NCLEX-RN® Question of the Day: Second-Degree Heart Block

Today’s NCLEX-RN® question of the day focuses on a second-degree heart block and a new medication. Do you know the answer? Let’s find out!

The nurse in the emergency department is gathering a health history for a patient who presents with intermittent chest pain occurring for several days and has a history of kidney disease. An electrocardiogram (ECG) is performed, which shows a second-degree heart block. The nurse learns the patient was recently started on several medications. Which medication could potentially cause this condition?

A. Lisinopril

B. Prednisone

C. Diltiazem

D. Albuterol 

Scroll down for the correct answer!

The correct answer to today’s NCLEX® Question is…

C. Diltiazem

Rationale: Diltiazem is a calcium channel blocker that can slow conduction through the heart. One of the side effects of diltiazem is heart block, especially for patients who are at risk of developing diltiazem toxicity due to renal damage. Therefore, this medication is most likely the cause of the patient’s new onset atrioventricular block.

Main Takeaway

Heart blocks, or atrioventricular (AV) blocks, are typically caused by any kind of structural damage or fibrosis to the electrical conduction system. Toxicity with calcium channel blockers, such as diltiazem, and other medications such as digoxin and beta blockers can cause delayed conduction resulting in a heart block, especially for patients with impaired drug excretion due to kidney damage. Heart damage of any kind is also strongly associated with risk for heart block. This includes ischemic heart disease, previous or recent myocardial infarction, congenital heart disease, myocarditis, as well as rheumatic fever.

Incorrect Answer Explanations

A. Lisinopril

Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure. This medication is not typically associated with the risk of developing a heart block.

C. Prednisone

Rationale: Prednisone is a corticosteroid used to decrease inflammation in the body. This medication is not typically associated with the risk of developing a heart block.

D. Albuterol

Rationale: Albuterol is a beta-adrenergic agonist that helps dilate the bronchioles when inhaled and is used to treat asthma. This medication typically causes an increase in heart rate and does not typically cause a heart block.

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