<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg 7-lb weight loss. Since the death of her husband one year ago, she has been living with her son and his wife. She is worried and feels guilty because she does not want to impose on them. She has stopped going to meetings at the senior center because she does not enjoy them anymore and also because she feels uncomfortable asking her son to give her a ride, especially since her son has had a great deal of stress lately. She is 155 cm 5 ft 1 in tall and weighs 51 kg 110 lb; BMI is 21 kgm2. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tired and has a flattened affect. Cognition is intact. Which of the following is the most appropriate initial step in management?? A: Notify adult protective services, B: Recommend relocation to a nursing home, C: Begin cognitive-behavioral therapy, D: Begin mirtazapine therapy, E: Assess for suicidal ideationn,  <response>: This is a question about the initial management of an elderly woman with symptoms of depression, including difficulty sleeping, fatigue, decreased appetite, weight loss, loss of interest in activities, guilt, and flattened affect. She is living with her son but feels like she is imposing. The question is asking for the most appropriate initial step to take in managing her case.Choice A of notifying adult protective services does not seem like an appropriate first step given the information provided. There are no clear signs of abuse or neglect. Choice B of recommending relocation to a nursing home also does not seem warranted as an initial step, since she is able to live with her son and there is no indication she requires skilled nursing care at this time.Choice C of beginning cognitive behavioral therapy may be appropriate as part of her overall treatment plan, but is likely premature as an initial step before making a diagnosis and assessing the severity of her symptoms.Choice D of beginning mirtazapine therapy, an antidepressant, seems reasonable as an initial step given her symptoms of depression. However, there may be some additional assessments warranted before starting medication.Choice E of assessing for suicidal ideation also seems like an appropriate initial step given her symptoms of depression. Screening for suicidal thoughts is important before determining treatment options.E: Assess for suicidal ideation 