# A client taking ivabradine develops an irregular rhythm at 118/min after diltiazem was added. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522763&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking ivabradine develops an irregular rhythm at 118/min after diltiazem was added. Which action should the nurse take?

## Option

1. Give both medications because tachycardia rules out an interaction.
2. Hold ivabradine, obtain rhythm assessment, and notify the prescriber about possible atrial fibrillation and the diltiazem interaction. **✔ Correct answer**
3. Administer an extra ivabradine dose to slow the irregular rhythm.
4. Reassure the client that every irregular rhythm is an expected luminous phenomenon.

**Correct answer: 2**

## Explanation

Ivabradine increases atrial-fibrillation risk, and diltiazem can increase ivabradine exposure while also lowering heart rate. New irregular tachycardia requires rhythm assessment, medication hold according to protocol, and prescriber notification.

## In-depth explanation

Quick answer
Treat new irregular rhythm during ivabradine as atrial fibrillation until evaluated.

Why this is correct
Ivabradine is discontinued if atrial fibrillation develops. Diltiazem and verapamil should be avoided because pharmacokinetic and negative-chronotropic effects increase risk.

Easy analogy or mental picture
Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings.

Memory hook
Cue cluster, medication mechanism, protective action, and measurable reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition.

Why the other choices are wrong
Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References
1DailyMed: CORLANOR (ivabradine) prescribing informationBradycardia, atrial fibrillation, rhythm monitoring, and avoidance of verapamil or diltiazem

## Clinical scenario

Medication-safety review
Verify the indication, current assessment, laboratory trend, timing, route, interactions, authorized action, and measurable follow-up.

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