A nurse is caring for a client who states, "Things will never work out." Which of the following responses should the nurse make?

Choice A reason:
When leading a crisis intervention group, especially for adolescents who have witnessed the traumatic event of a classmate's suicide, it is crucial to first identify the individuals' prior coping skills. This initial step is essential because it helps the nurse to understand the baseline coping mechanisms each adolescent has previously employed. Adolescents may have varying levels of resilience and different strategies for dealing with stress and trauma. By identifying these skills early on, the nurse can tailor the intervention to reinforce these existing skills while introducing new coping strategies. This personalized approach ensures that each adolescent's unique needs are addressed, which is particularly important in the aftermath of a suicide, where feelings of guilt, confusion, and grief can be overwhelming. Moreover, understanding their prior coping skills can help the nurse to predict potential challenges and provide targeted support to those who may be more vulnerable or at risk of negative outcomes.

Choice B reason:
Reviewing community resources is an important action but not the first one that should be taken. Community resources can provide additional support and services to the adolescents after the initial crisis intervention. These resources might include mental health services, support groups, or educational programs. However, before directing adolescents to these resources, it is essential to assess their current psychological state and coping abilities. This ensures that the resources recommended are appropriate and beneficial for each individual's specific situation.

Choice C reason:
Discussing the importance of confidentiality is a critical component of any therapeutic intervention, particularly in a group setting. It creates a safe space where adolescents feel secure to share their thoughts and feelings without fear of judgment or breach of privacy. However, this is not the first action to take. Establishing confidentiality is part of setting the ground rules for the group intervention, which typically occurs after initial assessments and once a rapport has been established.

Choice D reason:
Initiating referrals may be necessary for adolescents who require more specialized care or individual therapy. Referrals are an important part of the continuum of care and ensure that adolescents have access to the appropriate level of support. However, this action is typically taken after the initial crisis intervention session, where the nurse has had the opportunity to assess each adolescent's needs and determine who might benefit from additional services.

Choice A reason:
Urinary retention is not commonly associated with citalopram. Citalopram, an SSRI (Selective Serotonin Reuptake Inhibitor), primarily affects serotonin levels in the brain and does not typically impact the urinary system to the extent of causing retention.

Choice B reason:
Decreased libido is a known adverse effect of citalopram. SSRIs, including citalopram, can affect sexual function, leading to decreased libido, difficulty achieving orgasm, or erectile dysfunction. This is due to the increased serotonin levels which can negatively impact the sexual response cycle.

Choice C reason:
While bruising is not a hallmark side effect of citalopram, it can occur, especially if there is an interaction with other medications that affect blood clotting. Citalopram can potentially increase the risk of bleeding, and easy bruising may be a sign of this. However, it is less common than other side effects like sexual dysfunction.

Choice D reason:
Jaundice is not a typical adverse effect of citalopram. Jaundice usually indicates a problem with the liver, and while liver function abnormalities have been reported with citalopram use, they are rare. Monitoring for jaundice is not part of the routine assessment for patients on citalopram unless there is a pre-existing liver condition or concurrent use of other hepatotoxic drugs.