A nurse is caring for a client who has major depressive disorder and attempted suicide. The client tells the nurse, "I should have died because I am totally worthless." Which of the following responses should the nurse make?

A. Low self-esteem is a risk factor for depression because negative self-perception and feelings of worthlessness can contribute to the development of depressive symptoms.

B. Irritability is associated with depression, especially in adolescents. It can manifest as a mood symptom and is often seen alongside other depressive features.

C. Chronic pain can be both a symptom and a risk factor for depression. Persistent pain can lead to changes in mood, behavior, and physical function, contributing to the development of depressive symptoms.

D. Insomnia, or difficulty sleeping, is a common symptom of depression and can also be a risk factor. Sleep disturbances are often seen in individuals with depression, and they can contribute to the severity of the condition.

E. Euphoria is not a risk factor for depression. In fact, it is more commonly associated with conditions like bipolar disorder, where individuals experience periods of elevated mood (mania or hypomania) alternating with periods of depression.

A. Identify the client's nutritional status.

Explanation:

Given the significant weight loss and the client's distorted belief about her body image (believing she is fat despite losing weight), it is crucial to assess the client's nutritional status first. Rapid weight loss and distorted body image are characteristic features of an eating disorder, such as anorexia nervosa. The nurse needs to determine the extent of malnutrition and potential medical complications related to inadequate nutrition. This assessment will guide the subsequent interventions.

Why the other choices are incorrect:

B. Provide a structured environment for the client.

While providing a structured environment can be important in managing eating disorders, such as anorexia nervosa, it is not the first priority. Understanding the client's nutritional status and medical condition takes precedence.

C. Plan a therapeutic diet for the client.

Planning a therapeutic diet may be part of the client's care plan, but without understanding the underlying nutritional status and potential eating disorder, creating a diet plan may not be effective or appropriate.

D. Request a mental health consult.

While a mental health consult is important for addressing the client's distorted body image and potential eating disorder, it should follow the assessment of nutritional status. The nutritional assessment provides critical information for both medical and psychological interventions.