A nurse is admitting a client with major depressive disorder. Which finding requires the MOST immediate attention?

SUICIDAL IDEATION WITH A SPECIFIC PLAN represents the HIGHEST PRIORITY finding and requires IMMEDIATE intervention. The presence of a PLAN (as opposed to passive ideation without a plan) significantly elevates risk. The nurse must: notify the RN and provider IMMEDIATELY; implement suicide precautions (1:1 monitoring or close observation per facility policy); ensure environmental safety (remove potential means: sharps, cords, anything that could be used for self-harm); document the statement verbatim and the actions taken; initiate a suicide risk assessment (many facilities use tools like the Columbia Suicide Severity Rating Scale — C-SSRS); do NOT leave the client alone until the plan is in place.

Suicide risk factors:

Direct: suicidal ideation with plan or intent; previous attempts (strongest predictor); giving away possessions; saying goodbye; access to means (firearms, medications); hopelessness.

Contributing: depression, bipolar disorder, schizophrenia, substance use; history of trauma or abuse; chronic pain or illness; social isolation; recent loss; family history of suicide; impulsivity. OTHER DEPRESSIVE SYMPTOMS (Options A, C, D) are important to address and document but are not immediate safety emergencies: ANOREXIA/weight loss — monitor nutrition, consider nutritional consult; HYPERSOMNIA — common in atypical depression; ANHEDONIA (loss of interest in pleasurable activities) — characteristic symptom. ALL of these symptoms contribute to the diagnostic picture of major depressive disorder and should be thoroughly documented and reported, but none has the same IMMEDIATE SAFETY URGENCY as suicidal ideation with a plan.