A sixteen year old patient started on the serotonin/norepinephrine reuptake inhibitor venlafaxine 2 weeks ago. The patient states that he is confused since he thought he was supposed to "feel better with the medication. He goes on to say that he is tired of all the visits and just wants to "go to sleep forever". What is the most appropriate action for the nurse to take?

A. The nurse recognizes this as abnormal and responds with, "Do you have a plan to hurt yourself?": Statements such as wanting to “go to sleep forever” indicate passive suicidal ideation, especially concerning in an adolescent recently started on venlafaxine. SNRIs can increase suicidal thoughts early in treatment due to increased energy before mood improves. Directly asking about suicidal intent and planning is a priority safety intervention and does not increase suicide risk. B. The nurse recognizes this as normal and responds with, "SNRIs like venlafaxine can cause insomnia. Take your dosage earlier in the day to avoid this.": Focusing on insomnia ignores the patient’s verbalized desire to stop living. Medication side-effect teaching is not appropriate when suicidal ideation is present. This delays urgent mental health assessment and intervention. C. The nurse recognizes this as normal and responds with, "Maybe a long nap is just what you need to get some rest.": Normalizing or minimizing statements about wanting to “go to sleep forever” can reinforce feelings of hopelessness. This response fails to assess suicide risk and places the patient in danger. Therapeutic communication requires acknowledging and assessing the expressed concern. D. The nurse recognizes this as abnormal and responds with, "I will ask the doctor if we need to increase your dosage to treat your new symptoms.": Medication adjustment is not the immediate priority when suicidal ideation is suspected. Increasing the dose without assessing safety could worsen risk. Immediate assessment of suicidal thoughts and protective measures must occur first.