PrepU Ch. 34-35 Suicide and Crisis Intervention
Which of the following questions by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue? a) "Are we allowed to use the client kitchen whenever we want?" b) "When is my next schedule ECT session?" c) "Are clients allowed to keep drugstore medications at their bedside?" d) "When do you think the doctor will let me get my street clothes back?"
"Are clients allowed to keep drugstore medications at their bedside?" Explanation: Asking whether medications can be kept at the bedside is a suspicious question if a client is depressed and may precede an attempted overdose. The other questions are not necessarily suggestive of suicidal ideation.
A Red Cross nurse is working with tornado victims. The nurse is interviewing a woman whose house was totally destroyed during the night by the tornado. The woman's pet poodle died as a result of the tornado. Which of following would the nurse most likely expect to hear from the woman? a) "Devastated. . . . I just feel totally devastated. I don't know how I can go on living." b) "I always thought my dog would die peacefully in my arms. Now I'll never be able to hold her again." c) "I don't know. I can't feel anything right now. Nothing seems real." d) "I just want my insurance man to get here so I can file a claim. Everything I had is gone."
"I don't know. I can't feel anything right now. Nothing seems real." Explanation: In the beginning of a crisis, a victim may report the feeling of numbness and shock. The reality of the woman's loss has not had sufficient time to "sink in." When it does, she will experience intense emotions regarding her loss.
The wife of an affluent and well-known businessman is shocked and distraught at the fact that her husband has been charged with fraud and publicly arrested. Which of the nurse's following statements is most therapeutic? a) "It's very understandable that you would feel betrayed and embarrassed right now." b) "Try to focus on the changes that you and husband will make to prevent this from happening again." c) "When this eventually blows over, you'll probably find it wasn't as serious as it feels right now." d) "These things have a way of working themselves out."
"It's very understandable that you would feel betrayed and embarrassed right now." Explanation: Downplaying a crisis or providing false reassurance is not therapeutic. As well, it would be premature to have the client focus on the distant future. Conversely, validating the client's feelings at the present time is a therapeutic technique.
A nurse is completing an admission assessment of a young adult woman who has a history of depression, and who was brought to the hospital by her boyfriend. In response to the nurse's question regarding suicidal ideation, the client discloses that she is thinking about killing herself. Which question would be most appropriate for the nurse to ask next? a) "What does your boyfriend think about your desire to kill yourself?" b) "What will killing yourself accomplish?" c) "What are your spiritual beliefs about suicide?" d) "What thoughts have you had about how you would kill yourself?"
"What thoughts have you had about how you would kill yourself?" Explanation: Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt(s), suicide planning and implementation, and availability and lethality of the suicide method. Risk assessment also includes the patient's resources, including coping skills and social supports, that can be used to counter suicidal impulses.
Approximately what percentage of suicides in the United States are associated with mental illness or alcohol and substance abuse? a) 80% b) 90% c) 50% d) 70%
90% Explanation: More than 90% of suicides in the United States are associated with mental illness or alcohol and substance abuse.
A nurse is providing crisis care to a community. Which of the following clients is experiencing an adventitious crisis? a) A couple having relationship difficulties after 7 years of marriage b) A man who recently lost his job c) A family with a child who died of cancer d) A woman attending a music festival where rioting resulted in mass injuries
A woman attending a music festival where rioting resulted in mass injuries Explanation: An adventitious crisis is a crisis of disaster. Intervening with people at the festival will assist them to deal with the present crisis. The priority is to assist the client to return to normal function as soon as she is able. A man who has lost his job, a family who has lost a child, and a couple having relationship difficulties would all be in situational crises.
Which of the following statements best defines crisis intervention? a) An intervention in which a group of psychiatric professionals meet to determine which intervention might be most effective for a disturbed client b) An active but temporary entry into the life situation of an individual, a family, or a group during a period of stress c) A group intervention in which confrontation is used to promote change in the client d) A family meeting in which the treatment team assists with confrontation of the client's behavior
An active but temporary entry into the life situation of an individual, a family, or a group during a period of stress Explanation: Crisis intervention is temporary, but very active, and occurs only during a period of stress.
A possible outcome of surveying a disaster is that the surveyor often experiences ... a) An exaggerated fear for his or her safety b) An increase in psychotic symptomology c) Long-term financial difficulties d) Physical trauma as well
An exaggerated fear for his or her safety Explanation: A possible outcome of surveying a disaster is that the surveyor often experiences an exaggerated fear for his or her safety. The surveyor will likely not experience physical trauma, long-term financial difficulties, or an increase in psychotic symptomology.
After educating a class on factors that enhance the risk of suicide, the instructor determines the need for additional education when the class identifies which of the following? a) Loss b) Delusions c) Cautiousness d) Family member committing suicide
Cautiousness Explanation: Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.
When a nurse assesses prior self-harm behavior, this can provide information about the motivation behind the clients' actions and allows the nurse to do which of the following? a) Ignores the past attempts and focuses on the here and now b) Provides an understanding of the reactions of others c) Communicate concern and empathy to the client d) Creates a judgemental attitude
Communicate concern and empathy to the client Explanation: Assessing the context of each act of prior self-harm behavior begins to paint a picture of motivation behind the behavior. Exploration of prior behavior also gives a message of interest and concern on the part of the health professional.
The nurse is providing care for a 9-year-old boy whose family was just involved in a motor vehicle accident in which his father and brother died. The nurse should anticipate that the child is likely to exhibit which of the following responses when he learns these details? a) Confusion b) Resignation c) Rage d) Denial
Denial Explanation: Like adults, every child or adolescent is an individual with individualized responses to crises. However, it is natural for a child or adolescent to first experience denial that the crisis situation really happened.
Which of the following mental health disorders is a the most significant risk factor for suicide? a) Schizophrenia b) Mania c) Depression d) Anxiety
Depression Explanation: Depression is a major risk factor of suicide. Anxiety, schizophrenia, and mania are significant risk factors, but to a lesser degree than depression.
A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which nursing intervention would be most appropriate at this time? a) Developing a personal plan for managing suicidal thoughts when they occur b) Administering psychotropic drugs that decrease the client's serotonin levels c) Advising the client that he should consider electroconvulsive therapy treatments d) Assigning nursing staff to stay with him during his suicidal crisis
Developing a personal plan for managing suicidal thoughts when they occur Explanation: The client's immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like he is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.
A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which of the following is the nurse's priority intervention for this client? a) Encouraging attendance at group cognitive-behavioral therapy on the unit. b) Exploring the grief and loss issues concerning the baby's death. c) Encouraging the client to express feelings of isolation following the recent immigration. d) Ensuring that the client is not permitted to use anything that would be potentially dangerous.
Ensuring that the client is not permitted to use anything that would be potentially dangerous. Explanation: Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority.
Which of the following techniques utilized during crisis intervention would be detrimental to the client if utilized by the mental health nurse? a) Explaining that the client is exhibiting an abnormal reaction b) Setting limits on the client's self-destructive behavior c) Clarifying fantasies of the client d) Displaying acceptance of the client
Explaining that the client is exhibiting an abnormal reaction Explanation: A therapeutic technique used in crisis intervention would be to explain that the client's emotions are a normal reaction to the crisis.
It would be helpful for the parents of a suicidal adolescent to understand that the most frequent cause or motive for suicide in adolescents is what? a) Feelings of anger or hostility b) Reunion wish or fantasy c) Feelings of alienation or isolation d) Progressive failure to adapt
Feelings of alienation or isolation Explanation: In adolescent clients, the developmental task is of a sense of belonging. When adolescents feel alienated or isolated, suicidal thoughts may emerge. In adolescence, therefore, the most common motives are feelings of alienation or isolation.
Due to an accumulation of heavy snow, a shopping center's parking garage has collapsed and caused multiple deaths and injuries. At what point following the crisis are victims most likely to experience disillusionment and frustration? a) In the first month after the disaster b) From several weeks to 2 years after the disaster c) Several years after the disaster d) In the first 48 hours after the disaster
From several weeks to 2 years after the disaster Explanation: After the honeymoon period of 4 weeks to 6 months after the disaster, there may be a period of disillusionment that may last up to 2 years after the disaster.
A 32-year-old female is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, it is important to assess and explore if there is any family member who has committed suicide. Risk factors for suicidal behavior include ... a) Genetic abnormalities b) Lack of conflict resolution skills c) Disengagement of family d) Terminal illness
Genetic abnormalities Explanation: Suicide rates tend to be higher in families in which suicide has occurred, which are genetic and familial factors. First-degree relatives of individuals who have completed suicide have a two- to eight-times higher risk for suicide than do individuals in the general population.
A nurse assesses prior self-harm behavior, which provides information on the motivation behind the clients' actions and also ... a) Creates a judgemental attitude b) Provides an understanding of the reactions of others c) Gives a message of interest and concern d) Ignores the past attempts and focuses on the here and now
Gives a message of interest and concern Explanation: Assessing the context of each act of prior self-harm behavior begins to paint a picture of motivation behind the behavior. Exploration of prior behavior also gives a message of interest and concern on the part of the health professional.
Successful resolution of a crisis an individual is experiencing is more likely to occur if the individual ... a) Increases their own pressures to quickly resolve the situation effectively b) Seeks help from a professional c) Has experienced a prior stressor with greater magnitude d) Has a realistic view of the situation
Has a realistic view of the situation Explanation: The timely and successful resolution of a crisis is more likely if an individual has a realistic view of the situation, adequate supports available, and effective coping mechanisms.
A client comes to the health clinic stating that he wants to kill himself. He has made an elaborate plan and has access to a weapon. His lifestyle is unstable, and he is disoriented at the present time. The nurse would assess this client's degree of suicide risk as which of the following? a) Moderate b) Low c) High d) No risk
High Explanation: This client has predominantly destructive resources, his lifestyle is unstable, and he is markedly disoriented, which is classified as a high suicide risk.
Mr. and Mrs. Adams have just been informed that their 2-week-old daughter has a congenital neurologic demyelinating disorder that will result in progressive loss of function and a 2-year life expectancy. The couple are hugging each other and crying uncontrollably. The nurse evaluates their reaction as which phase of the crisis process? a) Precrisis b) Impact c) Resolution d) Crisis
Impact Explanation: The impact phase occurs when the individual learns of a situation that will create crisis.
A nurse who arranges an educational session about suicidal behavior in preparing a client for discharge ensures ... a) Reminding patient make an out-patient appointment for follow-up care b) Including significant others to provide a better understanding of illness c) Discussing the patients decreased risk factors following their hospitalization d) Avoiding inclusion of significant others to ensure confidentiality of patient
Including significant others to provide a better understanding of illness Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the patient's illness and also learn what is necessary in providing outpatient care.
Which of the following would be considered a situational crisis? a) War b) Job promotion c) Flood d) Murder
Job promotion Explanation: A situational crisis occurs whenever a specific stressful event threatens a person's biopsychosocial integrity and results in some degree of psychological disequilibrium. A move to another city, a job promotion, or graduation from high school can initiate a situational crisis even though they are positive events. Examples of a traumatic crisis include murder, floods, and war.
Which of the following would be inconsistent with provisions of a crisis response team? a) On-scene crisis intervention b) Referrals c) Emotional support d) Long-term support
Long-term support Explanation: Crisis response teams are on call to provide immediate, short-term, on-scene crisis intervention, emotional support, and referrals for families, neighbors, witnesses, and survivors who are traumatized by the experience.
A client is preparing to get married and move out of state. Which type of crisis would be related to the client's situation? a) Psychiatric situational b) Maturational c) Situational d) Developmental
Maturational Explanation: Maturational crises are those that occur during normal growth and development, such as getting married. Situational crisis occurs due to a sudden, unexpected traumatic stress. Developmental crisis involves an internal stress and psychosocial issue. Psychiatric situational crisis results in unpredictable behavior or the onset of an acute psychotic disorder.
Which of the following would not be essential to assess when working with a person in crisis? a) Coping skills b) Past history of mental health care c) Perception of the event d) Support systems
Past history of mental health care Explanation: The nurse first determines the client's perception of the stressful event. After determining the client's perception of the event, the nurse focuses on who is available to support the client, and encourages the client to describe specific coping methods, determining whether the coping mechanisms are adaptive or maladaptive. Past history is not an immediate priority when assessing a person's current state of crisis.
Which of the following has the most influence on the outcome for a person experiencing a crisis? a) Perception of the precipitating event b) Financial resources c) Membership in a vulnerable population d) Past coping skills
Perception of the precipitating event Explanation: Factors that influence the outcome of a crisis include previous problem-solving experience, perception or view of the problem, amount of help or hindrance from significant others, number and types of past crises, time elapsed since the last crisis, membership in a vulnerable population, sense of mastery, and resilience.
As part of a community program on crisis prevention, a nurse is describing the phases of crisis. Which of the following would the nurse identify as occurring first? a) Automatic relief behaviors take over as the "fight-or-flight" hormones dissipate b) Person has serious personality disorganization c) Person has a problem that doesn't "fit" with their usual problem-solving methods d) Trial and error attempts to alleviate the problem
Person has a problem that doesn't "fit" with their usual problem-solving methods Explanation: A crisis occurs in phases as identified by psychiatrist Gerald Caplan. A crisis occurs when a person faces a problem that cannot be solved by customary problem-solving methods. When the usual problem-solving methods no longer work, a person's life balance or equilibrium is upset, and the person uses trial and error to solve the problem. These attempts fail, and the anxiety rises to severe or panic levels, whereby the person then adopts automatic relief behaviors. When these fail, anxiety overwhelms the person and leads to serious personality disorganization, which signals the person is in crisis.
Which of the following is the greatest predictor of a future suicide attempt? a) Seriousness of suicidal ideation b) Previous attempt c) Suicide planning d) Degree of hopelessness
Previous attempt Explanation: The greatest predictor of a future suicide attempt is a previous attempt, in part because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning
A nurse is working with a client who is in crisis. Which of the following would be least appropriate for the nurse to do? a) Encourage the client to focus on one aspect at a time. b) Explain information clearly to clarify any misconceptions or myths. c) Support the client's cultural beliefs about expressing feelings. d) Provide the client with an understanding that everything will be okay.
Provide the client with an understanding that everything will be okay. Explanation: Telling the client that everything will be okay is false reassurance and blocks communication. Rather, the nurse should focus on what the information means to the client. Supporting the client's cultural beliefs about expressing his or her feelings, encouraging the client to focus on one thing at a time, and explaining information clearly are appropriate
It is critical that the psychiatric nurse providing crisis care for a suicidal client assess the client while ... a) Selecting client-focused interventions and effective evaluations b) Providing emotional support and enlisting her cooperation c) Communicating respectfully with her and establishing outcomes d) Documenting findings and consulting with her health care team
Providing emotional support and enlisting her cooperation Explanation: The most essential element of psychiatric-mental health intervention during a crisis or disaster is the ability of the nurse to provide emotional support while assessing the individual's emotional and physical needs and enlisting his or her cooperation.
When intervening with a suicidal client, the initial goal is to keep the client safe. Measures to optimize safety would include which of the following? a) Threats should not be taken seriously b) Avoid asking direct questions c) Remove methods of suicide from the client d) Less intervention is needed when mood improves
Remove methods of suicide from the client Explanation: It is important to remove methods of suicide, if possible, from the person. If a person has a concern that someone is thinking of suicide, ask directly. Nurses need to take any threat of suicide seriously. Mood disorders are common in people who die by suicide; treatment needs to be encouraged.
Suicide is the leading cause of death in which of the following patient populations? a) Eating disorders b) Personality disorders c) Schizophrenia d) Anxiety disorders
Schizophrenia Explanation: Suicide is the leading cause of premature death in people with schizophrenia.
People who complete suicide often have extremely low levels of which neurotransmitter? a) Serotonin b) Norepinephrine c) Acetylcholine d) GABA
Serotonin Explanation: People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides.
Which of the following is a primary risk factor for suicide? a) Poverty b) Economic deprivation c) Social isolation d) Unemployment
Social isolation Explanation: Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.
In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? a) Suicidal ideation b) Suicidal gesture c) Suicidal threat d) Suicidal intent
Suicidal intent Explanation: The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats, and gestures are typically more vague and less rooted in time and place.
In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? a) Suicidal threat b) Suicidal intent c) Suicidal ideation d) Suicidal gesture
Suicidal intent Explanation: The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats, and gestures are typically more vague and less rooted in time and place.
A client, 65 years, seeks crisis intervention in a community senior citizen center. She states she has very few financial resources, and her children never call or visit. She is sobbing and states, "I can't take it anymore. My life is so lonely and hard. I am living too long and shouldn't be here anymore." What is the most important assessment data for the nurse to further assess? a) The meaning of the statement "I cannot take it anymore" b) Coping skills c) Relationship with children d) Loneliness
The meaning of the statement "I cannot take it anymore" Explanation: The focus is on the client's safety. Investigating suicide risk is the priority nursing assessment. The priority data that the nurse would assess is what the client means by "I cannot take it anymore." Loneliness, children, and coping skills are important aspects of assessment, but should be addressed after the client's safely has been established.
Which is the most appropriate overall nursing goal for crisis intervention? a) Family and friends will provide support. b) The overall goal of crisis intervention is to help the client return to the pre-crisis level of functioning. c) The client will reduce the distortion of his or her perception of the event. d) Anxiety will decrease.
The overall goal of crisis intervention is to help the client return to the pre-crisis level of functioning. Explanation: The overall goal of crisis intervention is to help the client to re-establish equilibrium. With skills learned through crisis resolution, the optimum outcome is for the person to function even more effectively than the pre-crisis level.
A situational crisis refers to ... a) A stress-induced response that relates to an individual's exposure to the various developmental stages b) The result of an external source of severe stress the individual is not prepared to cope with effectively c) A term used to describe any severe stress reaction with a known origin of cause d) The extreme physiological response to events such as menopause and retirement
The result of an external source of severe stress the individual is not prepared to cope with effectively Explanation: A situational crisis refers to the result of an external source of severe stress the individual is not prepared to cope with effectively. A situational crisis does not refer to any of the following: a stress-induced response that relates to an individual's exposure to the various developmental stages; the extreme physiological response to events such as menopause and retirement; or a term used to describe any severe stress reaction with a known origin of cause.
A nurse will soon begin crisis intervention with a young mother who has suddenly been abandoned by her partner of several years. What is the primary goal of crisis intervention? a) To promote the client's understanding of ways that she may have contributed to the crisis b) To decrease the client's emotional stress and protect her from additional stress c) To help the client gain insight into her coping and defense mechanisms d) To foster empathy and understanding that the client may provide to individuals with similar crises in the future
To decrease the client's emotional stress and protect her from additional stress Explanation: Among the central goals of crisis intervention is the goal to decrease the client's emotional stress and protect the client from additional stress. This supersedes the importance of fostering insight and promoting empathy. Questioning the client's contribution to the crisis is inappropriate and counterproductive.
In assessing suicide potential, it is important for the community mental health nurse to know which of the following people are most prone to self-destructive behavior? a) Single working women b) Unemployed professional workers c) Married elderly men d) Caucasian teenagers
Unemployed professional workers Explanation: Professional workers who have become unemployed are at higher risk for suicide than other groups because of the multiple losses associated with losing their primary focus of self-identity.
A nurse has just completed a suicide risk assessment of a widowed man 76 years of age. In addition to documenting the presence or absence of suicidal thoughts, a suicide plan, and the client's available means, the nurse would also document which of the following? a) Amount of sleep in past 24 hours b) Use of substances 6 hours before the assessment c) Availability of support resources d) Speech patterns
Use of substances 6 hours before the assessment Explanation: The nurse should document the presence or absence of suicidal thoughts, intent, plan, and available means to illustrate current and ongoing suicide risk. If the client denies any suicidal ideation, it is important that the denial is documented. Documentation must include any use of drugs, alcohol, or prescription medications by the client during the 6 hours before the assessment. It should include the use of antidepressants that are especially lethal (e.g., tricyclics), as well as any medication that might impair the client's judgment (e.g., a sleep medication). Notes should reflect the level of the client's judgment and ability to be a partner in treatment.
Crisis intervention provided by a psychiatric clinician is necessary when an individual's ... a) Spiritual beliefs have been challenged b) Support system has failed them c) Trauma is psychosocial in nature d) Usual problem-solving methods are ineffective
Usual problem-solving methods are ineffective Explanation: Crisis intervention provided by a psychiatric clinician is necessary when an individual's usual problem-solving methods are ineffective. Crisis intervention may not be as necessary when a support system has failed, when the trauma is psychosocial in nature, or when spiritual beliefs have been challenged.
When conducting a suicide risk assessment, the nurse understands that which of the following methods has the least lethality? a) Overdose of benzodiazepines b) Jumping c) Wrist slashing d) Hanging
Wrist slashing Explanation: The least lethal of the options is wrist slashing. Hanging, overdose of benzodiazepines, and jumping are more lethal methods of suicide.
When conducting a suicide risk assessment, the nurse understands that which of the following methods has the least lethality? a) Wrist slashing b) Jumping c) Overdose of benzodiazepines d) Hanging
Wrist slashing Explanation: The least lethal of the options is wrist slashing. Hanging, overdose of benzodiazepines, and jumping are more lethal methods of suicide.
A primary prevention strategy for coping with a maturational or potential situational crisis includes ... a) childbirth classes for a couple having their first child. b) recognizing symptoms of relapse for those with chronic mental illness. c) marriage counseling for a couple contemplating divorce. d) assisting parents to select a group home for their troubled teen.
childbirth classes for a couple having their first child. Explanation: Education is an example of primary prevention by helping prepare the parents for both the physical aspects of birth and anticipated demands before they assume their new role.
A primary prevention strategy for coping with a maturational or potential situational crisis includes ... a) marriage counseling for a couple contemplating divorce. b) recognizing symptoms of relapse for those with chronic mental illness. c) childbirth classes for a couple having their first child. d) assisting parents to select a group home for their troubled teen.
childbirth classes for a couple having their first child. Explanation: Education is an example of primary prevention by helping prepare the parents for both the physical aspects of birth and anticipated demands before they assume their new role.
Crisis intervention differs from the typical therapeutic relationship in that ... a) the nurse assists the client in changing his or her personality to better cope with crisis situations. b) crisis intervention strives to assist the client in gaining insight into coping skills. c) the course of crisis intervention is determined by the needs identified by the client. d) crisis intervention seeks to alleviate the immediate external threat.
crisis intervention seeks to alleviate the immediate external threat. Explanation: Crisis intervention focuses on the problem or stressor that precipitated the crisis, rather than on personality traits. It views the person in crisis as normal and capable of problem-solving and growth with assistance from others. The goal is to assist the person in distress to resolve the immediate problem and regain emotional equilibrium.
Autumn's marriage of 3 years has just ended. She has a small child and is facing a crisis regarding how to manage her roles as mother and now provider for herself and her child. The nurse can assist Autumn by role-playing asking her parents for some temporary financial and custodial support. Autumn needs help with this process because she likely is a) struggling with feeling dependent on others. b) being judged unfit by others. c) being encouraged to become dependent on her parents. d) relinquishing care and responsibility for her child.
struggling with feeling dependent on others. Explanation: In a crisis, it is natural to withdraw and feel isolated. Therefore, the nurse helps the client to communicate directly with significant others. Clients who place high value on independence may need particular assistance to recognize interdependence as a healthy balance. Often, the nurse must teach such clients how to ask for help.
In which of the following settings may crisis intervention take place? Select all that apply. a) Psychiatric unit b) Schools c) Home d) Workplace e) Emergency department
• Psychiatric unit • Schools • Home • Workplace • Emergency department Explanation: Crisis intervention can occur in many settings: the home, emergency department (ED), workplace, schools/classroom, surgical intensive care unit, or psychiatric unit.
A high risk for suicide would be assessed as which of the following? a) Support systems available b) Feelings of self-worth c) Adequate sleep pattern d) Previous suicidal behavior
Previous suicidal behavior Explanation: Previous suicidal behaviors increase the risk of suicide.
Approximately what percentage of suicides in the United States are associated with mental illness or alcohol and substance abuse? a) 80% b) 90% c) 70% d) 50%
90% Explanation: More than 90% of suicides in the United States are associated with mental illness or alcohol and substance abuse.
A nurse is assessing a woman age 35 years who is seeking assistance at a local community counseling center. Which of the following statements made by the woman would indicate that she is experiencing a crisis? a) "I'm confused and hurt; I have lost my best friend and my lover." b) "No matter what I do, I am still overcome by these sad feelings." c) "I'm so upset; my husband has never left me like this before." d) "I don't understand; I can't seem to function like I usually do."
A nurse is assessing a woman age 35 years who is seeking assistance at a local community counseling center. Which of the following statements made by the woman would indicate that she is experiencing a crisis? You selected: "I don't understand; I can't seem to function like I usually do." Explanation: Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. Life is disrupted, and unexpected emotional (e.g., depression) and biologic (e.g., nausea, vomiting, diarrhea, headaches) responses occur. Functioning is severely impaired. Although feelings of upset, confusion, hurt, and sadness may occur with a crisis, the key component is impaired functioning.
A nurse is providing crisis care to a community. Which of the following clients is experiencing an adventitious crisis? a) A woman attending a music festival where rioting resulted in mass injuries b) A couple having relationship difficulties after 7 years of marriage c) A family with a child who died of cancer d) A man who recently lost his job
A woman attending a music festival where rioting resulted in mass injuries Explanation: An adventitious crisis is a crisis of disaster. Intervening with people at the festival will assist them to deal with the present crisis. The priority is to assist the client to return to normal function as soon as she is able. A man who has lost his job, a family who has lost a child, and a couple having relationship difficulties would all be in situational crises.
Which of the following would be inconsistent with provisions of a crisis response team? a) Referrals b) On-scene crisis intervention c) Long-term support d) Emotional support
Long-term support Explanation: Crisis response teams are on call to provide immediate, short-term, on-scene crisis intervention, emotional support, and referrals for families, neighbors, witnesses, and survivors who are traumatized by the experience.
Which client population has the highest risk for suicide? a) Elderly men b) Adolescent girls c) Elderly women d) Adolescent boys
Elderly men Explanation: The fastest growing age group is 80 years and older, and men older than 85 years have the highest risk for suicide.
When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of Xanax (alprazolam), the nurse describes which of the following behavioral clues? a) Giving away valued personal items b) Inquiry about doses of lethal drugs c) Experiencing the loss of a boyfriend or girlfriend d) Angry outbursts at significant others
Giving away valued personal items Explanation: The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following: • Talks about death, suicide, and wanting to be dead • Talks or thinks about punishment, torture, and being persecuted • Hears voices and suddenly seems very happy after being very depressed for some time • Is very aggressive or very impulsive, and acting suddenly and unexpectedly • Shows an unusual amount of interest in getting his or her affairs in order • Gives away personal belongings
A nurse is providing a presentation about suicide for a group of health professionals. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men? a) Substance abuse b) Lack of conflict resolution skills c) Parenting practices d) Media influences
Substance abuse Explanation: Substance abuse, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, just under 50% of suicide attempts among men between the ages of 42 and 77 years involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role, but are not considered major factors.
A nurse will soon begin crisis intervention with a young mother who has suddenly been abandoned by her partner of several years. What is the primary goal of crisis intervention? a) To foster empathy and understanding that the client may provide to individuals with similar crises in the future b) To decrease the client's emotional stress and protect her from additional stress c) To promote the client's understanding of ways that she may have contributed to the crisis d) To help the client gain insight into her coping and defense mechanisms
To decrease the client's emotional stress and protect her from additional stress Explanation: Among the central goals of crisis intervention is the goal to decrease the client's emotional stress and protect the client from additional stress. This supersedes the importance of fostering insight and promoting empathy. Questioning the client's contribution to the crisis is inappropriate and counterproductive.
A nurse will soon begin crisis intervention with a young mother who has suddenly been abandoned by her partner of several years. What is the primary goal of crisis intervention? a) To foster empathy and understanding that the client may provide to individuals with similar crises in the future b) To promote the client's understanding of ways that she may have contributed to the crisis c) To help the client gain insight into her coping and defense mechanisms d) To decrease the client's emotional stress and protect her from additional stress
To decrease the client's emotional stress and protect her from additional stress Explanation: Among the central goals of crisis intervention is the goal to decrease the client's emotional stress and protect the client from additional stress. This supersedes the importance of fostering insight and promoting empathy. Questioning the client's contribution to the crisis is inappropriate and counterproductive.
The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. A priority assessment for the nurse to make is to assess whether or not the client ... a) can identify a person to whom he or she can turn to for help after discharge. b) feels stigmatized by the hospitalization experience. c) understands the need for daily medications. d) will cease the suicidal ideation.
can identify a person to whom he or she can turn to for help after discharge. Explanation: The priority assessment for the nurse to make is whether or not the client can identify a person, or ideally, persons to whom he or she can turn to for help after discharge. Inability of the client to name any significant others portends a poor outpatient course.
When talking with the spouse of a client who attempted suicide, the psychiatric nurse shows an understanding of the priority areas of assessment when asking which of the following questions? Select all that apply. a) "Does your wife harm herself physically when she's stressed?" b) "Looking back on it, did your wife give you any clue that she was suicidal?" c) "I understand your wife attempted to kill herself by cutting her wrists." d) "Who will be responsible for getting your wife to her daily hospital therapy sessions?" e) "Has your wife ever been psychiatrically unstable before?"
• "Does your wife harm herself physically when she's stressed?" • "I understand your wife attempted to kill herself by cutting her wrists." • "Who will be responsible for getting your wife to her daily hospital therapy sessions?" Explanation: When talking with the spouse of a client who attempted suicide, the psychiatric nurse shows an understanding of the priority areas of assessment by the following: "Does your wife harm herself physically when she's stressed?"; "I understand your wife attempted to kill herself by cutting her wrists."; and "Who will be responsible for getting your wife to her daily hospital therapy sessions?".
A client comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. a) "I'm looking for a new job because my job is so stressful." b) "I'm so tired that all I ever want to do is sleep all the time." c) "I've been going out with my friends about once or twice a week." d) "I've been drinking about three or four more beers every night." e) "Most times, I feel like I'm trapped with no way out."
• "I've been drinking about three or four more beers every night." • "Most times, I feel like I'm trapped with no way out." • "I'm so tired that all I ever want to do is sleep all the time." Explanation: Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
When assessing risk of suicide, which of following are important assessment components? Select all that apply. a) Unemployment b) Degree of hopelessness c) Lethality of method d) Seriousness of suicidal ideation e) Previous attempt
• Degree of hopelessness • Lethality of method • Seriousness of suicidal ideation • Previous attempt Explanation: Assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt, suicide planning and implementation, and availability and lethality of the suicide method.
A nurse is performing an assessment of a client with suicidal ideation. Which question would the nurse most likely ask to determine the degree of planning? a) "Have you attempted suicide before?" b) "How seriously do you want to die?" c) "How much do the thoughts distress you?" d) "Could you stop yourself from killing yourself?"
"Could you stop yourself from killing yourself?" Explanation: The question about stopping oneself from suicide reflects the degree of planning. Asking the client about how seriously he wants to die and about previous attempts of suicide reflect the client's intent to die. Asking about how much the thoughts are distressing reflects the severity of the ideation.
After teaching a group of nursing students about crisis, the instructor determines that the education was successful when the students state which of the following? a) "Chronic crisis is a real situation." b) "Crisis triggers maladaptive responses." c) "Crisis is a time-limited event." d) "Events causing a crisis are similar for everyone."
"Crisis is a time-limited event." Explanation: Crisis is a time-limited event (usually no more than 4&emdash;6 weeks) that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences. By definition, there is no such thing as a chronic crisis. People who live in constant turmoil are not in crisis but in chaos. Although the feelings associated with a crisis are similar, the precipitating event and circumstances are unusual or rare, perceived as a threat and specific to the individual.
A legal secretary 25 years of age is seeking counseling because she recently lost her job unexpectedly. Which question would be most appropriate for a nurse to use in assessing the client's response to losing her job? a) "How have you responded to previous stressful situations?" b) "How did you feel immediately after being told you no longer had a job?" c) "What happened to cause you to lose your job?" d) "How do you expect yourself to be able to handle this situation?"
"How have you responded to previous stressful situations?" Explanation: Individual responses to a crisis can be best understood by assessing the usual responses of the person to stressful events. The response to the crisis also depends on the meaning of the event to the person. Asking about the cause of job loss, immediate feelings, and how the person expects to handle the situation do not address the client's response to the job loss.
A 40-year-old client was admitted to the psychiatric unit after a suicide attempt in which he was found standing on the edge of a bridge. Statements made by the client that would lead the nurse to suspect a potential imminent suicide attempt include what? a) "How often does the night personnel make rounds?" b) "When will I be discharged?" c) "I don't want to be alone just now." d) "I'm bored. What's there to do around here?"
"How often does the night personnel make rounds?" Explanation: Asking about unit procedures, such as frequency of checks or rounds, is a cue to an individual's potential suicidal thinking.
A Red Cross nurse is working with tornado victims. The nurse is interviewing a woman whose house was totally destroyed during the night by the tornado. The woman's pet poodle died as a result of the tornado. Which of following would the nurse most likely expect to hear from the woman? a) "Devastated. . . . I just feel totally devastated. I don't know how I can go on living." b) "I don't know. I can't feel anything right now. Nothing seems real." c) "I just want my insurance man to get here so I can file a claim. Everything I had is gone." d) "I always thought my dog would die peacefully in my arms. Now I'll never be able to hold her again."
"I don't know. I can't feel anything right now. Nothing seems real." Explanation: In the beginning of a crisis, a victim may report the feeling of numbness and shock. The reality of the woman's loss has not had sufficient time to "sink in." When it does, she will experience intense emotions regarding her loss.
A nurse is assessing a woman age 35 years who is seeking assistance at a local community counseling center. Which of the following statements made by the woman would indicate that she is experiencing a crisis? a) "No matter what I do, I am still overcome by these sad feelings." b) "I don't understand; I can't seem to function like I usually do." c) "I'm so upset; my husband has never left me like this before." d) "I'm confused and hurt; I have lost my best friend and my lover."
"I don't understand; I can't seem to function like I usually do." Explanation: Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. Life is disrupted, and unexpected emotional (e.g., depression) and biologic (e.g., nausea, vomiting, diarrhea, headaches) responses occur. Functioning is severely impaired. Although feelings of upset, confusion, hurt, and sadness may occur with a crisis, the key component is impaired functioning.
The wife of an affluent and well-known businessman is shocked and distraught at the fact that her husband has been charged with fraud and publicly arrested. Which of the nurse's following statements is most therapeutic? a) "It's very understandable that you would feel betrayed and embarrassed right now." b) "These things have a way of working themselves out." c) "When this eventually blows over, you'll probably find it wasn't as serious as it feels right now." d) "Try to focus on the changes that you and husband will make to prevent this from happening again."
"It's very understandable that you would feel betrayed and embarrassed right now." Explanation: Downplaying a crisis or providing false reassurance is not therapeutic. As well, it would be premature to have the client focus on the distant future. Conversely, validating the client's feelings at the present time is a therapeutic technique.
A nurse is presenting a discussion about suicide for a local community group. Which comment from an audience member indicates the need to clarify the information? a) "Suicides more often occur during the holiday seasons." b) "Warning signs about the person's intention often occur." c) "People who are suicidal are undecided about living or dying." d) "People who talk about suicide need to be taken seriously."
"Suicides more often occur during the holiday seasons." Explanation: The comment about suicides occurring more frequently during holiday seasons is a myth that requires clarification. Warning signs, indecision about living and dying, and taking individuals seriously when they discuss suicide are accurate facts.
An individual is seeking employment as a nurse in a crisis center. The interviewer asks the job candidate what he would ask someone who called the crisis hotline to determine whether the caller was experiencing a crisis. Which response would be most appropriate? a) "Why do you think you are in a crisis situation?" b) "Tell me about what you are experiencing and what it means to you." c) "How would you rate your level of functioning on a scale from 1 to 10?" d) "To what extent are you involved in a crisis situation?"
"Tell me about what you are experiencing and what it means to you." Explanation: A response to the crisis depends on the meaning of the event to the victim. Telling someone to describe what they are experiencing and what that experience means to them elicits more information than asking a person to quantify the extent of the crisis. Asking someone "why" tends to put an individual on the defensive because the question implies that the individual needs to "justify" his or her perception. Asking about the extent of the crisis would be difficult for the person to answer. In addition, it already assumes that the client is in crisis. Rating the level of functioning would be important information to ask later, after establishing what the client is experiencing.
A nurse is part of team working with hurricane victims. One of the hurricane victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with his situation and how much support he needs, which question would be most appropriate for the nurse to ask? a) "Are you feeling guilty because you survived and some of your neighbors did not?" b) "What are your thoughts about what you will do during the next few days?" c) "What kind of help do you need from us?" d) "How are you feeling about all that you have gone through?"
"What are your thoughts about what you will do during the next few days?" Explanation: By assessing the victim's ability to solve problems, the nurse can evaluate whether the victim can cognitively cope with the crisis situation and determine the kind and amount of support needed. At this point in time, the client may not be able to identify the type of help he needs or what he will be doing for the next few days. Asking about feeling guilty is inappropriate. Additionally, this is a closed-ended question that does not allow the victim to explore what he is feeling.
A nurse is providing crisis care to a community. Which of the following clients is experiencing an adventitious crisis? a) A woman attending a music festival where rioting resulted in mass injuries b) A family with a child who died of cancer c) A couple having relationship difficulties after 7 years of marriage d) A man who recently lost his job
A woman attending a music festival where rioting resulted in mass injuries Explanation: An adventitious crisis is a crisis of disaster. Intervening with people at the festival will assist them to deal with the present crisis. The priority is to assist the client to return to normal function as soon as she is able. A man who has lost his job, a family who has lost a child, and a couple having relationship difficulties would all be in situational crises.
Which of the following clients exhibits the most realistic perception of his or her present crisis? a) A woman newly diagnosed with lung cancer laments the fact that she has never made a sincere effort to quit smoking. b) A woman whose daughter will soon graduate from high school experiences chronic insomnia due to worrying about her daughter's future. c) A man believes that his business would have failed no matter what action he had taken to operate it differently. d) A woman with uncontrolled diabetes states that it is a waste of time to monitor her blood sugar levels because "whatever happens was supposed to happen."
A woman newly diagnosed with lung cancer laments the fact that she has never made a sincere effort to quit smoking. Explanation: Identifying a link between past smoking habits and present lung cancer shows a realistic understanding of the causation of a crisis. Severe anxiety without tangible cause, resignation, and fatalism are defense and coping mechanisms that are associated with an unrealistic understanding of a crisis.
The nurse is told by a client that she is having suicidal thoughts. Which of the following interventions has lowest priority? a) Administering a mental status exam to assess for psychosis b) Assessing the client for past history of suicidal attempts c) Maintaining a safe, secure environment d) Determining the client's concerns and if she has a plan
Administering a mental status exam to assess for psychosis Explanation: About 50% to 80% of people who commit suicide have previously attempted suicide; the more violent and lethal the plan, the higher the potential for suicide. Assessment of past attempts and current plan (not psychosis) as well as maintaining client safety would be priorities. Maintaining a safe, secure environment is an important intervention by the nurse to prevent a suicide attempt.
Which of the following would be considered a maturational crisis? a) Divorce b) Tornado c) Domestic violence d) Adolescence
Adolescence Explanation: A maturational crisis is an experience related to growth and development in which one's lifestyle is continually subject to change (eg, puberty, adolescence, young adulthood, marriage, aging). A situational crisis refers to an extraordinarily stressful event, such as domestic violence, divorce, or natural disasters (eg, tornado).
A nurse has become stuck in traffic on a bridge and now realizes that the problem is caused by a man who is straddling the handrail and threatening to jump. The nurse has approached the man and attempted to begin a therapeutic dialogue. At what point may the nurse discontinue this crisis intervention? a) After emergency responders arrive and take over b) When the man makes it clear that he wishes the nurse to leave him alone c) After 30 minutes d) When it becomes evident that the man is unwilling to dialogue
After emergency responders arrive and take over Explanation: The criteria or standards of care for a person providing crisis intervention state that the person who begins to intervene in a crisis is obligated to continue the intervention unless a more qualified person relieves him or her.
Which of the following statements best defines crisis intervention? a) An active but temporary entry into the life situation of an individual, a family, or a group during a period of stress b) A family meeting in which the treatment team assists with confrontation of the client's behavior c) A group intervention in which confrontation is used to promote change in the client d) An intervention in which a group of psychiatric professionals meet to determine which intervention might be most effective for a disturbed client
An active but temporary entry into the life situation of an individual, a family, or a group during a period of stress Explanation: Crisis intervention is temporary, but very active, and occurs only during a period of stress.
The mother of a suicidal adolescent is concerned that "only crazy people commit suicide." When helping her understand her daughter's suicidal behavior, the nurse would explain what? a) Suicidal tendencies are inherited. b) Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. c) Fifty percent of all suicides occur as a result of major psychoses. d) Suicide occurs more frequently among the very rich or poor.
Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. Explanation: It is important to teach survivors of suicide and those with a family member who is suicidal that depression, or feelings of unhappiness, is most often associated with suicidal thoughts and behaviors. The mentally ill group, or "crazy people," is not the primary group that commits suicide, and individuals who are suicidal are not necessarily "crazy."
The mother of a suicidal adolescent is concerned that "only crazy people commit suicide." When helping her understand her daughter's suicidal behavior, the nurse would explain what? a) Suicide occurs more frequently among the very rich or poor. b) Suicidal tendencies are inherited. c) Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. d) Fifty percent of all suicides occur as a result of major psychoses.
Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. Explanation: It is important to teach survivors of suicide and those with a family member who is suicidal that depression, or feelings of unhappiness, is most often associated with suicidal thoughts and behaviors. The mentally ill group, or "crazy people," is not the primary group that commits suicide, and individuals who are suicidal are not necessarily "crazy."
A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic event. Which of the following would the nurse identify as the priority for this family? a) Arranging for follow-up therapy to deal with the crisis b) Arranging for emergency shelter and food supplies c) Completing a family genogram to determine family patterns d) Assessing the impact of the loss on their lifestyle
Arranging for emergency shelter and food supplies Explanation: Safety interventions to protect people in crisis from harm should include preventing the individuals from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Additionally, the priorities of physical needs surpass those of psychosocial needs. After the individual's safety needs are met, the nurse can address the psychosocial aspects of the crisis.
A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic event. Which of the following would the nurse identify as the priority for this family? a) Arranging for emergency shelter and food supplies b) Arranging for follow-up therapy to deal with the crisis c) Completing a family genogram to determine family patterns d) Assessing the impact of the loss on their lifestyle
Arranging for emergency shelter and food supplies Explanation: Safety interventions to protect people in crisis from harm should include preventing the individuals from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Additionally, the priorities of physical needs surpass those of psychosocial needs. After the individual's safety needs are met, the nurse can address the psychosocial aspects of the crisis.
A nurse is caring for a white man age 30 years whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? a) Ask the client whether he is thinking about killing himself. b) Determine the client's risk of psychosis. c) Refer the client for long-term psychotherapy. d) Determine whether anyone in the client's family has had depression.
Ask the client whether he is thinking about killing himself. Explanation: The nurse should first ask whether the client is thinking about killing himself, because statistics show that among young, recently widowed white men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in that same age group. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.
A nurse is caring for a white man age 30 years whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? a) Determine the client's risk of psychosis. b) Determine whether anyone in the client's family has had depression. c) Ask the client whether he is thinking about killing himself. d) Refer the client for long-term psychotherapy.
Ask the client whether he is thinking about killing himself. Explanation: The nurse should first ask whether the client is thinking about killing himself, because statistics show that among young, recently widowed white men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in that same age group. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.
A client who lost a child 6 years ago as a result of an automobile accident caused by a drunk driver is seen for counseling. During the session, the mental health nurse recognizes the priority need to ... a) Encourage the client to become an activist in organizations such as Mothers Against Drunk Driving (MADD) b) Assess the client for suicidal ideations c) Assess the client for feelings regarding the driver responsible for the death d) Express condolences over the loss of the child
Assess the client for suicidal ideations Explanation: Research has shown that psychiatric-mental health nurses must assess for depression, distress, and suicidal ideation in clients who have experienced the sudden, violent death of a child. Furthermore, assessment may need to be repeated over time.
A 19-year-old college student has been date raped. She is in the emergency department, undergoing a forensic examination, and being assessed by the psychiatric emergency response team. The psychiatric nurse assessing this client should have which of the following as the primary concern? a) Provide support and comfort. b) Assist the client with crisis interventions. c) Understand that the client will have a long recovery period. d) Assist the client in developing prevention strategies for future dating situations.
Assist the client with crisis interventions. Explanation: A rape or assault of any kind is a crisis, and the primary nursing focus should be crisis intervention. Providing support and comfort and appreciating the recovery period are important, but the priority should be crisis management. Prevention strategies and teaching would not be appropriate at this time, because they would impart to the client that she should have prevented this situation. At this time, she needs to recover from the crisis response.
Living through an experience of suicide despite having expected or intended to die refers to ... a) Attempt of suicide b) Suicidal behavior c) Parasuicide d) Suicidal ideation
Attempt of suicide Explanation: An attempt of suicide can be characterized as living through an experience of suicide despite having expected or intended to die.
Living through an experience of suicide despite having expected or intended to die refers to ... a) Suicidal behavior b) Attempt of suicide c) Suicidal ideation d) Parasuicide
Attempt of suicide Explanation: An attempt of suicide can be characterized as living through an experience of suicide despite having expected or intended to die.
The nurse is providing care for a family whose members have been the recent victims of a violent home invasion and robbery. How should the nurse begin the process of crisis intervention? a) By enlisting the help of a multidisciplinary team b) By having the family members reflect on their defense mechanisms c) By identifying the facts surrounding the event and the severity of it d) By assessing the family members' perceptions of the event
By identifying the facts surrounding the event and the severity of it Explanation: The first factor in the assessment process in a crisis intervention is to determine the severity of the crisis situation and to identify the degree of disruption the client is experiencing.
The nurse is providing care for a family whose members have been the recent victims of a violent home invasion and robbery. How should the nurse begin the process of crisis intervention? a) By having the family members reflect on their defense mechanisms b) By assessing the family members' perceptions of the event c) By enlisting the help of a multidisciplinary team d) By identifying the facts surrounding the event and the severity of it
By identifying the facts surrounding the event and the severity of it Explanation: The first factor in the assessment process in a crisis intervention is to determine the severity of the crisis situation and to identify the degree of disruption the client is experiencing.
Several questions can be used to assess a suicidal person's intent to die, the severity of his or her suicidal ideation, and the degree of planning. Which of the following questions may be used to elicit information regarding the severity of suicidal ideation? a) How seriously do you want to die? b) Can you dismiss thoughts of killing yourself, or do they tend to return? c) Have you done anything to put the plan into action? d) Have you made any plans to kill yourself?
Can you dismiss thoughts of killing yourself, or do they tend to return? Explanation: A question to ask the person regarding severity of the suicidal ideation may include, "Can you dismiss thoughts of killing yourself, or do they tend to return?" The other questions focus on the intent to die and the degree of planning.
A nurse is reviewing the medical record of a client who has attempted suicide. Which of the following would the nurse identify as relating to a psychological cause? a) History of childhood trauma b) Social isolation c) Cluster B personality disorder d) Suicide contagion
Cluster B personality disorder Explanation: Emotional factors and personality traits also play a role in suicidal behavior, by enhancing perceptions of helplessness and hopelessness, contributing to poor self-esteem, and interfering with coping efforts. Emotional distress often is potentiated by personality traits such as cluster B symptoms (see Chapter 27) that contribute to poor self-esteem, impulsivity, and suicidal behavior. A history of childhood trauma reflects a biologic causation. Social isolation and suicide contagion reflect social causation.
A mental health nurse is caring for a depressed client, whose wife passed away 2 months ago. The client sates, "I'm going to kill myself." Which of the following is a behavioral sign of suicide? a) Isolation b) Guilt c) Hopelessness d) Making a will
Making a will Explanation: Making a will is a behavioral sign of suicide. The other options are emotional/psychological signs.
Which of the following mental health disorders is a the most significant risk factor for suicide? a) Mania b) Schizophrenia c) Depression d) Anxiety
Depression Explanation: Depression is a major risk factor of suicide. Anxiety, schizophrenia, and mania are significant risk factors, but to a lesser degree than depression.
A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which nursing intervention would be most appropriate at this time? a) Developing a personal plan for managing suicidal thoughts when they occur b) Advising the client that he should consider electroconvulsive therapy treatments c) Assigning nursing staff to stay with him during his suicidal crisis d) Administering psychotropic drugs that decrease the client's serotonin levels
Developing a personal plan for managing suicidal thoughts when they occur Explanation: The client's immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like he is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.
A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which nursing intervention would be most appropriate at this time? a) Administering psychotropic drugs that decrease the client's serotonin levels b) Assigning nursing staff to stay with him during his suicidal crisis c) Advising the client that he should consider electroconvulsive therapy treatments d) Developing a personal plan for managing suicidal thoughts when they occur
Developing a personal plan for managing suicidal thoughts when they occur Explanation: The client's immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like he is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.
An example of a situational crisis is ... a) Short stay hospitalization b) Birth of one's' child c) Completion of school d) Divorce
Divorce Explanation: Examples of situational crises include illness, the death of a loved one, separation or divorce, job loss, school problems, physical or sexual assault, or an unplanned pregnancy.
Nurses and other crisis workers should be aware of usual occurrences when dealing with crisis intervention. Which of the following would be inconsistent with a usual occurrence? a) The client in crisis may perceive the event to be life-threatening. b) During crisis, communication with significant others increases. c) Some displacement from familiar surroundings or significant others occurs during crisis. d) All crises have an aspect of an actual or a perceived loss involving a person, object, idea, or hope.
During crisis, communication with significant others increases. Explanation: During crisis, there is decreased or a loss of communication with significant others. The other statements about usual occurrences during crisis are true.
Nurses and other crisis workers should be aware of usual occurrences when dealing with crisis intervention. Which of the following would be inconsistent with a usual occurrence? a) Some displacement from familiar surroundings or significant others occurs during crisis. b) The client in crisis may perceive the event to be life-threatening. c) All crises have an aspect of an actual or a perceived loss involving a person, object, idea, or hope. d) During crisis, communication with significant others increases.
During crisis, communication with significant others increases. Explanation: During crisis, there is decreased or a loss of communication with significant others. The other statements about usual occurrences during crisis are true.
Which client population has the highest risk for suicide? a) Elderly women b) Elderly men c) Adolescent boys d) Adolescent girls
Elderly men Explanation: The fastest growing age group is 80 years and older, and men older than 85 years have the highest risk for suicide.
Which of the following is the most essential element of psychiatric-mental health intervention during a crisis or disaster? a) Financial support b) Education c) Emotional support d) Outcome identification
Emotional support Explanation: The most essential element of psychiatric-mental health intervention during a crisis or disaster is the ability of the nurse to provide emotional support while assessing the client's emotional and physical needs and enlisting his or her cooperation. Outcome identification, education, and financial support would be important to the client, but not the most essential element.
Which of the following is the most essential element of psychiatric-mental health intervention during a crisis or disaster? a) Financial support b) Outcome identification c) Emotional support d) Education
Emotional support Explanation: The most essential element of psychiatric-mental health intervention during a crisis or disaster is the ability of the nurse to provide emotional support while assessing the client's emotional and physical needs and enlisting his or her cooperation. Outcome identification, education, and financial support would be important to the client, but not the most essential element.
It would be helpful for the parents of a suicidal adolescent to understand that the most frequent cause or motive for suicide in adolescents is what? a) Progressive failure to adapt b) Reunion wish or fantasy c) Feelings of anger or hostility d) Feelings of alienation or isolation
Feelings of alienation or isolation Explanation: In adolescent clients, the developmental task is of a sense of belonging. When adolescents feel alienated or isolated, suicidal thoughts may emerge. In adolescence, therefore, the most common motives are feelings of alienation or isolation.
In the United States, nearly 60 percent of male suicide victims die by which method? a) Firearms b) Hanging c) Overdose d) Poisoning
Firearms Explanation: In the United States, nearly 60 percent of male suicide victims die by firearms. The most common cause of death by suicide in women is overdose or poisoning.
The majority of suicides among men are attributed to which of the following means? a) Drowning b) Hanging c) Overdose d) Firearms
Firearms Explanation: Men complete 79% of all suicides; 57.5% of these deaths are by firearms. The other means of suicide listed do not account for the majority of suicides in men.
Which of the following phases of a crisis is considered the active state of crisis? a) First b) Fourth c) Second d) Third
Fourth Explanation: In the fourth phase, the active state of crisis, inner resources and support systems are inadequate. The precipitating event is not resolved, stress and anxiety mount intolerably. The first phase is increased anxiety in response to trauma. If coping mechanisms are ineffective, a person enters the second phase of crisis, which is marked by further increased anxiety from the failure of usual coping mechanisms. In the third phase, anxiety continues to escalate. The person usually feels compelled to reach out for assistance.
A nurse assesses prior self-harm behavior, which provides information on the motivation behind the clients' actions and also ... a) Ignores the past attempts and focuses on the here and now b) Provides an understanding of the reactions of others c) Gives a message of interest and concern d) Creates a judgemental attitude
Gives a message of interest and concern Explanation: Assessing the context of each act of prior self-harm behavior begins to paint a picture of motivation behind the behavior. Exploration of prior behavior also gives a message of interest and concern on the part of the health professional.
A group of nursing students is reviewing information about the types of crisis. The students demonstrate understanding of the information when they identify which of the following as a developmental crisis? a) Earthquake b) Loss of a pet c) Obtaining a job promotion d) Going away to college
Going away to college Explanation: A developmental crisis is one that occurs with normal growth and development, such as going away to college. Obtaining a job promotion or loss of a pet is an example of a situational crisis. An earthquake is an example of a traumatic crisis.
Successful resolution of a crisis an individual is experiencing is more likely to occur if the individual ... a) Has experienced a prior stressor with greater magnitude b) Increases their own pressures to quickly resolve the situation effectively c) Has a realistic view of the situation d) Seeks help from a professional
Has a realistic view of the situation Explanation: The timely and successful resolution of a crisis is more likely if an individual has a realistic view of the situation, adequate supports available, and effective coping mechanisms.
The nurse recognizes that the parents of a child displaying the symptomology of a progressive, degenerate neurological disorder are in the crisis phase of the experience when they are ... a) Providing possible causes for the child's neurological symptoms b) Heard tearfully discussing the child's poor prognosis with their clergy c) Found crying after being told that the diagnosis has been confirmed d) Bringing disorder-related information to the health care team to review
Heard tearfully discussing the child's poor prognosis with their clergy Explanation: The nurse recognizes that the parents of a child displaying the symptomology of a progressive, degenerate neurological disorder are in the crisis phase of the experience when she hears them tearfully discussing their child's prognosis with a member of the clergy.
In the weeks following a natural disaster, which of the following client symptoms does the nurse least expect to see when assessing clients at the community mental health center? a) Hearing voices and seeing dead bodies b) Waking up early and unable to go back to sleep c) Headaches and muscle aches d) Problems staying focused at work
Hearing voices and seeing dead bodies Explanation: The nurse would least expect that clients will have auditory or visual hallucinations, because these symptoms are characteristic of psychosis. The nurse expects the symptoms of anxiety and stress in clients who have experienced a natural disaster. Headaches and muscle aches are common physical symptoms related to stress and anxiety. Waking up early and being unable to go back to sleep are common in people who are stressed or anxious. Similarly, anxiety and stress can frequently interfere with cognitive abilities such as concentration, attention, and memory.
In the weeks following a natural disaster, which of the following client symptoms does the nurse least expect to see when assessing clients at the community mental health center? a) Waking up early and unable to go back to sleep b) Headaches and muscle aches c) Problems staying focused at work d) Hearing voices and seeing dead bodies
Hearing voices and seeing dead bodies Explanation: The nurse would least expect that clients will have auditory or visual hallucinations, because these symptoms are characteristic of psychosis. The nurse expects the symptoms of anxiety and stress in clients who have experienced a natural disaster. Headaches and muscle aches are common physical symptoms related to stress and anxiety. Waking up early and being unable to go back to sleep are common in people who are stressed or anxious. Similarly, anxiety and stress can frequently interfere with cognitive abilities such as concentration, attention, and memory.
A client comes to the health clinic stating that he wants to kill himself. He has made an elaborate plan and has access to a weapon. His lifestyle is unstable, and he is disoriented at the present time. The nurse would assess this client's degree of suicide risk as which of the following? a) Moderate b) No risk c) High d) Low
High Explanation: This client has predominantly destructive resources, his lifestyle is unstable, and he is markedly disoriented, which is classified as a high suicide risk.
A nurse who arranges an educational session about suicidal behavior in preparing a client for discharge ensures ... a) Discussing the patients decreased risk factors following their hospitalization b) Avoiding inclusion of significant others to ensure confidentiality of patient c) Including significant others to provide a better understanding of illness d) Reminding patient make an out-patient appointment for follow-up care
Including significant others to provide a better understanding of illness Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the patient's illness and also learn what is necessary in providing outpatient care.
A nurse who arranges an educational session about suicidal behavior in preparing a client for discharge ensures ... a) Including significant others to provide a better understanding of illness b) Avoiding inclusion of significant others to ensure confidentiality of patient c) Discussing the patients decreased risk factors following their hospitalization d) Reminding patient make an out-patient appointment for follow-up care
Including significant others to provide a better understanding of illness Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the patient's illness and also learn what is necessary in providing outpatient care.
A nurse who arranges an educational session about suicidal behavior in preparing a client for discharge ensures ... a) Including significant others to provide a better understanding of illness b) Reminding patient make an out-patient appointment for follow-up care c) Avoiding inclusion of significant others to ensure confidentiality of patient d) Discussing the patients decreased risk factors following their hospitalization
Including significant others to provide a better understanding of illness Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the patient's illness and also learn what is necessary in providing outpatient care.
To care for an acutely suicidal client, which is the most effective initial mode of treatment? a) Group therapy b) Inpatient care c) Behavioral therapy d) Outpatient care
Inpatient care Explanation: If a person is acutely suicidal, inpatient care is often the initial mode of treatment. Frequently, inpatient treatment is short-term, focused on crisis intervention, and followed up with outpatient approaches when the immediate danger has subsided.
To care for an acutely suicidal client, which is the most effective initial mode of treatment? a) Outpatient care b) Behavioral therapy c) Group therapy d) Inpatient care
Inpatient care Explanation: If a person is acutely suicidal, inpatient care is often the initial mode of treatment. Frequently, inpatient treatment is short-term, focused on crisis intervention, and followed up with outpatient approaches when the immediate danger has subsided.
A nurse determines that a client is at imminent risk for suicide. Which of the following would be least appropriate to include in the client's plan of care? a) Listening intently and nonjudgmentally b) Validating the client's feelings and experience c) Instituting strict restriction on the client's activity d) Using cognitive interventions to foster hope
Instituting strict restriction on the client's activity Explanation: There are three urgent priorities for care of a person who is at imminent risk for suicide: (1) reconnecting the client to other people and instilling hope, (2) restoring emotional stability and reducing suicidal behavior, and (3) ensuring safety. Reconnecting the client interpersonally includes listening intently and without judgment to the client's thoughts and feelings, and validating the client's experience and suffering. This intervention directly challenges the client's belief that no one cares. Using cognitive interventions can help the client to regain hope. Restricting a client's activity can be very upsetting. Rather, the nurse should reduce the client's stress while ensuring safety by intruding as little as possible on the client's exercise of free will.
A nurse determines that a client is at imminent risk for suicide. Which of the following would be least appropriate to include in the client's plan of care? a) Instituting strict restriction on the client's activity b) Using cognitive interventions to foster hope c) Validating the client's feelings and experience d) Listening intently and nonjudgmentally
Instituting strict restriction on the client's activity Explanation: There are three urgent priorities for care of a person who is at imminent risk for suicide: (1) reconnecting the client to other people and instilling hope, (2) restoring emotional stability and reducing suicidal behavior, and (3) ensuring safety. Reconnecting the client interpersonally includes listening intently and without judgment to the client's thoughts and feelings, and validating the client's experience and suffering. This intervention directly challenges the client's belief that no one cares. Using cognitive interventions can help the client to regain hope. Restricting a client's activity can be very upsetting. Rather, the nurse should reduce the client's stress while ensuring safety by intruding as little as possible on the client's exercise of free will.
A 19-year-old college student sought care at the campus medical clinic with complaints of unusual vaginal discharge and was subsequently diagnosed with gonorrhea. The student's friends and family all live in her home state, and she has not yet formed close relationships with her classmates and roommates. What risk does the student's lack of situational support most clearly pose? a) Use of simplistic or ineffective coping mechanisms b) Deficient knowledge of the options available c) Failure to identify the severity of the crisis d) Interpretation of the crisis as overwhelming or irresolvable
Interpretation of the crisis as overwhelming or irresolvable Explanation: While numerous negative consequences exist when an individual lacks situational support in a crisis, one of the most common is the tendency to interpret a crisis as overwhelming or irresolvable.
A 19-year-old college student sought care at the campus medical clinic with complaints of unusual vaginal discharge and was subsequently diagnosed with gonorrhea. The student's friends and family all live in her home state, and she has not yet formed close relationships with her classmates and roommates. What risk does the student's lack of situational support most clearly pose? a) Use of simplistic or ineffective coping mechanisms b) Failure to identify the severity of the crisis c) Deficient knowledge of the options available d) Interpretation of the crisis as overwhelming or irresolvable
Interpretation of the crisis as overwhelming or irresolvable Explanation: While numerous negative consequences exist when an individual lacks situational support in a crisis, one of the most common is the tendency to interpret a crisis as overwhelming or irresolvable.
Crisis theory holds that an imbalance exists between the client's problem and the immediate resources available to deal with it. Which of the following best describes the active crisis state? a) It is often remedied by the appropriate medication. b) It is a pathological response to a normal problem. c) It lasts about 4 to 6 weeks. d) It lasts for 2 to 3 months if left untreated.
It lasts about 4 to 6 weeks. Explanation: During crisis, an imbalance exists between the magnitude of the problem and the immediate resources available to deal with it. This imbalance causes confusion and disorganization. The active crisis state is approximately 4 to 6 weeks as no person can tolerate this level of anxiety and imbalance for long.
Crisis theory holds that an imbalance exists between the client's problem and the immediate resources available to deal with it. Which of the following best describes the active crisis state? a) It lasts for 2 to 3 months if left untreated. b) It is a pathological response to a normal problem. c) It is often remedied by the appropriate medication. d) It lasts about 4 to 6 weeks.
It lasts about 4 to 6 weeks. Explanation: During crisis, an imbalance exists between the magnitude of the problem and the immediate resources available to deal with it. This imbalance causes confusion and disorganization. The active crisis state is approximately 4 to 6 weeks as no person can tolerate this level of anxiety and imbalance for long.
Environmental factors may be associated with suicide behavior. Which of the following is an environmental factor? a) Spinal cord injury b) Job loss c) Pain d) HIV infection
Job loss Explanation: Environmental factors may be associated with suicidal behaviors. Loss of job with a resultant loss of status, relationships, and social contacts can be contributing factors. Physical factors include spinal cord injury, HIV infection, and pain.
Nurses can contribute with knowledge of early intervention to make a difference responding to an active suicidal client by ... a) Living close by a health clinic b) Encouraging them not of think about suicide c) Knowing how to engage and respond d) Allowing client to have time alone
Knowing how to engage and respond Explanation: Nurses are in a unique position to contribute to preventive efforts. With knowledge of early risk assessment and interventions—understood within the context of a person's family, social world, and broader community—as well as knowledge of how to engage with and respond to the actively suicidal person, nurses can make a difference.
A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when they identify which of the following as the probability that a person will successfully complete suicide? a) Suicidal ideation b) Suicidality c) Parasuicide d) Lethality
Lethality Explanation: Lethality refers to the probability that a person will successfully complete suicide. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death (e.g., taking a sublethal drug). The term suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide, and suicide ideation. Suicidal ideation is thinking about and planning one's own death.
A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt? a) Man with bipolar I disorder b) Man with major depressive disorder c) Woman with acute stress disorder d) Woman with somatoform disorder
Man with major depressive disorder Explanation: Men have a higher suicide completion rate than women. For men, suicide is the eighth leading cause of death, with a rate of 17.5 per 100,000, more than four times the rate in women. White men complete 73% of all suicides; 80% of these deaths are by firearms. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance abuse.
A nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? a) Single woman b) Widowed woman c) Divorced man d) Married man
Married man Explanation: The nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. Marriage has been identified as a protective factor against mental disorders in older adults.
A nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? a) Widowed woman b) Single woman c) Divorced man d) Married man
Married man Explanation: The nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. Marriage has been identified as a protective factor against mental disorders in older adults.
A client is preparing to get married and move out of state. Which type of crisis would be related to the client's situation? a) Situational b) Maturational c) Psychiatric situational d) Developmental
Maturational Explanation: Maturational crises are those that occur during normal growth and development, such as getting married. Situational crisis occurs due to a sudden, unexpected traumatic stress. Developmental crisis involves an internal stress and psychosocial issue. Psychiatric situational crisis results in unpredictable behavior or the onset of an acute psychotic disorder.
The nurse is planning a presentation about suicide to a group of health professionals. Which of the following should be included in the nurse's teaching plan? a) Suicide tends to be most prevalent in the 30- to 40-year-old age group. b) Suicide rates for women are highest among women with children. c) The most common method of committing suicide is the use of sleeping pills. d) Men are more likely to commit suicide than women are.
Men are more likely to commit suicide than women are. Explanation: The nurse should include in the teaching plan that men are four times more likely to commit suicide than women are. Suicide rates are highest in the age 15 to 24 year group. Firearms contribute to high rates of suicide among adolescents.
The nurse is planning a presentation about suicide to a group of health professionals. Which of the following should be included in the nurse's teaching plan? a) The most common method of committing suicide is the use of sleeping pills. b) Suicide tends to be most prevalent in the 30- to 40-year-old age group. c) Men are more likely to commit suicide than women are. d) Suicide rates for women are highest among women with children.
Men are more likely to commit suicide than women are. Explanation: The nurse should include in the teaching plan that men are four times more likely to commit suicide than women are. Suicide rates are highest in the age 15 to 24 year group. Firearms contribute to high rates of suicide among adolescents.
A nurse determines that a client has poor social skills that have interfered with his ability to engage others, which has contributed to his feelings of purposelessness, hopelessness, and withdrawal. Which of the following would be most important for the nurse to recommend in order to help the client begin to develop social skills? a) Self-help group b) Recovery group c) Limit setting d) Nurse-client relationship
Nurse-client relationship Explanation: Poor social skills may interfere with the client's ability to engage others. The nurse should assess the client's social capability early in treatment and make necessary provisions for social skills training. The interpersonal relationship with the nurse is an ideal place to begin shaping social behaviors that will help the client establish a social network that will sustain him during periods of discouragement or crisis. Thereafter, participation in support networks such as recovery groups, clubhouses, drop-in centers, self-help groups, or other therapeutic social engagements will help the client become connected to others.
A nurse maintains a safe environment for a client who is suicidal by ... a) Observing the client regularly b) Maintaining confidentiality at all times with the patient c) Creating a stimulating environment d) Ensuring client has access to all of his personal belongings to make them feel at home
Observing the client regularly Explanation: Maintaining a safe environment includes observing the client regularly for suicidal behavior, removing dangerous objects, and providing counseling opportunities for the patient.
Which of the following is accurate regarding a crisis? a) Occurs when an individual is at a breaking point b) Lasts longer than 6 weeks c) Occurs from a common precipitating event d) Defined as being in constant turmoil
Occurs when an individual is at a breaking point Explanation: A crisis occurs when the individual is at a breaking point. It generally lasts no longer than 4 to 6 weeks. People who live in constant turmoil are not in crisis but in chaos. Feelings of fear, desperation, and being out of control are common during a crisis, but the precipitating event and circumstances are unusual or rare, perceived as a threat, and specific to the individual.
Which of the following would not be essential to assess when working with a person in crisis? a) Past history of mental health care b) Support systems c) Perception of the event d) Coping skills
Past history of mental health care Explanation: The nurse first determines the client's perception of the stressful event. After determining the client's perception of the event, the nurse focuses on who is available to support the client, and encourages the client to describe specific coping methods, determining whether the coping mechanisms are adaptive or maladaptive. Past history is not an immediate priority when assessing a person's current state of crisis
Which of the following would not be essential to assess when working with a person in crisis? a) Past history of mental health care b) Coping skills c) Perception of the event d) Support systems
Past history of mental health care Explanation: The nurse first determines the client's perception of the stressful event. After determining the client's perception of the event, the nurse focuses on who is available to support the client, and encourages the client to describe specific coping methods, determining whether the coping mechanisms are adaptive or maladaptive. Past history is not an immediate priority when assessing a person's current state of crisis.
A nurse is working as part of a community disaster response team. When responding to a community disaster, the nurse integrates understanding of individuals' responses, anticipating which of the following? a) People can become aggressive and violent when their basic needs are threatened. b) People involved in the disaster will always put the welfare of others before their own. c) The psychological distress associated with disasters is felt immediately. d) Losses incurred during the disaster have little, if any, long-term effect on victims.
People can become aggressive and violent when their basic needs are threatened. Explanation: In a disaster, shelter, money, and food may not be available. The absence of basic human needs such as food, a place to live, or immediate transportation quickly becomes a priority that may precipitate acts of violence. Additionally, the victims may experience economic distress because of job loss and loss of other resources. This may ultimately lead to psychological distress, potential acts of aggression, and other mental health problems. Long-term mental health consequences are evident in most disasters.
Which of the following has the most influence on the outcome for a person experiencing a crisis? a) Financial resources b) Perception of the precipitating event c) Membership in a vulnerable population d) Past coping skills
Perception of the precipitating event Explanation: Factors that influence the outcome of a crisis include previous problem-solving experience, perception or view of the problem, amount of help or hindrance from significant others, number and types of past crises, time elapsed since the last crisis, membership in a vulnerable population, sense of mastery, and resilience.
A client on the inpatient psychiatric-mental health unit was discovered attempting to asphyxiate himself using a blanket. Which of the following measures should the care team prioritize in the client's immediate care? a) Assessing the specific motivation for the client's attempted suicide b) Managing the client's anxiety c) Teaching the client improved coping skills d) Placing the client on suicide precautions
Placing the client on suicide precautions Explanation: The need for safety and suicide prevention supersedes the importance of client education, anxiety management, and assessment of the patient's motivations.
A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting which of the following? a) A typical response to the medication b) Possible decision to complete a suicide attempt c) An act to cover up the client's true feelings d) Effectiveness of the drug therapy
Possible decision to complete a suicide attempt Explanation: In many cases, clients are admitted to the psychiatric hospital because of a suicide attempt. Suicidality should continually be evaluated, and the client should be protected from self-harm (see Chapter 21). During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety. Antidepressants take several weeks to become effective.
The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? a) Assess the cause of his or her depression. b) Assist him or her in the expression of sad and helpless feelings. c) Develop rapport based on trust and understanding. d) Prevent self-destructive behavior.
Prevent self-destructive behavior. Explanation: Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.
The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? a) Assess the cause of his or her depression. b) Prevent self-destructive behavior. c) Assist him or her in the expression of sad and helpless feelings. d) Develop rapport based on trust and understanding.
Prevent self-destructive behavior. Explanation: Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.
Which of the following is the greatest predictor of a future suicide attempt? a) Degree of hopelessness b) Suicide planning c) Seriousness of suicidal ideation d) Previous attempt
Previous attempt Explanation: The greatest predictor of a future suicide attempt is a previous attempt, in part because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.
A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, "What might predict the possibility of future suicide attempts?" Which of the following would the nurse include in the response? a) Death of a spouse b) Previous suicide attempt c) Polydrug use d) Unemployment
Previous suicide attempt Explanation: Although factors such as unemployment, death of a spouse, and polydrug use can contribute to depression and suicidal ideation, one of the best predictors for suicide during adolescence is a previous attempt.
It is critical that the psychiatric nurse providing crisis care for a suicidal client assess the client while ... a) Providing emotional support and enlisting her cooperation b) Communicating respectfully with her and establishing outcomes c) Documenting findings and consulting with her health care team d) Selecting client-focused interventions and effective evaluations
Providing emotional support and enlisting her cooperation Explanation: The most essential element of psychiatric-mental health intervention during a crisis or disaster is the ability of the nurse to provide emotional support while assessing the individual's emotional and physical needs and enlisting his or her cooperation.
A 38-year-old man has just received word that his latest computed tomography (CT) scan of his head indicates an inoperable brain tumor that is associated with an exceptionally poor prognosis. The man has confided to the nurse, "I think that this is punishment for being unfaithful to my wife, and she doesn't even know that." The nurse would recognize a possible deficit in which of the balancing factors affecting the client's crisis response? a) Adequate defense or coping mechanisms b) Experience with similar situations c) Realistic perception of the event d) Adequate situational support
Realistic perception of the event Explanation: The interpretation of a medical diagnosis as punishment by a higher power may signal an unrealistic perception of the crisis, potentially affecting the individual's ability to respond. The client's statement does not suggest a lack of support or impaired coping strategies. While the client likely has little experience with similar situations, this is not the focus of his statement.
When intervening with a suicidal client, the initial goal is to keep the client safe. Measures to optimize safety would include which of the following? a) Remove access to the means to attempt suicide b) Avoid asking direct questions c) Less intervention is needed when mood improves d) Threats should not be taken seriously
Remove access to the means to attempt suicide Explanation: It is important to remove methods of suicide, if possible, from the person. If a person has a concern that someone is thinking of suicide, ask directly. Nurses need to take any threat of suicide seriously. Mood disorders are common in people who die by suicide; treatment needs to be encouraged.
When intervening with a suicidal client, the initial goal is to keep the client safe. Measures to optimize safety would include which of the following? a) Less intervention is needed when mood improves b) Threats should not be taken seriously c) Remove methods of suicide from the client d) Avoid asking direct questions
Remove methods of suicide from the client Explanation: It is important to remove methods of suicide, if possible, from the person. If a person has a concern that someone is thinking of suicide, ask directly. Nurses need to take any threat of suicide seriously. Mood disorders are common in people who die by suicide; treatment needs to be encouraged.
A 20-year-old college student has been admitted to the emergency department after taking an overdose of Tylenol. Which of the following nursing diagnoses should be prioritized in the care of this client after she is medically stabilized? a) Risk for Violence, Self-Directed, related to recent suicide attempt b) Impaired Social Interaction related to alienation secondary to depressive behavior c) Ineffective Coping as evidenced by recent suicide attempt d) Hopelessness as evidenced by recent suicide attempt
Risk for Violence, Self-Directed, related to recent suicide attempt Explanation: The client's risk for subsequent suicide attempts is a priority over other psychosocial diagnoses, even though these are each likely applicable in this client's case.
The nurse is working with a 50-year-old woman admitted for major depressive episode. The client has remained isolated and withdrawn since her admission and is reluctant to speak. Which of the following therapeutic communication skills is most likely to encourage the client to verbalize her feelings? a) Reality orientation b) Direct confrontation c) Projective identification d) Silence and active listening
Silence and active listening Explanation: Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism
Losing one's job is an example of which type of crisis? a) Adventitious b) Maturational c) Unexpected d) Situational
Situational Explanation: A situational crisis is a response to a sudden and unavoidable traumatic event that largely affects a person's identity and roles. When a stressful event threatens a person's physical, emotional, or social integrity, crisis is likely.
A 15-year-old client comes to the clinic in a state of crisis because her boyfriend has ended their relationship. Which type of crisis would the nurse describe this as? a) Developmental b) Maturational c) Situational d) Adventitious
Situational Explanation: The client is experiencing the loss of a significant person. Situational crises, such as death of a significant other, loss of a job, or other loss, affect self-confidence. A maturational crisis occurs in developmental stages or passages. Adventitious crises are disasters, crimes of violence, and national disasters.
It is believed that for every death by suicide, how many additional people are affected? a) Two b) Six c) Four d) Eight
Six Explanation: It is believed that for every death by suicide, at least six other people are affected.
Which of the following is a primary risk factor for suicide? a) Social isolation b) Unemployment c) Poverty d) Economic deprivation
Social isolation Explanation: Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.
Which of the following is a primary risk factor for suicide? a) Unemployment b) Social isolation c) Poverty d) Economic deprivation
Social isolation Explanation: Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.
A nurse is with an adolescent who states that she has nothing to live for and she just wishes she was dead. Which nursing action would be the priority? a) Going to the client's psychiatrist to tell him of the girl's suicidal ideation b) Ascertaining the client's beliefs about what happens when you die c) Putting the client in seclusion with a staff assigned to watch her at all times d) Staying with the client to explore more of her thoughts about suicide
Staying with the client to explore more of her thoughts about suicide Explanation: A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. The first priority is to provide for the client's safety while initiating the least restrictive care possible. Staying with the client and further exploring her thoughts about suicide will enhance safety and allow the nurse to more thoroughly understand the extent of the client's suicidal risk. It would not be appropriate to leave the client alone while the nurse goes to talk with the psychiatrist. Seclusion would be used only as a last resort because it is a highly restrictive environment. Determining the client's beliefs about death would be a topic to be addressed much later in the process.
Which of the following is a myth regarding suicide? a) The suicide rate is lowest in December. b) Most suicidal people are undecided about living or dying. c) Suicidal people are fully intent on dying. d) Many people who die by suicide have given definite warnings of their intentions.
Suicidal people are fully intent on dying. Explanation: A myth regarding suicide is that suicidal people are fully intent on dying. Most suicidal people are undecided about living or dying. Facts about suicide include that the suicide rate is the lowest in December and that many people who die by suicide have given definite warnings of their intentions.
A 19-year-old college student was date raped a few months ago. The campus health nurse is caring for the client during a follow-up appointment. Which of the following indicates to the nurse that the client is adjusting successfully to the trauma? a) The client selects to move to another city to go to a different college to "get away from it all." b) The client is silent about the assault, preferring to "just move on." c) The client resumes her course work and campus activities. d) The client takes courses in the martial arts.
The client resumes her course work and campus activities. Explanation: The goal of crisis intervention is to support clients to resume pre-crisis levels of functioning. Resuming activities and schoolwork in time would indicate a successful adjustment after her crisis experience. Taking courses in martial arts could be a strategy, but not an indication of successful adjustment. Remaining silent or avoiding the city physically by moving would not be signs of recovery and adjustment.
A 50-year-old man who has recently been diagnosed with amyotrophic lateral sclerosis (ALS) has announced to the nurse his intention to commit suicide in order to prevent future suffering. Which of the following facts should underlie the nurse's response to this client? a) The nurse must refer the client to a physician who is authorized to assist the man with a suicide. b) The nurse is required to document the client's wishes and begin to facilitate an assisted suicide. c) The nurse is obliged to protect the client from self-harm. d) The nurse is ethically obliged to inform law enforcement.
The nurse is obliged to protect the client from self-harm. Explanation: While the nurse is not obliged to inform law enforcement, he or she is ethically obligated to protect the client from self-harm. Participation or referral for assisted suicide has not been recognized as an acceptable component of nursing practice.
Which is the most appropriate overall nursing goal for crisis intervention? a) Anxiety will decrease. b) The overall goal of crisis intervention is to help the client return to the pre-crisis level of functioning. c) The client will reduce the distortion of his or her perception of the event. d) Family and friends will provide support.
The overall goal of crisis intervention is to help the client return to the pre-crisis level of functioning. Explanation: The overall goal of crisis intervention is to help the client to re-establish equilibrium. With skills learned through crisis resolution, the optimum outcome is for the person to function even more effectively than the pre-crisis level.
Which of the following statements most accurately describes the relationship between psychiatric illness and suicide risk? a) The vast majority of people who commit suicide have a diagnosed mental disorder. b) Clients with depression are at increased risk of suicide, but suicide rates among persons with schizophrenia equal those of the general population. c) According to the DSM-IV-TR, suicide is considered to be a psychiatric diagnosis in and of itself. d) Psychiatric-mental health clients are stereotyped as being at high risk of suicide, but this is untrue.
The vast majority of people who commit suicide have a diagnosed mental disorder. Explanation: Approximately 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. These disorders are varied and include schizophrenia. Suicide is not a recognized diagnosis.
Which of the following statements most accurately describes the relationship between psychiatric illness and suicide risk? a) Clients with depression are at increased risk of suicide, but suicide rates among persons with schizophrenia equal those of the general population. b) Psychiatric-mental health clients are stereotyped as being at high risk of suicide, but this is untrue. c) According to the DSM-IV-TR, suicide is considered to be a psychiatric diagnosis in and of itself. d) The vast majority of people who commit suicide have a diagnosed mental disorder.
The vast majority of people who commit suicide have a diagnosed mental disorder. Explanation: Approximately 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. These disorders are varied and include schizophrenia. Suicide is not a recognized diagnosis.
The definition of suicide is ... a) Living through a traumatic experience and unintentionally killing oneself b) The voluntary and intentional act of killing oneself c) The engagement of suicidal behavior where death has occurred d) The primary motivating force of action when one is not trying to kill oneself
The voluntary and intentional act of killing oneself Explanation: The definition of suicide is the voluntary and intentional act of killing oneself.
Women make how many suicide attempts for every attempt by their male counterparts? a) One b) Two c) Three d) Four
Three Explanation: Women make three attempts to every one attempt by men. Women are less likely to complete a suicide, in part because they are more likely to choose less lethal methods.
In assessing suicide potential, it is important for the community mental health nurse to know which of the following people are most prone to self-destructive behavior? a) Single working women b) Caucasian teenagers c) Unemployed professional workers d) Married elderly men
Unemployed professional workers Explanation: Professional workers who have become unemployed are at higher risk for suicide than other groups because of the multiple losses associated with losing their primary focus of self-identity.
Crisis intervention provided by a psychiatric clinician is necessary when an individual's ... a) Spiritual beliefs have been challenged b) Trauma is psychosocial in nature c) Support system has failed them d) Usual problem-solving methods are ineffective
Usual problem-solving methods are ineffective Explanation: Crisis intervention provided by a psychiatric clinician is necessary when an individual's usual problem-solving methods are ineffective. Crisis intervention may not be as necessary when a support system has failed, when the trauma is psychosocial in nature, or when spiritual beliefs have been challenged.
A nurse is part of team working with hurricane victims. One of the hurricane victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with his situation and how much support he needs, which question would be most appropriate for the nurse to ask? a) "Are you feeling guilty because you survived and some of your neighbors did not?" b) "What are your thoughts about what you will do during the next few days?" c) "What kind of help do you need from us?" d) "How are you feeling about all that you have gone through?"
What are your thoughts about what you will do during the next few days?" Explanation: By assessing the victim's ability to solve problems, the nurse can evaluate whether the victim can cognitively cope with the crisis situation and determine the kind and amount of support needed. At this point in time, the client may not be able to identify the type of help he needs or what he will be doing for the next few days. Asking about feeling guilty is inappropriate. Additionally, this is a closed-ended question that does not allow the victim to explore what he is feeling.
Carrie, age 20, was admitted to your unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ... a) assessing Carrie's current suicidal ideation and putting her on suicide precautions. b) rehydrating Carrie by forcing fluids. c) assisting Carrie with her activities of daily living, including a shower and clean clothing. d) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it.
assessing Carrie's current suicidal ideation and putting her on suicide precautions. Explanation: The first step is to provide for Carrie's safety by assessing her risk for suicide. Because Carrie has attempted suicide, the nurse immediately places her on suicide precautions with frequent or continuous one-to-one observation and reassessment.
Crisis intervention differs from the typical therapeutic relationship in that ... a) the course of crisis intervention is determined by the needs identified by the client. b) crisis intervention seeks to alleviate the immediate external threat. c) the nurse assists the client in changing his or her personality to better cope with crisis situations. d) crisis intervention strives to assist the client in gaining insight into coping skills.
crisis intervention seeks to alleviate the immediate external threat. Explanation: Crisis intervention focuses on the problem or stressor that precipitated the crisis, rather than on personality traits. It views the person in crisis as normal and capable of problem-solving and growth with assistance from others. The goal is to assist the person in distress to resolve the immediate problem and regain emotional equilibrium.
What is the priority nursing diagnosis for a depressed client exhibiting signs of acute mania that include agitation, insomnia, increased physical activity, and anorexia? a) insomnia b) risk for injury c) noncompliance d) chronic low self-esteem
risk for injury Explanation: The first priority is to determine whether a client with depression is suicidal. Risk for injury is the priority diagnosis. The other options are valid diagnoses, but not of highest priority.
What is the primary nursing concern related to a depressed client who has been taking amitriptyline 50 mg three times a day for the past 3 weeks? a) risk for self-injury b) chronic low self-esteem c) ineffective coping d) anxiety
risk for self-injury Explanation: Clients with depression are at increased risk for suicide when they have been on antidepressant medication for 2 weeks, because they are regaining some energy but may not have achieved full therapeutic effect with mood improvement. Poor coping is important but it is not the priority. Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders.
Autumn's marriage of 3 years has just ended. She has a small child and is facing a crisis regarding how to manage her roles as mother and now provider for herself and her child. The nurse can assist Autumn by role-playing asking her parents for some temporary financial and custodial support. Autumn needs help with this process because she likely is a) struggling with feeling dependent on others. b) being judged unfit by others. c) being encouraged to become dependent on her parents. d) relinquishing care and responsibility for her child.
struggling with feeling dependent on others. Explanation: In a crisis, it is natural to withdraw and feel isolated. Therefore, the nurse helps the client to communicate directly with significant others. Clients who place high value on independence may need particular assistance to recognize interdependence as a healthy balance. Often, the nurse must teach such clients how to ask for help.
The term suicide ideation is defined as the ... a) wishing that one had the strength to commit suicide. b) feebly attempting to commit suicide without success. c) accidental act of killing oneself. d) thinking about and planning one's own death.
thinking about and planning one's own death. Explanation: The term "suicide ideation" is the thinking about and planning one's own death. Parasuicide is an unsuccessful attempt at suicide.
The act of suicide is often linked to ... a) unemployment. b) terminal illness. c) homosexuality issues. d) fear of growing older.
unemployment. Explanation: Studies show a strong relationship between unemployment and suicide.
A client comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. a) "I've been going out with my friends about once or twice a week." b) "I've been drinking about three or four more beers every night." c) "I'm looking for a new job because my job is so stressful." d) "Most times, I feel like I'm trapped with no way out." e) "I'm so tired that all I ever want to do is sleep all the time."
• "I've been drinking about three or four more beers every night." • "Most times, I feel like I'm trapped with no way out." • "I'm so tired that all I ever want to do is sleep all the time." Explanation: Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
For a client in crisis, assessment of the psychological domain focuses on which of the following? Select all that apply. a) Capability of the community to respond in a supportive way b) Emotions c) Disturbances in sleep patterns d) Coping strengths e) Disturbances in nutrition
• Emotions • Coping strengths Explanation: A psychological assessment focuses on an individual's emotions and coping strengths. Assessment of the social domain is essential because a crisis usually severely disrupts social proficiencies; the nurse should assess the severity of the crisis to determine the capability of the individual or the community to respond in a supportive way. Assessment of the biological domain focuses on changes in body function such as sleep patterns or nutrition.
When assessing risk of suicide, which of following are important assessment components? Select all that apply. a) Lethality of method b) Previous attempt c) Seriousness of suicidal ideation d) Degree of hopelessness e) Unemployment
• Seriousness of suicidal ideation • Degree of hopelessness • Previous attempt • Lethality of method Explanation: Assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt, suicide planning and implementation, and availability and lethality of the suicide method
Family education concerning the safe care of a client with a history of suicidal attempts includes which of the following? Select all that apply. a) Techniques to help the client cope with known triggers b) Information on how to determine if the threat of suicide is legitimate c) Information regarding the stressors that trigger the client's suicidal ideations d) Signs and symptoms that indicate a mood change that could indicate the client is suicidal e) List of emergency service telephone numbers
• Signs and symptoms that indicate a mood change that could indicate the client is suicidal • Information regarding the stressors that trigger the client's suicidal ideations • Techniques to help the client cope with known triggers • List of emergency service telephone numbers Explanation: Family education should include information regarding recognizing changes in mood or behavior that could indicate a plan for self-injury (e.g., irritability, anger, agitation, withdrawal, or self-deprecating comments) and notify the client's health care provider. It should also include how to anticipate future stressors that trigger the client, along with information regarding how to assist the client with coping skills. Also important to family education is information regarding a 24-hour emergency hotline phone number--and the need to keep the information readily available.