[RELIAS ADVANCED DYSRHYTHMIA EXAM A] COMPLETE
EXAM QUESTIONS AND VERIFIED ANSWERS | 2026–2027
LATEST UPDATE | GUARANTEED PASS | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP | PRACTICE
TEST | CERTIFICATION PREPARATION
1. A telemetry nurse identifies an ECG rhythm with an irregularly irregular pattern, absent P waves,
and a ventricular rate of 118 bpm. What rhythm is most likely present?
A. Atrial flutter
B. Atrial fibrillation with rapid ventricular response
C. Sinus tachycardia
D. Multifocal atrial tachycardia
Correct Answer: B. Atrial fibrillation with rapid ventricular response
Rationale: The absence of P waves and irregularly irregular rhythm strongly indicate atrial fibrillation.
The elevated rate confirms rapid ventricular response. Atrial flutter typically shows sawtooth waves,
sinus tachycardia maintains P waves, and MAT shows varying P wave morphologies.
2. A patient develops ventricular fibrillation on the monitor. What is the priority intervention?
A. Administer amiodarone
B. Initiate immediate defibrillation
C. Check pulse and blood pressure
D. Start IV lidocaine infusion
Correct Answer: B. Initiate immediate defibrillation
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. Delaying
for pulse checks or medications reduces survival. Antiarrhythmics may follow resuscitation efforts.
3. Which ECG finding is most consistent with complete heart block (third-degree AV block)?
A. PR interval progressively lengthening
B. Random relationship between P waves and QRS complexes
C. Narrow QRS with fast ventricular rate
D. Dropped QRS complexes every third beat
Correct Answer: B. Random relationship between P waves and QRS complexes
Rationale: Third-degree AV block shows AV dissociation with no correlation between atrial and
ventricular activity. Wenckebach shows progressive PR lengthening, and Mobitz II shows dropped
beats.
4. A patient has a heart rate of 42 bpm with upright P waves before each QRS and a constant PR
interval. What rhythm is this?
A. Junctional bradycardia
B. Sinus bradycardia
C. Second-degree AV block type I
D. Atrial fibrillation
Correct Answer: B. Sinus bradycardia
Rationale: Normal P waves with consistent PR intervals and slow rate indicate sinus bradycardia.
Junctional rhythms often lack upright P waves.
,5. A nurse notes ST elevation in leads II, III, and aVF. What area of the heart is most affected?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Septal wall
Correct Answer: C. Inferior wall
Rationale: Leads II, III, and aVF reflect inferior myocardial territory, typically supplied by the right
coronary artery.
6. A patient has wide QRS complexes, no identifiable P waves, and a rate of 180 bpm. What is the
most likely rhythm?
A. Ventricular tachycardia
B. Supraventricular tachycardia
C. Atrial flutter
D. Sinus tachycardia
Correct Answer: A. Ventricular tachycardia
Rationale: Wide QRS tachycardia without P waves suggests ventricular tachycardia, a life-threatening
rhythm requiring urgent intervention.
7. Which medication is commonly first-line for stable monomorphic ventricular tachycardia?
A. Adenosine
B. Amiodarone
C. Atropine
D. Digoxin
Correct Answer: B. Amiodarone
Rationale: Amiodarone is commonly used for stable VT. Adenosine is for SVT, atropine for
bradycardia, and digoxin for rate control in atrial fibrillation.
8. A rhythm strip shows sawtooth flutter waves with a regular ventricular response of 150 bpm.
What is the likely conduction ratio?
A. 1:1
B. 2:1
C. 3:1
D. 4:1
Correct Answer: B. 2:1
Rationale: Atrial flutter with 2:1 conduction commonly produces a ventricular rate around 150 bpm
due to atrial rate near 300 bpm.
9. Which condition is most associated with the development of premature ventricular contractions
(PVCs)?
A. Hypercalcemia
B. Myocardial ischemia
C. Hypernatremia
D. Hypothermia
Correct Answer: B. Myocardial ischemia
Rationale: PVCs commonly arise from myocardial irritability due to ischemia. Electrolyte imbalances
can contribute but ischemia is a major cause.
10. A patient presents with narrow-complex tachycardia at 190 bpm and sudden onset
palpitations. Vagal maneuvers are ineffective. What is next?
, A. Defibrillation
B. Adenosine administration
C. Synchronized cardioversion
D. Lidocaine infusion
Correct Answer: B. Adenosine administration
Rationale: Stable SVT is treated with adenosine after vagal maneuvers fail. Cardioversion is reserved
for instability.
11. Which ECG characteristic is most indicative of hyperkalemia?
A. Flattened T waves
B. Peaked T waves
C. ST depression
D. U waves
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia classically causes tall, peaked T waves and can progress to widened QRS
complexes.
12. A patient has a heart rate of 30 bpm with no identifiable P waves and a regular rhythm. What
rhythm is most likely?
A. Junctional escape rhythm
B. Sinus arrest
C. Atrial flutter
D. Ventricular fibrillation
Correct Answer: A. Junctional escape rhythm
Rationale: Junctional escape rhythms occur when SA node fails, producing slow, regular rhythms
without visible P waves.
13. Which rhythm is considered non-shockable in ACLS protocols?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Torsades de pointes
Correct Answer: C. Asystole
Rationale: Asystole is a non-shockable rhythm requiring CPR and epinephrine, not defibrillation.
14. A patient with chest pain shows ST depression and T-wave inversion. What is the most likely
interpretation?
A. Acute STEMI
B. Myocardial ischemia
C. Pericarditis
D. Normal variant
Correct Answer: B. Myocardial ischemia
Rationale: ST depression and T-wave inversion are classic signs of ischemia rather than infarction.
15. Which electrolyte imbalance is most associated with torsades de pointes?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
EXAM QUESTIONS AND VERIFIED ANSWERS | 2026–2027
LATEST UPDATE | GUARANTEED PASS | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP | PRACTICE
TEST | CERTIFICATION PREPARATION
1. A telemetry nurse identifies an ECG rhythm with an irregularly irregular pattern, absent P waves,
and a ventricular rate of 118 bpm. What rhythm is most likely present?
A. Atrial flutter
B. Atrial fibrillation with rapid ventricular response
C. Sinus tachycardia
D. Multifocal atrial tachycardia
Correct Answer: B. Atrial fibrillation with rapid ventricular response
Rationale: The absence of P waves and irregularly irregular rhythm strongly indicate atrial fibrillation.
The elevated rate confirms rapid ventricular response. Atrial flutter typically shows sawtooth waves,
sinus tachycardia maintains P waves, and MAT shows varying P wave morphologies.
2. A patient develops ventricular fibrillation on the monitor. What is the priority intervention?
A. Administer amiodarone
B. Initiate immediate defibrillation
C. Check pulse and blood pressure
D. Start IV lidocaine infusion
Correct Answer: B. Initiate immediate defibrillation
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. Delaying
for pulse checks or medications reduces survival. Antiarrhythmics may follow resuscitation efforts.
3. Which ECG finding is most consistent with complete heart block (third-degree AV block)?
A. PR interval progressively lengthening
B. Random relationship between P waves and QRS complexes
C. Narrow QRS with fast ventricular rate
D. Dropped QRS complexes every third beat
Correct Answer: B. Random relationship between P waves and QRS complexes
Rationale: Third-degree AV block shows AV dissociation with no correlation between atrial and
ventricular activity. Wenckebach shows progressive PR lengthening, and Mobitz II shows dropped
beats.
4. A patient has a heart rate of 42 bpm with upright P waves before each QRS and a constant PR
interval. What rhythm is this?
A. Junctional bradycardia
B. Sinus bradycardia
C. Second-degree AV block type I
D. Atrial fibrillation
Correct Answer: B. Sinus bradycardia
Rationale: Normal P waves with consistent PR intervals and slow rate indicate sinus bradycardia.
Junctional rhythms often lack upright P waves.
,5. A nurse notes ST elevation in leads II, III, and aVF. What area of the heart is most affected?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Septal wall
Correct Answer: C. Inferior wall
Rationale: Leads II, III, and aVF reflect inferior myocardial territory, typically supplied by the right
coronary artery.
6. A patient has wide QRS complexes, no identifiable P waves, and a rate of 180 bpm. What is the
most likely rhythm?
A. Ventricular tachycardia
B. Supraventricular tachycardia
C. Atrial flutter
D. Sinus tachycardia
Correct Answer: A. Ventricular tachycardia
Rationale: Wide QRS tachycardia without P waves suggests ventricular tachycardia, a life-threatening
rhythm requiring urgent intervention.
7. Which medication is commonly first-line for stable monomorphic ventricular tachycardia?
A. Adenosine
B. Amiodarone
C. Atropine
D. Digoxin
Correct Answer: B. Amiodarone
Rationale: Amiodarone is commonly used for stable VT. Adenosine is for SVT, atropine for
bradycardia, and digoxin for rate control in atrial fibrillation.
8. A rhythm strip shows sawtooth flutter waves with a regular ventricular response of 150 bpm.
What is the likely conduction ratio?
A. 1:1
B. 2:1
C. 3:1
D. 4:1
Correct Answer: B. 2:1
Rationale: Atrial flutter with 2:1 conduction commonly produces a ventricular rate around 150 bpm
due to atrial rate near 300 bpm.
9. Which condition is most associated with the development of premature ventricular contractions
(PVCs)?
A. Hypercalcemia
B. Myocardial ischemia
C. Hypernatremia
D. Hypothermia
Correct Answer: B. Myocardial ischemia
Rationale: PVCs commonly arise from myocardial irritability due to ischemia. Electrolyte imbalances
can contribute but ischemia is a major cause.
10. A patient presents with narrow-complex tachycardia at 190 bpm and sudden onset
palpitations. Vagal maneuvers are ineffective. What is next?
, A. Defibrillation
B. Adenosine administration
C. Synchronized cardioversion
D. Lidocaine infusion
Correct Answer: B. Adenosine administration
Rationale: Stable SVT is treated with adenosine after vagal maneuvers fail. Cardioversion is reserved
for instability.
11. Which ECG characteristic is most indicative of hyperkalemia?
A. Flattened T waves
B. Peaked T waves
C. ST depression
D. U waves
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia classically causes tall, peaked T waves and can progress to widened QRS
complexes.
12. A patient has a heart rate of 30 bpm with no identifiable P waves and a regular rhythm. What
rhythm is most likely?
A. Junctional escape rhythm
B. Sinus arrest
C. Atrial flutter
D. Ventricular fibrillation
Correct Answer: A. Junctional escape rhythm
Rationale: Junctional escape rhythms occur when SA node fails, producing slow, regular rhythms
without visible P waves.
13. Which rhythm is considered non-shockable in ACLS protocols?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Torsades de pointes
Correct Answer: C. Asystole
Rationale: Asystole is a non-shockable rhythm requiring CPR and epinephrine, not defibrillation.
14. A patient with chest pain shows ST depression and T-wave inversion. What is the most likely
interpretation?
A. Acute STEMI
B. Myocardial ischemia
C. Pericarditis
D. Normal variant
Correct Answer: B. Myocardial ischemia
Rationale: ST depression and T-wave inversion are classic signs of ischemia rather than infarction.
15. Which electrolyte imbalance is most associated with torsades de pointes?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
