# A nurse is working with an adolescent client experiencing an acute psychological crisis after a school bullying incident, showing withdrawal and tearfulness. Which intervention should the nurse implement first to effectively manage this crisis situation?

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> subject: Mental Health

## 문제

A nurse is working with an adolescent client experiencing an acute psychological crisis after a school bullying incident, showing withdrawal and tearfulness. Which intervention should the nurse implement first to effectively manage this crisis situation?

## 보기

1. Encourage the client to express feelings through journaling or art therapy
2. Arrange for immediate psychiatric consultation and medication evaluation
3. Establish safety and assess for immediate risk of harm to self or others **✔ 정답**
4. Provide detailed education about coping strategies and stress management techniques

**정답: 3**

## 해설

In acute psychological crisis, safety assessment for harm risk is the priority as impaired judgment increases danger. Other interventions like expression or education are secondary until safety is established.

## 심화 해설

Crisis Intervention Priority: Safety First

In any acute psychological crisis, the nurse's initial and most critical action is to establish safety and conduct a thorough risk assessment. This principle is the cornerstone of crisis intervention and aligns directly with the NCLEX-RN priority-setting framework, which mandates addressing physiological and safety needs before psychosocial or educational interventions. Before a client can engage in therapeutic communication or learn coping skills, their immediate physical and psychological safety must be secured.

The presented scenario describes an adolescent exhibiting withdrawal and tearfulness following a traumatic bullying incident. While these signs may appear passive, they are also hallmark indicators of profound distress that can escalate to self-harm or suicidal ideation. The foundational literature on suicide prevention emphasizes that a safety planning intervention is the first-line, evidence-based response to acute suicidal or self-harm risk. A safety plan is a co-created, actionable set of coping strategies designed for use at the very onset of distress, making it a direct and immediate tool for managing a crisis [3]. The process of creating this plan inherently begins with a direct assessment of the client's current thoughts, plans, and means regarding harm to self or others.

This approach is universally applicable across clinical settings. For instance, research on emergency department protocols for patients who have attempted suicide highlights that the first point of contact must focus on identifying and managing the risk of subsequent suicidal behaviors through structured, evidence-informed protocols [2]. A systematic review further confirms that training healthcare professionals, including nurses, in safety plan implementation is effective in reducing suicide risk, underscoring that this assessment and planning skill is a core nursing competency in crisis care [4]. Even in complex cases, such as an adolescent with a comorbid neuromuscular disorder, the initial management of a suicidal crisis requires prioritizing safety assessment over other medical or therapeutic interventions, as physical vulnerability may limit standard emergency options and necessitate a carefully tailored safety plan [1].

Therefore, interventions like encouraging journaling, arranging a psychiatric consultation, or providing education on coping strategies are all secondary. They are valuable components of a comprehensive care plan but are only appropriate after the nurse has ruled out an immediate threat to safety. A client in a state of high emotional turmoil cannot effectively process educational material or engage in insight-oriented therapy until the crisis is stabilized, a process that starts with the nurse's direct, empathetic, and systematic risk assessment.

References (research sources)

- [1]Management of suicidal crisis in an adolescent with Becker muscular dystrophy: a case report.Case reportWan H, Zheng L, Wu X, Xiong J, Zhou C. (2026) · DOI: 10.1186/s12888-026-08139-1

- [2]Development of a Repeat Suicide Risk Management Protocol for Emergency Department Patients With Suicide Attempts: An Exploratory Sequential Mixed-Methods Study.Research articleTan R, Teng F, Wang JQ, Wang YD, Li LC, Hu DY. (2026) · DOI: 10.1111/inm.70252

- [3]Integrating safety planning, problem-solving therapy and peer support for suicide prevention among adolescents living with HIV in Malawi: An application of the ADAPT-ITT adaptation framework.Research articleStockton MA, Waddell K, Bhushan NL, Mphonda S, Constantine V, Masulani-Mwale C, January J, Brown G, Udedi M, Nyirenda J, Mahuka E, Pence B, Gaynes B, Owusu MTK, Verhey R, Kulisewa K. (2026) · DOI: 10.1017/gmh.2026.10181

- [4]Training health care professionals in safety plan implementation to prevent suicide reattempts: A systematic review.Meta-analysis/systematic reviewChalancon B, Vacher A, Leaune E, Vieux M, Poulet E, Leblanc J. (2026) · DOI: 10.1016/j.ijnsa.2026.100539

## 임상 시나리오

Crisis Intervention: Safety FirstManaging Acute Psychological Crisis in Adolescents
The priority intervention in any acute psychological crisis is to establish safety and conduct a thorough risk assessment for harm to self or others. This precedes all other therapeutic actions.

Withdrawal and tearfulness are signs of profound distress that can escalate. Directly ask the client about suicidal ideation, plans, and means. A safety plan is an evidence-based, co-created tool initiated at the onset of distress.

CautionDo not delay risk assessment to provide education or encourage expression of feelings. A client cannot engage in coping strategies until their immediate physical and psychological safety is secured.

## 핵심 개념

- **Crisis Intervention** — A short-term, immediate intervention focused on stabilizing a client in acute distress and ensuring safety.
- **Safety Planning** — A collaborative, evidence-based process to identify coping strategies and resources for a client at risk of self-harm.
- **Risk Assessment** — A clinical evaluation to determine the presence, severity, and immediacy of a client's potential for harm to self or others.

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