Psychiatric / mental health nursing · practice question
A 42-year-old client in a crisis stabilization unit is being evaluated for auditory hallucinations. Assessment data include the client is withdrawn, flat affect, and refusing meals for 2 days. Which action should the nurse take first?
Multiple choiceMediumnclex-rn-bsnnclex-validatednclex-2026psychiatric-mental-health
Answer and explanation
Correct answer
B. Assess airway, breathing, and circulation; address immediate safety risk; then notify the provider per protocol.
Why
NCLEX priority questions require stabilizing the client first using ABCs and focused assessment before comfort measures, documentation only, or delayed escalation.
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