What action should a nurse take first when a client with major depressive disorder expresses feelings of hopelessness and intermittent thoughts of suicide?

Choice A reason: The first and most critical nursing action is to assess the lethality of the suicidal ideation. The nurse must determine if the client has a specific plan, the access to the means (such as pills or weapons), and the intent to act, as this determines the level of supervision required. Choice B reason: While encouraging the client to express feelings is therapeutic and builds rapport, it is a secondary intervention. Verbalization of hopelessness is the trigger for the assessment, but it does not provide the concrete safety data needed to protect the client's life in the immediate moment. Choice C reason: A referral to a psychiatrist is an appropriate part of the multidisciplinary treatment plan; however, the nurse at the bedside is responsible for the immediate safety of the client. The nurse cannot wait for a consultation to occur before establishing the current level of risk and implementing safety precautions. Choice D reason: Nurses do not "start" clients on medications, as this is a provider's role. Furthermore, antidepressants take time to work and can actually increase suicide risk initially by providing the energy to carry out a plan. The immediate priority is environmental safety and observation, not pharmacological initiation.