St. John’s wort is an herbal supplement often used to treat depression. However, due to its central and peripheral effects on serotonin, St. John’s wort is prone to increase blood pressure, which would be contraindicated in this patient with malignant hypertension. The nurse tells the patient the medication will be held until after the nurse and the patient have spoken with the provider. This response creates a plan for the patient while maintaining safety. It is not appropriate to say that St. John’s wort is fine as an adjunctive treatment given its hypertensive side effects. It is also not appropriate to forbid the use of any herbal remedies or supplements as many have important ethnic and cultural uses and may be important to a patient’s sense of well-being. Although medications are preferred to come from the pharmacy, herbal remedies and supplements may not be available in-house.