A nurse working on a surgical unit is developing a care plan for a client who has paraplegia. The client has an area of nonblanchable erythema over his ischium. Which of the following interventions should the nurse include in the care plan?

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: Beneficence, acting for patient benefit, is not breached, as both clients receive care and supplies, albeit differently. Unequal distribution reflects access issues, not failure to promote well-being, making beneficence less relevant than justice in addressing this ethical concern.
Choice B reason: Nonmaleficence, avoiding harm, is not violated, as both clients access supplies without direct harm. The inequality in delivery method raises fairness concerns, not harm, making justice the primary ethical principle breached in this scenario of differential treatment.
Choice C reason: Justice, ensuring fair treatment, is breached when one client receives supplies directly and another must seek them externally due to insurance status. This inequality in resource access violates equitable care principles, critical in healthcare ethics to ensure fairness across patient populations.
Choice D reason: Autonomy, respecting patient choices, is not breached, as both clients receive care consistent with their needs. The issue lies in unequal resource access, not decision-making restrictions, making justice the relevant ethical principle over autonomy in this scenario.