# Review the follow-up timeline after sertraline initiation and determine when routine monitoring must change to urgent suicide-safety intervention. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393513&lang=en > language: en > subject: Crisis Intervention > category: PSI ## Question Review the follow-up timeline after sertraline initiation and determine when routine monitoring must change to urgent suicide-safety intervention. | Time | Data | | --- | --- | | Week 1 | PHQ-9 score 18. Mild nausea and fatigue. The client denies suicidal thoughts, plan, or intent and agrees to the next scheduled contact. | | Week 2 | PHQ-9 score 16. Nausea is decreasing and sleep is slightly improved. The client denies suicidal thoughts. | | Week 3 | PHQ-9 score 14. The client says, My family would be better off without me. A loaded firearm is accessible at home. | | Week 4 | After urgent crisis evaluation, the client denies current intent. A written safety plan is present, the firearm is stored outside the home, a support person is involved, and follow-up is scheduled for tomorrow. | Q1. Which response is appropriate at the week 1 contact? Stop all monitoring because suicidal thoughts are denied Assess symptoms, adverse effects, and suicidality directly and continue planned follow-up Assume the medication is ineffective and double the dose without an order Q2. What is the nurse's priority at week 3? Schedule the next routine visit and advise the client to call if thoughts worsen Ask the client to sign a no-suicide contract and then leave alone Stay with the client, assess plan and intent, activate urgent evaluation, and restrict firearm access Q3. Which week 4 information best supports a safer follow-up plan? A collaborative written safety plan, restricted firearm access, involved support, and rapid follow-up A verbal promise never to think about suicide again A lower PHQ-9 score without any assessment of means or support ## Explanation All clients taking an antidepressant should be monitored for clinical worsening and emergent suicidality, especially early in treatment and around dose changes; the safety assessment is not limited to clients younger than 25. At week 3, the statement about being better off dead plus firearm access requires immediate direct assessment and urgent escalation. The nurse should not leave the client alone, should activate the emergency behavioral-health pathway, and should collaborate on lethal-means restriction and a written safety plan. A promise or no-suicide contract is not sufficient. After crisis evaluation, denial of current intent does not end follow-up; the nurse verifies the safety plan, restricted firearm access, rapid follow-up, and support engagement. ## In-depth explanation Trend to recognize Early nausea and gradual symptom improvement may be monitored, but the week 3 statement and firearm access change the encounter to an urgent safety problem. Immediate response Ask directly about thoughts, plan, intent, and means; stay with the client; activate urgent evaluation; and reduce access to lethal means. Do not rely on a later appointment or a verbal promise. Safety planning rule A collaborative safety plan names warning signs, coping steps, people and services to contact, and how lethal means will be restricted. Age correction The boxed warning highlights increased risk in younger people, but monitoring for worsening and emergent suicidality applies to every antidepressant-treated client. Why the alternatives fail Waiting for the next routine visit ignores a time-sensitive risk. A no-suicide contract does not establish safety. Improvement in a symptom score does not override a direct suicidal statement or access to a firearm. Source 1FDA Sertraline Label 2VA/DoD Clinical Practice Guideline for Suicide Risk 32026 NCLEX-RN Test Plan ## Clinical scenario Outpatient follow-up A 28-year-old client with major depressive disorder started sertraline 4 weeks ago. At every contact, the nurse evaluates symptoms, adverse effects, suicidal thoughts, access to lethal means, supports, and the follow-up plan. ## Related questions - [A nurse is admitting a 32-year-old client to an inpatient mental health unit with a diagno…](https://mymerci.kr/pages/nclex_q.php?qn_id=360525&lang=en) - [A 28-year-old client with schizophrenia is admitted to the inpatient psychiatric unit. 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