A client admitted with major depression has a risk for self-harm. What is a priority nursing action?

• A. Allow unrestricted access to personal items
• B. Encourage self-disclosure during group therapy
• C. Have the client's possessions searched for sharps
• D. Begin discharge planning immediately

Answer: (C)

The main concept is safety first: when a client with major depression is at risk for self-harm, the priority is to minimize opportunities for self-injury by removing access to means. Checking and removing sharps or other potential implements from the client’s possessions directly reduces the immediate danger and supports a safer environment. This hands-on safety measure is done while the team assesses risk, sets up appropriate precautions (like close observation or a safer room), and plans further care.

Actions that don’t address the immediate risk aren’t as effective now. Letting unrestricted access to personal items could enable self-harm. Encouraging self-disclosure in group therapy is beneficial for ongoing treatment but doesn’t prevent an imminent act. Starting discharge planning while the risk remains is inappropriate. Prioritizing safety establishes a foundation for all subsequent interventions.