Chapter 12: Suicide Prevention

Some biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? A. Genetics and decreased levels of serotonin B. Heredity and increased levels of norepinepherine C. Temporal lobe atrophy and decreased levels of acetylcholine D. Structural alterations of the brain and increased levels of dopamine.

A.Genetics and decreased levels of serotonin

Which of the following interventions are appropriate for a client on suicide precautions? Select all that apply. A. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. B. Accompany the client to off-unit activities. C. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours. D. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

A, B, C A. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. B. Accompany the client to off-unit activities. C. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours.

The nurse identified the primary nursing diagnosis for Theresa as Risk for Suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would most accurately measure achievement of this diagnosis? A. The client has experienced no physical harm to herself. B. The client sets realistic goals for herself. C. The client expresses some optimism and hope for the future. D. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend.

A. The client has experienced no physical harm to herself.

12. A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? 1. The more specific the plan is, the more likely the client will attempt suicide. 2. Clients who talk about suicide never actually commit it. 3. Clients who threaten suicide should be observed every 15 minutes. 4. After a brief assessment, the nurse should avoid the topic of suicide.

ANS: 1 Page: 236 Feedback 1 Clients who have specific plans are at greater risk for suicide. 2 Clients who talk about suicide should be taken seriously. 3 One-to-one supervision should be provided for any client who threatens suicide. 4 The nurse should be direct and upfront when discussing suicide with clients and their families.

23. A client has been brought to the emergency department for signs and symptoms of chronic obstructive pulmonary disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? 1. Assessing the client's pulse oximetry and vital signs 2. Developing a plan for safety for the client 3. Assessing the client for suicidal ideations 4. Establishing a trusting nurse-client relationship

ANS: 1 Page: 237 Feedback 1 It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow's hierarchy of needs. This client's problems with oxygenation will take priority over assessing for current suicidal ideations as they can lead to death more quickly if not reversed. 2 Developing a plan for safety can occur after physical needs have been met. 3 Assessing for suicidal ideation can occur after physical needs have been met. 4 Establishing a nurse-client relationship can occur after physical needs have been met.

19. Which nursing intervention strategy is most important to implement initially with a suicidal client? 1. Ask a direct question such as, "Do you ever think about killing yourself?" 2. Ask client, "Please rate your mood on a scale from 1 to 10." 3. Establish a trusting nurse-client relationship. 4. Apply the nursing process to the planning of client care.

ANS: 1 Page: 237 Feedback 1 The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. 2 Asking the client to rate mood does not help assess suicide risk. 3 Establishing a nurse-client relationship does not help assess suicide risk. 4 Applying the nursing process to planning does not help assess suicide risk.

24. After a teenager reveals that he is gay, his father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal grief responses should a nurse anticipate? Select all that apply. 1. "I can't believe this is happening." 2. "If only I had been more understanding." 3. "How dare he do this to me!" 4. "I'm just going to have to accept that he was gay." 5. "Well, that was a selfish thing to do."

ANS: 1, 2, 3 Page: 239-240 Feedback 1. Suicide of a family member can induce a whole gamut of feelings in the survivors, including shock. 2. Suicide of a family member can induce a whole gamut of feelings in the survivors, including guilt. 3. Suicide of a family member can induce a whole gamut of feelings in the survivors, including anger. 4. Stating, "I'm just going to have to accept that he was gay," reflects acceptance and understanding. 5. Stating, "Well, that was a selfish thing to do," reflects acceptance and understanding.

11. A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? 1. Elderly people use less lethal means to commit suicide. 2. Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3. Suicide is the second leading cause of death among the elderly. 4. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

ANS: 2 Page: 234 Feedback 1 The elderly do not necessarily use less lethal means of committing suicide. 2 Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3 Suicide is not the second leading cause of death among the elderly. 4 An expressed desire to die is not normal in any age group.

10. After years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care? 1. "Have there been any changes in appetite or sleep?" 2. "How often is your spouse left alone?" 3. "Has your spouse been following a diet and exercise program consistently?" 4. "How would you characterize your relationship with your spouse?"

ANS: 2 Page: 237 Feedback 1 Changes in appetite or sleep do not accurately indicate risk for suicide. 2 This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of self-harm. 3 Asking about diet and exercise do not assess risk for suicide. 4 Asking about the client's relationship with his spouse does not accurately assess the risk for suicide.

5. A nurse admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this client's safety upon discharge? 1. Provide a 6-month supply of Elavil to ensure long-term compliance. 2. Provide a 3-day supply of Elavil with refills contingent on follow-up appointments. 3. Provide a pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

ANS: 2 Page: 237 Feedback 1 This amount of medication may be enough for the client to overdose. 2 The health-care provider should provide no more than a 3-day supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential. In addition, clients may gain energy to carry out a suicide once they begin to have more energy from taking the antidepressants. 3 This option would not prevent the client from committing suicide. 4 This option does not prevent suicide.

17. A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? 1. "Suicidal threats and gestures should be considered manipulative and/or attention-seeking." 2. "Suicide is the act of a psychotic person." 3. "All suicidal individuals are mentally ill." 4. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

ANS: 4 Page: 230-232 Feedback 1 This statement is inaccurate regarding suicide. 2 This statement is untrue regarding suicide. 3 This statement is a myth about suicide. 4 It is a fact that between 50 and 80 percent of all people who kill themselves have a history with a previous attempt.

16. Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? 1. The client will not physically harm self. 2. The client will express three positive self-attributes by day four. 3. The client will reveal a suicide plan. 4. The client will establish a trusting relationship.

ANS: 2 Page: 237 Feedback 1 This outcome may take time for the client to commit to. 2 Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes should be client-centered, specific, realistic, and measurable and contain a time frame. 3 This outcome may be a big step for the client. 4 This outcome may not be realistic right away for the client.

9. A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? 1. "Your grieving will subside within 1 year; until then I recommend antidepressants." 2. "Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area." 3. "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them." 4. "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

ANS: 2 Page: 240 Feedback 1 This statement is not therapeutic for the family or helpful. 2 Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work. 3 This statement provides inaccurate information to the family. 4 This statement is inaccurate and not therapeutic to the family.

18. A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse should conclude which client would potentially be at highest risk for suicide? 1. Roman Catholic 2. Protestant 3. Atheist 4. Muslim

ANS: 3 Page: 231 Feedback 1 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin. 2 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin. 3 An atheist does not believe in punishment for suicide by a higher power. 4 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin.

22. A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? 1. Family history of depression 2. The client's orientation to reality 3. The client's history of suicide attempts 4. Family support systems

ANS: 3 Page: 232 Feedback 1 Family history of depression is not critical to determining risk for suicide. 2 Client's orientation to reality not critical to determining risk for suicide. 3 A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client's risk. Of those who commit suicide, 50-80 percent had a previous attempt. 4 Family support systems are not critical to determining risk for suicide.

14. A new nursing graduate asks the psychiatric nurse manager how to best classify suicide. Which is the nurse manager's best reply? 1. "Suicide is a DSM-5 diagnosis." 2. "Suicide is a mental disorder." 3. "Suicide is a behavior." 4. "Suicide is an antisocial affliction."

ANS: 3 Page: 236 Feedback 1 Suicide is not a diagnosis. 2 Suicide is not a disorder. 3 Suicide is a behavior. 4 Suicide is not an affliction.

4. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase frequency of client observation. 4. Request that the psychiatrist reevaluate the current medication protocol.

ANS: 3 Page: 236 Feedback 1 The client should not be given off-unit privileges, as this could be unsafe. 2 Group involvement is important, but client safety must take priority. 3 The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication. 4 Medication can be reevaluated after client safety has been established.

21. Which client data indicates that a suicidal client is participating in a plan for safety? 1. Compliance with antidepressant therapy 2. A mood rating of 9/10 3. Disclosing a plan for suicide to staff 4. Expressing feelings of hopelessness to nurse

ANS: 3 Page: 238-239 Feedback 1 Compliance with antidepressant therapy does not indicate the client participating in a plan for safety. 2 A mood rating of 9/10 does not indicate the client participating in a plan for safety. 3 A degree of the responsibility for the suicidal client's safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide. 4 Expressing feelings of hopelessness do not indicate the client participating in a plan for safety.

20. A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? 1. Encouraging participation in the milieu to promote hope 2. Developing a strong personal relationship with the client 3. Observing the client at intervals determined by assessed data 4. Encouraging and redirecting the client to concentrate on happier times

ANS: 3 Page: 238-239 Feedback 1 Encouraging participation does not best lower the client's risk for suicide. 2 Developing a personal relationship with the client does not best lower the client's risk for suicide. 3 The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors. 4 Encouraging and redirecting the client does not best lower the client's risk for suicide.

8. The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? 1. Address only serious suicide threats to avoid the possibility of secondary gain. 2. Promote trust by verbalizing a promise to keep suicide attempt information within the family. 3. Offer a private environment to provide needed time alone at least once a day. 4. Be available to actively listen, support, and accept feelings.

ANS: 4 Page: 236 Feedback 1 Addressing only serious suicide threats would not be helpful to the client. 2 Keeping suicide attempts a secret in the family does not help the client. 3 Providing alone time does not help the client. 4 Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

15. A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first? 1. Communicate therapeutically. 2. Observe the client. 3. Provide a hazard-free environment. 4. Assess suicide risk.

ANS: 4 Page: 236 Feedback 1 After assessing suicide risk, the nurse can communicate therapeutically. 2 After assessing suicide risk, the nurse can observe the client. 3 After assessing suicide risk, the nurse can provide a hazard-free environment. 4 Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment should always be the first step taken when working with depressed or suicidal patients.

7. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? 1. No previous admissions for major depressive disorder 2. Vital signs stable; no psychosis noted 3. Able to comply with medication regimen; able to problem-solve life issues 4. Able to participate in a plan for safety; family agrees to constant observation

ANS: 4 Page: 236 Feedback 1 History of admissions does not focus on suicide prevention. 2 Assessment of vital signs does not focus on suicide prevention. 3 Compliance with medication regimen does not focus on suicide prevention. 4 Participation in a plan of safety and constant family observation will decrease the risk for self-harm.

6. During a one-to-one session with a client, the client states, "Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? 1. Powerlessness R/T altered mood AEB client statements 2. Risk for injury R/T altered mood AEB client statements 3. Risk for suicide R/T altered mood AEB client statements 4. Hopelessness R/T altered mood AEB client statements

ANS: 4 Page: 236 Feedback 1 The client is experiencing hopelessness. This diagnosis would be inappropriate. 2 Risk for injury has not been identified. 3 Risk for suicide has not been identified. 4 The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the client's suicidal ideations and intent would be necessary.

13. A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? 1. "Why don't you consider doing volunteer work in a homeless shelter?" 2. "Let's discuss the negative aspects of your life." 3. "Things will look better in the morning." 4. "It sounds like you are feeling pretty hopeless."

ANS: 4 Page: 236 Feedback 1 This question does not help the client open up about feelings. 2 This statement does not help the client discuss feelings. 3 This statement may be degrading to the client's feelings. 4 This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

3. A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse's priority intervention at this time? A. Obtaining an order for locked seclusion until client is no longer suicidal B. Conducting 15-minute checks to ensure safety C. Placing the client on one-to-one observation while monitoring suicidal ideations D. Encouraging client to express feelings related to suicide

ANS: C Page: 236 Feedback A. Seclusion may be excessive for this client. B. Checks every 15 minutes would be inadequate for this client. C. The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation. D. The client's physical safety is the priority.

1. A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note B. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting, because the client's threat must be addressed

ANS: C Page: 236 Feedback A. This action would not be appropriate and could be considered a restraint. B. Establishing room restrictions does not keep the client safe in the immediate situation. C. The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide. D. The client's immediate safety is a priority.

2. During the planning of care for a suicidal client, which correctly written outcome should be a nurse's first priority? A. The client will not physically harm self. B. The client will express hope for the future by day three. C. The client will establish a trusting relationship with the nurse. D. The client will remain safe during the hospital stay.

ANS: D Page: 236 Feedback A. This answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, realistic, and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated. B. This option may take longer to achieve. C. This option is important, but safety must be established first. D. The nurse's priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's priority.

Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is the most appropriate in this instance? A. Obtain an order from the physician to place Theresa in restraints to prevent any attempts to harm herself. B. Check on Theresa every 15 minutes or assign a staff person to stay with her on a one-to-one basis. C. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas. D. Do not allow Theresa to participate in any unit activities while she is on suicide precautions.

B. Check on Theresa every 15 minutes or assign a staff person to stay with her on a one-to-one basis.

Which of the following individuals is at highest risk for suicide? A. Nancy, age 33, Asian American, Catholic, middle socioeconomic group, alcoholic b. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastatic cancer of the pancreas C. Carol, age 15, African American, Baptist, high socioeconomic group, no physical or mental health problems D. Mike, age 55, Jewish, middle socioeconomic group, suffered myocardial infarction a year ago

B. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastatic cancer of the pancreas

Success of long-term psychotherapy with Theresa (Who attempted suicide following a break up with her boyfriend) could be measured by which of the following behaviors? A. Theresa has a new boyfriend B. Theresa has an increased sense of self-worth C. Theresa does not take antidepressants anymore D. Theresa told her old boyfriend how angry she was with him for breaking up with her

B. Theresa has an increased sense of self-worth

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa." b. "Forget him. There are other fish in the sea." c. "You must be feeling very sad about your loss." d. "Why do you think he broke up with you, Theresa?"

C. "You must be feeling very sad about your loss."

In determining the degree of suicidal risk with a suicidal client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily liver, no close support systems. The nurse identifies the client's risk for suicide as: A. Low B. Moderate C. High D. Unable to determine

C. High

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? A. You are safe here. We will make sure nothing happens to you. B. You're just lucky your roommate came home when she did. C. What exactly do you plan to do? D. I don't understand. You have so much to live for.

C. What exactly do you plan to do?

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain that Theresa's suicide attempt in which of the following ways? A. She feels hopeless about her future without her boyfriend. B. Without her boyfriend, she feels like an outsider with her peers. C She is feeling intense guilt because her boyfriend broke up with her. D. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

D. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.