A nurse is caring for a client who has a depressive disorder. Which of the following factors should the nurse identify as a risk factor for developing this condition?

• Paranoia: Stimulant intoxication, such as from cocaine or methamphetamine, often causes heightened alertness, suspiciousness, and paranoia. Hallucinogens can also alter perception and cognition, leading to paranoid ideation. Paranoia is not characteristic of opioid intoxication.

• Sedation: Opioid intoxication commonly produces CNS depression, resulting in drowsiness, lethargy, and decreased responsiveness. Sedation is a hallmark feature of opioid use and helps differentiate opioids from stimulants and hallucinogens, which typically cause increased arousal.

• Seizures: Seizures can occur with high doses or toxicity of stimulants due to CNS overstimulation and excitotoxicity. Hallucinogens may also precipitate seizures in susceptible individuals. Opioid intoxication rarely causes seizures unless in combination with other substances.

• Dilated pupils: Pupillary dilation (mydriasis) is a classic effect of stimulant intoxication from increased sympathetic activity. Hallucinogens, such as LSD or psilocybin, also cause mydriasis due to their effects on the autonomic nervous system.

• Tachycardia: Stimulants increase catecholamine release, leading to tachycardia. Hallucinogens can also increase heart rate by stimulating the sympathetic nervous system. Opioids generally cause bradycardia or normal heart rate unless hypoxia is present.

• Hypertension: Elevated blood pressure is common with stimulant use due to increased sympathetic activity. Hallucinogens can also cause transient hypertension. Opioids typically lower blood pressure through CNS depression and vasodilation.

• Pinpoint pupils: Miosis, or pinpoint pupils, is a classic sign of opioid intoxication. It results from parasympathetic stimulation via the Edinger-Westphal nucleus. Stimulants and hallucinogens usually cause normal or dilated pupils rather than constriction.

A. Smoked turkey: Smoked, cured, or processed meats contain high levels of tyramine, which can interact with MAOIs like isocarboxazid, potentially causing a hypertensive crisis. Clients on MAOIs must avoid foods high in tyramine to prevent dangerous blood pressure spikes.

B. Strawberries: Fresh strawberries are low in tyramine and generally safe for clients taking MAOIs. They do not pose a significant risk of interaction with isocarboxazid.

C. Yogurt: Plain yogurt contains only minimal tyramine and is typically considered safe in moderation. It does not usually precipitate hypertensive reactions with MAOIs unless it is aged or fermented.

D. 1% milk: Milk is low in tyramine and does not interact significantly with MAOIs. It is generally considered safe for consumption while on isocarboxazid.

E. Tomatoes: Fresh tomatoes have low tyramine content and are safe for clients on MAOIs. Only aged or processed tomato products (e.g., sauces, paste) pose a risk.

F. Lettuce: Lettuce contains negligible tyramine and does not interact with MAOI therapy, making it safe for the client to consume.

G. Swiss cheese: Aged cheeses like Swiss contain high levels of tyramine, which can interact with isocarboxazid and increase the risk of hypertensive crisis. Clients on MAOIs should avoid all aged cheeses.

H. Avocados: Overripe avocados contain significant tyramine and can trigger hypertensive reactions in clients taking MAOIs. Only unripe or fresh avocados are considered safer, but caution is generally advised.