A nurse is caring for a client who has a substance use disorder. The client states, “The state took my child away after my overdose. I don’t want to go on living without them.” Which of the following therapeutic responses should the nurse make?

Choice A reason: Prescribing a sedative addresses symptoms but not the client’s suicidal ideation. Sedatives, like benzodiazepines, depress the central nervous system but carry addiction risks, especially in substance use disorder. This response fails to assess immediate safety risks, prioritizing medication over critical suicide risk evaluation. Choice B reason: Stating counseling will regain custody is misleading and non-therapeutic, as it oversimplifies legal processes. Substance use disorder recovery requires addressing psychological despair, and false promises may erode trust. This response ignores the client’s suicidal statement, missing the priority of safety assessment. Choice C reason: Suggesting family custody focuses on practicalities but ignores the client’s expressed hopelessness and suicidal intent. While custody solutions may be relevant later, immediate assessment of self-harm risk is critical, as substance use disorder increases suicide vulnerability due to impulsivity and emotional dysregulation. Choice D reason: Asking about self-harm directly addresses the client’s suicidal statement, a critical risk in substance use disorder. Despair and loss can trigger suicidal ideation, and immediate assessment allows for safety planning, psychiatric evaluation, or crisis intervention, prioritizing the client’s safety and mental health stabilization.