NCLEX · Therapeutic Communication

A client with major depression states, 'There's no point in any of this. Nothing will ever get better.' What is the priority nursing assessment in response to this statement?

Correct answer

Assess for suicidal ideation — hopelessness and statements suggesting life is pointless are warning signs that require direct assessment of suicidal thoughts, plan, and intent

  1. A Assess the client's sleep patterns
  2. B Assess for suicidal ideation — hopelessness and statements suggesting life is pointless are warning signs that require direct assessment of suicidal thoughts, plan, and intent
  3. C Assess the client's appetite
  4. D Assess the client's family support

Why this is the answer

HOPELESSNESS AND SUICIDE RISK: Statements expressing hopelessness ('nothing will ever get better,' 'no point') are significant suicide warning signs. HOPELESSNESS is one of the strongest predictors of suicide. PRIORITY: Directly assess for suicidal ideation — ask directly: 'Are you having thoughts of harming or killing yourself?' (asking does NOT plant the idea — it opens communication and allows assessment); ASSESS: Ideation (thoughts), Plan (specific method), Intent (intention to act), Means (access to method), Lethality of plan; previous attempts (strongest predictor); SAFETY: If suicidal, ensure immediate safety — do not leave alone, remove means, implement suicide precautions, notify provider, possible 1:1 observation; PROTECTIVE FACTORS: Assess reasons for living, support, future orientation; DIRECT QUESTIONING is essential and therapeutic — vague or indirect approaches miss risk; MYTH: Asking about suicide does NOT increase risk — it's a critical safety assessment; nursing role: directly assess suicidal ideation when warning signs appear, ensure safety, never ignore hopelessness statements.
Source: NCLEX-RN Psychosocial — Depression, Hopelessness and Suicide Assessment