LEARNING SYSTEM QUIZ# 2.2

A nurse on a mental health unit is assisting with the care of a client who is experiencing psychosis. The nurse is preparing to administer haloperidol 3mg IM to the client. Available is haloperidol solution 5mg/ml. How many mL should the nurse administer? (Round to the nearest tenth. Use a leading zero if applicable. Do not use a trailing zero.)

0.6

A nurse is caring for a client who has a prescription for lithium. The nurse should recognize which of the following as a therapeutic serum lithium level? 1. 1.2 mEq/L 2. 1.6 mEq/L 3. 2.0 mEq/L 4. 2.5 mEq/L

1. 1.2 mEq/L The nurse should recognize the a serum level of 1.2 mEq/L is within the expected reference range for a lithium level.

A nurse on a mental health unit is caring for a group of clients. The nurse should recommend weekly team meetings to discuss staff splitting regarding which of the following clients? 1. A client who has a borderline personality disorder. 2. A client who has dementia. 3. A client who has separation anxiety disorder. 4. A client who has major depressive disorder.

1. A client who has a borderline personality disorder. Splitting of staff members is a clinical finding frequently seen in clients who have borderline personality disorder. Conducting weekly team meeting allows the staff members to voice their feelings and agree upon strategies to implement when working with the client.

A nurse is working with a group of clients who have personality disorders. Which of the following clients should the nurse see first? 1. A client who has antisocial personality disorder and is demonstrating impulsive behaviors. 2. A client who has a dependent personality disorder and is excessively clinging. 3. A client who has a borderline personality disorder and shoes separation anxiety. 4. A client who has a histrionic personality disorder and is displaying attention-seeking behaviors.

1. A client who has antisocial personality disorder and is demonstrating impulsive behaviors. When use the urgent vs. nonurgent approach to client care, the nurse should determine the client who has antisocial personality disorder and is demonstrating impulsive behaviors should be seen first. Impulsive behaviors place the client and others at risk for injury. It is important to address the behaviors by setting clear boundaries and consequences for the client's actions.

A nurse in an acute mental health facility is prioritizing care for a group of clients. Which of the following actions should the nurse implement first? 1. Conduct an abnormal involuntary movement scale test. 2. Discuss behavioral expectations with a client. 3. Orient a client to unit policies. 4. Reinforce teaching regarding causes of depression.

1. Conduct an abnormal involuntary movement scale test. The first action the nurse should take using the nursing process is to collect data. The abnormal involuntary movement scale (AIMS) is a monitoring tool for clients who are prescribed antipsychotic medication for movement disorders. Therefore, the nurse should conduct the AIMS test first.

A nurse is discussing risk factors associated with child abuse with a group of newly licensed nurses. Which of the following factors should the nurse identify as increasing a child's risk of being abused? 1. Congenital abnormalities 2. School-age children 3. Oldest sibling 4. Acute illness

1. Congenital abnormalities The nurse should identify Congenital abnormalities, developmental disabilities, emotional and behavioral difficulties, chronic illnesses, children younger than 3 years of age, unwanted or unplanned pregnancy, and preterm birth s risk factors that place a child at increased risk for child abuse.

A nurse is collecting psychosocial data from a client. Which of the following questions should the nurse include in the psychosocial examination? 1. Do you have a hobby that you enjoy? 2. What is the date and where are you living? 3. How are an apple and an orange alike? 4. Can you take this pencil and put it in the cup?

1. Do you have a hobby that you enjoy? The nurse should collect data regarding the client's interests and abilities when conducting a psychosocial examination.

A nurse in an urgent care clinic is collecting data from a client whose friend reports a suspicion of cocaine use. The nurse should identify which of the following findings as an indicator of the client's use of the substance? 1. Hypertension 2. Drowsiness 3. Bradycardia 4. Constricted pupils

1. Hypertension Cocaine is a CNS stimulant; therefore, HTN is an expected finding.

A nurse is caring for a client who has recently been diagnosed with paranoid schizophrenia. The nurse should understand that the client needs further reinforcement of teaching when he makes which of the following statements? 1. I will probably not ever be able to live independently. 2. My dad had schizophrenia, so it makes sense that I have developed this disorder. 3. I understand that symptoms of this disease occur during the late teen years. 4. This means I'll have to take medications for the rest of my life.

1. I will probably not ever be able to live independently. Many clients who have paranoid schizophrenia can learn to live independently with medication management, counseling, and social support.

A nurse is reinforcing teaching with the family of a client who has opioid use disorder. The nurse should determine understanding of the teaching when the family identifies which of the following manifestations as an indication of opioid intoxication? 1. Impaired coordination 2. Paranoia 3. Increased alertness 4. Tachypnea

1. Impaired coordination Opiates, due to their sedative effect on the body, can result in impaired coordination as an indication of intoxication.

A nurse is caring for a client in an alcohol treatment program. The client asks the nurse, "Is there anything I can take to control my craving for a drink?" The nurse should anticipate a prescription for which of the following? 1. Naltrexone 2. Lorazepam 3. Buproprion 4. Buprenophine

1. Naltrexone Clients can take naltrexone to decrease the risk for relapse by reducing the craving for alcohol.

A nurse is reinforcing teaching with the family of a client who has dementia. Which of the following requires immediate attention by the client's provider? 1. Nocturnal confusion 2. Demand for constant attention 3. Hoarding of food 4. Progressive personality changes.

1. Nocturnal confusion Nocturnal confusion places the client at greatest risk for injury due to falls and wandering; therefore, the nurse should report this finding to the provider immediately.

A nurse is organizing care for a group of clients. Which of the following activities should the nurse perform first? 1. Offer high caloric fluids to a client who is constantly pacing. 2. Practice relaxation techniques with a client who has anxiety disorder. 3. Assist a client with decision making regarding group activities. 4. Encourage a client to verbalize feelings of hopelessness.

1. Offer high caloric fluids to a client who is constantly pacing. When using Maslow's hierarchy of needs, the nurse should determine the priority action is to address a client's physiological needs. The nurse should offer high caloric fluids to prevent dehydration and exhaustion.

A nurse is caring for a client who is being admitted to an acute-care mental health facility. The client reports suicidal ideations. Based on this report, when evaluating the client's belonging's, which of the following should the nurse remove? 1. Perfume 2. Lipstick 3. Ring 4. Comb

1. Perfume Perfume is considered a potentially harmful object and the nurse should remove is from the client's belongings. Perfumes are prohibited because they are potentially toxic is ingested.

The partner of a client diagnosed with a substance use disorder states to the nurse, "If I didn't have to travel so much for my work, I'd be able to watch him more, and he wouldn't drink so much.: Which of the following defense mechanisms is the partner demonstrating? 1. Rationalization 2. Displacement 3. Projection 4. Suppression

1. Rationalization Rationalization is a way of justifying unreasonable feelings with acceptable explanations. The client's partner is exhibiting this defense mechanism.

A nurse is reviewing the health history of an adult client who has a depressive disorder. Which of the following factors should the nurse identify as increasing the client's risk for depression? . 1. The client is female. 2. The client is married. 3. The client lives in an urban setting. 4. The client is an only child.

1. The client is female. The nurse should identify female gender as a primary risk factor for depression.

A nurse is caring for a client who has been abused by her partner. Which of the following outcomes indicates that nursing interventions have been successful? 1. The client speaks up on her own behalf. 2. The client learns how to avoid triggering violence. 3. The client develops trust in her partner's promises to change. 4. The client accepts responsibility for the abuse.

1. The client speaks up on her own behalf. The client who speaks on her own behalf is demonstrating empowerment and an increased self-esteem. This behavior shows a change in the client's attitude and indicates effectiveness of interventions.

A nurse is assisting with the admission of an adolescent who has an eating disorder. Upon data collection, which of the following manifestations are consistent with a diagnosis of bulimia nervosa? (Select all that apply) 1. Tooth erosion 2. Hand calluses 3. Lanugo 4. Amenorrhea 5. Hypokalemia

1. Tooth erosion 2. Hand calluses 5. Hypokalemia Tooth erosion is a clinical manifestation resulting from self-induced vomiting. Callused hands are a clinical manifestation resulting from self-induced vomiting. Hypokalemia is a clinical manifestation resulting from volume depletion due to self-induced vomiting or nonprescribed diuretic and/or laxative use. Lanugo and Amenorrhea are clinical manifestations for ANOREXIA nervosa

A nurse is assisting with the planning care for a client who has anorexia nervosa. Which of the following nursing actions should the nurse recommend in the plan of care? 1. Use a cognitive-behavioral approach regarding fears of weight gain. 2. Observe the client 30 minutes after meals. 3. Discuss healthy eating habits during mealtimes. 4. Encourage oral intake of fluids prior to obtaining morning weight.

1. Use a cognitive-behavioral approach regarding fears of weight gain. The nurse should recommend a cognitive-behavioral approach to address any client fears regarding weight gain. It is important to confront irrational beliefs to change eating behaviors.

A client who has a diagnosis of depression reports consuming a quart of vodka a day. On admission, which of the following questions should the nurse ask first? 1. When did you take your last drink? 2. Do you have a family history of alcohol use disorder? 3. Have you been treated for alcohol use disorder before? 4. Do you take any medications to treat your depression?

1. When did you take your last drink? The greatest risk to this client is alcohol withdrawal, which can begin within 4 to 12 hours following the last alcoholic drink and can progress to alcohol withdrawal delirium. Therefore, this is the first question the nurse should ask as that medical staff can anticipate client needs.

A client diagnosed with schizophrenia is experiencing auditory hallucinations. When contributing to the plan of care for this client, the nurse should be aware of which of the following? 1. Clients who have schizophrenia are incapable of ignoring hallucinations. 2. Anxiety may indicate that hallucinations are increasing. 3. Hallucinations become more prominent in the evening hours. 4. Clients who have schizophrenia generally accept explanations that hallucinations are not real.

2. Anxiety may indicate that hallucinations are increasing. The nurse should recognize increased anxiety as a possible indication that hallucinations are increasing as well.

A nurse is reinforcing teaching with an adolescent who has a history of aggressive behavior. Which of the following statements is appropriate? 1. If you can control you actions this week, I'll talk to you parents about extending your curfew. 2. Have you considered participating in a sport to help control your aggression? 3. If you become aggressive, your parents will take away privileges. 4. You're hurting others. Do you understand why that's wrong?

2. Have you considered participating in a sport to help control your aggression? It is appropriate for the nurse to encourage sports and other physical activities, which can provide an appropriate outlet for aggression.

A nurse is caring for a client who recently lost her daughter in a motor-vehicle crash. The client is expressing feelings of hopelessness. Which of the following questions is the most important for the nurse to ask? 1. Are there times when you feel more upset than others? 2. Have you had any thoughts of harming yourself? 3. What type of support system do you currently have? 4. During difficult time in the past, what did you do to cope?

2. Have you had any thoughts of harming yourself? The greatest risk to the client is self-injury due to suicide. Asking the question whether or not she has plans to hurt herself is the most important questions for the nurse to ask at this time.

A nurse is monitoring the nutritional status of a client who has bulimia nervosa. The nurse should monitor for which of the following medical complications? 1. Hyperchloremia 2. Hyponatremia 3. Decreased bone density 4. Increased WBC count

2. Hyponatremia The nurse should monitor the client who has bulimia nervosa for hyponatremia, which results from purging, vomiting, and laxative and/or diuretic use.

A nurse is reinforcing teaching with a client who has a new prescription for lithium carbonate. Which of the following statements by the client indicates an understanding of the teaching? 1. I should take a dose of lithium just before I have my lithium level drawn. 2. I will need to have my lithium level drawn weekly for the next 6 months. 3. I should bring in a urine specimen when I have my lithium level drawn. 4. I will have my lithium level drawn if my dosage is change.

2. I will need to have my lithium level drawn weekly for the next 6 months. Clients who take lithium should have serum lithium testing if they have a change in dosage.

A nurse is evaluating a school-age child's response to methylphenidate. Which of the following statements by the child's parents indicates that the medication is effective? 1. My son is sleeping so much better now. 2. I've noticed that my son focuses better on doing his homework. 3. My son used to panic when he couldn't find something. He seems a little less anxious now. 4. I was always concerned that my son ate too much. He seems to curb his appetite now.

2. I've noticed that my son focuses better on doing his homework. The nurse should evaluate that methylphenidate therapy has been successful for this client. Methylphenidate, a CNS stimulant, improves attention and focus while reducing restlessness and managing impulse control.

A nurse is collecting data from a client who is diagnosed with Alzheimer's disease. The nurse should expect which of the following findings? 1. Altered LOC 2. Impairment of judgment 3. Rapid change in personality 4. Disturbances in perception.

2. Impairment of judgment Impairment of judgment occurs in clients who have dementia as they lose their ability to reason, think abstractly, and have rational thoughts. Therefore, the nurse should expect impaired judgment in the client who has Alzheimer's disease.

A nurse is contributing to a plan of care for a school-age child who as attention deficit hyperactivity disorder. Which of following interventions should the nurse recommend? 1. Provide an immediate response to the child's attention-seeking behavior. 2. Instruct the child to apologize for behavior that negatively affects others. 3. Maintain a scheduled plan of activities regardless of the child's behavior. 4. Administer psychostimulant medication PRN when the child exhibits disruptive behavior.

2. Instruct the child to apologize for behavior that negatively affects others. The nurse should recommend simple restitution as a technique to manage the child's behavior This technique includes apologizing to others when the client's behavior has a negative effect.

A nurse in an acute-care mental health facility is caring for a client who is admitted with dementia. The client is becoming increasingly agitate. Which of the following should the nurse implement first? 1. Place the client in a private room. 2. Offer diversionary activities. 3. Administer haloperidol 4. Apply a wrist restraint.

2. Offer diversionary activities. When providing client care, the nurse should first use the least restrictive intervention; therefore, the nurse should first offer diversionary activities to distract the client and redirect energy into more appropriate behaviors.

A nurse is planning to reinforce discharge teaching for a client recovering from a heroin use disorder. Which of the following relapse prevention techniques should the nurse include in the plan? 1. Attending weekly Al-Anon meetings. 2. Participating in a methadone maintenance program. 3. Initiating psychoanalytic treatment. 4. Acquiring a prescription for acamprosate.

2. Participating in a methadone maintenance program. Part of an effective treatment strategy for a client who has a heroin use disorder is participating in a methadone maintenance program.

A school nurse is caring for an 8-year-old child who reports abdominal pain. The nurse asks, "When did the pain start?" The child replies, "It started when mommy's boyfriend hit me." Which of the following actions should the nurse perform first? 1. Notify the school administrator. 2. Perform a physical examination of the child. 3. Document the child's report of the injury. 4. Request for the school counselor to meet with the child.

2. Perform a physical examination of the child. The first action the nurse should take using the nursing process is to collect data from the client. Therefore, the first action the nurse should take is to perform a physical examination of the child.

A staff nurse is discussing client care with another nurse who is displaying behaviors of chemical impairment. Which of the following is an appropriate action? 1. File a report with the state board of nursing. 2. Report the concern the the nurse manager. 3. Verify suspicions with other nurses currently working. 4. Instruct the nurse to leave the facility.

2. Report the concern the the nurse manager. If a nurse suspects a colleague is chemically impaired, she is obligated to report this concern to the nurse manager. The nurse manager is then responsible for the intervention.

A nurse is reinforcing teaching with the family of a client who has been diagnosed with histrionic personality disorder. Which of the following high-risk behaviors should the family be instructed to observe for in the client? 1. Self-mutilation through cutting 2. Sexual activity with multiple partners 3. Repeated physical aggression 4. Reckless driving.

2. Sexual activity with multiple partners Sexual activity with multiple partners is a characteristic seen in clients who have histrionic personality disorder

A nurse is caring for a client who has bipolar disorder and is in a partial hospitalization program in which a therapeutic milieu has been established. Which of the following interventions should the nurse plan as the highest priority? 1. Assisting the client with baths and personal grooming. 2. Supporting the client's self-administration of medications. 3. Promoting communication with staff and other clients. 4. Encouraging the client to remain at the facility for at least 1 month.

2. Supporting the client's self-administration of medications. Nonadherence to the medication regimen places this client at the greatest risk for rehospitalization. Therefore, the priority intervention is to support the client in achieving self-administration of medication.

A charge nurse is assisting a newly licensed nurse with the care of an agitated adult client. The charge nurse plans to apply mechanical restraints. Which of the following statements made by the newly licensed nurse demonstrates an understanding of the appropriate guidelines for the use of restraints. 1. The nurse can have an assistive personnel evaluate the client's restraints at regular intervals. 2. The provider should make an in-person evaluation of the client within 1 hour of initiating the restraints. 3. The nurse requires a provider's prescription prior to initiating mechanical restraints. 4. The provider must reissue prescriptions for restraints every 8 hours for an adult client.

2. The provider should make an in-person evaluation of the client within 1 hour of initiating the restraints. The Joint Commission requires an in-person evaluation of a client within 1 hour of initiating restraints for safety and protection.

A nurse is assisting with a group therapy session. During the session, a client begins to use loud, aggressive language. Which of the following responses by the nurse is appropriate? 1. Why do you feel the need to speak aggressively to others in the group? 2. When you raise your voice, I feel uncomfortable and unsafe. 3. You are frightening others in the group when you show your anger. 4. Why are you attending group therapy but not respecting the feeling of others?

2. When you raise your voice, I feel uncomfortable and unsafe. Sending "I feel" messages models the sharing/owning of personal feelings and tends not to cause defensiveness in the client.

A nurse is an outpatient facility is caring for a client who has anxiety disorder. When the nurse attempts to administer an anxiolytic medications, the client refuses to take it. Which of the following is an appropriate nursing response? 1. This medication is quite safe for you to take. 2. You have the right to refuse this medication. 3. You are presenting a risk to other clients. 4. This medication is part of your treatment plan.

2. You have the right to refuse this medication. Clients have the right to refuse treatment, including medications, unless the client undergoes a court hearing during which the judge decides that the client meets criteria for involuntary medication administration.

A nurse is reinforcing teaching with a client who has obsessive-compulsive disorder and performs hand hygiene to decrease anxiety. Which of the following actions by he nurse indicates modeling as a behavioral intervention strategy? 1. Setting a time limit between episodes of hand hygiene. 2. Reminding the client to shout "stop" each time there is an urge to perform hand hygiene. 3. Demonstrating performing hand hygiene at appropriate times. 4. Instructing the client to practice muscle relaxation when experiencing the urge to perform hand hygiene.

3. Demonstrating performing hand hygiene at appropriate times. This action is an example of modeling, which is the behavioral intervention strategy that allows the client to see the expected behaviors performed by another.

A nurse is reinforcing teaching with a client whose provider has prescribed electroconvulsive therapy (ECT). Which of the following is appropriate to include in the teaching? 1. ECT is a first-line treatment for depression. 2. One to three ECT treatments is usually sufficient to treat manifestations of depression. 3. ECT may be prescribed for clients after lithium carbonate has been unsuccessful. 4. Some permanent memory impairment will occur as a result of ECT.

3. ECT may be prescribed for clients after lithium carbonate has been unsuccessful. Clients who have bipolar disorder and are in the manic phase may benefit from ECT is a course of medication is ineffective.

A nurse is caring for a client who has just experienced the death of her partner of 40 years. The client is having difficulty dealing with the loss. Which of the following is an appropriate suggestion that the nurse can give to help the client? 1. Recommend that the client spend time alone to reflect on the loss. 2. Suggest that the client try new activities every day. 3. Encourage the client to attend a grief group. 4. Explain to the client that the grief will resolve in a few months.

3. Encourage the client to attend a grief group. The nurse should suggest participation in a grief group, which will allow the client to share feeling and work through her grief with others experiencing similar feelings.

A nurse is caring for a newly admitted client in an acute care mental health facility. Which of the following activities should the nurse plan during the working phase of the therapeutic relationship? 1. Define the specific responsibilities of the client and of the nurse. 2. Assist the client to establish mutual goals. 3. Evaluate the client's progress toward meeting his goals. 4. Discuss how the client can incorporate new strategies into daily life.

3. Evaluate the client's progress toward meeting his goals. During the working phase of the therapeutic relationship, the nurse and the client explore together the problematic areas of the client's life. It is essential to evaluate the progress the client is making toward the goals he has established.

A nurse is collecting data from a client who has depression and is taking a monoamine oxidase inhibitor (MAOI). The nurse should report the use of which of the following OTC medications? 1. Docusate Sodium 2. IBU 3. Pseudoephedrine 4. Famotidine

3. Pseudoephedrine Pseudoephedrine is an OTC medication containing ephedrine and can interact with MAOIs, causing a HTN crisis. Therefore, the nurse should report the use of this medication to the provider.

A nurse is talking with a client who has borderline personality disorder. The client states she is lonely and thinks the other nurses avoid her but is afraid to share this concern with the other staff. Which of the following actions is appropriate for the nurse to take? 1. Encourage the use of transference in the nurse-client relationship. 2. Offer to talk to the staff until the client gains an increased level of trust. 3. Role-play this situation so the client can gain confidence expressing her feelings. 4. Ask the client why she thinks the staff is avoiding her.

3. Role-play this situation so the client can gain confidence expressing her feelings. Role-playing can provide practice in a safe environment where the client can learn new behaviors or skills. It could be a first step toward increased comfort in expressing concerns directly.

A nurse in a facility is caring for a client who has end-stage kidney failure. The client's family has been told that the client is not expected to live through the week. Which of the following statements by the nurse will assist the family with coping? 1. I will leave you to grieve for your father. 2. Your father won't be suffering much longer. 3. Tell me what activities your father enjoys. 4. You should try to adhere to your normal daily routine.

3. Tell me what activities your father enjoys. The nurse should use attentive listening and the therapeutic communication technique of exploring to give the family a chance to reflect on the client's life, which can facilitate the family's grieving process.

A nurse is caring for an older adult client who has a neurocognitive disorder (NCD) and whose partner dies several years ago. The client asks the nurse when his partner will visit because he misses her. The nurse states, "I can understand that you are lonely without your partner. Let's go to the lounge where you can join an activity and talk with others." Which of the following strategies is the nurse using? 1. Reminiscence therapy 2. Thought stopping 3. Validation therapy 4. Reality orientation

3. Validation therapy Validation therapy confirms and respects the client's feelings, even when the feelings don't correspond with reality. The goal is to validate feelings and integrate redirection techniques.

A nurse is reinforcing teaching with an adult client who has injuries as a result of intimate partner abuse. Which of the following actions should the nurse take? 1. Insist that the client report the attack to the authorities before beginning treatment. 2. Advise the client to obtain an order of protection from the court. 3. Recommend the client's partner be present during the interview with the client. 4. Encourage the client to develop a safety plan.

4. Encourage the client to develop a safety plan. The nurse should encourage the client to develop a safety plan to aid in escaping further abuse.

A nurse is monitory communication between a client who has alcohol use disorder and his partner. Which of the following communication patterns of the client's partner should the nurse identify as being effective? 1. I can never talk to you, because you are always drunk. 2. Don't be mad at the kids. It was my fault that the dishes did not get done. 3. Because of your drinking, we can't have guests in our home. 4. I become very angry when you get drunk.

4. I become very angry when you get drunk. This is an example of a healthy, effective communication pattern. The family member is discussing personal feelings, rather than focusing on the client's negative behavior.

A nurse is caring for a client who is being treated for alcohol use disorder. Which of the following statements by the client requires further reinforcement of teaching? 1. It is likely that I will experience episodes of relapse as I continue to recover. 2. Attendance to AA is my best bet for recovery. 3. It is okay to reach out and begin to make amends with those I may have hurt when I was drinking. 4. I can still go out with my usual friends. as long as I do not drink.

4. I can still go out with my usual friends. as long as I do not drink. Socializing with friends who drink alcohol can make it difficult for the client to abstain. Clients should avoid situations that are likely to result in relapse, such as socializing with friends who drink alcohol.

A client who is slightly overweight is admitted to an inpatient eating disorder unit for bulimia nervosa with purging. Which of the following client statements indicates a need for further reinforcement of client teaching regarding effective management of bulimia? 1. I will have staff observing me during and after my meals for a while. 2. I can eventually strive to achieve my ideal weight. 3. I should explore my perception of shape and weight. 4. I need to avoid exercise until I am recovered.

4. I need to avoid exercise until I am recovered. A progressive exercise program is an important part of health and weight management and is appropriate for a client who has bulimia nervosa and is slightly overweight.

A nurse working is an inpatient facility is caring for a client who has severe depression. A no-suicide contract is in place. The client reports "finally being at peace" and suddenly displays a higher level of energy. Which of the following actions is appropriate? 1. Discontinue the no-suicide contract. 2. Tell the client this change is an indicator for discharge. 3. Reward the client with independent free time. 4. Suspect an upcoming suicide attempt.

4. Suspect an upcoming suicide attempt. The nurse should be aware that clients displaying increased energy levels are at higher risk for putting suicidal plans into action. Clients may develop a sense of well-being by reaching the decision to move forward with the suicidal plan.