Difficulty: Medium
Average Score: 72%
Simulated
A nurse on an inpatient mental health unit is assisting with the admission of a client who reports feeling depressed, sad, moody, and overly anxious. Which of the following assessments should the nurse make first?
Correct answer
B
Rationale
Choice B is correct because suicide risk is the most urgent assessment for a client reporting depression and anxiety. It indicates the clientÔÇÖs level of hopelessness and intent to harm themselves, requiring immediate intervention to ensure safety. Choice A (psychiatric history) provides background but isnÔÇÖt urgent. Choices C and D (support systems, coping abilities) are secondary to ensuring safety.