria as MAT but rate <100
bpm.
7. Clinical Significance: Often normal variant in athletes, elderly. No treatment
needed.
Q5: EKG Description: Rhythm: Regular. Rate: 150 bpm. P waves: Hidden in preceding T
waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST/T: T waves distorted by
hidden P waves.
A. Sinus tachycardia
, B. Paroxysmal supraventricular tachycardia (PSVT)
C. Atrial flutter
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular.
2. Rate: 150 bpm (typical for PSVT).
3. P waves: Hidden in T waves - retrograde conduction in AVNRT.
4. PR interval: Not measurable due to hidden P waves.
5. QRS: Narrow indicating supraventricular origin.
6. Interpretation: PSVT/AVNRT - sudden onset, regular narrow complex tachycardia.
7. Clinical Action: Vagal maneuvers, adenosine if unstable.
Q6: EKG Description: Rhythm: Irregular baseline with sawtooth pattern. Rate: Atrial 300
bpm, ventricular 150 bpm. P waves: Replaced by flutter waves. PR interval: Not
applicable. QRS: Narrow (0.08s). ST/T: Flutter waves obscure baseline.
A. Atrial fibrillation
B. Atrial flutter with 2:1 conduction
C. Sinus tachycardia
D. Multifocal atrial tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular ventricular response.
2. Rate: Atrial 300 bpm, ventricular 150 bpm (2:1 conduction).
3. P waves: Replaced by sawtooth flutter waves at 300 bpm.
4. PR interval: Not measurable.
5. QRS: Narrow indicating supraventricular origin.
