Psychosocial IntegrityQuestion 947 of 2368
A client answers "yes" to the ASQ question about having thoughts of killing themselves right now. Which action should the nurse take?
- Complete a brief safety assessment and reassess the client at the start of the next shift
- Provide the 988 number and allow the client to go home with a family member overnight
- Have the client wait in the lobby until the provider becomes available to evaluate
- Keep the client under continuous observation, remove dangerous objects, and notify the provider
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Correct answer: Keep the client under continuous observation, remove dangerous objects, and notify the provider
An acute positive screen means imminent risk. The client needs continuous observation, a safe room, and immediate provider notification.
Source: Nursing Health Promotion (Open RN, Chippewa Valley Technical College, 2025), Mental Health Conditions: Suicide Risk Screening. Licensed under CC BY 4.0.
Practice the topic "Psychosocial Integrity"Questions last reviewed: 18 October 2026