For a client with major depressive disorder reporting persistent insomnia, what should the nurse assess next?

Choice A reason: While social withdrawal is a symptom of major depressive disorder, assessing adherence to social activities does not directly address the immediate physiological and behavioral causes of insomnia. The priority for sleep disturbances is to identify factors that directly interfere with the initiation or maintenance of the sleep cycle. Choice B reason: Dietary habits, such as caffeine intake, can certainly influence sleep quality. However, a comprehensive assessment of sleep hygiene specifically requires looking at the broader context of the client's behaviors during the pre-sleep period. Rituals and routines provide a more direct window into the client's sleep-wake regulation. Choice C reason: Family history is important for establishing a genetic predisposition to depression, but it offers little utility in managing acute, persistent insomnia. The clinical focus must remain on modifiable behavioral factors and the current symptom profile to develop an effective nursing care plan for sleep restoration. Choice D reason: Assessing nighttime rituals and routines is a critical component of evaluating sleep hygiene. The nurse must identify behaviors that may be disrupting the circadian rhythm, such as irregular sleep schedules, blue light exposure from screens, or stimulating activities late in the evening, to provide targeted educational interventions.