A nurse is preparing to administer metoprolol 25 mg PO to a client with a history of hypertension and heart failure. The client’s vital signs are: BP 132/78 mm Hg, HR 86 beats per minute, and respiratory rate 18 breaths per minute. Which action should the nurse take?

Choice A reason: Giving half the dose of metoprolol is inappropriate without a medical order, as it may reduce therapeutic efficacy. The client’s vital signs (BP 132/78, HR 86) are stable, indicating no need to alter the prescribed dose, which is intended to manage hypertension and heart failure. Choice B reason: Metoprolol, a beta-blocker, reduces heart rate and blood pressure in hypertension and heart failure. The client’s vital signs (BP 132/78, HR 86) are within acceptable ranges, indicating the full 25 mg dose is safe and appropriate to maintain therapeutic control of their condition. Choice C reason: Delaying the dose until the pulse is below 60 is unnecessary, as the client’s heart rate of 86 is not bradycardic. Metoprolol is indicated for heart rates above 60 in heart failure and hypertension, and withholding it could worsen blood pressure control. Choice D reason: Omitting the dose due to a pulse of 86 is inappropriate, as this heart rate is not dangerously low. Metoprolol is prescribed to manage hypertension and heart failure, and withholding it without clinical justification could lead to uncontrolled symptoms or disease progression.