A nurse participates in psychotherapy sessions for three clients with obsessive-compulsive disorder who are scheduled to be discharged tomorrow. Which statement by a client indicates the discharge plan may need to be changed?

• A. I can't stop thinking that teenagers are out to kill me, and I should get them first.
• B. I wash my hands frequently but feel in control now.
• C. I have a routine that helps me manage my symptoms.
• D. I can resist urges without support.

Answer: (A)

Safety risk assessment during discharge planning is being tested. The statement that signals discharge may need to be changed is the one in which the client expresses violent ideation—believing teenagers are out to kill the nurse and that the client should act first to prevent it. This indicates a real risk of harm to others, meaning the client is not safely discharge-ready and requires continued treatment, enhanced safety planning, or a reassessment of the discharge plan.

The other statements reflect better stabilization: one client notes frequent hand washing but feels in control, suggesting rituals are manageable; another has a routine that helps manage symptoms, indicating useful coping strategies; and the last can resist urges without support, showing increasing autonomy and safety for discharge. Overall, the dangerous mindset that includes intent to harm others is the red flag that necessitates reconsidering the discharge plan.