Suicide

A nurse working on an inpatient unit is assigned to care for two clients diagnosed with severe depression and attempted suicide. After reviewing the client care assignment, the nurse should institute which nursing action? A. Consult with the admitting physician about the clients' condition B. Ask the supervisor to move both clients to the same room C. Request that the client care assignment be changed D. Document on the client's chart the lack of staffing resources

C The request for an assignment change would help ensure client safety and is a reasonable nursing action. Suicidal clients require frequent assessments, and the nurse can't safely monitor both clients.

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? A. A client's verbal threat of suicide is attention-seeking behavior B. Interventions are ineffective for clients who really want to commit suicide C. Using the term suicide increases the client's risk for a suicide attempt D. A no-suicide contract decreases the client's risk for suicide

D The use of a no-suicide contract decreases the client's risk for suicide by promoting and maintaining trust between the nurse and the client. However, it should not replace other suicide prevention strategies.

A client with major depression tells the nurse, "Life isn't worth living. I can't stand the pain any longer." The nurse should recognize this statement as indicative of: A. the need for a suicide assessment B. the need for a pain assessment C. the need to administer an antidepressant D. the need to provide diversional stimuli

A Because this client has verbalized passive suicidal ideation, the nurse should begin a suicide assessment with a direct question about suicide.

Recently, an adolescent has become increasingly withdrawn, has grown irritable with family members, and has been getting lower grades on schoolwork. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which problem is the adolescent at risk for? A. Suicide B. Anorexia C. School phobia D. Psychotic episode

A Changes in academic performance, familial communication, social withdrawal, and the giving away of treasured possessions are behaviors that suggest this adolescent is contemplating suicide.

Which nursing intervention takes priority when working with a newly admitted client experiencing suicidal ideations? A. Monitor the client at close, but irregular, intervals B. Encourage the client to participate in group therapy C. Enlist friends and family to assist the client in remaining safe after discharge D. Remind the client that it takes 6 to 8 weeks for antidepressants to be fully effective

A Clients who experience suicidal ideations must be monitored closely to prevent suicide attempts. By monitoring at irregular intervals, the nurse would prevent the client from recognizing patterns of observation. If a client recognizes a pattern of observation, the client can use the time in which he or she is not observed to plan and implement a suicide attempt.

A 35-year-old - who's a divorced patent of three - was admitted 5 days ago with major depression after a suicide attempt. He was prescribed a daily dosage of fluoxetine (Prozac). Since starting the medication, his appetite and participation in group therapy have improved. Which nursing diagnosis should receive the highest priority? A. Risk for self-directed violence related to suicide attempt B. Deficient knowledge related to antidepressant therapy C. Chronic low self-esteem related to recurrent depression D. Anxiety related to disruption in role performance

A Despite the improvement in appetite and group participation, the client's risk for self-inflicted harm remains a priority. When depression is resolving, the client can focus more on carrying out a suicide plan.

A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client? A. Allow the client time to mourn the loss during his time of shiva B. Distract the client from the loss and encourage participation in unit group C. Teach the client alternative coping skills to deal with grief D. Discuss positive aspects the client has in his or her life to build on strengths

A In the Jewish faith, the 7-day period beginning with the burial is called shiva. During this time, mourners do not work, and no activity is permitted that diverts attention from thinking about the deceased. Because this client's parent died 2 days ago, the client needs time to participate in this religious ritual.

A client has a nursing diagnosis of risk for suicide R/T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize? A. The client will remain free from injury throughout hospitalization B. The client will set one realistic goal related to relationships by day 3 C. The client will verbalize one positive attribute about self by day 4 D. The client will be easily redirected when discussion about suicide occurs by day 5

A Remaining free from injury throughout hospitalization is a priority outcome for the nursing diagnosis of risk for suicide R/T a past suicide attempt. Because this outcome addresses client safety, it is prioritized.

A client, admitted after experiencing suicidal ideations, is prescribed citalopram (Celexa). Four days later, the client has pressured speech and is noted wearing heavy makeup. What may be a potential reason for this client's behavior? A. The client is in a manic episode caused by the citalopram (Celexa) B. The client is showing improvement and is close to discharge C. The client is masking depression in an attempt to get out of the hospital D. The client has "cheeked" medications and taken them all in an attempt to overdose

A When an SSRI is prescribed for clients diagnosed with bipolar affective disorder, it can cause alterations in neurotransmitters and trigger a hypomanic or manic episode.

The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical. A. "Are you currently thinking about suicide?" B. "Do you have a gun in your possession?" C. "Do you have a plan to commit suicide?" D. "Do you live alone? Do you have local friends or family?"

A,C,B,D -Assessment of suicidal ideations must occur before any other assessment data are gathered. If the client is not considering suicide, continuing with the suicide assessment is unnecessary. -Assessment of a suicide plan is next. A client's risk for suicide increases if the client has developed a specific plan. -Assessment of the access to the means to commit suicide is next. The ability for the client to access the means to carry out the suicide plan is an important assessment in order for the nurse to intervene appropriately. If a client has a loaded gun available to him or her at home, the nurse would be responsible to assess this information and initiate actions to decrease the client's access. -Assessment of the client's potential for rescue is next. If a client has an involved support system, even if a suicide attempt occurs, there is a potential for rescue. Without an involved support system, the client is at higher risk.

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (Select all that apply) A. Conducting a suicide risk screening on all new clients B. Creating a support group for family members of clients who completed suicide C. Educating high school teens about suicide prevention D. Initiating one-on-one observation for a client who has current suicidal ideation E. Teaching middle-school educators about warning indicators of suicide

A,C,E -Primary interventions include suicide prevention through the use of screenings to identify individuals at risk. Conducting a suicide risk screening on all new clients is an example of a primary intervention. -Primary interventions include suicide prevention through the use community education. Educating high school teens about suicide prevention is an example of a primary intervention. -Primary interventions include suicide prevention through the use community education. Educating middle-school teachers to recognize the warning indicators of suicide is an example of a primary intervention.

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply) A. "My family will be better off if I'm dead." B. "The stress in my life is too much to handle." C. "I wish my life was over." D. "I don't feel like I can ever be happy again." E. "If I kill myself then my problems will go away."

A,C,E These statements are overt comments about suicide in which the client directly talks about his perception of an outcome of his death. The nurse should assess the client further for a suicide plan.

A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred? A. "Approximately 10,000 individuals in the United States will commit suicide each year." B. "Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder." C. "Suicide is the eighth leading cause of death among young Americans 15 to 24 years old." D. "Depressive disorders account for 1/3 of all individuals who commit or attempt suicide."

B Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. Most suicides are associated with mood disorders.

A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first ? A. Request a psychiatric consultation B. Complete a thorough physical assessment including lab tests C. Remove all hazardous materials from the environment D. Place the client on a one-to-one observation

B Numerous physical conditions can contribute to symptoms of insomnia, including irritability, anorexia, and depressed mood. It is important for the nurse to rule out these physical problems before assuming that the symptoms are psychological in nature. The nurse can do this by completing a thorough physical assessment including review of lab tests.

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of the client's social support D. Client's insight into the reasons for the decision

B The greatest risk to the client is self-harm as a result of carrying out a suicide plan. The priority assessment is to determine how lethal the method is, how available the method is, and how detailed the plan is.

A client has taken a bottle of acetaminophen (Tylenol) in an attempt to commit suicide. In response to the client's situation, the nurse follows proper protocol. List in chronological order the priority of the nursing actions that should be taken. Use all options. A. Speak directly about the suicide attempt B. Don't leave the client alone C. Focus on the current crisis D. Evaluate teh need for medication

B,A,C,D When executing the protocol for a client who has attempted suicide, the nurse should institute one-on-one observation so that the client is never left alone. After observation is established, the nurse should speak openly and directly about the suicide attempt. The nurse should accept the client's thoughts and feelings, especially negative feelings. Discussion should focus on the client's current crisis situation. After performing these actions, the client should be evaluated for the need for antidepressant therapy, if warranted.

A client diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Aoprazolam (Xanax) is prescribed. Which assessment should be prioritized? A. Monitor for signs and symptoms of physical and psychological withdrawal B. Teach the client about side effects of the medication and how to handle these side effects C. Assess for nausea and give the medication with food if nausea occurs D. Ask the client to rate his or her mood on a mood scale and monitor for suicidal ideations.

D Alprazolam is a central nervous system depressant, and it is important for the nurse in this situation to monitor for worsening depressive symptoms and possible worsening of suicidal ideations.

After an upsetting divorce, a client had been threatening to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis has the highest priority for this client? A. Hopelessness related to recent divorce B. Ineffective coping related to inadequate stress management C. Spiritual distress related to conflicting thoughts about suicide and sin D. Risk for self-directed violence related to planning to commit suicide by handgun

D Although all of these nursing diagnoses may apply to this client, the nurse's first priority in caring for any suicidal client is safety. The presence of a plan increases the level of suicidal risk.

A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. Assign the client to a private room B. Document the client's behavior every hour C. Allow the client to keep perfume in her room D. Ensure that the client swallows medication

D Ensure that the client swallows medication to prevent hoarding of medication for an attempted overdose.

A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Vilazodone (Viibryd) is prescribed. Which nursing intervention takes priority? A. Remind the client that medication effectiveness may take 2 to 3 weeks B. Teach the client to take the medication with food to avoid nausea C. Check the client's blood pressure every shift to monitor for hypertension D. Monitor closely for signs that the client might be "cheeking" medication.

D If a client comes into the in-patient psychiatric unit with a plan to overdose, it is critical that the nurse monitor for cheeking and hoarding of medications. Clients may cheek and hoard medications to take, as an overdose, at another time.

A nurse is caring for a client who is suicidal. When accompanying the client to the bathroom, the nurse should: A. give him privacy B. allow him to shave C. open the window and allow him to get some fresh air D. observe him

D The nurse has a responsibility to continuously observe an acutely suicidal client. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent the client from attempting to hang himself or otherwise injure himself. The nurse should check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse should also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.