Question

a nurse working in an inpatient mental health unit is caring for a client.
exhibit 1 exhibit 2 exhibit 3
nurses notes
day 1:
client reports frequent changes in appetite; some days it is greatly increased, and some days greatly decreased. they expressed concern about nutrition while hospitalized, because they eat primarily a vegetarian diet that includes a lot of cheese for protein.
complete the diagram by dragging from the choices below to specify the medication the nurse should anticipate the provider to prescribe, 2 teaching points the nurse should make about the medication, and 2 adverse effects the nurse should monitor.
planned client teaching about medication 1
planned client teaching about medication 2
anticipated medication
adverse effects to monitor 1
adverse effects to monitor 2
planned client teaching about medication
report spasms of the tongue, face, and extremities
decrease consumption of cheese
rise slowly when standing
change path + meal administration to accommodate
discuss alternate caloric intake
anticipated medication
bupropion
phenelzine
chlorpromazine
fluoxetine
adverse effects to monitor
muscle rigidity
orthostatic hypotension
gastrointestinal bleeding
seizure activity
hypertension crisis

Explanation:

1. Anticipated Medication: The client has appetite changes and a vegetarian diet with cheese (high in tyramine). Phenelzine is a monoamine oxidase inhibitor (MAOI), and MAOIs interact with tyramine (found in cheese), so the nurse would anticipate Phenelzine.
2. Planned Client Teaching about Medication:

• “Decrease consumption of cheese”: Since Phenelzine is an MAOI, tyramine - rich foods like cheese can cause hypertensive crises, so reducing cheese intake is a key teaching point.
• “Change diet to limit interaction to catecholamines”: This also relates to managing the diet to avoid interactions with MAOIs.

1. Adverse Effects to Monitor:

• “Hypertensive crisis”: A major adverse effect of MAOIs when interacting with tyramine (from cheese).
• “Serious activity” (likely a typo, maybe “Serotonin syndrome” or related, but given the context of MAOIs, hypertensive crisis is a primary one, and also, MAOIs can have other effects, but the diet - related adverse effect here is hypertensive crisis. Also, “Gastrointestinal bleeding” is not typical for MAOIs, “Muscle rigidity” is more for antipsychotics, “Orthostatic hypotension” can be a side effect but the diet interaction points to hypertensive crisis.

Answer:

• Anticipated Medication: Phenelzine
• Planned Client Teaching about Medication 1: Decrease consumption of cheese
• Planned Client Teaching about Medication 2: Change diet to limit interaction to catecholamines
• Adverse Effects to Monitor 1: Hypertensive crisis
• Adverse Effects to Monitor 2: (If considering other MAOI effects, but based on diet interaction, Hypertensive crisis is key; if a typo “Serious activity” is ignored, and another effect like maybe serotonin syndrome, but with the given options and context, Hypertensive crisis and maybe another, but the main ones related to MAOIs and the diet here are Hypertensive crisis and perhaps orthostatic hypotension, but the teaching about cheese points to hypertensive crisis. So:

Anticipated Medication: Phenelzine
Planned Client Teaching about Medication 1: Decrease consumption of cheese
Planned Client Teaching about Medication 2: Change diet to limit interaction to catecholamines
Adverse Effects to Monitor 1: Hypertensive crisis
Adverse Effects to Monitor 2: Orthostatic hypotension (as a common MAOI side effect)