A nurse is caring for a client who is to undergo a bilateral prophylactic mastectomy. The client states that her family opposes her decision. Which of the following responses should the nurse make?

Choice A reason: Avoiding eye contact with a client experiencing auditory hallucinations may increase feelings of isolation or mistrust. Appropriate eye contact fosters therapeutic communication, conveying empathy and engagement. This action is not evidence-based for managing hallucinations, as it fails to address the client’s experience or build trust, making it inappropriate.
Choice B reason: Encouraging the client to lie down in a quiet room may reduce stimuli but does not directly address auditory hallucinations. This approach is more suitable for sensory overload or anxiety, not for engaging with or understanding the client’s hallucinations, which requires active communication to assess and manage symptoms effectively.
Choice C reason: Asking the client directly what they are hearing is a therapeutic approach that validates their experience and helps assess the nature and impact of hallucinations. This facilitates reality orientation, builds trust, and informs treatment, such as adjusting antipsychotics. It aligns with evidence-based care for schizophrenia, making it the correct action.
Choice D reason: Administering antianxiety medication immediately is not the first step for auditory hallucinations, which are primarily managed with antipsychotics. Without assessing the hallucinations’ content or severity, this action is premature and may not address the underlying psychotic symptoms, making it less appropriate than engaging the client directly.

Choice A reason: Smoked salmon is high in tyramine, which phenelzine, an MAOI, prevents from being metabolized. This risks hypertensive crisis due to norepinephrine release, potentially causing stroke or cardiovascular complications. Avoiding tyramine-rich foods is critical for safety in clients on MAOI therapy.
Choice B reason: Cottage cheese is low in tyramine, safe for phenelzine users. Unlike aged cheeses, fresh dairy poses minimal risk of hypertensive crisis, as it lacks significant tyramine content. MAOIs require avoiding high-tyramine foods, making cottage cheese an acceptable dietary choice for these clients.
Choice C reason: Grapefruit affects CYP450 enzymes, interacting with some drugs, but is not contraindicated with phenelzine. It lacks significant tyramine, so it does not trigger hypertensive crises. Avoidance is unnecessary, as it does not impact MAOI metabolism or related cardiovascular risks.
Choice D reason: Fresh apples are low in tyramine and safe for phenelzine users. MAOIs require avoiding tyramine-rich foods like aged meats, but fresh fruits do not cause hypertensive crises, as they lack amino acids interacting with MAOI metabolism, making them safe for consumption.