RELIAS Dysrhythmia Basic Test (Revised Version) Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiac Anatomy & Basic Electrophysiology | Q1 – Q10
Section 2 | Sinus Rhythms & Atrial Arrhythmias | Q11 – Q20
Section 3 | Junctional Rhythms & AV Blocks | Q21 – Q30
Section 4 | Ventricular Dysrhythmias & Asystole | Q31 – Q40
Section 5 | Clinical Recognition & Emergency Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIAC ANATOMY & BASIC ELECTROPHYSIOLOGY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient is on telemetry after coronary artery bypass surgery. The nurse is
reviewing the normal conduction pathway to understand why the patient's intrinsic
rhythm originates from the sinus node. The sinoatrial node is located in which
anatomical area of the heart?
A. The inferior wall of the left ventricle near the apex
B. The posterior wall of the right atrium near the superior vena cava opening ✓
CORRECT
C. The interventricular septum at the junction of the right ventricle
D. The anterior wall of the left atrium adjacent to the pulmonary veins
Correct Answer: B
Rationale: The sinoatrial node is located in the posterior wall of the right atrium near the
superior vena cava opening. The inferior wall of the left ventricle describes the apex
region where Purkinje fibers terminate. Understanding SA node anatomy is essential for
recognizing why sinus rhythms produce upright P waves in lead II.
,Question 2 of 50
A 45-year-old patient is in the emergency department with chest pain. The nurse
attaches a 12-lead ECG and notes the standard calibration. Each small square on the
ECG paper represents how much time and voltage?
A. 0.04 seconds and 0.5 millivolts
B. 0.20 seconds and 1.0 millivolts
C. 0.02 seconds and 0.5 millivolts
D. 0.04 seconds and 0.1 millivolts ✓ CORRECT
Correct Answer: D
Rationale: Each small square on standard ECG paper represents 0.04 seconds
horizontally and 0.1 millivolts vertically, while large squares represent 0.20 seconds and
0.5 millivolts. Many students confuse small and large square values, which leads to
incorrect heart rate and amplitude calculations. Accurate ECG measurement is the
foundation of all rhythm interpretation.
Question 3 of 50
A 55-year-old patient with hypokalemia is on telemetry. The nurse understands that
electrolyte imbalances affect cardiac electrophysiology. Potassium levels primarily
influence which phase of the cardiac action potential?
A. Phase 3 repolarization, by altering potassium efflux through delayed rectifier
channels ✓ CORRECT
B. Phase 0 depolarization, by blocking fast sodium channels
C. Phase 4 spontaneous depolarization, by increasing calcium influx
D. Phase 1 initial repolarization, by enhancing chloride influx
Correct Answer: A
Rationale: Potassium efflux through delayed rectifier channels is the primary current
driving Phase 3 repolarization, so hypokalemia prolongs and hyperkalemia shortens or
, distorts this phase. Phase 0 depends on sodium influx, not potassium. ECG changes
from electrolyte imbalances are often the first clinical sign of metabolic derangement.
Question 4 of 50
A 72-year-old patient with a history of heart failure is being monitored. The nurse
observes that when the vagus nerve is stimulated, the heart rate slows. This effect is
primarily mediated by which neurotransmitter and receptor interaction?
A. Norepinephrine binding to beta-1 adrenergic receptors
B. Epinephrine binding to alpha-1 adrenergic receptors
C. Acetylcholine binding to muscarinic M2 receptors ✓ CORRECT
D. Dopamine binding to D1 receptors in the sinoatrial node
Correct Answer: C
Rationale: Vagal stimulation releases acetylcholine which binds to muscarinic M2
receptors in the sinoatrial and atrioventricular nodes, slowing heart rate and conduction.
Norepinephrine and beta-1 stimulation increase heart rate through sympathetic
activation. This autonomic balance explains why carotid massage can terminate some
supraventricular tachycardias.
Question 5 of 50
A 62-year-old patient is undergoing electrophysiology testing. The cardiologist explains
that the heart has a period during which no new stimulus can trigger another
depolarization. This protective mechanism is known as which of the following?
A. The relative refractory period only
B. The absolute refractory period ✓ CORRECT
C. The supernormal period
D. The resting membrane potential phase
Correct Answer: B
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiac Anatomy & Basic Electrophysiology | Q1 – Q10
Section 2 | Sinus Rhythms & Atrial Arrhythmias | Q11 – Q20
Section 3 | Junctional Rhythms & AV Blocks | Q21 – Q30
Section 4 | Ventricular Dysrhythmias & Asystole | Q31 – Q40
Section 5 | Clinical Recognition & Emergency Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIAC ANATOMY & BASIC ELECTROPHYSIOLOGY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient is on telemetry after coronary artery bypass surgery. The nurse is
reviewing the normal conduction pathway to understand why the patient's intrinsic
rhythm originates from the sinus node. The sinoatrial node is located in which
anatomical area of the heart?
A. The inferior wall of the left ventricle near the apex
B. The posterior wall of the right atrium near the superior vena cava opening ✓
CORRECT
C. The interventricular septum at the junction of the right ventricle
D. The anterior wall of the left atrium adjacent to the pulmonary veins
Correct Answer: B
Rationale: The sinoatrial node is located in the posterior wall of the right atrium near the
superior vena cava opening. The inferior wall of the left ventricle describes the apex
region where Purkinje fibers terminate. Understanding SA node anatomy is essential for
recognizing why sinus rhythms produce upright P waves in lead II.
,Question 2 of 50
A 45-year-old patient is in the emergency department with chest pain. The nurse
attaches a 12-lead ECG and notes the standard calibration. Each small square on the
ECG paper represents how much time and voltage?
A. 0.04 seconds and 0.5 millivolts
B. 0.20 seconds and 1.0 millivolts
C. 0.02 seconds and 0.5 millivolts
D. 0.04 seconds and 0.1 millivolts ✓ CORRECT
Correct Answer: D
Rationale: Each small square on standard ECG paper represents 0.04 seconds
horizontally and 0.1 millivolts vertically, while large squares represent 0.20 seconds and
0.5 millivolts. Many students confuse small and large square values, which leads to
incorrect heart rate and amplitude calculations. Accurate ECG measurement is the
foundation of all rhythm interpretation.
Question 3 of 50
A 55-year-old patient with hypokalemia is on telemetry. The nurse understands that
electrolyte imbalances affect cardiac electrophysiology. Potassium levels primarily
influence which phase of the cardiac action potential?
A. Phase 3 repolarization, by altering potassium efflux through delayed rectifier
channels ✓ CORRECT
B. Phase 0 depolarization, by blocking fast sodium channels
C. Phase 4 spontaneous depolarization, by increasing calcium influx
D. Phase 1 initial repolarization, by enhancing chloride influx
Correct Answer: A
Rationale: Potassium efflux through delayed rectifier channels is the primary current
driving Phase 3 repolarization, so hypokalemia prolongs and hyperkalemia shortens or
, distorts this phase. Phase 0 depends on sodium influx, not potassium. ECG changes
from electrolyte imbalances are often the first clinical sign of metabolic derangement.
Question 4 of 50
A 72-year-old patient with a history of heart failure is being monitored. The nurse
observes that when the vagus nerve is stimulated, the heart rate slows. This effect is
primarily mediated by which neurotransmitter and receptor interaction?
A. Norepinephrine binding to beta-1 adrenergic receptors
B. Epinephrine binding to alpha-1 adrenergic receptors
C. Acetylcholine binding to muscarinic M2 receptors ✓ CORRECT
D. Dopamine binding to D1 receptors in the sinoatrial node
Correct Answer: C
Rationale: Vagal stimulation releases acetylcholine which binds to muscarinic M2
receptors in the sinoatrial and atrioventricular nodes, slowing heart rate and conduction.
Norepinephrine and beta-1 stimulation increase heart rate through sympathetic
activation. This autonomic balance explains why carotid massage can terminate some
supraventricular tachycardias.
Question 5 of 50
A 62-year-old patient is undergoing electrophysiology testing. The cardiologist explains
that the heart has a period during which no new stimulus can trigger another
depolarization. This protective mechanism is known as which of the following?
A. The relative refractory period only
B. The absolute refractory period ✓ CORRECT
C. The supernormal period
D. The resting membrane potential phase
Correct Answer: B
