# Complete the statement about the newly entered heart-failure medication order.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513813&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Complete the statement about the newly entered heart-failure medication order.

Because lisinopril was administered at 0800 today, the nurse should ::선택::administer both medications with fooddiscontinue both medications permanentlyhold and clarify the sacubitril/valsartan ordergive sacubitril/valsartan at the next medication pass and verify that sacubitril/valsartan begins ::선택::immediately after lisinoprilno sooner than 36 hours after the last lisinopril dosewhen the heart rate exceeds 100/minafter the next potassium result only.

## Explanation

Sacubitril/valsartan is contraindicated with concomitant ACE inhibitor use. A 36-hour washout is required when switching from lisinopril or another ACE inhibitor.

## In-depth explanation

Quick answer
Hold and clarify the sacubitril/valsartan order, then verify a start time at least 36 hours after the last lisinopril dose.

Why this is correct
Lisinopril is an ACE inhibitor. DailyMed states that sacubitril/valsartan must not be used concomitantly with an ACE inhibitor and requires a 36-hour washout when switching.

Easy analogy or mental picture
Picture two trains sharing a tunnel. The ACE inhibitor must fully clear the scheduled tunnel before sacubitril/valsartan enters.

Memory hook
ACE inhibitor to ARNI: separate by 36 hours.

NCLEX decision rule
Before administering a newly substituted cardiovascular medication, reconcile the last dose and required washout. Do not shorten a labeled safety interval because vital signs are stable.

Why the other choices are wrong
Immediate coadministration violates the contraindication. Waiting only until the next routine medication pass is not the required interval, and permanently discontinuing both drugs is not the nurse's independent decision.References
1DailyMed: EntrestoACE inhibitor contraindication and 36-hour washout

## Clinical scenario

Interaction check
Verify the exact last ACE inhibitor dose and the scheduled first sacubitril/valsartan dose before administration.

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