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

The nurse is caring for five patients. Which patient presents with comorbidities of suicide? Select all that apply. 1 Patient with anorexia 2 Patient with psychosis 3 Patient with depression 4 Patient with attention deficient disorder 5 Patient with posttraumatic stress disorder

1 Patient with anorexia 3 Patient with depression 5 Patient with posttraumatic stress disorder Patients with depression, anorexia, and posttraumatic stress disorder are at a greater risk of suicide, as suicidal ideation is the result of inner pain, sadness, helplessness, and hopelessness. Attention deficit disorder and psychosis are not comorbidity factors that put patients at risk for suicide.

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.

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.

2 Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself. Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life, such as giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the patient on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the patient that he will need his shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is nonconclusive and subjective.

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

2 Clozapine 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 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.

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

2 Decreased serotonin activity in the brainstem and prefrontal cortex. 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.

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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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.

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.

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.

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.

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.

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.

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.

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.

Unit practice requires inspection of all items being brought onto the unit by visitors. How can this be most effectively done? a. Having a staff member sit at the door and check packages as visitors enter. b. Having a staff member make frequent rounds during visiting hours to inspect gifts. c. Asking all visitors to report to the nurse's station before visiting a client. d. Asking clients to give staff any unsafe item that might have been left by a visitor.

a. Having a staff member sit at the door and check packages as visitors enter. A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety. None of the other options provide a measure of control before clients and visitors meet. Self-reporting by the visitors is not reliable.

A client tells the nurse that he believes his situation is intolerable and is observed isolating socially. Which nursing diagnosis should be considered? a. Hopelessness b. Deficient knowledge c. Chronic low self-esteem d. Compromised family coping

a. Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness. The characteristics of the other options are not presented in the statement or behavior of the client.

While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms? a. It is high risk, or a hard method. b. It is low risk, or a soft method. c. It was not an actual suicide attempt because the client was intoxicated. d. Considering the results, it is a nonlethal means.

a. It is high risk, or a hard method. Higher risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

Kara is a 23 year old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara SATA a) Focus primarily on developing solutions to the problems leading the patient to feel suicidal b) Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate c) Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior d) Meet regularly with the patient to provide opportunities for the patient to express and explore feelings e) Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group f) Help the patient identify positive self-attributes and to question negative self-perceptions that are unrealistic

b, d, e, f

Which is the greatest protective factor against the risk of suicide? a. One or more previous suicide attempts b. A sense of responsibility to family c. Fear of dying d. A cultural belief that suicide is a shameful resolution for a dilemma

b. A sense of responsibility to family Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor. Previous attempts are a high risk factor. None of the remaining options have the impact that support has on preventing suicide.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of which feeling? a. Anger b. Disbelief c. Confusion d. Sympathy

b. Disbelief Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life." The statement doesn't demonstrate any of the other options as significantly.

What is the focus of the SAFE-T assessment tool? (Select all that apply.) a. Facilitate hospitalization. b. Identify level of suicidal risk. c. Development of client focused treatment. d. Introduce antidepressant medication therapy e. Stress collaboration with the client

b. Identify level of suicidal risk. c. Development of client focused treatment. e. Stress collaboration with the client The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is an assessment tool that allows the clinician to benchmark relative risk (high, moderate, low) and to develop a treatment plan, in consultation with the patient, to reduce current risk. The tool does not provide for specific interventions.

Which of the following statements is true regarding culture and protective factors against suicide? a. Asian Americans have the highest rates of suicide. b. Religion and the importance of family are protective factors for Hispanic Americans. c. Older women have the highest risk for suicide among African Americans. d. American Indians and Pacific Islanders have the lowest rates of suicide.

b. Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

An assessment tool that is useful to nurses in rating suicide risk is the a. AIMS scale. b. SAFE-T. c. CAGE questionnaire. d. Mini-Mental Status Examination.

b. SAFE-T. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The SAFE-T is short and easy to use and is focused on the risk for self-injury. That is not the focus of the other options.

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? (Select all that apply.) a. How long the client has been suicidal b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan e. Has the client been suicidal in the past

b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan Lethality refers to how deadly a plan is. The length of time a client has been suicidal or a history suicidal thoughts have nothing to do with the lethality of the plan. While the remaining options present important about the seriousness of the plan.

A student nurse on the psychiatric unit expresses being uncomfortable about discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern? a. "I'm glad you are thinking that way. They may not have thought of suicide before, and we don't want to introduce that." b. "You are right; however, because of professional liability, we have to ask that question." c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." d. "If I were you, I'd ask the health provider to talk to the patient about that subject."

c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

Which suicide prevention intervention that has the greatest impact on a client's safety? a. Educating visitors about potentially dangerous gifts. b. Restricting the client from potentially dangerous areas of the unit. c. One-on-one observation by the staff. d. Removal of personal items that might prove harmful.

c. One-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm. While the remaining options provide some protection, none have the impact of constant supervision.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. Which is the most appropriate short-term goal for this diagnosis? a. Will reclaim any prized possessions that were given away. b. Be able to name three personal strengths. c. Seek help when feeling self-destructive. d. Consistently participate in a self-help group.

c. Seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal presented for Risk for self-directed violence since it focuses on client safety.

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? a. γ-Amino-butyric acid b. Dopamine c. Serotonin d. Acetylcholine

c. Serotonin Low serotonin levels have been noted among individuals who have committed suicide. None of the other options are as directly related in the physiology of depression.

What are the most important characteristics for staff members who work with suicidal clients? a. Organization b. Problem-solving skills c. Warm, consistent interaction d. Effective interview and counseling skills

c. Warm, consistent interaction Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency since they support the nurse-client relationship. While helpful, none of the other options have the impact of a effective nurse-client relationship.

Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment? a. "I know a lot of people care about me and want me to get better." b. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I think things will be better soon."

d. "I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

Which statement factually describes the act of suicide? a. More women than men commit suicide. b. The Jewish culture has the lowest suicide rate. c. Suicide is the leading cause of death in the United States. d. A client diagnosed with schizophrenia is at great risk for attempting suicide.

d. A client diagnosed with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 8 times more likely to attempt suicide than is the general public. Suicide is the tenth leading cause of death in the United States. Protestants and the Jewish culture have a higher rate of suicide than do Catholics. More women attempt suicide, but more men are successful.

When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement? a. Being careful not to mention the idea of suicide. b. Listening carefully to see whether the client mentions suicide more overtly. c. Asking about the possibility of suicidal thoughts in a covert way. d. Asking the client directly if they are thinking of attempting suicide.

d. Asking the client directly if they are thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. None of the other options should direct this discussion.

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.

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." How should the nurse respond to the client's concern? a. "I understand" and allow the client to close the door. b. Keep the door open, but step to the side out of the client's view. c. Leave the client's room and wait outside in the hall. d. "For your safety I can be no more than an arm's length away."

d. "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate. The correct statement reinforces the basic need for client safety. The other options fail to provide for the degree of client safety required.

Research supports which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patietn diagnosed with bipolar disorder a) SSRIs b) ECT c) One to one observation d) Lithium

lithium

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?"

1

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

1

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

1

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.

1

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.

1

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 Call the security staff immediately to control the patient. 3 Restrain the patient to the bed as there is risk of injury to others. 4 Ask the patient to cooperate as all the patients get the same meals.

1 Remain neutral and do not react angrily to the patient. Patients who are at high risk of suicide can show anger. In such a situation, the nurse should remain neutral and not react. This reduces power struggles and also discourages the acting-out behavior. Restraining the patient will not help. It is not required to call security at this stage. It is also inappropriate to tell the patient that all other patients get the same meals as this may aggravate the situation.

A patient who has no family is admitted to the hospital for treatment of bronchial carcinoma. The nurse finds that though the patient is in pain, the patient is improving. The patient says to the nurse, "I won't be a problem much longer." What should the nurse understand from this? 1 The patient will be discharged soon. 2 The patient is contemplating suicide. 3 The patient is happy with the treatment. 4 The patient does not require treatment anymore.

2 The patient is contemplating suicide. The factors that put this patient at higher risk of suicide include age, gender, lack of social support, lack of spouse, and a chronic medical condition. When such a patient makes a covert statement like "I won't be a problem much longer," the nurse should understand that the patient is contemplating suicide. In such situations, the nurse should ask the patient directly about suicidal ideation and whether he or she has thoughts of suicide or has developed a plan. The patient is in pain and thus would not be in a happy mood. The patient has not fully recovered yet and may not be discharged soon. Further treatment is required for the patient unless the patient has fully recovered.

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?"

1 "Do you have access to a gun?" The evaluation of a suicide plan is important in determining the degree of suicidal risk. Three main elements that must be considered when evaluating lethality are whether there is a specific plan with details (in this scenario, a self-inflicted gunshot wound), how lethal is the proposed method (guns are high lethality methods of suicide), and whether there is access to the planned method (does the patient have a gun). People who have definite plans for the time, place, and means are at high risk. "Why" questions are probing, nontherapeutic communication techniques. "Have you failed any other subjects?" and "Did something happen with your parents?" are yes/no questions that do not encourage the patient's self-disclosure.

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 "Can you please tell me the exact duration of your married life?" 4 "Do you have any relatives to look after you when you are sick?"

1 "Do you have any plans to end your life right now?" When a patient expresses not wanting to continue his or her life, the nurse should immediately ask if he or she has made any plans to commit suicide. Research shows that asking about suicidal ideas directly opens a conversation and can lead to problem-solving alternatives. It is more important for the nurse to assess if the patient has plans for suicide than to reassure the patient by saying that life has its ups and downs. Asking about relatives and the duration of marriage will not reduce the risk of suicide in the patient.

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 Assess the patient's risk for suicide. 2 Give information on local support groups. 3 Arrange a consultation with the social worker. 4 Discuss results of the newest medication research.

1 Assess the patient's risk for suicide. The patient is at risk for suicide, so safety is the highest priority. The patient will need support, medication education, and counseling at some point, but this is not the highest priority.

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

1 Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness.

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.

A 21-year-old college student undergoes a depression screening at the student health center. The student says, "I know I'm gay but I can't tell my family or straight friends." Which statement is accurate regarding this student's suicide risk? 1 This student's sexual preference has no bearing on suicide risk. 2 This student has a higher suicide risk than his or her heterosexual peers. 3 This student's suicide risk will decline if the family is informed of his or her sexual preferences. 4 This student's suicide risk is lower than that of heterosexual students because there is an identified gay and lesbian support community.

2 This student has a higher suicide risk than his or her heterosexual peers. Suicide is the third leading cause of death among lesbian, gay, bisexual, and transgender (LGBT) youth in the United States. Informing the family may or may not change the risk. LGBT youth are more likely to attempt suicide than their heterosexual peers.

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.

2

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.

2

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.

2

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

2 Identify the problems experienced by the patient. The nurse should try to identify the problems experienced by the patient and his or her feelings toward it. It helps to explore alternative ways of helping the patient and decrease hopelessness in the patient. The patient could develop a positive orientation toward the future. The nurse should encourage the patient to interact verbally. When the feelings are conveyed verbally, the actions to show aggression will be reduced, which decreases physical harm. Though the patients deny a suicide idea, they may have a future plan of committing suicide. The nurse should not connect emotionally with the patient's situation as it can distract his or her attention and can lead to counter transference. The nurse should remain neutral to avoid arguments and sympathy with the patient.

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.

A schizophrenic patient is aggressive and says, "I want to kill myself with a gun." What appropriate action should the nurse take while caring for the patient? 1 Instruct the staff to stay away from the patient. 2 Instruct the staff to observe the patient 24 hours a day. 3 Instruct the staff to let the patient interact with other patients. 4 Instruct the staff to chart the patient's whereabouts and record mood every 5 hours.

2 Instruct the staff to observe the patient 24 hours a day. The patient is clearly communicating suicidal intentions. The staff should observe the patient 24 hours a day. The nurse should be around the patient and record his or her mood and behavior every 15-30 minutes. One-to-one nursing interaction must be done with the patient 24 hours a day. The patient should not be allowed to mingle with other patients as the patient can harm them. The nurse is supposed to chart the patient's whereabouts and record the mood and behavior every 15-30 minutes, not every 5 hours.

A nurse is interacting with a patient with HIV and finds that the patient has suicidal ideation. Which patient response is indicative of suicidal ideations? 1 "My family wants me to be in a rehabilitation center." 2 "I feel like sleeping forever and never waking up again." 3 "I don't want to take the medications; they are very costly." 4 "I am upset with the people around me for their insensitive behavior."

2 "I feel like sleeping forever and never waking up again." The statement that the patient feels like sleeping and never waking up again is a covert statement. The statement indicates that the patient is frustrated with the illness and wants to die to get rid of it. The statement that the patient does not want to take the medications as they are costly indicates that the patient is unable to afford the medication. The patient needs financial assistance. The patient is upset with people for their insensitive behavior; this indicates that the patient is depressed. That the patient's family wants the patient to be in a rehabilitation center indicates that the patient is highly motivated and wants to recover soon.

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.

2, 3, 5

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.

2,3,5

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.

2,4

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.

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

3

A patient was admitted to the intensive care unit. After interacting with the patient's mother, the nurse documents in the assessment sheet that the patient attempted a copycat suicide. Which appropriate response by the patient's mother supports the report of the nurse? 1 "My son's classmates are responsible, as they used to humiliate him." 2 "My son was worried that he had performed poorly on the school exams." 3 "A few weeks ago, one of my son's classmates also attempted suicide in the same way." 4 "A few days back my son said he would die if we tried to send him to boarding school as we've been discussing."

3 "A few weeks ago, one of my son's classmates also attempted suicide in the same way." Copycat suicide is commonly seen during adolescence. Adolescents may glamorize the suicides of peers and classmates and perform copycat suicide due to immature reasoning and the function of an underdeveloped prefrontal cortex. The statement that the patient was worried about his poor performance on school exams indicates that academic performance was one of the probable reasons for attempting suicide. The statement that the patient's classmates are responsible for the suicide indicates that the patient's mother is blaming others, or that the patient has been the victim of bullying but it does not indicate risk for copycat suicide. The statement that the patient fought with his parents about school does not indicate a risk for copycat suicide.

A divorced woman is treated with antidepressants in an inpatient setting. The patient expresses to the nurse, "My depression is gone. I feel very energetic today. Soon everything will be fine." What would be the most appropriate response for the nurse? 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."

3 "Do you have any sort of suicidal ideas or plans?" It is important for the nurse to be aware of verbal and nonverbal hints of suicide by a patient to prevent suicide. When there is a sudden rise in the mood and energy of a depressed patient, the nurse should understand that the patient may have suicidal ideation. These behavioral changes may be the patient's attempt to mask suicidal intent. In such situations, the nurse should ask the patient directly about suicidal ideation. The patient should not be discharged as the patient is not safe. The patient should not be congratulated for recovery from depression because the patient is still not mentally stable. The patient does not seem to have recovered from depression. Therefore the nurse should not express satisfaction with the patient's recovery.

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 a highly publicized suicide of a public figure 4 After losing freedom due to imminent incarceration

3 After a highly publicized suicide of a public figure Theories of suicide have recently focused on a combination of suicidal fantasies with loss of job, rage, guilt, or identification with an individual who has committed suicide. A person commits copycat suicide after a highly publicized suicide of a public figure or an idol or a peer in the community. Losing a job, losing self-esteem due to various reasons, and feeling trapped in a jail may also be reasons for committing suicide, but they are not the reasons for a copycat suicide.

Which term is used in the medical record to indicate a patient wishes to be dead and is thinking about methods to use to accomplish death? 1 Suicide 2 Suicide attempt 3 Suicidal ideation 4 Completed suicide

3 Suicidal ideation Suicidal ideation is the term used to describe thinking about death, wishes to die, and methods of accomplishing death. Suicide is not a formal term used in the medical record. It describes the intentional act of killing oneself by any means. Suicide attempt is the behavior of carrying out acts with the intention of death. Completed suicide is a term used to describe actions committed by an individual that lead to death.

A patient reports lethargy, decreased appetite, and generalized body aches. The nurse finds out that the patient's teenaged child committed suicide a year ago. How should the nurse respond to this finding? 1 Avoid talking about the incident with the patient. 2 Do not ask further questions about the deceased child. 3 Ask the patient not to think about her daughter anymore. 4 Ask the patient open-ended questions about the incident.

4 Ask the patient open-ended questions about the incident. Risk of suicide in a family member of a person who has committed suicide is 4.5 times higher than in the general population. Therefore, it is important to ask open-ended questions about the incident and review the current situation of the patient. Mentioning or talking about the daughter can reduce hurt, stigma, and isolation in the patient. Survivors always want their loved ones to be remembered, so it would be inappropriate to ask the patient not to think about his or her child anymore. The nurse should always encourage the patient to express feelings about the traumatic event. This will make the patient feel comforted.

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

4 Have the patient identify three people to call if the patient is overwhelmed by hopelessness. For suicidal patients treated in the community, establishing a network of individuals to whom the patient may turn if the suicidal urge becomes great is important.

Which person is at highest risk for suicide a) A 50 year old married white male with depression who has a plan to overdose if circumstances at work do not improve b) A 45 year old married white female who recently lost her parents, suffers from bipolar disorder and attempted suicide once as a teenager c) A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend and has ready access to a gun he has hidden d) An older Hispanic male, who is Catholic, is living with a debilitating chronic illness, is recently widowed and who states, "I wish that God would take me too"

A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend and has ready access to a gun he has hidden

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.

Which patient statement does not demonstrate an understanding of a suicide safety plan a) I know that when I start thinking about my dad, I'm going to start thinking about killing myself b) Going for a really long, hard run helps clear my mind and stops the suicidal thoughts c) My sister is always there for me when I start getting suicidal d) I keep the suicide prevention phone number in my wallet

Going for a really long, hard run helps clear my mind and stops the suicidal thoughts

Gladys is seeing a therapist because her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?". The therapist's best response would be a) He probably acted quickly on impulse to kill himself b) He did not want to think about the pain he would cause you c) He was not able to think clearly due to his emotional pain d) He thought you may think it was an accident if there was no note

He was not able to think clearly due to his emotional pain

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? a. Plastic plate b. Cloth napkin c. Styrofoam cup d. Metal utensils

d. Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays since metal utensils can be used to cause physical harm. None of the other options carry that same degree of risk.

Martin, a 23 year old male with a new diagnosis of schizophrenia and his family is receiving information from a home health nurse. The topic of education is suicide prevention and the nurse recognizes effective teaching when the mother says a) Persons with schizophrenia rarely commit suicide b) Suicide risk is greatest in the first few years after diagnosis c) Suicide is not common in schizophrenia due to confusion d) Most persons diagnosed with schizophrenia die of suicide

Suicide risk is greatest in the first few years after diagnosis

Freud, Menninger and Aaron Beck theorized that hopelessness was an integral part of why a person commits suicide. A more recent theory suggest suicide results from a) Elevated serotonin levels b) The diathesis-stress model c) Outward aggression turned inward d) A lack of perfectionism

The diathesis-stress model

What are the nursing responsibilities to a patient expressing suicidal thoughts SATA a) Instituting one to one observation b) Documenting the patient's whereabouts and mood every 15-30 min c) Ensuring that the patient has no contact with glass or metal utensils d) Ensuring that patient has swallowed each individual dose of medication e) Discussing triggers of depression

a, b, c, d

Which interventions will help make the environment on the unit safer for suicidal patients SATA a) All windows are kept locked b) Every shower has a breakaway shower rod c) Eating utensils are counted when trays are collected d) Patient doors are kept open e) Staying within listening distance of the patient

a, b, c, d

When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings SATA a) 10-34 year olds b) Males c) College-educated adults d)Rural populations c) Native americans

a, b, d

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

a. Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.