A postpartum patient says she may harm herself. What should the nurse do first?
- AAsk her to agree to a no-harm safety contract
- BNotify the provider and recheck her mood in 30 minutes
- CStay with her and arrange urgent mental-health assessment
- DRemove harmful objects from the room, then notify the provider urgently
Show answer and explanations
Answer
C
A
No-harm contracts are not evidence-based and do not keep a patient safe; she still needs continuous presence and urgent assessment.
B
Notifying the provider is right, but leaving her for 30 minutes leaves an immediate self-harm risk unsupervised.
C
Statements of self-harm require the nurse to stay with her for safety and arrange an urgent mental-health assessment.
D
Removing means is part of safety, but doing it before ensuring continuous observation leaves her alone at a moment of risk, and notifying the provider alone does not arrange urgent mental-health assessment.