What is the most important question for a client hearing voices that suggest self-harm?

In the context of a client who is experiencing auditory hallucinations that suggest self-harm, the most important question to ask is whether they are going to hurt themselves. This question directly addresses the immediate safety concerns associated with the client’s condition. It invites the client to express their current feelings and intentions regarding self-harm, which is critical in assessing risk and determining the necessary level of care and intervention. By asking this question, the nurse can gauge the seriousness of the client's situation and respond appropriately, whether that involves initiating safety measures, connecting the client with support systems, or providing therapeutic intervention.

The other questions, while possibly relevant for understanding the client’s experience, do not prioritize immediate safety. Asking about why the voices are starting again or how long the client has been hearing them focuses on exploring the client’s symptom history rather than assessing their current risk. Similarly, inquiring about when the voices usually appear may help in understanding patterns of distress but does not provide insight into the risk of self-harm. In crisis situations, especially when there is a potential for harm, the priority must always be the client’s safety and well-being.