A nurse is providing end-of-life care to a client. Which of the following actions should the nurse take?

Clients admitted with self-inflicted injuries require immediate psychiatric and safety-focused assessment to determine current risk of suicide or further self-harm. The nurse must prioritize identifying life-threatening risk before exploring emotional triggers, coping strategies, or support systems. Establishing the presence of suicidal ideation guides the level of observation and safety precautions needed. Therapeutic communication in this phase is directed toward ensuring immediate client safety.

Rationale:
A. “Do you have thoughts of suicide?” This is the priority question because it directly assesses current suicidal ideation and immediate risk to the client’s safety. Clients who engage in self-inflicted injury may have active suicidal thoughts even if they do not initially disclose them. Early identification of suicide risk determines the need for constant observation or emergency interventions.

B. “Tell me why you hurt yourself.” This is not the priority because it focuses on exploring underlying reasons rather than immediate safety risk. While understanding triggers is important for long-term care planning, it should only be addressed after ensuring the client is not at imminent risk of self-harm or suicide.

C. “Who can we call to support you?” This is premature because it assumes the client is safe and stable. Social support is important in care planning, but it does not address immediate suicide risk. Safety assessment must occur before involving external supports.

D. “What coping methods help you when you feel bad?” This is appropriate for later stages of therapeutic communication but is not the initial priority. Coping strategies are explored after determining the client is not in immediate danger. The first step is always to assess for suicidal intent or plans.

Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis. It is characterized by inflammation of the upper respiratory tract leading to severe, uncontrollable coughing episodes. The illness typically progresses through stages, with the paroxysmal stage being most clinically distinctive. Recognition of hallmark symptoms is essential for early diagnosis, isolation, and prevention of transmission, especially in pediatric populations.

Rationale:
A. Koplik spots are small bluish-white lesions on an erythematous base found on the buccal mucosa and are a classic early sign of measles (rubeola), not pertussis. Their presence indicates a viral exanthem rather than a bacterial respiratory infection. They are not associated with pertussis.

B. A beefy, red tongue is commonly associated with conditions such as scarlet fever or vitamin deficiencies. It reflects mucosal inflammation or systemic infection affecting the oral cavity. This finding is not characteristic of pertussis, which primarily affects the respiratory tract rather than oral mucosa.

C. Peeling of the hands and feet is typically seen in conditions such as Kawasaki disease, where vasculitis leads to desquamation during the subacute phase. This manifestation is unrelated to pertussis, which does not involve systemic vasculitis or skin desquamation as a primary feature.

D. A paroxysmal cough is the hallmark manifestation of pertussis, characterized by sudden, intense coughing fits that may end with a whooping sound during inspiration. These episodes can be followed by vomiting or exhaustion due to increased intrathoracic pressure. This symptom results from toxin-mediated damage to the respiratory epithelium caused by Bordetella pertussis.