Varcarolis Chapter 25: Suicide and Non-Suicidal Self-Injury

3. Which measure would be considered a form of primary prevention for suicide? a. Psychiatric hospitalization of a suicidal patient b. Referral of a formerly suicidal patient to a support group c. Suicide precautions for 24 hours for newly admitted patients d. Helping school children learn to manage stress and be resilient

ANS: D This measure promotes effective coping and reduces the likelihood that such children will become suicidal later in life. Admissions and suicide precautions are secondary prevention measures. Support group referral is a tertiary prevention measure.

A child dies after being struck by a car. The health care provider tells the parents, "Your child's injuries were so severe that there was nothing we could do." What is the initial nursing intervention? 1. Bring the parents to a room to be alone. 2. Explain all the medical interventions attempted. 3. Stay with the parents until a support person arrives. 4. Give the parents a referral for a grief-counseling group.

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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

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21. The feeling experienced by a patient that should be assessed by the nurse as most predictive of elevated suicide risk is a. hopelessness. b. sadness. c. elation. d. anger.

ANS: A Of the feelings listed, hopelessness is most closely associated with increased suicide risk. Depression, aggression, impulsivity, and shame are other feelings noted as risk factors for suicide.

1. A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk? Select all that apply. a. 82-year-old white male b. 17-year-old white female c. 22-year-old Hispanic male d. 19-year-old Native American male e. 39-year-old African American male

ANS: A, B, D Whites have suicide rates almost twice those of non-whites, and the rate is particularly high for older adult males, adolescents, and young adults. Other high-risk groups include young African American males, Native American males, and older Asian Americans. Rates are not high for Hispanic males.

Which change in neurotransmission is associated with suicidal thinking? 1. Increased gamma-aminobutyric acid (GABA) activity in the hypothalamus. 2. Increased norepinephrine reserves in the thalamus and pons. 3. Decreased serotonin activity in the brainstem and prefrontal cortex. 4. Decreased numbers of dopamine and glutamate receptors in the temporal lobes.

3 Low serotonin levels are related to depressed mood and depression is commonly associated with suicide. Postmortem examinations of individuals who complete suicide also reveal a low level of serotonin in the brainstem or the frontal cortex. GABA is associated with anxiety. Increased norepinephrine is associated with stimulation of the sympathetic nervous system.

A nurse is taking caring of a patient who has attempted suicide. What appropriate intervention should the nurse follow for effective treatment? 1. Encourage nonverbal communication in the patient. 2. Believe that the patient doesn't plan to commit suicide in the future. 3. Emotionally connect with the patient's situation. 4. Identify the problems experienced by the patient.

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A patient admitted to the hospital for radiation therapy for lung cancer wants to end his life. What would be the most appropriate response of the nurse? 1. Inform the health care provider. 2. Inform the hospital security staff. 3. Ignore the patient and continue with the assessment. 4. Ask if the patient has any plans to commit suicide.

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A patient 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." The nurse should 1. Say "I understand" and allow the patient to close the door 2. Keep the door open, but step to the side out of the patient's view 3. Leave the patient's room and wait outside in the hall 4. Say "For your safety I can be no more than an arm's length away"

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The nurse is giving information about different theories of suicide. When does a person usually commit copycat suicide? 1. After a person loses his or her job 2. After a person loses his or her self-esteem 3.After losing freedom due to imminent incarceration 4. After a highly publicized suicide of a public figure

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A nurse is conducting a clinical interview of a patient with chronic illness. The patient reports being divorced and an alcoholic. What appropriate action does the nurse take for the patient following an assessment with the SAD PERSONS scale? 1. The nurse suggests the patient take medications regularly. 2. The nurse suggests not consuming alcohol. 3. The nurse immediately admits the patient to the hospital. 4. The nurse closely follows up with the patient and suggests admitting him or her to the hospital.

4 The nurse can assess the suicidal potential of the patient by using the SAD PERSONS scale. Based on the presence of the above traits scoring is given to the patient. A patient who is divorced, alcoholic, and suffers from chronic illness scores 3. A patient with a score of 3-4 has to be closely followed up with and should be considered for hospitalization. A patient with a score of 0-2 can be given advice to take prescribed medications regularly and avoid alcohol. These patients don't require hospitalization. A patient with a score of 7-10 must be immediately admitted to the hospital.

16. Which statement provides the best rationale for closely monitoring a severely depressed patient during antidepressant medication therapy? a. As depression lifts, physical energy becomes available to carry out suicide. b. Patients who previously had suicidal thoughts need to discuss their feelings. c. For most patients, antidepressant medication results in increased suicidal thinking. d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

ANS: A Antidepressant medication has the objective of relieving depression. Risk for suicide is greater as the depression lifts, primarily because the patient has more physical energy at a time when he or she may still have suicidal ideation. The other options have little to do with nursing interventions relating to antidepressant medication therapy.

18. A depressed patient says, "Nothing matters anymore." What is the most appropriate response by the nurse? a. "Are you having thoughts of suicide?" b. "I am not sure I understand what you are trying to say." c. "Try to stay hopeful. Things have a way of working out." d. "Tell me more about what interested you before you became depressed."

ANS: A The nurse must make overt what is covert; that is, the possibility of suicide must be openly addressed. The patient often feels relieved to be able to talk about suicidal ideation.

9. A college student who attempted suicide by overdose was hospitalized. When the parents were contacted, they responded, "We should have seen this coming. We did not do enough." The parents' reaction reflects: a. guilt. b. denial. c. shame. d. rescue feelings.

ANS: A The parents' statements indicate guilt. Guilt is evident from the parents' self-chastisement. The feelings suggested in the distracters are not clearly described in the scenario.

11. It has been 5 days since a suicidal patient was hospitalized and prescribed an antidepressant medication. 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 discontinuation of suicide precautions.

ANS: A The patient now has more energy and may have decided on suicide, especially given the prior suicide attempt history. The patient must be supervised 24 hours per day. The patient is still a suicide risk.

24. After one of their identical twin daughters commits suicide, the parents express concern that the other twin may also have suicidal tendencies. Which reply should the nurse provide? a. "Genetics are associated with suicide risk. Monitoring and support are important." b. "Apathy underlies suicide. Instilling motivation is the key to health maintenance." c. "Your child is unlikely to act out suicide when identifying with a suicide victim." d. "Fraternal twins are at higher risk for suicide than identical twins."

ANS: A Twin studies suggest the presence of genetic factors in suicide; however, separating genetic predisposition to suicide from predisposition to depression or alcoholism is difficult. Primary interventions can be helpful in promoting and maintaining health and possibly counteracting genetic load. The incorrect options are untrue statements or an oversimplification.

2. Which nursing interventions will be implemented for a patient who is actively suicidal? Select all that apply. a. Maintain arm's-length, one-on-one direct observation at all times. b. Check all items brought by visitors and remove risk items. c. Use plastic eating utensils; count utensils upon collection. d. Remove the patient's eyeglasses to prevent self-injury. e. Interact with the patient every 15 minutes.

ANS: A, B, C One-on-one observation is necessary for anyone who has limited or unreliable control over suicidal impulses. Finger foods allow the patient to eat without silverware; "no silver or glassware" orders restrict access to a potential means of self-harm. Every-15-minute checks are inadequate to assure the safety of an actively suicidal person. Placement in a public area is not a substitute for arm's-length direct observation; some patients will attempt suicide even when others are nearby. Vision impairment requires eyeglasses (or contacts); although they could be used dangerously, watching the patient from arm's length at all times would allow enough time to interrupt such an attempt and would prevent the disorientation and isolation that uncorrected visual impairment could create.

3. A college student is extremely upset after failing two examinations. The student said, "No one understands how this will hurt my chances of getting into medical school." The student then suspends access to his social networking website and turns off his cell phone. Which suicide risk factors are evident? Select all that apply. a. Shame b. Panic attack c. Humiliation d. Self-imposed isolation e. Recent stressful life event

ANS: A, C, D, E Failing examinations in the academic major constitutes a recent stressful life event. Shame and humiliation related to the failure can be hypothesized. The statement, "No one can understand," can be seen as recent lack of social support. Terminating access to one's social networking site and turning off the cell phone represents self-imposed isolation. The scenario does not provide evidence of panic attack.

22. Which statement by a depressed patient will alert the nurse to the patient's need for immediate, active intervention? a. "I am mixed up, but I know I need help." b. "I have no one to turn to for help or support." c. "It is worse when you are a person of color." d. "I tried to get attention before I cut myself last time."

ANS: B Hopelessness is evident. Lack of social support and social isolation increases the suicide risk. Willingness to seek help lowers risk. Being a person of color does not suggest higher risk because more whites commit suicide than do individuals of other racial groups. Attention seeking is not correlated with higher suicide risk.

23. A patient hospitalized for 2 weeks committed suicide during the night. Which initial nursing measure will be most important regarding this event? a. Ask the information technology manager to verify the hospital information system is secure. b. Hold a staff meeting to express feelings and plan care for the other patients. c. Ask the patient's roommate not to discuss the event with other patients. d. Prepare a report of a sentinel event.

ANS: B Interventions should help the staff and patients come to terms with the loss and grow because of the incident. Then, a community meeting should occur to allow other patients to express their feelings and request help. Staff should be prepared to provide additional support and reassurance to patients and should seek opportunities for peer support. A sentinel event report can be prepared later. The other incorrect options will not control information or would result in unsafe care.

4. Which change in the brain's biochemical function is most associated with suicidal behavior? a. Dopamine excess b. Serotonin deficiency c. Acetylcholine excess d. Gamma-aminobutyric acid deficiency

ANS: B Research suggests that low levels of serotonin may play a role in the decision to commit suicide. The other neurotransmitter alterations have not been implicated in suicidality.

1. An adult outpatient diagnosed with major depression has a history of several suicide attempts by overdose. Given this patient's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed? a. Amitriptyline (Elavil), a sedating tricyclic medication b. Fluoxetine (Prozac), a selective serotonin reuptake inhibitor c. Desipramine (Norpramin), a stimulating tricyclic medication d. Tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor

ANS: B Selective serotonin reuptake inhibitor antidepressants are very safe in overdosage situations, which is not true of the other medications listed. Given this patient's history of overdosing, it is important that the medication be as safe as possible in case she takes an overdose of her prescribed medication.

10. Select the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills. 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?"

ANS: B The nurse must assess the patient's access to means to carry out the plan and, if there is access, alert the parents to remove from the home and take additional actions to assure the patient's safety. The information in the other questions may be important to ask but are not the most critical.

5. A college student who failed two tests cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate and asked to be left alone for a few hours. 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 dorm room

ANS: C Giving away prized possessions may signal that the individual thinks he or she will have no further need for the item, such as when a suicide plan has been formulated. Calling parents, remaining in a dorm, and crying do not provide direct clues to suicide.

20. When assessing a patient's plan for suicide, what aspect has priority? a. Patient's financial and educational status b. Patient's insight into suicidal motivation c. Availability of means and lethality of method d. Quality and availability of patient's social support

ANS: C If a person has plans that include choosing a method of suicide readily available and if the method is one that is lethal (i.e., will cause the person to die with little probability for intervention), the suicide risk is high. These areas provide a better indication of risk than the areas mentioned in the other options. See relationship to audience response question.

15. Which intervention will the nurse recommend for the distressed family and friends of someone who has committed suicide? a. Participating in reminiscence therapy b. Psychological postmortem assessment c. Attending a self-help group for survivors d. Contracting for at least two sessions of group therapy

ANS: C Survivors need outlets for their feelings about the loss and the deceased person. Self-help groups provide peer support while survivors work through feelings of loss, anger, and guilt. Psychological postmortem assessment would not provide the support necessary to work through feelings of loss associated with the suicide. Reminiscence therapy is not geared to loss resolution. Contracting for two sessions of group therapy would not provide sufficient time to work through the issues associated with a death by suicide.

6. 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.

ANS: C The SAD PERSONS tool evaluates 10 major risk factors in suicide potential: sex, age, depression, previous attempt, ethanol use, rational thinking loss, social supports lacking, organized plan, no spouse, and sickness. The tool does not have categories to provide information on the other options listed.

12. A nurse and patient construct a no-suicide contract. Select the preferable wording. 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 in any way attempt to harm or kill myself." d. "I will not kill myself until I call my primary nurse or a member of the staff."

ANS: C The correct answer leaves no loopholes. The wording about not harming oneself and not making an attempt leaves loopholes or can be ignored by the patient who thinks "I am not going to harm myself, I am going to kill myself" or "I am not going to attempt suicide, I am going to commit suicide." A patient may call a therapist and leave the telephone to carry out the suicidal plan.

14. A nurse interacts with an outpatient who has a history of multiple suicide attempts. Select the most helpful response for a nurse to make when the patient states, "I am considering committing suicide." a. "I'm glad you shared this. Please do not worry. We will handle it together." b. "I think you should admit yourself to the hospital to keep you safe." c. "Bringing up these feelings is a very positive action on your part." d. "We need to talk about the good things you have to live for."

ANS: C The correct response gives the patient reinforcement, recognition, and validation for making a positive response rather than acting out the suicidal impulse. It gives neither advice nor false reassurance, and it does not imply stereotypes such as "You have a lot to live for." It uses the patient's ambivalence and sets the stage for more realistic problem solving.

7. A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority? a. Powerlessness b. Social isolation c. Risk for suicide d. Compromised family coping

ANS: C This diagnosis is the only one with life-or-death ramifications and is therefore of higher priority than the other options.

13. 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 lethality of suicide plan. b. encourage expression of anger. c. establish rapport with the patient. d. determine risk factors for suicide.

ANS: C This scenario presents a potential crisis. Establishing rapport facilitates a therapeutic alliance that will allow the nurse to obtain relevant assessment data such as the presence of a suicide plan, lethality of plan, and presence of risk factors for suicide.

17. A nurse assesses a patient who reports a 3-week history of depression and periods of uncontrolled crying. The patient says, "My business is bankrupt, and I was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a concealed suicidal message? a. "I wish I were dead." b. "Life is not worth living." c. "I have a plan that will fix everything." d. "My family will be better off without me."

ANS: C Verbal clues to suicide may be overt or covert. The incorrect options are overt references to suicide. The correct option is more veiled. It alludes to the patient's suicide as being a way to "fix everything" but does not say it outright.

25. Which individual in the emergency department should be considered at highest risk for completing suicide? a. An adolescent Asian American girl with superior athletic and academic skills who has asthma b. A 38-year-old single, African American female church member with fibrocystic breast disease c. A 60-year-old married Hispanic man with twelve grandchildren who has type 2 diabetes d. A 79-year-old single, white male diagnosed recently with terminal cancer of the prostate

ANS: D High-risk factors include being an older adult, single, male, and having a co-occurring medical illness. Cancer is one of the somatic conditions associated with increased suicide risk. Protective factors for African American women and Hispanic individuals include strong religious and family ties. Asian Americans have a suicide rate that increases with age.

8. A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. The initial outcome is that 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 attempts to harm self for 24 hours.

ANS: D Suicide self-restraint relates most directly to the priority problem of risk for self-directed violence. The other outcomes are related to hope, coping, and self-esteem.

19. A nurse counsels a patient with recent suicidal ideation. Which is the nurse's most therapeutic comment? a. "Let's make a list of all your problems and think of solutions for each one." b. "I'm happy you're taking control of your problems and trying to find solutions." c. "When you have bad feelings, try to focus on positive experiences from your life." d. "Let's consider which problems are very important and which are less important."

ANS: D The nurse helps the patient develop effective coping skills. Assist the patient to reduce the overwhelming effects of problems by prioritizing them. The incorrect options continue to present overwhelming approaches to problem solving.

2. Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk? a. Turning on the oven and letting gas escape into the apartment during the night b. Cutting the wrists in the bathroom while the spouse reads in the next room c. Overdosing on aspirin with codeine while the spouse is out with friends d. Jumping from a railroad bridge located in a deserted area late at night

ANS: D This is a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential. See relationship to audience response question.

A man tells the nurse that his life became a mess after he married his wife a few months earlier and he has no reason to continue living. What should the nurse ask him first? 1. "Do you have any plans to end your life right now?" 2. "Life has ups and downs, but we need 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?"

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A patient tells the nurse that he or she believes his or her situation is intolerable. The nurse assesses that the patient is isolating socially. A nursing diagnosis that should be considered is 1. Hopelessness 2. Deficient knowledge 3. Chronic low self-esteem 4. Compromised family coping

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A patient with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? 1. Constant 24-hour, one-to-one observation at arm's length 2. One-to-one observation while patient is awake 3. Every 15-minutes observation around the clock 4. Seclusion with 15-minute observation

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A student nurse participated in a survey on suicide to identify the risk factors and protective factors among various communities. What appropriate conclusion does the nurse derive after completing the study? 1. The majority of African Americans have religious beliefs against suicide. 2. The majority of Hispanics blame themselves for uncontrolled situations and adverse events. 3. In Asian Americans the suicide rate decreases with age. 4. The majority of Muslims avoid suicide due to their religious beliefs.

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An identical twin recently committed suicide. The mother tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is 1. Not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide 2. Justified because twin studies suggest no genetic factor is involved in suicide 3. Unjustified because the parent has failed to consider the importance of the "copycat" factor 4. Likely evidence of her denying the possibility of a parental role in the causation of the suicide

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If a suicidal patient is to be treated outside the hospital, which intervention would be of highest priority? 1. Have the patient identify three people to call if the patient is overwhelmed by hopelessness. 2. Make sure the patient has food enough to last for two to three days. 3. Arrange for a police visit every 24 hours. 4. Provide a one-week supply of antidepressant medication.

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the nurse is caring for a patient who has been admitted for being at a risk of suicide. The patient is very angry about the meals that are provided. How should the nurse respond to the patient's behavior? 1. Remain neutral and do not react angrily to the patient. 2. Restrain the patient to the bed as there is risk of injury to others. 3. Call the security staff immediately to control the patient. 4. Ask the patient to cooperate as all the patients get the same meals.

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A 70-year-old male patient lost a spouse 3 months ago, has no children, and lives alone. The patient had depression at the age of 25, started drinking alcohol then, and has been treated with antidepressants. The patient reports disturbed sleep and decreased appetite. On assessment the nurse finds that the patient has 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 patient. 2. Refer the patient to a psychiatrist. 3. Follow up the next day. 4. Follow up after a few days

1 The nurse should evaluate the patient for the risk of suicide according to the SAD PERSONS scale. According to this scale, the patient's total score is 7, with 1 point each for age (1), gender (1), lack of spouse (1), lack of social support (1), use of alcohol (1), episode of depression (1), and loss of ability to think rationally (1). Therefore, the nurse should immediately hospitalize the patient as there is high risk for suicide. The psychiatrist can be contacted once the patient is hospitalized. The patient should not be sent home and asked to come for follow-up because the patient is at high risk of suicide.

Which intervention is required when a patient is being observed 1-to-1 to prevent a suicide attempt? Select all that apply. 1. Staff must remain within arm's length of the patient at all times 2. Assure that the patient has no access to glass or metal objects 3. Assess the patient's mouth after each medication administration 4. Documentation should include the patient's verbatim statements 5. The patient's hands must be visible at all times except when sleeping

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A young adult is informed of a positive laboratory test for human immunodeficiency virus (HIV). The patient tells the nurse, "Well, I know what I need to do now." What is the nurse's next action? 1. Give information on local support groups. 2. Assess the patient's risk for suicide. 3. Discuss results of the newest medication research. 4. Arrange a consultation with the social worker.

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An adult attempted suicide after termination from employment. This patient was hospitalized and has taken antidepressant medication for two weeks. The nurse observes the patient is now brighter and more sociable. What is the nurse's highest priority intervention? 1. Begin discharge planning for the patient. 2. Maintain continuous supervision of the patient. 3. Consider discontinuation of suicide precautions. 4. Refer the patient for cognitive behavioral therapy.

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The nurse is concerned that a depressed male patient may be displaying a nonverbal suicidal threat when he presents another patient with his favorite shirt as a "gift." What is the nurse's initial intervention? 1. Place the patient on suicide precautions, including 15-minute checks. 2. Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself. 3. Support the patient by telling him that he will need the shirt when he's discharged. 4. Document that the patient has shown behaviors that are likely subtle suicide threats.

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A patient is given an antidepressant for depression related to undiagnosed bipolar disorder. Which drug can lead to mania in this patient? 1. Tricyclic antidepressants 2. Selective serotonin reuptake inhibitor (SSRI) 3. Monoamine oxidase inhibitors 4. Nonsteroidal antiinflammatory drug (NSAID)

2 Administration of a selective serotonin reuptake inhibitor (SSRI) in a patient with depression related to undiagnosed bipolar disorder can lead to mania. Such patients are at high risk of suicide. Tricyclic antidepressants and monoamine oxidase inhibitors are used to treat depression but are not necessarily associated with mania in underdiagnosed bipolar disorder. Oral hypoglycemic drugs and NSAIDs are not used for treatment of depression.

A patient who has come for flu treatment is found to have agranulocytosis and myocarditis on assessment. He has taken acetaminophen (Tylenol) and cetirizine (Zyrtec) for flu. The patient is also a known diabetic and has schizophrenia. He is taking metformin (Glucophage) for diabetes and clozapine (Clozaril) for schizophrenia. Which of these drugs could have caused agranulocytosis and myocarditis? 1. Metformin (Glucophage) 2. Clozapine (Clozaril) 3. Cetirizine (Zyrtec) 4. Acetaminophen (Tylenol)

2 Clozapine decreases the risk of suicide in patients with schizophrenia. However, these patients should be regularly monitored for severe side effects of clozapine, like agranulocytosis, myocarditis, and altered glucose metabolism. A common side effect of metformin is gastrointestinal disturbance; cetirizine can cause drowsiness; and paracetamol in large amounts can lead to liver toxicity.

A patient's history documents that there have been examples of indirect self-destructive behavior. Which nursing assessment data support this diagnosis? 1. Patient has attempted suicide on three other occasions. 2. Reports of abusing alcohol since the age of 16 3. Patient experiences episodes of hypoglycemia on a regular basis. 4. Although acknowledging suicidal thoughts, the patient denies any plan.

2 Indirect self-destructive behaviors are any activity harmful to the person's physical well-being that may result in death. Alcohol abuse is an example of such behavior. A suicide attempt is a direct self-destructive behavior. Regular episodes of hypoglycemia are examples of risk for physical harm but are not necessarily indicators of self-destructiveness unless there is some element of conscious attempt at self-harm. Suicidal thoughts without a plan are considered direct self-destructive behaviors.

The nurse is preparing for the admission of an elderly patient in the terminal stages of hepatocarcinoma. The patient has no support from family members or friends. A few months ago, the patient attempted to commit suicide by hanging. The patient is presently taking an antidepressant drug for depression. The patient lost his spouse recently in a tragic accident. What measures should the nurse take for this patient to ensure that the patient is safe? Select all that apply. 1. Assign the patient to a private room in the hospital. 2. Use plastic utensils for serving food to the patient. 3. Keep electrical cords to a minimal length. 4. Check the personal belongings of the patient in his absence. 5. Install breakaway shower rods and recessed shower nozzles.

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A patient with major depression committed suicide in the hospital. What appropriate action should the nurse take? Select all that apply. 1. Suspend the staff for not taking proper care of the patient. 2. Review the events to find the overlooked clues. 3. Give adequate support to the staff of the unit. 4. Recommend not sharing information with the patient's family until after the investigation is complete. 5. Recommend conducting psychological postmortem.

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A primary health care provider prescribes a tricyclic antidepressant to treat a depressive patient who is being held for psychiatric observation. The nurse observes that the patient is expressing suicidal thoughts and intentions. What should the nurse do while caring for the patient? Select all that apply. 1. Suggest that the patient take a larger dose of the medication. 2. Check the patient's mouth after providing doses of the medication. 3. Hand over the complete course of medication to the patient. 4. Advise the patient's family to closely monitor the medication if the dose is taken at home. 5. Give a reduced dose of the prescribed medication to prevent risk of overdose.

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