NUR 414A Suicide

The nurse is performing an admission assessment on a client at high risk for suicide. Which assessment question will best elicit data related to this risk? 1."What are you feeling right now?" 2."Do you have a plan to commit suicide?" 3."How many times have you attempted suicide in the past?" 4."Why were your attempts at suicide unsuccessful in the past?"

2

what is the biggest risk factor for suicide?

a previous attempt

what medications may be used for the pt with suicidal ideation

antidepressants -- monitor for increased mood, may indicate impending suicide because they now have the energy to do it

what are the THEMES in pts with suicidal ieation

hopelessness, meaninglessness, being out of control

A client who attempted suicide by hanging is brought to the emergency department by emergency medical services. Which is the immediate nursing action? 1.Take the client's vital signs, including pulse oximetry reading. 2.Assess the client's respiratory status and for the presence of neck injuries. 3.Perform a focused assessment, paying particular attention to the client's neurological status. 4.Call the mental health crisis team and notify them that a client who attempted suicide is being admitted.

2

A depressed client is found unconscious on the floor in the dayroom of a health care facility. The nurse finds several empty bottles of a prescribed tricyclic antidepressant lying near the client. Which is the priority action of the nurse? 1.Call the poison control center. 2.Call the emergency response team. 3.Determine the exact number of pills taken. 4.Induce vomiting and notify the primary health care provider.

2

Which client's death was achieved by what is considered a soft suicide method? 1.Claimed to be going hunting and then shot himself while alone in the woods 2.Hung himself after becoming aware that he would be arrested for domestic violence 3.Sat in a running car parked in her locked garage to die of the carbon monoxide inhalation 4.Left a suicide note sharing that she was planning to jump off the bridge into a secluded part of the river

3

The nurse is interviewing a client in crisis to assess the risk for self-harm. The nurse interprets that the client is most at risk for suicide when which factor is identified? 1.Client exhibits impulsive behavior. 2.Client exhibits disorganized behavior. 3.Client has a history of suicide attempts. 4.Client has an immediate plan for a suicide attempt.

4

treatments for suicide prevention

CBT-SP (suicide prevention) antidepressants try to give pt hope; crucial to replace suicidal tendencies with active pursuit of life purpose and meaning

what is suicide

when pts direct violence at themselves with the intent to end their lives, dying as a result

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? 1.Requesting that a peer remain with the client at all times. 2.Removing the client's clothing and placing the client in a hospital gown. 3.Assigning to the client a staff member who will remain with the client at all times. 4.Admitting the client to a seclusion room where all potentially dangerous articles are removed.

3

what are protective factors

-buffer pts from suicidal thoughts and behaviors -easy access to clinical interventions and support -family and community support -cultural and religious beliefs (get chaplain to speak with pt)

what are non-verbal clues of suicide

-seeking lethal means (weapons, drugs, locations) -getting ones affairs in order by giving away possessions -withdrawing from others socially, refusing to interact with others, or self-imposed isolation -self destructive behavior (drugs, violence, self-injury) -sudden sense of calm in pt who has been depressed as though they have a "solution" -changes in eating, sleeping, hygiene, reduced engagement in previously enjoyable activities

what are soft methods?

-slashing one's wrists -inhaling natural gas -ingesting pills

The emergency department nurse is preparing to administer fomepizole to a client suspected of ingesting antifreeze solution during a suicidal attempt. The nurse should prepare to administer this medication by which method? 1.Direct intravenous (IV) bolus 2.Diluting the medication and administering it rapidly by the IV route 3.Administering the medication through a nasogastric tube, followed by activated charcoal 4.Diluting the medication in 100 mL of 0.9% normal saline and administering it over 30 minutes

4

The spouse of a client prescribed an antidepressant tells the home health nurse, "Now that the antidepressant is working, the suicidal risk is over and you can stop making these home visits." How does the nurse appropriately respond? 1."I need to continue with my visits since this disease tends to run in families." 2."I agree with you that the medication will greatly reduce the risk for suicidal behavior." 3."I agree with you that continuing to visit would reintroduce the possibility of suicidal ideations." 4."I need to continue visiting since the client may now have the energy to act on suicidal intentions."

4

the nurse should communicate openness and acceptance of suicidal pts feelings and life situation. the nurse should encourage ____?

expression of feelings

what is lethality

how capable something is of causing death

what are the 2 levels of suicide prevention

level 1 (frequent observation) -- checks Q15min level 2 (continuous observation) -- IMMEDIATE AND SERIOUS THREAT, uninterrupted observation is required

what is the primary intervention for suicide

provide support, information, and education to prevent suicide

what is suicidal ideation

pt has thoughts of wanting to die

what is secondary intervention for suicide

screening for suicide and suicide hotline

what is one of the most important things for the nurse to remember when asking the pt about their plan for suicide?

talking to the pt about the suicidal ideation DOES NOT drive them to suicide -- it provides a sense of RELIEF

what are the most frequent methods of suicide in an inpatient setting

hanging, suffocation, jumping

What is the priority nursing action when admitting a client who has just attempted suicide? 1.Ensure constant observation of the client at all times. 2.Conduct a thorough mental health assessment of the client. 3.Determine whether the client has ever attempted suicide previously. 4.Remove all potentially dangerous articles from among the client's belongings.

1

Which client is at greatest risk for committing suicide? 1.A client with metastatic cancer 2.A client with a newly diagnosed cardiac disorder 3.A client who just had an argument with her fiancé 4.A newly divorced client who states she has custody of the children

1

Which assessment data would indicate that a client is most at risk for suicide? 1.The client demonstrates impulsiveness. 2.The client is disorganized in actions and thoughts. 3.The client has an immediate plan for a suicide attempt. 4.The client has a history of unsuccessful suicide attempts.

3

what are hard methods?

-using a gun -jumping off a high place -hanging -poisoning with carbon monoxide -staging a car crash

what are suicide precautions and what care is needed

-1 on 1 observation that is continuous -pt not allowed to go or do anything by themselves (not even go to bathroom alone) -provide no harm/no-suicide contract -use plastic silverware, not metal -private rooms with doors open, but windows cannot be opened with unbreakable glass -unable to hang anything from shower curtain rod and everything is locked -belongings are searched (no razor, matches, etc. to hurt themselves) and make sure visitors don't bring anything

who is at risk for suicide?

-chronic mental disorders -soldiers and veterans -hx of trauma/abuse as a child -hx of prior suicide attempts - BIG RISK FACTOR -family hx of suicide -alcohol and drug use -economic or bereavement loss -serious physical illness or chronic pain -social isolation -access to lethal means -recent release from inpatient psychiatric hospitalization

how do you assess lethality?

-is there a specific plan with details? -how lethal is the proposed method? -is there access to the planned method?

The nurse is caring for a client who is at risk for suicide. What is the priority nursing action for this client? 1.Provide authority, action, and participation. 2.Display an attitude of detachment, confrontation, and efficiency. 3.Demonstrate confidence in the client's ability to deal with stressors. 4.Provide hope and reassurance that the problems will resolve themselves.

1

if the pt is POSITIVE for suicidal ideation, continue to ask about "SAL", which is:

is it specific? is it accessible? is it lethal?

what is the 1st step to assessing a pt who is potentially suicidal

ask the pt about suicidal thoughts directly -have you been having thoughts about wanting to harm yourself? -have you been feeling like you don't want to live anymore?

how should you prevent inpatient suicides

-breakaway bars, rods, shower heads -low flushing toilets -adequate visualization of high risk areas -use of monitoring equipment -observation at frequency by risk -prescribed observation checklist -suicide risk assessments -check for contraband on admission -meds to tx conditions that contribute to risk -engagement of family/friends -identify high-risk populations -consideration of staff assignments -staff performance reviews -provisions for shift change

important discharge planning for pt who was suicidal

-explain uneven recovery path to family and pt -inform family/friends about s/s of increased suicide risk - sleep disturbance, anxiety, agitation, suicidal expressions or behaviors -document if pt does not want contact with family -provide info for follow up appointment -provide prescriptions that allow for reasonable supply to last until follow up appointment -provide info on local resources

The nurse is working at a Veterans Affairs clinic that provides services for homeless veterans. Which client should the nurse attend to first? 1.A client with a persistent cough 2.A client with a plan to harm himself 3.An amputee with an infected wound 4.A client with a history of substance abuse

2

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? 1."You have everything to live for." 2."Why do you see yourself as a failure?" 3."Feeling like this is all part of being depressed." 4."You've been feeling like a failure for a while?"

4

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? 1."Have you talked to your family about this?" 2."Everyone feels this way when they are depressed." 3."You will feel better once your medication begins to work." 4."You sound very upset. Are you thinking of hurting yourself?"

4

The nurse determines that which client is at highest risk for suicide? 1.An African American male lawyer who is 47 years old and recently divorced 2.A 25-year-old housewife who cares for a 2-year-old son and a 3-year-old stepdaughter 3.A 39-year-old single parent who dropped out of high school and whose children are both in medical school 4.An 18-year-old who abuses both alcohol and drugs and who will not meet the requirements for graduation

4

what is tertiary intervention for suicide

care for pt who is a survivor of suicide attempt OR care for family members where pt was successful in suicide

what are verbal clues of suicide

-taking about suicide -preoccupation with death and generally obsessively focused on morbid concepts -no hope for future as expressed in helplessness -giving up or avoiding long-term plans -saying goodbye to loved ones or writing messages that seem to be suicide notes -expressing self-hatred, loathing, regret, worthlessness, feeling like a burden -complaints about physical discomforts like pain, exhaustion, or nausea

The nurse is planning care for a client being admitted to the nursing unit who attempted suicide. Which priority nursing intervention should the nurse include in the plan of care? 1.One-to-one suicide precautions 2.Suicide precautions with 30-minute checks 3.Checking the whereabouts of the client every 15 minutes 4.Asking the client to report suicidal thoughts immediately

1

Which statement made by an assistive personnel (AP) indicates to the registered nurse that the AP understands the concepts related to suicide? 1."Discussing suicide with a client is not harmful." 2."Those clients who talk about suicide never do it." 3."Depressed clients are the only persons who commit suicide." 4."A suicide threat is a cry for attention from family and friends."

1

The nurse is creating a plan of care for a newly admitted client at high risk for suicide. With the focus of the plan being to promote a safe and therapeutic environment, which intervention should the nurse include? 1.Place the client in a private room. 2.Establish a therapeutic relationship. 3.Assign a leadership task to the client. 4.Maintain a distance of 10 inches at all times.

2

The nursing care plan indicates a problem of self-directed violence and the risk for suicide related to suicidal ideations with a specific plan. The nurse develops a plan of care for the client and identifies which expected client outcome? 1.Displays less anxiety and agitation 2.Denies presence of suicidal ideations 3.Develops adequate problem-solving skills 4.Establishes a relationship with staff and peers

2

A homebound client confidentially discusses suicidal plans with the visiting nurse. Based on professional duty to observe confidentiality, which statement describes the nurse's obligation to the client? 1.Arrange for the client to go to the local mental health center daily for counseling. 2.Ask the client's permission to reveal the suicidal plans to the primary health care provider (PHCP). 3.Assure the client that the confidence between nurse and client will be strictly adhered to. 4.Share that the risk to the client's safety requires that the client's PHCP be notified.

4

The police arrive at the emergency department with a client who has lacerated both wrists. Which is the initial nursing action? 1.Administer an antianxiety agent. 2.Assess and treat the wound sites. 3.Secure and record a detailed history. 4.Encourage and assist the client to ventilate feelings.

2