A client is admitted for alcohol detoxification and reports feeling anxious, tremulous, and nauseated. Vital signs include BP 150/90 mmHg, pulse 120 bpm, and diaphoresis. The client is alert but irritable. Which nursing intervention should be implemented first?

During alcohol withdrawal, the client is at significant risk for progression to severe complications including seizures and delirium tremens, which can be fatal. The clinical picture described — anxiety, tremors, nausea, elevated blood pressure at 150/90 mmHg, tachycardia at 120 bpm, and diaphoresis — indicates active autonomic hyperactivity consistent with moderate to severe alcohol withdrawal. The first priority intervention is administering the prescribed benzodiazepine, as this class of medication is the gold standard for managing alcohol withdrawal symptoms by enhancing GABA activity to suppress CNS hyperexcitability and prevent seizure progression. Assessing the client for risk of injury is important and should occur as part of the ongoing assessment, but it is not the immediate first action when withdrawal symptoms are already clinically present and a medication order exists to address them. Encouraging the client to verbalize guilt is a psychotherapeutic intervention appropriate later in recovery, not during acute withdrawal management. Administering thiamine and vitamins is essential to prevent Wernicke's encephalopathy and should be done early, but addressing the life-threatening physiological withdrawal process with a benzodiazepine takes precedence in the immediate moment. Safety through pharmacological stabilization is the first nursing priority.