The nurse is caring for a client who has a history of alcohol use disorder and is experiencing withdrawal symptoms. Which of the following should be the priority action by the nurse?

Choice A reason:
Complicated grieving is a natural response to the loss of a loved one, characterized by intense sorrow and longing. However, the client's statement indicates a sense of hopelessness and a lack of desire to continue living, which goes beyond the typical symptoms of complicated grieving. While it is important to assess for complicated grieving, the client's expression of not wanting to go on suggests a more immediate risk.

Choice B reason:
Chronic pain can lead to depression and decreased quality of life, but the client does not mention any physical pain. The absence of such complaints makes chronic pain a less likely cause for the client's current state. It is still important to assess for any physical discomfort that the client may not be communicating.

Choice C reason:
The client's statement of questioning the purpose of continuing life is a clear indicator of suicidal ideation, which warrants immediate further assessment. The risk for suicide is often heightened following significant life events such as the loss of a spouse. The nurse must prioritize this assessment to ensure the client's safety.

Choice D reason:
Social isolation can contribute to feelings of loneliness and depression, particularly in the elderly who have lost a significant other. While social isolation is a concern and can exacerbate other mental health issues, the client's explicit questioning of life's worth points more directly to a risk for suicide.

Choice A reason:

Missing a dose of medication that increases serotonin levels does not typically increase the risk of serotonin syndrome. In fact, missing a dose may lead to lower levels of serotonin in the body, which is contrary to the condition of serotonin syndrome that arises from an excess of serotonin.

Choice B reason:

Taking MAOI medication alone does not inherently increase the risk of serotonin syndrome. However, combining MAOIs with other medications that affect serotonin levels can significantly increase the risk. It is crucial to avoid taking MAOIs and other serotonergic drugs concurrently without medical supervision.

Choice C reason:

Taking SNRIs as directed by a healthcare provider generally does not increase the risk of serotonin syndrome. These medications are designed to be taken regularly to manage conditions like anxiety and depression. However, any changes in dosage or frequency should be done under medical guidance to avoid any adverse effects.

Choice D reason:

Combining medications that increase serotonin levels is the primary risk factor for developing serotonin syndrome. This can occur when a patient takes multiple serotonergic drugs, such as combining an SNRI with an SSRI, certain pain medications, or even some over-the-counter drugs and supplements that increase serotonin levels. This combination can lead to an excessive accumulation of serotonin in the body, triggering the symptoms of serotonin syndrome.