The nurse is monitoring the client for early signs of lithium (Eskalith) toxicity. Which symptoms, if present, may indicate that toxicity is developing? Select all that apply

• GI upset, confusion, and polyuria are early warning signs of lithium toxicity.
• Severe symptoms such as ataxia and seizures occur in advanced toxicity.
• Continuous monitoring of serum lithium levels and client symptoms is essential to maintain safety.

Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) used for treatment-resistant depression. The most important safety concern with MAOIs is the risk of a hypertensive crisis when foods or medications containing tyramine or sympathomimetic agents are ingested. Teaching should emphasize dietary and drug restrictions.

C. Read labels of food and over-the-counter drugs to avoid those with substances that should be avoided as directed. – This is the priority teaching point. Tyramine-containing foods (aged cheese, cured meats, wine) and many OTC medications (cold remedies, stimulants) can trigger hypertensive crisis when combined with phenelzine.

A. Headaches may occur. OTC medications will usually be effective. – OTC drugs such as decongestants can dangerously interact with MAOIs and precipitate a hypertensive crisis; this statement is unsafe.

B. Hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported. – Blood sugar changes are not a major risk with phenelzine, so this teaching is not a priority.

D. Monitor blood pressure for hypotension and report any BP below 90/60. – Orthostatic hypotension may occur, but it is not as life-threatening as a hypertensive crisis, making this less critical than dietary and drug restrictions.

Take-Home Points:

• The most important teaching for clients on MAOIs is to avoid tyramine-rich foods and contraindicated OTC drugs.
• Failure to follow these precautions can lead to hypertensive crisis, a life-threatening emergency.
• Nurses should provide clients with a clear list of restricted foods and medications before discharge.