A mother brings her obese adolescent daughter to the clinic because for the last 6 months her daughter sleeps every day after school, has lost weight, and has not had a period for 3 months. After sending the mother to the waiting room, which assessment is most important for the nurse to implement?

Rationale: A. Request a 24-hour dietary recall: Gathering a dietary history can help assess nutritional intake and obesity management. However, given the significant behavioral changes—excessive sleeping, weight loss, and amenorrhea—the immediate concern is not nutrition but potential underlying psychological distress, which requires urgent attention. B. Question her about thoughts of self-harm: Sudden weight loss, excessive sleep, amenorrhea, and behavioral withdrawal in adolescents can signal depression, which carries a risk for self-harm and suicide. Screening for suicidal ideation is a priority to ensure the teen's immediate safety and determine if emergency intervention is necessary. C. Ask the teen if she is sexually active: While assessing sexual activity is important, especially with menstrual irregularities, it is secondary in priority compared to assessing for life-threatening psychological conditions. Sexual history can be explored after ensuring the adolescent is not in immediate psychological danger. D. Inquire about the use of illicit drugs: Substance use can contribute to mood changes, weight loss, and altered sleep patterns, but it is not the primary concern given the combination of depressive symptoms. Safety screening for self-harm or suicidal ideation takes precedence before evaluating for substance abuse.