A nurse is reinforcing teaching with an older adult client who has major depressive disorder and a prescription for nortriptyline 25 mg daily. Which of the following client statements indicates understanding of the teaching?

A. "I will avoid drinking caffeinated beverages." While it is generally a good idea to reduce caffeine intake, especially since it can interfere with sleep, it is not a specific or necessary instruction for a client taking nortriptyline. There is no strong contraindication between nortriptyline and caffeine consumption. B. "I should take my nortriptyline before breakfast." Nortriptyline, a tricyclic antidepressant, is typically taken at bedtime due to its sedating effects. Taking it in the morning could cause excessive drowsiness or sedation during the day. Therefore, this statement is incorrect. C. "I should sit on the side of the bed before standing up in the morning." This statement indicates proper understanding. Nortriptyline can cause orthostatic hypotension (a drop in blood pressure when standing up), which can lead to dizziness or falls, especially in older adults. Sitting on the side of the bed before standing up helps to mitigate this risk. D. "I can no longer eat pepperoni pizza." There is no specific contraindication between nortriptyline and eating pepperoni pizza. The main dietary concern with tricyclic antidepressants like nortriptyline is avoiding excessive alcohol use or managing anticholinergic effects (e.g., dry mouth, constipation). However, avoiding pizza is not necessary unless there are other dietary restrictions unrelated to the medication.