A client states 'I just can't take this anymore. I want to end it all.' What is the nurse's most appropriate initial response?

When suicidal ideation is suggested or stated, the nurse must directly assess for suicide intent — this is the priority intervention. Asking about suicide does NOT plant the idea or increase risk; on the contrary, direct assessment is essential and may relieve the client. Assessment questions: (1) 'Are you thinking of hurting yourself or ending your life?' — direct, non-judgmental; (2) 'Do you have a plan?' — specific method, when, where? (3) 'Do you have means available?' (firearms, medications, etc.); (4) 'Have you tried before?' — past attempts are major risk factor; (5) 'What's keeping you alive right now?' — protective factors. Risk levels: (1) Ideation alone without plan — concerning but lower risk; (2) Ideation with plan — high risk; (3) Ideation, plan, and means — imminent risk requiring immediate safety; (4) Active attempt — emergency. Nursing actions for high risk: (1) Stay with client or arrange constant observation; (2) Remove access to means (medications, sharp objects, firearms); (3) Notify physician and mental health team; (4) Suicide precautions per facility policy (typically including line-of-sight observation, removal of harmful items, ligature risks addressed); (5) Therapeutic, supportive communication; (6) No-suicide contracts have limited evidence — better to focus on safety planning and means restriction. Suicide is a leading cause of death; nurses are often the first to identify risk.