The nurse is caring for a patient newly diagnosed with hypertension. What barrier to blood pressure management will the nurse identify?

A. "I will take this medication at the same time each day": This statement demonstrates an understanding of the importance of consistency in medication administration, which is essential for maintaining therapeutic levels of warfarin in the bloodstream. Therefore, this statement does not indicate a need for further teaching.
B. "I will add a green leafy salad to my dinner today": This statement is concerning because warfarin interacts with vitamin K, which is abundant in green leafy vegetables. Increasing intake of vitamin K-rich foods, such as green leafy salads, can interfere with the anticoagulant effects of warfarin, potentially leading to ineffective treatment. The patient should be educated to maintain a consistent intake of vitamin K-containing foods to avoid fluctuations in warfarin effectiveness.
C. "I will avoid alcohol when I am taking warfarin": This statement demonstrates an understanding of the potential interactions between alcohol and warfarin. Alcohol can increase the risk of bleeding in individuals taking warfarin, so it is advisable to limit or avoid alcohol consumption while on this medication. Therefore, this statement does not indicate a need for further teaching.
D. "I will use an electronic shaver and a soft toothbrush": This statement reflects the patient's understanding of the precautions to minimize the risk of bleeding while taking warfarin. Using an electronic shaver and a soft toothbrush helps reduce the risk of cuts or injuries that could lead to bleeding, especially in individuals whose blood clotting ability may be compromised by warfarin therapy. Therefore, this statement does not indicate a need for further teaching.

A. Continue to administer the metoprolol tartrate as ordered:
Metoprolol is a beta-blocker commonly used to treat hypertension, angina, and heart failure. One of its main effects is to decrease heart rate and blood pressure. In this scenario, the patient's vital signs reveal a low heart rate (48 bpm) and relatively low blood pressure (100/50 mmHg). Given that metoprolol can further reduce heart rate and blood pressure, it would be prudent for the nurse to withhold the medication until further assessment is conducted.

B. Ask the patient if her pulse is within the normal range:
While it's essential to assess the patient's understanding of her condition, asking if her pulse is within the normal range is not sufficient. The nurse should perform a more thorough assessment and consider the clinical significance of the vital signs obtained. In this case, a heart rate of 48 bpm is lower than the typical normal range for adults (60-100 bpm), indicating bradycardia, which may be symptomatic or concerning in the context of administering a beta-blocker like metoprolol.

C. Hold the medication and call the provider:
Given the patient's low heart rate (bradycardia) and relatively low blood pressure, holding the metoprolol tartrate and contacting the healthcare provider is the most appropriate action. Bradycardia and hypotension can be signs of excessive beta-blockade, especially with medications like metoprolol, which can further lower heart rate and blood pressure. The nurse should notify the provider promptly to discuss the patient's condition and determine the appropriate course of action.

D. Ask the patient to eat salty foods:
Encouraging the patient to eat salty foods would not address the underlying issue of bradycardia and hypotension. While increasing salt intake may help raise blood pressure in some cases, it is not a standard intervention for managing symptomatic bradycardia or low blood pressure caused by medication effects.