# A nurse is caring for a client with major depressive disorder who has been expressing suicidal ideation. Which nursing intervention should be the highest priority?

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## 문제

A nurse is caring for a client with major depressive disorder who has been expressing suicidal ideation. Which nursing intervention should be the highest priority?

## 보기

1. Encourage the client to participate in group therapy sessions to improve social interaction
2. Administer prescribed antidepressant medication as ordered to improve mood
3. Implement one-on-one suicide precautions and remove all potentially harmful objects from the environment **✔ 정답**
4. Provide psychoeducation about depression and coping strategies to increase understanding

**정답: 3**

## 해설

For a client expressing suicidal ideation, the highest priority is immediate safety via suicide precautions (e.g., one-on-one observation, removing harmful objects). Other interventions (group therapy, medication, education) are important but secondary until safety is ensured.

## 심화 해설

Priority Intervention for Suicidal Ideation in Major Depressive Disorder

The correct answer is implement one-on-one suicide precautions and remove all potentially harmful objects from the environment.

Rationale Based on the Hierarchy of Needs and Safety

In the NCLEX-RN framework, client safety is always the highest priority. For a client with major depressive disorder (MDD) actively expressing suicidal ideation, the immediate risk of self-harm supersedes all other therapeutic interventions. This principle aligns directly with the evidence that MDD is the leading diagnosis among suicide deaths, a finding highlighted in a large-scale randomized clinical trial examining suicide prevention programs for this specific population [1]. While pharmacotherapy, psychoeducation, and group therapy are all vital components of a comprehensive care plan, they do not address the imminent threat to the client's physical safety. An antidepressant medication, for instance, may take weeks to achieve its full therapeutic effect and does not provide immediate protection against a suicidal impulse.

Clinical Application of Safety Precautions

Implementing one-on-one supervision ensures continuous monitoring, which is a critical environmental safeguard. Removing potentially harmful objects—such as sharp items, cords, belts, glass, and certain personal care products—is a form of environmental risk mitigation that directly prevents the means for self-harm. This intervention is supported by research examining the mechanisms of self-harm in adolescents with mood disorders, which emphasizes that targeted interventions must address the immediate behavioral risk to prevent an act of self-harm [3]. The nursing action here is not merely observational; it is an active, preventive strategy to create a safe milieu until the acute suicidal crisis resolves.

Understanding the Context of Suicidal Ideation in MDD

The urgency of this intervention is further contextualized by the prevalence and barriers to care associated with suicidal ideation. Research on mental health in college populations indicates that a significant proportion of individuals with depression experience suicidal ideation, and a reluctance to openly discuss these feelings can exacerbate risk . This underscores why a client who is verbalizing these thoughts requires an immediate, high-level protective response. Furthermore, predictive modeling studies in mood disorders identify suicidal ideation as a critical variable for risk stratification, reinforcing that the verbal expression of these thoughts is a clinical red flag demanding a direct safety-focused intervention . The nurse’s primary role shifts to a guardian of safety before progressing to therapeutic communication or health teaching.References (research sources)

- [1]Hospital-Based Psychosocial Case Management and Suicide Prevention in South Korea: A Randomized Clinical Trial.RCT/clinical trialLee SM, Kim KH, Han KM, Kim MH, Kim MK, Choi KY, Park AL, Baik M, Lee AR, Na PJ, Lee HA, Lee HY, Paik JW. (2026) · DOI: 10.1001/jamanetworkopen.2026.20950

- [3]The association of different dimensions of anhedonia in the relationship between depressive symptoms and self-harm in adolescents with mood disorders.Research articleXiao J, Liu D, Cheng L, Zhang M, Wu M, Du N, Zhu L, Zhu D. (2026) · DOI: 10.3389/fpsyt.2026.1845853

## 임상 시나리오

Suicide Prevention: Immediate Safety ActionsHighest priority nursing interventions for a client with active suicidal ideation
For a client expressing suicidal ideation, the immediate priority is physical safety. Initiate one-to-one continuous observation at all times, ensuring the patient remains within arm's reach of a staff member, including during bathroom use and showers.

Conduct a thorough environmental safety sweep of the patient's room. Remove all potentially dangerous items such as sharps (razors, scissors), cords (phone chargers, call bell cords), belts, drawstrings, plastic bags, and glass containers.

CautionDo not rely on medications or psychotherapy as the primary intervention for an acute suicidal crisis. Antidepressants have a delayed onset of 2-4 weeks and do not protect against an immediate impulse. Safety precautions must be non-negotiable and implemented first.

## 핵심 개념

- **Suicidal Ideation** — Thoughts about, or an unusual preoccupation with, suicide; can range from fleeting considerations to detailed planning.
- **One-to-One Observation** — A safety precaution where a staff member is assigned to monitor a patient continuously and remain within arm's reach at all times.
- **Environmental Safety** — The process of removing all potentially harmful objects (e.g., sharps, cords, glass) from a patient's immediate surroundings to prevent self-harm.
- **Major Depressive Disorder (MDD)** — A mood disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life and carrying a high risk for suicide.
- **Priority Setting** — A clinical decision-making process based on a hierarchy of needs, where physiological and safety needs take precedence over psychosocial needs.

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