Today’s NCLEX-RN® question of the day focuses on a nurse who is speaking with a client diagnosed with major depressive disorder who has taken phenelzine. Can you figure it out?
The nurse is speaking with a client diagnosed with major depressive disorder who has taken phenelzine for 10 years. The nurse should be most concerned by which client statement? A. “I am so excited for my Italian vacation next month!”
B. “I recently rescued a kitten from an animal shelter.”
C. “My son is moving away and I may not see him as often.”
D. “My partner and I have been discussing moving into a senior living facility.”Scroll down for the correct answer!
The correct answer to today’s NCLEX-RN® Question is…
A. “I am so excited for my Italian vacation next month!”
Rationale: A primary concern for clients taking monoamine oxidase inhibitors (MAOIs) like phenelzine is consumption of tyramine-rich foods and beverages. MAOIs break down the enzyme monoamine oxidase. This enzyme is responsible for breaking down tyramine. Therefore, clients who take MAOIs are at risk of increased tyramine levels in the blood. This can cause a rise in blood pressure and lead to a hypertensive emergency. Many Italian meals include wine and cheese, which contain high amounts of tyramine. The nurse should provide education to the client to reinforce the importance of maintaining a low-tyramine diet while traveling in Italy.
Major Takeaway
A dangerous side effect of monoamine oxidase inhibitors (MAOIs) like phenelzine is hypertensive crisis, which is most commonly seen when combined with tyramine-rich food and drinks, such as cheese, red wine, and beer. This can also occur with foods containing phenylalanine, such as chocolate and caffeine. Clients that develop hypertensive crisis typically present with hypertension, tachycardia, arrhythmias, hyperthermia, and agitation. The Italian diet often includes cheese, wine, and meat and since this client is traveling to Italy next month, the nurse should provide education to reinforce the importance of maintaining a low-tyramine diet.
Incorrect answer explanations
B. “I recently rescued a kitten from an animal shelter.”
Rationale: It is unclear whether there is a link between pet ownership and improvement in depressive symptoms. However, this is not a cause for concern for a client prescribed phenelzine.
C. “My son is moving away and I may not see him as often.”
Rationale: Clients with a history of major depressive disorder may be at risk for a return of or exacerbation of depressive symptoms when a lifestyle change takes place, such as a child moving away. Although the nurse should follow up on the client’s feelings about their child moving away, this is not the most concerning statement.
D. “My partner and I have been discussing moving into a senior living facility.”
Rationale: Clients with a history of major depressive disorder may be at risk for a return or exacerbation of depressive symptoms when a lifestyle change takes place, such as moving. Although the nurse should follow up on the client’s feelings about possibly moving into a senior living facility, this is not the most concerning statement.
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