What is the first step in managing altered mental status?

• A. Full ALS assessment and treatment
• B. Immediate imaging only
• C. Administer insulin
• D. Reassess mental status in 24 hours

Answer: (D)

In altered mental status, ongoing evaluation and monitoring is essential. The first step is to reassess the patient's mental status to track any changes and guide what to do next. Rechecking at a 24-hour interval fits this approach, because it provides a structured plan to observe how the patient evolves, decide if further testing is needed, and escalate care only if deterioration or new findings appear. The other options are actions that are important in specific situations (airway/breathing/circulation stabilization, imaging for definite red flags, treating a suspected glucose problem), but they aren’t the initial step when you’re focusing on how to begin management—continuous reassessment sets the stage for appropriate, timely interventions as the situation unfolds.