const regex = /(?:^\K.*+\R?){6}/gm;
// Alternative syntax using RegExp constructor
// const regex = new RegExp('(?:^\\K.*+\\R?){6}', 'gm')
const str = `Question text
A. Answer Option
B. Answer Option
C. Answer Option
D. Answer Option
Explanation text
Question text
E. Answer Option
F. Answer Option
G. Answer Option
H. Answer Option
Explanation text
Question text
I. Answer Option
J. Answer Option
K. Answer Option
L. Answer Option
Explanation text
Question text
M. Answer Option`;
const subst = `Explanation\n$0`;
// The substituted value will be contained in the result variable
const result = str.replace(regex, subst);
console.log('Substitution result: ', result);
Please keep in mind that these code samples are automatically generated and are not guaranteed to work. If you find any syntax errors, feel free to submit a bug report. For a full regex reference for JavaScript, please visit: https://developer.mozilla.org/en/docs/Web/JavaScript/Guide/Regular_Expressions