# Stage 1 — Recognize cues. Highlight the findings that increase concern for the client's safety tonight. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617252&lang=en > language: en > subject: Crisis Intervention > category: PSI ## Question Stage 1 — Recognize cues. Highlight the findings that increase concern for the client's safety tonight. At 2100, a 21-year-old college student is brought to the emergency department by a friend after six weeks of worsening depression. The client started escitalopram nine days ago and made an overdose attempt at age 17. The client says, 'I collected my prescription bottles and planned to take them tonight,' and later adds, 'Part of me wishes the attempt would work.' The friend reports the client gave a laptop away yesterday. The client called the friend when frightened, agrees to stay for evaluation, and says a brother keeps them going. The client has no access to firearms and sees a campus counselor weekly. HR 88/min, BP 118/72 mm Hg; the toxicology screen is negative, and no ingestion is identified. ## Explanation A plan with timing, stated intent, preparatory behavior, a previous overdose, and the early weeks of antidepressant therapy in a client under 25 all raise acute risk. Help-seeking, agreement to stay, a named reason for living, no firearm access, weekly counseling, and a negative toxicology screen are real protective or reassuring data, but they do not reduce the danger created by a current plan and intent. ## In-depth explanation Quick answer Started escitalopram nine days ago, overdose attempt at age 17, planned to take them tonight, wishes the attempt would work, gave a laptop away yesterday. Why this is correct Acute risk is driven by what the client intends to do and how close they are to doing it: a specific method and time (tonight), stated intent, and preparatory behavior (giving away a valued possession). A prior attempt by the same method is one of the strongest predictors of a future attempt. The first weeks of antidepressant therapy in clients younger than 25 carry a boxed warning for emergent suicidality, because energy can return before mood improves. Easy analogy or mental picture Picture a scale: protective factors are real weights on one side, but a loaded plan for tonight is a heavy weight the protective side cannot offset in the emergency department. Memory hook "Plan, intent, preparation, past attempt, early SSRI" = five red flags that protective factors do not cancel. NCLEX decision rule When current plan and intent are present, protective factors are documented for later planning but do not lower the immediate level of precautions. Why the other choices are wrong Calling the friend and agreeing to stay are genuine help-seeking behaviors, which makes them tempting to count as risk-lowering, but they reflect ambivalence and do not negate a plan for tonight. Naming a brother as a reason for living is protective but coexists with stated intent. No access to firearms is tempting because it concerns lethal means, but the means this client has chosen are the collected prescription bottles, so the absence of firearms does not lower tonight's risk. Weekly counseling is an established support that matters for discharge planning, yet the plan formed despite it. A negative toxicology screen shows there has been no ingestion yet; it says nothing about the likelihood of an attempt. References 1The Joint Commission: Suicide Prevention (NPSG 15.01.01)Screening, direct assessment of plan, intent, and means, and safety precautions for at-risk clients 2NIMH: Suicide PreventionWarning signs such as giving away possessions, talking about a plan, and prior attempts 3DailyMed: escitalopram prescribing information (boxed warning on suicidal thoughts and behaviors)Close monitoring for suicidality early in antidepressant treatment; boxed warning extends to young adults under 25 ## Clinical scenario Case update Initial interview — a young adult with worsening depression is brought in by a friend. ## Key concepts - **Preparatory behavior** — Actions taken in anticipation of death, such as giving away possessions or gathering means, that signal higher acute suicide risk. - **Antidepressant boxed warning** — FDA warning of increased suicidal thinking and behavior in children, adolescents, and young adults under 25 during early treatment and dose changes. - **Protective factor** — A characteristic, such as help-seeking or connectedness, that lowers long-term risk but does not override a current plan and intent. ## 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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