A nurse is reviewing the medical histories of four clients.
Which of the following clients may develop extrapyramidal symptoms from medication therapy?

Rationale:

Choice A: While social isolation can be a risk factor for suicide, spending time with close friends can actually be protective. This statement alone does not suggest an increased risk.

Choice B: Religious involvement and participation in religious activities can be protective factors against suicide by providing support, meaning, and a sense of belonging. This statement does not indicate a specific risk.

Choice C: Consistent, healthy sleep patterns are generally associated with positive mental health and are not indicative of suicidal ideation. This statement does not raise concerns for suicide risk.

Choice D: Exposure to suicide, particularly within one's social circle or among individuals one admires, is a significant risk factor for suicide due to the phenomenon of "social contagion." The recent suicide of the adolescent's favorite actor increases his vulnerability and necessitates immediate assessment and intervention.

Social contagion refers to the tendency for suicidal behaviors to spread within a community or group, particularly among adolescents and young adults. Exposure to a suicide can trigger suicidal thoughts and feelings in vulnerable individuals, especially if they identify with the deceased or perceive the suicide as a viable coping mechanism.

The adolescent's age (15 years) is also a crucial factor. Adolescence is a period of heightened emotional vulnerability and increased risk for suicidal ideation and behavior due to various developmental and psychosocial challenges.

The father's concern suggests that the adolescent may be exhibiting other concerning behaviors or changes in mood or behavior. The nurse should gather more information and conduct a comprehensive suicide risk assessment to determine the level of risk and implement appropriate interventions.

Additional considerations:

The nurse should inquire about the nature of the adolescent's relationship with the deceased actor, his emotional state since the suicide, and any other potential stressors or vulnerabilities he may be facing.

The nurse should involve the parents in the assessment and intervention process, providing them with education and resources on suicide prevention and support.

If the assessment indicates a high risk of suicide, the nurse should immediately refer the adolescent to a mental health professional or emergency department for further evaluation and treatment.

Remember: Suicide is a serious public health issue, and early identification and intervention are crucial in preventing tragic outcomes. School nurses play a vital role in recognizing warning signs and providing timely support and resources to adolescents at risk.

Choice A rationale:

Coercion to take necessary prescribed medications is not an appropriate indication for the use of mechanical restraints. It violates the client's right to autonomy and informed consent.

Forcing a client to take medication against their will can lead to psychological trauma, distrust of healthcare providers, and even legal action.

Alternative interventions, such as patient education, negotiation, and behavioral strategies, should be explored first to encourage medication compliance.

If a client is refusing medication due to a lack of understanding, providing clear and concise information about the medication's purpose, benefits, and potential side effects can help facilitate informed decision-making.

Negotiation strategies can involve exploring the client's concerns and preferences, and working collaboratively to find a solution that addresses those concerns.

Behavioral strategies may include positive reinforcement for medication adherence, or the use of techniques such as distraction or relaxation to reduce anxiety associated with medication administration.

Choice B rationale:

Punishment for verbally abusing other clients is also not an appropriate indication for mechanical restraints.

Restraints should never be used as a form of punishment, as this can be considered abuse and can worsen the client's behavior.

Verbal abuse is often a symptom of underlying mental health issues, and it's important to address the root cause of the behavior rather than simply trying to suppress it through restraints.

Alternative interventions for verbal abuse might include de-escalation techniques, conflict resolution strategies, and individual or group therapy to address underlying emotional or behavioral issues.

Choice C rationale:

Discipline for throwing objects at staff in the nursing station is not an appropriate indication for mechanical restraints. Restraints should only be used as a last resort to protect the client or others from imminent harm.

Throwing objects may be a sign of agitation, frustration, or anger, and it's important to address the underlying cause of these behaviors.

Alternative interventions could include de-escalation techniques, providing a safe space for the client to calm down, medication to manage agitation, or behavioral therapy to teach coping skills.

Choice D rationale:

Self-destructive behavior after all previous alternative interventions have been unsuccessful is the only appropriate indication for mechanical restraints among the choices provided.

When a client is at risk of seriously harming themselves, and other interventions have failed to protect them, restraints may be necessary to prevent injury or death.

However, it's crucial to use restraints only as a temporary measure and to continuously monitor the client's condition and behavior.

As soon as the client is no longer at risk of self-harm, the restraints should be removed.