A nurse is providing teaching to a client who has a depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse instruct the client to avoid?

Rationale: A. Smoked salmon: Smoked and cured meats are rich in tyramine, which can trigger a hypertensive crisis when combined with monoamine oxidase inhibitors (MAOIs) such as phenelzine. Clients must avoid aged, fermented, or smoked foods to prevent dangerous elevations in blood pressure related to MAOI therapy. B. Grapefruit: Grapefruit primarily interacts with medications metabolized by the cytochrome P450 enzyme system, but it does not have a clinically significant interaction with MAOIs like phenelzine. Therefore, grapefruit is not restricted for clients taking this medication. C. Spinach: Fresh vegetables, including spinach, contain negligible amounts of tyramine and are safe to consume with phenelzine. A diet rich in fresh fruits and vegetables is encouraged to support overall health and medication adherence. D. Cottage cheese: Unlike aged cheeses, cottage cheese contains minimal tyramine and is considered safe for clients on MAOIs. It provides a good source of protein and calcium without the risk of precipitating hypertensive complications.