A client reporting fatigue and lack of pleasure in daily activities meets criteria for a diagnosis of major depressive disorder. What risk should be assessed first?

Choice A reason: Assessing for chronic medical conditions is an important part of a holistic physical exam to rule out secondary causes of depression, such as hypothyroidism or anemia. However, physiological assessments are secondary to the immediate psychological safety of a client presenting with core symptoms of major depression. Choice B reason: Financial struggles are significant psychosocial stressors that can exacerbate depressive symptoms and affect access to care. While important for social work referrals and discharge planning, financial status does not present an immediate threat to the client's physical life during the initial nursing assessment. Choice C reason: Social isolation is a known risk factor for the development and maintenance of depressive disorders. While the nurse should evaluate the client's support system to determine their level of resource availability, this assessment is lower in priority than identifying active, life-threatening psychiatric emergencies. Choice D reason: Suicidal ideation is the most critical risk associated with major depressive disorder. Because the safety of the patient is the foundation of all nursing care, the nurse must first determine if the client has thoughts of self-harm, a specific plan, or the means to carry it out.