Relias Dysrhythmia- advanced A Questions With Complete
Solutions
Course
NURS 4572
1. Question:
A patient’s ECG strip shows a regular rhythm with a rate of 160 bpm, narrow QRS complexes,
and no visible P waves. What is the most likely dysrhythmia?
Solution:
A regular tachycardia with a rate above 150 bpm and no visible P waves suggests
supraventricular tachycardia (SVT).
The narrow QRS indicates that the origin is above the ventricles.
Treatment includes vagal maneuvers, adenosine, or synchronized cardioversion if the
patient is unstable.
Answer: Supraventricular Tachycardia (SVT)
2. Question:
A patient with a heart rate of 45 bpm, regular rhythm, and a prolonged PR interval (> 0.20 sec)
is most likely experiencing which type of dysrhythmia?
Solution:
A slow heart rate (bradycardia) with a prolonged PR interval suggests first-degree
AV block.
This is usually benign, but may indicate increased vagal tone, medication effects (e.g.,
beta-blockers, digoxin), or ischemia.
Treatment is usually not required unless symptomatic (then, atropine or pacing may
be needed).
Answer: First-degree AV block
3. Question:
A patient presents with a heart rate of 150 bpm, wide QRS complexes, and an irregular rhythm.
What is the most likely diagnosis?
Solution:
, Irregular wide complex tachycardia is most often associated with atrial fibrillation
with rapid ventricular response (Afib-RVR) and aberrancy or polymorphic VT.
Differentiation:
o If P waves are absent and the rhythm is chaotic → Atrial fibrillation with
RVR.
o If QRS complexes twist around the baseline → Torsades de Pointes.
Treatment depends on stability:
o Unstable: Immediate synchronized cardioversion
o Stable: Amiodarone or procainamide if VT, beta-blockers or calcium channel
blockers if Afib-RVR
Answer: Atrial fibrillation with RVR or polymorphic VT
4. Question:
A patient’s ECG shows a progressively lengthening PR interval until a QRS complex is
dropped. What type of heart block is this?
Solution:
This pattern is characteristic of second-degree AV block, Type I (Mobitz I or
Wenckebach).
The PR interval gradually lengthens until a QRS is dropped.
Causes: High vagal tone, ischemia, or medications (beta-blockers, digoxin).
Treatment: Usually benign, but atropine or pacing may be needed if symptomatic.
Answer: Second-degree AV block Type I (Mobitz I or Wenckebach)
5. Question:
A patient has an ECG with wide QRS complexes, a regular rhythm, and a rate of 180 bpm. No P
waves are visible. What is the most likely dysrhythmia?
Solution:
A wide QRS tachycardia is typically ventricular tachycardia (VT).
No P waves + Rate >150 bpm + Wide QRS → Suggests VT.
, Treatment:
o Stable: Amiodarone, procainamide, or lidocaine
o Unstable: Synchronized cardioversion
o Pulseless: Defibrillation, CPR, epinephrine, amiodarone
Answer: Ventricular Tachycardia (VT)
6. Question:
Which dysrhythmia is characterized by irregularly irregular rhythm, no distinct P waves, and
varying R-R intervals?
Solution:
Atrial fibrillation (Afib) is an irregularly irregular rhythm without distinct P waves.
Causes: Hypertension, heart disease, hyperthyroidism, alcohol abuse.
Treatment:
o Rate control (beta-blockers, calcium channel blockers)
o Anticoagulation (warfarin, DOACs) to prevent stroke
o Cardioversion if indicated
Answer: Atrial fibrillation
7. Question:
A patient in ventricular fibrillation (VFib) is unresponsive. What is the priority intervention?
Solution:
Ventricular fibrillation is a lethal arrhythmia that requires immediate defibrillation.
Steps:
1. Start CPR immediately
2. Defibrillate ASAP (biphasic 200J or monophasic 360J)
3. Epinephrine 1 mg every 3-5 minutes
4. Amiodarone 300 mg IV after 2nd shock
, Answer: Defibrillation (Shock) and CPR
8. Question:
A patient’s ECG shows wide, bizarre QRS complexes at a rate of 30 bpm. P waves and QRS
are independent. What is this dysrhythmia?
Solution:
Complete dissociation between P waves and QRS complexes suggests third-degree
(complete) AV block.
The ventricles generate their own rhythm (junctional or ventricular escape rhythm).
Treatment: Immediate pacing (transcutaneous, then transvenous).
Answer: Third-degree AV block (Complete Heart Block)
9. Question:
A patient with torsades de pointes (polymorphic VT) is stable. What is the first-line treatment?
Solution:
Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia often caused by
prolonged QT interval.
First-line treatment: IV Magnesium sulfate
If unstable: Defibrillation
Answer: IV Magnesium Sulfate
10. Question:
A patient with a history of myocardial infarction suddenly develops sinus bradycardia at 38
bpm, hypotension, and dizziness. What is the best immediate treatment?
Solution:
Bradycardia with symptoms (hypotension, dizziness) → Unstable bradycardia
Treatment:
o Atropine 0.5 mg IV every 3-5 min (max 3 mg)
Solutions
Course
NURS 4572
1. Question:
A patient’s ECG strip shows a regular rhythm with a rate of 160 bpm, narrow QRS complexes,
and no visible P waves. What is the most likely dysrhythmia?
Solution:
A regular tachycardia with a rate above 150 bpm and no visible P waves suggests
supraventricular tachycardia (SVT).
The narrow QRS indicates that the origin is above the ventricles.
Treatment includes vagal maneuvers, adenosine, or synchronized cardioversion if the
patient is unstable.
Answer: Supraventricular Tachycardia (SVT)
2. Question:
A patient with a heart rate of 45 bpm, regular rhythm, and a prolonged PR interval (> 0.20 sec)
is most likely experiencing which type of dysrhythmia?
Solution:
A slow heart rate (bradycardia) with a prolonged PR interval suggests first-degree
AV block.
This is usually benign, but may indicate increased vagal tone, medication effects (e.g.,
beta-blockers, digoxin), or ischemia.
Treatment is usually not required unless symptomatic (then, atropine or pacing may
be needed).
Answer: First-degree AV block
3. Question:
A patient presents with a heart rate of 150 bpm, wide QRS complexes, and an irregular rhythm.
What is the most likely diagnosis?
Solution:
, Irregular wide complex tachycardia is most often associated with atrial fibrillation
with rapid ventricular response (Afib-RVR) and aberrancy or polymorphic VT.
Differentiation:
o If P waves are absent and the rhythm is chaotic → Atrial fibrillation with
RVR.
o If QRS complexes twist around the baseline → Torsades de Pointes.
Treatment depends on stability:
o Unstable: Immediate synchronized cardioversion
o Stable: Amiodarone or procainamide if VT, beta-blockers or calcium channel
blockers if Afib-RVR
Answer: Atrial fibrillation with RVR or polymorphic VT
4. Question:
A patient’s ECG shows a progressively lengthening PR interval until a QRS complex is
dropped. What type of heart block is this?
Solution:
This pattern is characteristic of second-degree AV block, Type I (Mobitz I or
Wenckebach).
The PR interval gradually lengthens until a QRS is dropped.
Causes: High vagal tone, ischemia, or medications (beta-blockers, digoxin).
Treatment: Usually benign, but atropine or pacing may be needed if symptomatic.
Answer: Second-degree AV block Type I (Mobitz I or Wenckebach)
5. Question:
A patient has an ECG with wide QRS complexes, a regular rhythm, and a rate of 180 bpm. No P
waves are visible. What is the most likely dysrhythmia?
Solution:
A wide QRS tachycardia is typically ventricular tachycardia (VT).
No P waves + Rate >150 bpm + Wide QRS → Suggests VT.
, Treatment:
o Stable: Amiodarone, procainamide, or lidocaine
o Unstable: Synchronized cardioversion
o Pulseless: Defibrillation, CPR, epinephrine, amiodarone
Answer: Ventricular Tachycardia (VT)
6. Question:
Which dysrhythmia is characterized by irregularly irregular rhythm, no distinct P waves, and
varying R-R intervals?
Solution:
Atrial fibrillation (Afib) is an irregularly irregular rhythm without distinct P waves.
Causes: Hypertension, heart disease, hyperthyroidism, alcohol abuse.
Treatment:
o Rate control (beta-blockers, calcium channel blockers)
o Anticoagulation (warfarin, DOACs) to prevent stroke
o Cardioversion if indicated
Answer: Atrial fibrillation
7. Question:
A patient in ventricular fibrillation (VFib) is unresponsive. What is the priority intervention?
Solution:
Ventricular fibrillation is a lethal arrhythmia that requires immediate defibrillation.
Steps:
1. Start CPR immediately
2. Defibrillate ASAP (biphasic 200J or monophasic 360J)
3. Epinephrine 1 mg every 3-5 minutes
4. Amiodarone 300 mg IV after 2nd shock
, Answer: Defibrillation (Shock) and CPR
8. Question:
A patient’s ECG shows wide, bizarre QRS complexes at a rate of 30 bpm. P waves and QRS
are independent. What is this dysrhythmia?
Solution:
Complete dissociation between P waves and QRS complexes suggests third-degree
(complete) AV block.
The ventricles generate their own rhythm (junctional or ventricular escape rhythm).
Treatment: Immediate pacing (transcutaneous, then transvenous).
Answer: Third-degree AV block (Complete Heart Block)
9. Question:
A patient with torsades de pointes (polymorphic VT) is stable. What is the first-line treatment?
Solution:
Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia often caused by
prolonged QT interval.
First-line treatment: IV Magnesium sulfate
If unstable: Defibrillation
Answer: IV Magnesium Sulfate
10. Question:
A patient with a history of myocardial infarction suddenly develops sinus bradycardia at 38
bpm, hypotension, and dizziness. What is the best immediate treatment?
Solution:
Bradycardia with symptoms (hypotension, dizziness) → Unstable bradycardia
Treatment:
o Atropine 0.5 mg IV every 3-5 min (max 3 mg)
