The client admitted to the mental health unit with major depression 3 days ago could hardly get out of bed without coaxing and needed constant encouragement to get dressed and participate in unit activities
Today, the client appears in the dayroom dressed and well-groomed, without any guidance from the staff. The client appears to be calm and relaxed, yet more energetic than be-fore. The nurse should take which initial action after noting this client's behavior? 1. Continue to monitor the client's behavior from a distance.
2. Document that the client is adapting to the unit and is feeling safe.
3. Notify the staff of these observations at the team meeting, which will begin in 3 hours.
4. Speak to the client personally about the nurse's observations, and ask if the client is thinking about suicide.
4
Rationale: A sudden improvement in a depressed client's mood may indicate that the client has decided to commit suicide. The most direct way to validate the nurse's impression is to ask the client directly about suicidal ideation or plans. The other options are not the most appropriate initially.
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