A nurse is educating a client who has been prescribed phenelzine, an MAOI, for treatment-resistant depression. Which of the following instructions is most critical to prevent potentially life-threatening complications associated with this medication?
Avoid foods high in tyramine, such as aged cheeses, smoked meats, and fermented products.
Use over-the-counter cold medications containing pseudoephedrine cautiously.
Take the medication with food to minimize gastrointestinal upset.
Avoid driving or operating heavy machinery until the effects are known.
The Correct Answer is A
Choice A reason: The most critical teaching with MAOIs is to avoid foods containing tyramine. Eating these foods can trigger a hypertensive crisis, a potentially fatal complication.
Choice B reason: Cold medications with pseudoephedrine may also increase blood pressure and should be avoided, but dietary restrictions are more essential because food exposure is more common and life-threatening if overlooked.
Choice C reason: Taking the medication with food may reduce mild gastrointestinal side effects, but this is not the priority safety teaching.
Choice D reason: Avoiding hazardous activities until medication effects are known is general advice for many psychotropic drugs, but it is not specific or lifesaving for MAOI therapy.
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Related Questions
Correct Answer is A
Explanation
Choice A reason: This presentation is consistent with neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction to antipsychotics characterized by severe muscle rigidity, hyperthermia, altered mental status, and autonomic dysfunction. Immediate discontinuation of the drug and emergency treatment are required.
Choice B reason: Restlessness and inability to sit still are signs of akathisia, an extrapyramidal side effect of antipsychotics. While distressing and requiring management, it is not life-threatening compared to NMS.
Choice C reason: A flat affect and reduced speech are negative symptoms of schizophrenia and may persist despite treatment. These are concerning for quality of life but do not require urgent medical intervention.
Choice D reason: Mild weight gain is a known side effect of many antipsychotics. It should be monitored and managed with lifestyle modifications but does not represent an immediate threat.
Correct Answer is A
Explanation
Choice A reason: The M’Naghten Rule requires proof that, due to mental illness, the person did not understand the nature of the act or could not distinguish right from wrong at the time of the offense. This is the key standard used in many jurisdictions for insanity defenses.
Choice B reason: Having a history of mental illness alone is not sufficient; the rule focuses on the client’s mental state during the offense, not prior diagnoses.
Choice C reason: Being driven by uncontrollable impulses is not part of the M’Naghten criteria. This falls more under the “irresistible impulse” test, which is separate.
Choice D reason: Intoxication, even if it impairs judgment, does not qualify under the M’Naghten Rule. Voluntary substance use generally excludes insanity defenses.
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