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Paula is a 32-year-old woman seeking evaluation and treatment of major depressive symptoms. A major nursing priority during the assessment process includes which of the following?
A. meaning of current stressors
B. possibility of self-harm
C. motivation to participate in treatment
D. presence of alcohol or other drug use
Correct Answer: B
Explanation/Reference:
Explanation:
Unless the client is first assessed for self-harm or suicide potential, the staff might not observe the necessary degree of vigilance needed in the client’s environment. Physical needs are the second most critical concern with a depressive client. Though the client may be encouraged to attend group therapy as part of the treatment plan, the client’s safety takes precedence. Response to medication takes time and is not an initial concern.Physiological Adaptation
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