A nurse is providing teaching to a client who is to start taking valproic acid. Which of the following instructions should the nurse include?

Choice A reason: The belief that clients who talk about suicide are less likely to attempt it is a myth. Verbalizing suicidal ideation often reflects severe distress and heightened risk, as it may indicate prefrontal cortex dysfunction and impaired impulse control. This misconception underestimates the neurobiological basis of suicidal behavior, requiring vigilant assessment.

Choice B reason: Assuming clients who fail a suicide attempt will not try again is incorrect. Previous attempts increase future risk, as suicidal behavior is linked to persistent psychological distress and serotonin dysregulation. This assumption ignores the chronicity of underlying conditions like depression, necessitating ongoing monitoring and intervention to prevent recurrence.

Choice C reason: Claiming failed suicide attempts indicate a lack of intent to die is false. Many attempts fail due to external factors, not lack of intent. Suicidal behavior reflects complex neurobiological factors, including serotonin imbalance and prefrontal cortex deficits, requiring serious intervention regardless of outcome, as intent persists in high-risk individuals.

Choice D reason: A specific suicide plan indicates high risk, as it reflects advanced ideation and intent, often linked to prefrontal cortex dysfunction and reduced impulse control. Detailed planning suggests the client has visualized the act, increasing likelihood of completion. This principle guides nursing care to prioritize safety and immediate psychiatric intervention.

Choice A reason: Responding positively to flattery risks reinforcing manipulative behavior and does not address potential underlying distress. The client’s statement may reflect emotional dysregulation or suicidal ideation, common in psychiatric conditions with serotonin imbalances. This response fails to probe for serious neurobiological risks, missing a critical assessment opportunity.

Choice B reason: Assuming the client wants something is confrontational and dismissive, ignoring potential suicidal ideation or emotional distress. The statement may reflect serotonin-driven mood instability or a cry for help, requiring sensitive exploration. This response risks alienating the client, missing neurobiological cues for underlying psychiatric concerns.

Choice C reason: Asking about suicidal thoughts is appropriate, as the client’s statement may signal ideation, linked to serotonin dysregulation and prefrontal cortex deficits. Such expressions can indicate despair or intent in psychiatric conditions, necessitating direct assessment to ensure safety and address potential neurobiological imbalances driving suicidal behavior.

Choice D reason: Dismissing the statement as insincere ignores potential distress signals, such as suicidal ideation or emotional dysregulation from serotonin imbalances. This response fails to engage the client’s underlying neurobiological state, risking missed opportunities to assess serious psychiatric concerns and provide appropriate intervention or support.