Chapter 23 Suicide Ideation
1
A client diagnosed with major depressive disorder was hospitalized for two weeks on an acute unit. One day after discharge, the client commits suicide. Which action should the nursing supervisor implement? 1 Provide a private setting for staff to talk about feelings associated with the event. 2 Remind staff that suicide is a risk for the client population and they are not at fault. 3 Invite a guest speaker to conduct an educational session for staff about suicide risk factors. 4 Assess staff members individually for information about the client's suicidal intent and/or plans.
a
A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond, "There must be a mistake. This could not have happened. We've given our child everything." The parents' reaction reflects: a. denial. b. anger. c. anxiety. d. rescue feelings.
d
A person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial outcome? The patient will: a. verbalize a will to live by the end of the second hospital day. b. describe two new coping mechanisms by the end of the third hospital day. c. accurately delineate personal strengths by the end of first week of hospitalization. d. exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours
4
The nurse is assessing a client diagnosed with depression who has expressed suicidal ideations. The client begins to cry and states, "I lost my job. I don't know how I am going to pay my bills. What if I lose my house?" What is the most appropriate response from the nurse? 1 "I'm here and I will stay with you." 2 "Do you have family or friends you can stay with?" 3 "Sometimes I worry about my bills too. It is normal." 4 "How devastating. Does that make you think about suicide again?"
4
Which provision should the nurse include in a client's no-suicide contract? 1 Never to attempt suicide. 2 To alert someone if an attempt is planned. 3 To discuss why the client feels suicidal 4 Not to attempt suicide in the next 24 hours.
2,3,4
Which short-term outcomes would be appropriate for a teenager diagnosed with impulse control disorder who has been hospitalized for suicidal ideations? Select all that apply. 1 Express two negative outcomes of acting on ideations. 2 Identify support persons to contact when ideations occur. 3 Express feelings that trigger ideations to staff as soon as they occur. 4 Agree not to harm self for the next 12 hours. 5 Identify two coping strategies to implement when ideations occur.
c
A person intentionally overdoses on antidepressant drugs. Which nursing diagnosis has the highest priority? a. Powerlessness b. Social isolation c. Risk for suicide d. Ineffective management of the therapeutic regimen
2,3
A pregnant woman seeks counseling after losing a parent. She informs the nurse that she has lost her job a few days ago and is aware of her responsibility for her family. Which factors put her at greater risk of suicide? Select all that apply. 1 Being pregnant 2 Losing a job 3 The death of her parent 4 Accessing health care 5 Being responsible for her family
2
A 30-year-old divorced male with a history of alcohol abuse is admitted with a diagnosis of depression with suicidal ideation with a detailed plan. According to the SAD PERSONS scale, what score will the client earn? 1)3 2)6 3)7 4)10
1
A 70-year-old male client lost a spouse 3 months ago, has no children, and lives alone. The client had depression at the age of 25, started drinking alcohol then, and has been treated with antidepressants. The client reports disturbed sleep and decreased appetite. On assessment the nurse finds that the client is demonstrating behaviors associated with dementia and is unable to think rationally. What would be the most appropriate intervention for the nurse according to the SAD PERSONS scale? 1 Hospitalize the client. 2 Refer the client to a psychiatrist. 3 Follow up the next day. 4 Follow up after a few days.
4
A client admitted to the hospital for radiation therapy for lung cancer wants to end his life. How should the nurse initially respond to this client? 1 Inform the health care provider. 2 Inform the hospital security staff. 3 Ignore the client and continue with the assessment. 4 Ask if the client has any plans to commit suicide
3
A community nurse is assessing the risk factors for suicide among a group of people. What are the factors that are associated with high risk of suicide? 1 Pregnancy in women 2 Religious values and beliefs 3 Family history of suicide 4 Responsibility to the family
1
A high school student tells the school nurse, "I just failed my chemistry test. I'm going to shoot myself." What is the most critical question for the nurse to ask this student? 1 "Do you have access to a gun?" 2 "Why do you want to kill yourself?" 3 "Have you failed any other subjects?" 4 "Did something happen with your parents?"
c
A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to: a. current stress level. b. mood disturbance. c. suicide potential. d. level of anxiety.
b
An adolescent tells the school nurse, "My friend threatened to take an overdose of pills." The nurse talks to the friend who verbalized the suicide threat. The most critical question for the nurse to ask would be: a. "Why do you want to kill yourself?" b. "Do you have access to medications?" c. "Have you been taking drugs and alcohol?" d. "Did something happen with your parents?"
2
How often should the nurse chart the whereabouts and record mood, verbatim statements, and behavior of a client assessed for being at a very high risk for self-harm? 1 Three times a day 2 Every 15 minutes 3 Every 60 minutes 4 Every other day
3
If a client's SAD PERSONS score is 5, what does this indicate regarding care? 1 The client should be immediately hospitalized. 2 The client should be strictly followed up with on a regular basis. Correct3 The client should be strongly considered for hospitalization. 4 The client should be sent home and asked to return later for follow-up.
2
Postvention for the family and friends who are survivors of a suicide is most successful when initiated within which time frame? 1 4 to 8 hours 2 24 to 72 hours Incorrect3 After 72 hours 4 Within 24 hours
0-2
Sending home with follow-up SAD PERSONS
5-6
Strongly considering hospitalization SAD PERSONS
4
The nurse is assessing a client with a history of attempted suicide. Which method used by the client in the previous suicide attempt would put the client at higher risk? 1 Ingesting sleeping pills 2 Inhaling natural gas 3 Slashing the wrists 4 Staging a car crash
4
When working with a client who may have made a covert reference to suicide, the nurse should implement which intervention? 1 Being careful not to mention the idea of suicide. 2 Listening carefully to see whether the client mentions it a second time. 3 Asking about the possibility of suicidal thoughts in a covert way. 4 Asking the client directly if he or she is thinking of attempting suicide.
2
Which assessment tool is useful to nurses in rating suicide risk? 1 Abnormal Involuntary Movement scale (AIMS) 2 SAD PERSONS scale 3 CAGE questionnaire 4 Mini-Mental Status examination (MMSE)
b
Which changes in brain biochemical function is most associated with suicidal behavior? a. Dopamine excess b. Serotonin deficiency c. Acetylcholine excess d. Gamma-aminobutyric acid deficiency
low
________ levels of 5-hydroxyindoleacetic in cerebral spinal fluid are associated with impulsive suicide-like violence.
1
client is admitted to the hospital for treatment of bronchial carcinoma. While still reporting pain, there are clinical signs the tumor is shrinking. The client says to the nurse, "I won't be a problem much longer." What should the nurse understand from this statement? 1 The client is contemplating suicide. 2 The client is happy with the treatment. 3 The client will be discharged soon. 4 The client does not require treatment anymore
hostile laughter
shows a client's ineffective coping skills.
1
On the sixth anniversary of the spouse's death a widow says, "Sometimes life does not seem worth living anymore. I wish I could go to sleep and never wake up." Which comment by the nurse is appropriate? 1 "Are you considering suicide?" 2 "You still have so much to live for." 3 "I'm not sure I understand what you're saying." 4 "Why do you continue to grieve something from so long ago?
3-4
Closely following up SAD PERSONS
3
The nurse responsible for the safety of a 10-year-old client diagnosed with impulse control disorder is most concerned about which of the following? Incorrect1 The child stating that he or she wishes to die. 2 The child's preoccupation with violent television programs. 3 A notation in the child's medical history describing a previous suicide attempt. 4 The father's report that the child is clumsy and is always hurting him- or herself.
2
parent tells the nurse about the death of a child two years ago. Which comment by this parent warrants the nurse's priority attention? 1 "I still have some of my child's toys and clothes." 2 "A parent should never live longer than their child." 3 "I never returned to church again after the death of my child." 4 "My child has been dead a long time, but it seems like only yesterday."
2,3,5
A client diagnosed with major depression successfully committed suicide while hospitalized. What appropriate action should the nurse manager take regarding the unit's staff? Select all that apply. 1 Reprimand the staff for not taking proper care of the client. 2 Review the events for the possible overlooked client clues. 3 Provide adequate emotional support to the staff of the unit. 4 Recommend not sharing information with the client's family until after the investigation is complete. 5 Recommend conducting a psychological postmortem.
3
A client scores 1 on the SAD PERSONS scale. What should the nurse's next step be? 1 Hospitalize the client 2 Consider hospitalization 3 Send the client home with follow-up 4 Strongly consider hospitalization
3
A nurse interacts with a depressive client. The client says, "Can you get me a sharp knife?" What conclusion is mostappropriate for the nurse to make from the client's response? 1 The client is socially withdrawn. 2 The client has delusions. 3 The client is at higher risk of suicide. 4 The client can cause harm to others.
2,3,5
A nurse is providing postvention to a client whose partner committed suicide. What statements indicate that the nurse understands the goals of postvention? Select all that apply. 1 "Why didn't you admit yourself immediately for treatment of depression?" 2 "Don't be afraid to talk about the memories you have of your partner." 3 "Would meeting with your partner's primary health care provider be helpful?" 4 "You should be a strong role model for your family and friends." 5 "Donating your husband's belongings may help you work through your grief."
4
A nurse who cared for a client who completed suicide has begun exhibiting signs of guilt, shock, anger, shame, and decreased self-esteem. This nurse is exhibiting symptoms of which type of trauma? 1 Burnout 2 Depression 3 Adaptive grief process 4 Posttraumatic stress disorder
a
An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a. Supervise the patient 24 hours a day. b. Begin discharge planning for the patient. c. Refer the patient to art and music therapists. d. Consider the discontinuation of suicide precautions.
2
In the absence of a previous suicide attempt, the nurse is most concerned about a risk for self-harm when the client shares which information? 1 The client was divorced six months ago. 2 The client was diagnosed with major depression 10 years ago. 3 The client's mother experienced postpartum depression after the client's birth. 4 The client often spends days alone in a cabin located miles away from the main road.
postvention
Intervention for family and friends of a person who has completed a suicide
1
Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? 1 How long the client has been suicidal. 2 Whether the plan has specific details. 3 Whether the method is one that causes death quickly. 4 Whether the client has the means to implement the plan.
3,4,5
Which situation supports the fact that a client has a lethal suicide plan? Select all that apply. 1 Client's plan involves taking an overdose of pills with a friend 2 Client has decided on slashing his or her wrists if a significant other leaves 3 Woods are behind the house is where the suicide will take place 4 Client plans to activate the plan on the anniversary of the client's divorce 5 Client plans to jump from a bridge when the voices command him or her to do so
3
Which statement does the nurse know exemplifies suicidal ideation? 1 "My neighbor killed himself." 2 "I overdosed on medicine, but it wasn't enough to kill me." 3 "I plan to kill myself by slitting my wrists." 4 "I have a terminal illness and have found a doctor who will help me end my life peacefully."
4
Which statement made by a client admitted with a diagnosis of chronic depression indicates the need for further assessment? 1 "I know a lot of people care about me and want me to get better." 2 "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." 3 "I don't have a good support system, but I am planning on joining a recovery group." 4 "I'm not worried. I know that things will be better soon."
2
Whom should the head nurse ask to sign the no-suicide contract? 1 Nurse 2 Client 3 Health care provider 4 Caregiver of client
2
he nurse is concerned when a depressed client presents another client with a favorite shirt as a "gift." What is the nurse's initial intervention? 1 Place the client on suicide precautions, including 15-minute checks. 2 Ask the client if he or she is experiencing suicidal ideations with a plan to hurt him or herself. 3 Support the client by telling him or her that he or she will need the shirt when upon discharge. 4 Document that the client has shown behaviors that are likely subtle suicide threats.
2,3,4
nurse is assessing a client diagnosed with conduct disorder. Which assessment findings would indicate suicidal risk in the client? Select all that apply. 1 Effective coping skills 2 Feelings of despair 3 Impulsive behavior 4 Past suicide attempts 5 Improved decision making
3
A client recently prescribed antidepressants says to the nurse, "My depression is gone. I feel very energetic today. Soon everything will be fine." What response should the nurse provide this client? 1 "Yes, I will surely plan for your discharge." 2 "Congrats! You seem to have recovered well." 3 "Do you have any sort of suicidal ideas or plans?" 4 "I am happy to see you recover from depression."
1
A client tells the nurse that life became a mess after getting married a few months earlier and that there is no reason to continue living. What should the nurse ask the client initially? 1 "Do you have any plans to end your life right now?" 2 "Life has ups and downs, but can you to face it bravely?" 3 "Do you have any relatives to look after you when you are sick?" 4 "Can you please tell me the exact duration of your married life?"
1
A client who had a stroke three days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." What should be the nurse's priority action? 1 Implement the institutional protocol for suicide risk. 2 Educate the client about the success of stroke rehabilitation. 3 Support the client in clarifying and expressing feelings of grief. 4 Offer the client an opportunity to confer with the pastoral counselor.
3
The nursing diagnosis, "Risk for self-directed violence" has been added to the care plan of a suicidal client. During hospitalization, what is the most appropriate short-term goal for this client? 1 Reclaim any prized possessions that were given away 2 Name three personal strengths 3 Seek help when feeling self destructive 4 Participate in a self-help group
2
What is the major reason for hospitalization of depressed clients? 1 Inability to go to work 2 Suicidal ideations 3 Loss of appetite 4 Psychomotor agitation
2
Which neurobiological factor is the greatest predictor of suicide? 1 Dizygotic twins 2 Low levels of 5-hydroxyindoleacetic 3 Underactivity of the noradrenergic system 4 Normal hypothalamic-pituitary-adrenal axi
1
A client with a history of psychosis is admitted after a suicide attempt. During the initial assessment the client states, "The voices are still telling me to kill myself. Which is the priority nursing intervention for this patient? 1 Place the client on suicide precautions. 2 Obtain an order for a psychiatric consult. 3 Get the client to sign a suicide contract. 4 Ask a family member or friend to stay with the client.
1,2,5,6
What suicidal predictors does the nurse assess for in the client diagnosed with impulse disorder? Select all that apply. 1 Past suicidal attempts 2 Family history of suicide attempt 3 Hostile laughter 4 Clenching of fists and jaws 3 Feeling of hopelessness 6 Drug or alcohol use
2
When a client in an outpatient program scores a 7 on the SAD PERSONS scale, what action should the nurse take? 1 Closely follow up; consider hospitalization 2 Hospitalization of the client 3 Send the client home with follow-up 4 Strongly consider hospitalization
3
Which client response is most indicative of suicidal ideations? 1 "I don't want to take the medications; they are very costly." 2 "I am upset with the people around me for their insensitive behavior." 3 "I feel like sleeping forever and never waking up again." 4 "My family wants me to be in a rehabilitation center."
2
A client hospitalized after unsuccessfully attempting suicide had been adherent to antidepressant medication therapy for two weeks. The nurse observes the client is now brighter and more sociable. What is the nurse's highest priority intervention? 1 Begin discharge planning for the client. 2 Maintain continuous supervision of the client. 3 Consider discontinuation of suicide precautions. 4 Refer the client for cognitive behavioral therapy.
c
A college student failed two tests. Afterward, the student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt? a. Calling parents b. Excessive crying c. Giving away sweaters d. Staying alone in a dorm room
c
A nurse and patient construct a no-suicide contract. Select the preferable wording for the contract. a. "I will not try to harm myself during the next 24 hours." b. "I will not make a suicide attempt while I am hospitalized." c. "For the next 24 hours, I will not kill or harm myself in any way." d. "I will not kill myself until I call my primary nurse or a member of the staff."
7-10
A score of__________ on the SAD PERSONS scale indicates hospitalization or commitment, because the person would be considered a high risk for suicide.
4
A single adult says to the nurse, "Both of my parents died several years ago and my only sibling committed suicide two weeks ago. I feel so alone." After determining this adult has no suicidal ideation, what should the nurse do? 1 Explore the adult's feelings of survivor's guilt. 2 Assess the adult's cultural beliefs and spirituality. 3 Refer the adult for cognitive behavioral therapy (CBT). 4 Refer the adult to a self-help group for suicide survivors.
1,2,4
Which factors are considered when determining a client is at high risk for suicide? Select all that apply. 1 Attempted suicide two years ago 2 Father committed suicide at age 45 3 Consistently did poorly in school 4 Reports excessive reliance upon alcohol 5 Is currently living with family members
3
Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? 1 γ-Aminobutyric acid 2 Dopamine 3 Serotonin 4 Acetylcholine
2
Which nursing intervention should be implemented during a suicidal client's crisis period? 1 Arranging for the client to stay with family or friends 2 Establishing frequent rapport with the client 3 Activating links to community social support 4 Identifying situations that trigger suicidal thoughts
2,3,5,6
Which states have legalized physician assisted suicide (PAS)/physician aid in dying (PAD)? Select all that apply. 1 Florida 2 Oregon 3 Vermont 4 Michigan 5 California 6 Washington
4
A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." What should the nurse do? 1 Say "I understand" and allow the client to close the door 2 Keep the door open, but step to the side out of the client's view 3 Leave the client's room and wait outside in the hall 4 Say "For your safety I can be no more than an arm's length away"
c
A tearful, anxious patient at the outpatient clinic reports, "I should be dead." The initial task of the nurse conducting the assessment interview is to: a. assess the lethality of a suicide plan. b. encourage expression of anger. c. establish a rapport with the patient. d. determine risk factors for suicide.
