A patient expresses hopelessness and intent to harm self. The priority action is:

• A. Assess for suicide risk and implement safety measures, including one-to-one observation
• B. Notify family and discharge
• C. Administer sedatives immediately
• D. Document and wait for physician order

Answer: (A)

When someone shows hopelessness and intent to harm themselves, the immediate priority is safety. Starting with an urgent suicide risk assessment helps gauge how imminent the danger is, what kind of plan exists, what means are available, and what protective factors are present. Based on that assessment, you implement safety measures right away, including one-to-one observation, so the patient isn’t left alone and a continuous supervisor can interrupt any impulsive act. Simultaneously, remove means for self-harm and create a safe environment, and begin forming a crisis plan with the patient.

This approach addresses the crisis directly and buys time to gather more information and involve the right team for further treatment decisions. Discharging the patient, notifying family for discharge, or waiting for orders without acting on safety can increase risk. Sedatives don’t resolve the underlying risk and could mask the situation, delaying essential assessment and protection.