A mental health nurse is providing teaching for a client who has major depressive disorder (MDD) and is seeking voluntary admission to an acute mental health facility.
Which of the following statements should the nurse include?

Choice A rationale: Identifying triggers for anxiety reactions is a crucial part of managing chronic anxiety. By recognizing what situations, thoughts, or feelings provoke anxiety, the client can begin to develop coping strategies to handle these triggers effectively. This approach is often used in cognitive-behavioral therapy, which is a common treatment for anxiety disorders.

Choice B rationale: While contacting a crisis counselor can be helpful in acute situations, it may not be necessary for a client with chronic anxiety to do so on a weekly basis. Regular therapy sessions with a mental health professional would likely be more beneficial, as they can provide ongoing support and help the client develop long-term coping strategies.

Choice C rationale: It’s unrealistic and unfeasible to completely eliminate stress and anxiety from daily life. Stress is a normal part of life, and everyone experiences it to some degree. Instead, the focus should be on managing stress and anxiety effectively through techniques such as relaxation exercises, mindfulness, and cognitive-behavioral strategies.

Choice D rationale: Trying to repress feelings of anxiety can actually exacerbate them. It’s important for individuals with anxiety disorders to acknowledge their feelings and learn how to manage them, rather than trying to suppress them. Repression can lead to increased anxiety and other mental health issues over time.

The correct answer(s) is/are:

C. Telling his parents that he doesn't want to talk about the suicide attempt.

Rationale:

Choice A: Planning to give his Xbox console to his best friend.

While giving away possessions can be a sign of hopelessness or detachment, in this case, it could also be interpreted as a gesture of closure or wanting to leave something meaningful behind for a loved one. It doesn't necessarily indicate ongoing suicidal intent.

Choice B: Stating that he wants to be with his peers more than with his parents.

This desire for social connection and autonomy is actually a positive sign in a post-suicidal attempt adolescent. It demonstrates a shift towards seeking support from outside the family unit and engaging with life beyond the immediate aftermath of the attempt.

Choice C: Telling his parents that he doesn't want to talk about the suicide attempt. This reluctance to discuss the attempt can be a red flag for several reasons:

Avoidance: Suppressing or avoiding thoughts and feelings related to the attempt can indicate a struggle to cope with the emotional trauma and potentially harboring lingering suicidal ideation.

Isolation: Withdrawing from open communication about the event can isolate the adolescent further, hindering the support system and potentially increasing the risk of reattempt.

Underlying distress: The inability to talk about the event may suggest unresolved emotional distress, unresolved conflicts, or ongoing stressors that could contribute to suicidal thoughts.

Therefore, while not wanting to talk doesn't definitively signify current suicidal intent, it warrants further exploration by the nurse to understand the underlying reasons behind the avoidance and ensure appropriate support and safety measures are in place.

Choice D: Preferring to eat his meals while watching TV.

This behavior is relatively neutral and doesn't directly suggest ongoing suicidal intent. While it might indicate depression or low motivation, it's not a specific indicator of suicide risk.

Conclusion:

Based on the rationale above, "telling his parents that he doesn't want to talk about the suicide attempt" (Choice C) is the most concerning behavior that suggests the adolescent might still have suicidal intent. It's crucial for the nurse to address this reluctance with empathy and understanding, exploring the underlying reasons and ensuring continued monitoring and support for the adolescent.