Ati Fundamentals Proctored Exam(Applied Nursing Skills)
A nurse is caring for a client who is experiencing suicidal thoughts. Which of the following actions should the nurse take?
Explanation & Rationale
A. Allowing unrestricted visitors could increase stress or provide access to potentially harmful items, so this is not a safety-first intervention. B. Visitors might inadvertently bring items that could be used for self-harm. Nurses must ensure the environment is safe first. C. Clients with suicidal thoughts require constant or frequent observation, often one-to-one supervision depending on risk, rather than a 12-hour periodic check. D. This is the priority action. Ensuring the environment is free from objects that could be used for self-harm (sharp objects, cords, medications, etc.) is the first step in protecting a client who is suicidal.
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