Relias Dysrhythmia Basic Test B Mastery Guide 2026 | Full 35-
Question Practice Exam, ECG Rhythm Interpretation, Pacemaker
Malfunctions, and ACLS Intervention Protocols for Nurses and
Telemetry Technicians
Key Exam Components
Measurement Mastery: You must accurately identify cardiac intervals. Normal PR
Interval is 0.12–0.20 seconds, and a normal QRS duration is 0.04–0.10 seconds.
Heart Block Differentiation:
o 1st Degree Block: A constant PR interval greater than 0.20 seconds.
o 2nd Degree Type I (Wenckebach): The PR interval gets progressively longer until a
QRS complex is dropped.
o 2nd Degree Type II (Mobitz II): The PR interval remains constant, but QRS complexes
are dropped randomly.
o 3rd Degree Block: Complete dissociation between P waves and QRS complexes; they
"march out" independently.
Lethal Rhythms (Auto-Fail if missed): Missing these on the exam is often a
disqualifier as they require immediate intervention:
o Ventricular Fibrillation (V-Fib): Chaotic electrical activity with no recognizable
complexes; ventricles quiver, and there is no cardiac output.
o Ventricular Tachycardia (V-Tach): Three or more PVCs in a row at a rate >100 bpm.
o Asystole: Total absence of ventricular electrical activity.
o PEA (Pulseless Electrical Activity): An organized rhythm appears on the monitor, but
the patient has no pulse. Treatment is CPR and Epinephrine, never defibrillation.
Common Test Scenarios
1. Symptomatic Bradycardia: A patient with a rate <60 bpm, clammy skin, and low blood
pressure (e.g., 70/42) requires Atropine IV.
, 2. Unresponsive V-Tach: For a patient with no pulse in V-Tach, the priority is
immediate Defibrillation after starting chest compressions.
3. Stable vs. Unstable SVT: If a pulse is present but the patient is symptomatic, prepare
for Synchronized Cardioversion
Part 1: Atrial Fibrillation with RVR (Rapid Ventricular Response)
In Exam B, you aren't just identifying A-Fib; you are managing the complications of a
high heart rate.
Identification: Irregularly irregular rhythm, no P waves (fibrillatory "f" waves), and a
ventricular rate > 100 bpm (often 150–180).
The Danger: High rates decrease ventricular filling time, leading to a drop in cardiac
output and potential heart failure or stroke.
Interventions:
o Stable Patient: Medications to slow the rate, such as Diltiazem (Cardizem), Beta-
blockers (Metoprolol), or Digoxin. American Heart Association (AHA)
o Unstable Patient: (Hypotensive, chest pain, altered mental status) Requires
immediate Synchronized Cardioversion.
o Anticoagulation: Because the atria are quivering, blood pools and clots; patients
usually need Heparin or Warfarin to prevent an embolic stroke.
Part 2: Pacemaker Malfunctions
Exam B often includes strips where a "pacer spike" is visible but the heart isn't
responding correctly.
Malfunction What it looks like on the EKG Common Cause / Fix
Failure to No pacer spikes are seen when the heart Battery failure or broken lead wire.
Pace rate drops below the set limit.
Failure to Pacer spikes are present, but no P wave or Lead displacement, electrolyte
Capture QRS complex follows them. imbalance, or output (mA) set too
low.
Failure to Pacer spikes occur randomly or on top of Sensitivity (mV) is too low (the pacer
Sense the patient's own beats (R-on-T danger). is "blind" to the patient's rhythm).
Question Practice Exam, ECG Rhythm Interpretation, Pacemaker
Malfunctions, and ACLS Intervention Protocols for Nurses and
Telemetry Technicians
Key Exam Components
Measurement Mastery: You must accurately identify cardiac intervals. Normal PR
Interval is 0.12–0.20 seconds, and a normal QRS duration is 0.04–0.10 seconds.
Heart Block Differentiation:
o 1st Degree Block: A constant PR interval greater than 0.20 seconds.
o 2nd Degree Type I (Wenckebach): The PR interval gets progressively longer until a
QRS complex is dropped.
o 2nd Degree Type II (Mobitz II): The PR interval remains constant, but QRS complexes
are dropped randomly.
o 3rd Degree Block: Complete dissociation between P waves and QRS complexes; they
"march out" independently.
Lethal Rhythms (Auto-Fail if missed): Missing these on the exam is often a
disqualifier as they require immediate intervention:
o Ventricular Fibrillation (V-Fib): Chaotic electrical activity with no recognizable
complexes; ventricles quiver, and there is no cardiac output.
o Ventricular Tachycardia (V-Tach): Three or more PVCs in a row at a rate >100 bpm.
o Asystole: Total absence of ventricular electrical activity.
o PEA (Pulseless Electrical Activity): An organized rhythm appears on the monitor, but
the patient has no pulse. Treatment is CPR and Epinephrine, never defibrillation.
Common Test Scenarios
1. Symptomatic Bradycardia: A patient with a rate <60 bpm, clammy skin, and low blood
pressure (e.g., 70/42) requires Atropine IV.
, 2. Unresponsive V-Tach: For a patient with no pulse in V-Tach, the priority is
immediate Defibrillation after starting chest compressions.
3. Stable vs. Unstable SVT: If a pulse is present but the patient is symptomatic, prepare
for Synchronized Cardioversion
Part 1: Atrial Fibrillation with RVR (Rapid Ventricular Response)
In Exam B, you aren't just identifying A-Fib; you are managing the complications of a
high heart rate.
Identification: Irregularly irregular rhythm, no P waves (fibrillatory "f" waves), and a
ventricular rate > 100 bpm (often 150–180).
The Danger: High rates decrease ventricular filling time, leading to a drop in cardiac
output and potential heart failure or stroke.
Interventions:
o Stable Patient: Medications to slow the rate, such as Diltiazem (Cardizem), Beta-
blockers (Metoprolol), or Digoxin. American Heart Association (AHA)
o Unstable Patient: (Hypotensive, chest pain, altered mental status) Requires
immediate Synchronized Cardioversion.
o Anticoagulation: Because the atria are quivering, blood pools and clots; patients
usually need Heparin or Warfarin to prevent an embolic stroke.
Part 2: Pacemaker Malfunctions
Exam B often includes strips where a "pacer spike" is visible but the heart isn't
responding correctly.
Malfunction What it looks like on the EKG Common Cause / Fix
Failure to No pacer spikes are seen when the heart Battery failure or broken lead wire.
Pace rate drops below the set limit.
Failure to Pacer spikes are present, but no P wave or Lead displacement, electrolyte
Capture QRS complex follows them. imbalance, or output (mA) set too
low.
Failure to Pacer spikes occur randomly or on top of Sensitivity (mV) is too low (the pacer
Sense the patient's own beats (R-on-T danger). is "blind" to the patient's rhythm).
