A nurse on a mental health unit is planning care for a client who is being admitted immediately following a sexual assault. Which of the following interventions should the nurse include in the plan of care?

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.

Choice A reason: Hypothermia increases metabolic demand in newborns, depleting glucose stores rapidly. Neonates have limited glycogen reserves, and cold stress accelerates glucose use for thermogenesis, risking hypoglycemia. This is critical in nurseries, as thermoregulation is essential to prevent metabolic imbalances in vulnerable infants.
Choice B reason: Thrombocytopenia, low platelet count, affects clotting, not glucose metabolism. It may occur in sepsis but does not directly cause hypoglycemia. Glucose regulation depends on liver function and insulin balance, not platelets, making this irrelevant to hypoglycemia risk in newborns.
Choice C reason: Prematurity heightens hypoglycemia risk due to immature liver glycogen stores and limited gluconeogenesis. Preterm infants have high metabolic demands and low reserves, increasing susceptibility to low blood glucose, necessitating close monitoring and early feeding to stabilize glucose levels.
Choice D reason: Anemia, low red blood cell count, impacts oxygen delivery but not glucose metabolism directly. Severe anemia may increase metabolic stress, but it is not a primary hypoglycemia cause. Glucose regulation relies on hepatic and insulin functions, not hematologic status, in newborns.
Choice E reason: Maternal diabetes causes fetal hyperinsulinemia from maternal hyperglycemia, leading to neonatal hypoglycemia post-birth. Excess insulin depletes glucose stores after umbilical cord clamping, as maternal glucose supply ceases, making this a critical risk factor requiring vigilant monitoring in newborns.