A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?

A) Tell the client to leave the group if they cannot contribute.
This response is inappropriate as it does not support the client’s participation or create an open, supportive environment. Forcing the client to leave would alienate them and potentially discourage future participation. Group therapy should foster inclusiveness and understanding, not create pressure or exclusion.

B) Allow the client extra time to think of a response.
This is the most appropriate action. Some clients may need additional time to process their thoughts before speaking, especially in a group setting where they may feel anxious or hesitant. Giving the client space and time to formulate a response can encourage participation without forcing them. It allows them to engage at their own pace, promoting comfort and confidence in the group.

C) Appoint the client to lead the discussion.
While giving the client an active role might help them engage, appointing them to lead the discussion could cause undue stress or anxiety, particularly if they are already struggling to contribute. This could overwhelm the client and make them feel more isolated. Instead, a gradual approach to participation is more effective.

D) Ask other group members to limit the number of times they speak.
While this may seem like an effort to allow more time for the silent client, it may not be the best solution. Group therapy is meant to be interactive, and limiting others’ participation may make the group feel less collaborative. It is better to encourage the silent client to speak at their own pace rather than restricting the group’s natural flow of discussion.

A) "I get nervous when I'm in a large group": Social anxiety or nervousness in large groups is common, especially during adolescence. While it can indicate discomfort in social situations, it is not necessarily a warning sign of suicidal ideation.

B) "My partner and I had our first argument last night": Relationship conflicts are a normal part of adolescent development, and although they can cause emotional distress, a single argument does not typically indicate a risk for suicide. It’s important to assess the client’s overall emotional state and coping mechanisms, but this statement alone does not suggest suicidal thoughts.

C) "I am not interested in anything anymore.": This statement is a red flag for depression and potential suicidal ideation. A loss of interest or pleasure in activities that were once enjoyable (anhedonia) is a core symptom of depression, which can be a significant risk factor for suicide. This warrants further exploration and immediate attention from the nurse.

D) "I'm not sleeping much because of all the homework I have.": While lack of sleep can be a concern and may affect an adolescent’s overall health and well-being, it is more likely related to stress or academic pressure rather than suicidal thoughts. Sleep disturbances in adolescents are common, particularly when facing high academic expectations, but this is not an immediate sign of suicide risk.