A nurse is teaching a client who is prescribed a monoamine oxidase inhibitor (MAO) about how to follow a tyramine-restricted diet. Which of the following meals should the nurse approve?

A. Smoked salmon bagel with cream cheese, pickled beets, and cola: Smoked salmon and pickled foods are high in tyramine and can trigger hypertensive crises in clients taking MAO inhibitors. Cola contains caffeine, which can also exacerbate blood pressure increases. B. Pepperoni pizza, mixed greens with blue cheese dressing, and iced tea: Pepperoni and blue cheese are aged or fermented foods that contain high levels of tyramine. Consuming these with an MAOI can result in dangerous elevations in blood pressure. C. Grilled chicken breast, steamed green beans, mashed potatoes, and apple slices: This meal is low in tyramine, consisting of fresh, unaged, and non-fermented foods. It is safe for clients taking MAO inhibitors and supports adherence to dietary restrictions. D. Tuna salad sandwich with aged cheddar cheese and a chocolate protein shake: Aged cheddar cheese contains high tyramine, and tuna may also pose a risk if not fresh. These foods are inappropriate for a tyramine-restricted diet and could precipitate hypertensive episodes.