Level: Foundational
Difficulty: Easy
Subtopic: Suicide risk
NCLEX: A client states, “I don’t want to live anymore.” What is the nurse’s priority response?
Psychiatric / mental health nursing Psychosocial Integrity
Case Study
A client states, "I don't want to live anymore." What is the nurse's priority response?
Question
A. Stay with the client, assess suicide risk, and follow facility safety protocol.
B. Tell the client to think about positive things and leave to finish charting.
C. Promise confidentiality and avoid telling the health care team.
D. Remove all visitors so the client can rest alone in the room.
B. Tell the client to think about positive things and leave to finish charting.
C. Promise confidentiality and avoid telling the health care team.
D. Remove all visitors so the client can rest alone in the room.
Rationale
Correct answer: A. Stay with the client, assess suicide risk, and follow facility safety protocol.
Rationale: Suicidal ideation requires immediate safety assessment, observation, and team communication; leaving the client alone is unsafe.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Suicidal ideation requires immediate safety assessment, observation, and team communication; leaving the client alone is unsafe.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.