NCLEX · Mental Health Disorders

A client with major depressive disorder reports: 'I've been feeling much better lately. I've given away my jewelry and written a goodbye letter to my children.' What is the nurse's priority concern?

Correct answer

This presentation is a HIGH-RISK WARNING for imminent suicide — giving away possessions and writing goodbye letters are behavioral indicators of suicidal intent; the client's reported 'improvement' may reflect resolution of ambivalence after deciding to act; this requires immediate safety assessment and intervention

  1. A The client is recovering and has improved insight
  2. B This presentation is a HIGH-RISK WARNING for imminent suicide — giving away possessions and writing goodbye letters are behavioral indicators of suicidal intent; the client's reported 'improvement' may reflect resolution of ambivalence after deciding to act; this requires immediate safety assessment and intervention
  3. C The client needs follow-up in 2 weeks
  4. D The client is experiencing a manic episode

Why this is the answer

PARADOXICAL IMPROVEMENT IN DEPRESSION is a well-documented and dangerous phenomenon: EXPLANATION: Severely depressed clients often lack the energy to act on suicidal thoughts; when they 'improve' slightly, they have enough energy to act but their hopelessness has not resolved; their apparent improvement may actually reflect a decision to act — the 'calm before the storm'; BEHAVIORAL WARNING SIGNS OF IMMINENT SUICIDAL INTENT: Giving away valued possessions (rings, jewelry, meaningful items); saying goodbye in unusual ways; writing final notes/letters; sudden calm after prolonged distress; putting affairs in order; IMMEDIATE NURSING ACTIONS: DO NOT leave the client alone; NOTIFY physician/psychiatrist immediately; implement safety precautions (1:1 observation, remove ligatures and sharps, check belongings); REASSESS suicide risk using validated tool; HOSPITALIZATION is likely indicated. NEVER interpret these signs as reassuring improvement without thorough investigation.
Source: NCLEX-RN Test Plan: Psychosocial — Mental Health, Suicidal Behavioral Warning Signs

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