A client with post-MI HFrEF has a new eplerenone prescription. Potassium is 5.8 mEq/L and creatinine clearance is 28 mL/min. Which action should the nurse take?
1Administer the first dose with a potassium supplement
2Give half the dose and recheck in 1 month
3Hold the medication and clarify the prescription immediately✓ Correct answer
4Administer it because eplerenone lowers potassium
Explanation
Eplerenone is contraindicated at initiation when potassium exceeds 5.5 mEq/L or creatinine clearance is 30 mL/min or less.
Quick answer Hold and clarify because both potassium and renal contraindications are present.
Why this is correct Eplerenone blocks mineralocorticoid effects and can raise potassium. Current labeling requires baseline potassium and renal assessment and lists these values as contraindications.
Easy analogy or mental picture The drug closes a potassium exit pathway; high potassium and low clearance make the room unsafe before the first dose.
Memory hook Eplerenone start: potassium 5.5 or lower and CrCl above 30.
NCLEX decision rule Check hard contraindication thresholds before applying the heart-failure benefit.
Why the other choices are wrong Dose reduction or delayed monitoring does not override two initiation contraindications, and potassium supplementation worsens risk.
References
1DailyMed: EplerenonePotassium and renal contraindications, monitoring, and post-MI HFrEF therapy
Mineralocorticoid antagonist checkVerify potassium, creatinine clearance, ACE or ARB use, NSAIDs, supplements, CYP3A inhibitors, blood pressure, and monitoring dates.