Ch 16 Davis advantage for psychiatric mental health nursing

19. Which strategy should the nurse implement first with a suicidal patient? 1. Ask a direct question such as, "Do you ever think about killing yourself?" 2. Ask the patient to rate his or her mood on a scale from 1 to 10. 3. Establish a trusting nurse-patient relationship. 4. Apply the nursing process to the planning of patient care.

1. This is correct. Client safety is always the nurse's priority. The nurse must determine whether the client has suicidal ideations, has developed a plan, and, if so, the means exist to execute the plan.

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

1. This is correct. The risk of suicide is greatly increased if the client has developed a plan with lethal means, particularly if means are accessible for the client to execute the plan.

24. Which epidemiological factor related to suicide makes it difficult to determine the number of attempts that happen each year? 1. The number of suicide attempts reflects only those who enter treatment. 2. More people attempt suicide than die by suicide each year. 3. Unintentional injuries kill more people than suicide attempts each year. 4. Suicide rates consistently increased from 2000 to 2017.

1. This is correct. When people who attempt suicide do not enter treatment settings, they are not counted in the number of suicide attempts, making it difficult to fully understand the number of attempts each year.

28. Which of the following occupational groups are at highest risk of suicide? 1. Mechanics 2. Priests 3. Teachers 4. Librarians

1. This is correct. While the occupational demographic alone does not directly translate into an individual's risk, it will provide information as part of a comprehensive assessment of potentiating risk factors.

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

2. This is correct. Amitriptyline (Elavil) is a tricyclic antidepressant. Tricyclic antidepressants have a narrow therapeutic range and can be used to commit suicide by overdosing. The physician or nurse practitioner should prescribe no more than a 3-day supply of the medication with no refills.

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

2. This is correct. Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work.

25. The predisposing factor, anger turned inward, is a psychological theory of Freud's proposing which of the following? 1. The strength of a person's intention to die is as significant as his or her feelings of hopelessness. 2. Suicide occurs because of an earlier repressed desire to kill someone else. 3. Suicide is a way to prevent public humiliation following a social defeat. 4. Suicide occurs when a person feels separate from the mainstream of society.

2. This is correct. Freud believed that suicide was a response to intense self-hatred. The anger originated toward a love object but was ultimately turned inward against the self.

31. A client was diagnosed with depression resulting from the loss of her twin sister in a skiing accident. Her parents reported that all the client has done since the accident was lay in her bed and cry, asking why she survived the accident. The physician prescribed Prozac to treat the depression and suggested that the parents "keep a close eye on her." After a week, the client began to show some signs of improvement, even coming out of her room to eat with the family. After 2 months, the client committed suicide despite seeming to come out of the depression. What is the likeliest reason? 1. The Prozac prescription was not effective. 2. Suicide risk can increase early in treatment with antidepressants. 3. The client was not kept under direct supervision. 4. A preexisting mental illness was compounded by the death of her sister.

2. This is correct. Suicide risk may increase early in treatment with antidepressants. One possible reason is that as an individual's energy returns, he or she may have an increased ability to act out self-destructive wishes.

22. Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge? 1. "I must observe you continually for 1 hour to keep you safe." 2. "Let's review the resources that you may need after discharge." 3. "You must have been very upset to do what you did today." 4. "Are you currently thinking about harming yourself?"

2. This is correct. The nurse functions in the advocacy role by collaborating with the client and treatment team to provide client-centered interventions based on the client's problems and needs. Reviewing the resources the client may need after discharge demonstrates collaboration.

11. A nursing instructor is teaching about suicide in the elderly population. Which information is appropriate to include? 1. Elderly men use less-lethal means to commit suicide. 2. The second-highest rates of suicide are among those 85 years or older. 3. Suicide is the second-leading cause of death among the elderly. 4. The elderly who are single are less likely to attempt and succeed at suicide.

2. This is correct. The second-highest rates of suicide are among those 85 years or older.

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

2. This is correct. The term following hospital discharge is a high-risk period, and the client has numerous risk factors for suicide: exhaustion, depression, and a chronic medical illness. A detailed safety plan should be developed that includes preventing the client from being left alone.

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

2. This is correct. This outcome is measurable, specific, and addresses self-esteem.

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

3. This is correct. A degree of the responsibility for the suicidal client's safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide.

3. A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. Which is the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until the client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while monitoring suicidal ideations 4. Encouraging client to express feelings related to suicide

3. This is correct. Client safety is always the nurse's priority. The nurse must place the client on one-to-one observation and continue to monitor suicidal ideations.

27. Which of the following is considered a fact about suicide? 1. Drug overdose is the leading cause of death among suicide victims. 2. Once a person is considered suicidal, he or she should be viewed as suicidal indefinitely. 3. Most suicidal people have ambivalent feelings regarding living or dying. 4. Suicide runs in families.

3. This is correct. It is a myth that you cannot stop a suicidal person. Most suicidal people are ambivalent about their feelings regarding living or dying. Most are "gambling with death" and see it as a cry for someone to save them.

18. A nurse is caring for four clients diagnosed with major depressive disorder. What impact could religion have on the risk for suicide in these clients? 1. Religious affiliation has no impact on suicide risk. 2. One's type of religion can eliminate suicide risk. 3. Religious affiliation can be protective against suicide attempts. 4. One's type of religion is more important than social support.

3. This is correct. Religious affiliation can be protective against suicide attempts.

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

3. This is correct. Suicide is a behavior.

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

3. This is correct. Suicide risk is higher for individuals who have made previous suicide attempts. About half of individuals who kill themself have previously attempted suicide.

29. According to the Three-Step Theory, when strong, active suicide ideation is present: 1. An attempt occurs usually within 3 to 6 months of the initial ideation. 2. Pain management usually prevents escalation to an attempt. 3. It leads to an attempt only if the individual has the capacity to make an attempt. 4. Connectedness to family typically resolves any attempt.

3. This is correct. The Three-Step Theory mentions that when a strong, active ideation is present, it leads to an attempt if the capacity to make the attempt is present.

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

3. This is correct. The nurse should continuously observe the actively suicidal client for the first hour after admission then as frequently as needed based on assessment findings. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.

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

3. This is correct. The nurse should monitor the client more frequently or implement one-to-one observation. A sudden increase in mood rating and change in affect may indicate the client is at serious risk for suicide. Serious suicide risk may occur early during treatment with antidepressants.

1. A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What is the priority nursing intervention and accompanying rationale for this action? 1. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note 2. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff 3. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide 4. Calling an emergency treatment team meeting, because the client's threat must be addressed

3. This is correct. The priority nursing action is to place the client on one-to-one suicide precautions. A client with a specific plan is at very high risk of attempting suicide. The appropriate nursing diagnosis for this client is "risk for suicide."

8. The family of a suicidal client is supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? 1. Address only serious suicide threats to avoid the possibility of secondary gain. 2. Promote trust by not sharing suicide attempt information outside the family. 3. Offer a private environment to provide needed time alone at least once a day. 4. Be available to actively listen, support, and accept the client's feelings.

4. This is correct. Active listening, providing support, and accepting feelings increase the potential that a client would confide suicidal ideations to family members

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

4. This is correct. Assessment is the first step of the nursing process. Interventions are based on data gathered from the nursing assessment.

30. Based on epidemiological factors, who is at the greatest risk for suicide? 1. An 11-year old African American male 2. A 31-year old American Indian female 3. A 68-year old Hispanic female 4. An 82-year old Caucasian male

4. This is correct. Caucasian Americans account for 14.7% of all suicides, representing the highest risk statistically for suicide.

2. During the planning of care for a suicidal client, which correctly written outcome should be the nurse's priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day 3. 3. The client will establish a trusting relationship. 4. The client will remain safe during the hospital stay.

4. This is correct. Client safety is always the nurse's priority. The outcome to remain safe during the hospital stay addresses the priority and provides a measurable time frame.

26. Thomas Joiner's interpersonal theory of suicide proposes which of the following? 1. An interruption in the customary norms of behavior instills fears of being without support. 2. Impulsivity is elevated in people who have made suicide attempts. 3. Allegiance is so strong to a group that the individual will sacrifice their life for the group. 4. The concept of suicide ideation and suicide attempts are distinct processes.

4. This is correct. Joiner's theory introduces the concept that suicide ideation and suicide attempts need to be understood as distinct processes.

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

4. This is correct. The client's ability to participate in a safety plan and constant family observation will also decrease the risk for self-harm. These aspects support the client's safety.

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

4. This is correct. The client's statements indicate the problem of hopelessness.

13. A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the best nursing reply? 1. "Have you considered doing volunteer work?" 2. "Let's discuss the negative aspects of your life." 3. "Things will look better to you in the morning." 4. "It sounds like you are feeling pretty hopeless."

4. This is correct. The statement "It sounds like you are feeling pretty hopeless" helps establish trust and a therapeutic relationship. The nurse is verbalizing the client's implied feelings and allowing the client to validate and explore them.

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

4. This is correct. This statement is a fact.

1. Which of the following individuals is at highest risk for a suicide attempt? a. A client who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me." b. A client who has been seeing a doctor for chronic, intractable pain and is taking pain medication. c. An American Indian client who just graduated from high school with honors. d. A physician who reports feeling "burnt out" and is considering retirement.

A

7. The nurse identifies the primary nursing diagnosis for a client as Risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis? a. The client has experienced no self-harm. b. The client sets realistic goals. c. The client expresses some optimism and hope for the future. d. The client has reached a stage of acceptance in the loss of the relationship.

A

4. Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply) a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Reassess intensity of suicidal thoughts and urges on a regular basis. d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

A B C

2. The nurse in the emergency department encounters a client who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all that apply.) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

A C D E

5. Success of long-term psychotherapy with a client (who attempted suicide following a break-up with her boyfriend) could be measured by which of the following behaviors? a. The client has a new boyfriend. b. The client has an increased sense of self-worth. c. The client does not take antidepressants anymore. d. The client told her old boyfriend how angry she was with him for breaking up with her.

B

9. In determining the degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to be determined

B

10. A client who has been hospitalized following a suicide attempt is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions are most appropriate in this instance? (Select all that apply.) a. Restrict access to any item that might be harmful by placing the client in a seclusion room. b. Check on the client every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. c. Obtain an order from the physician to give the client a sedative to calm her and reduce suicide ideas. d. Do not allow the client to participate in any unit activities while she is on suicide precautions. e. Ask the client specific questions about her thoughts, plans, and intentions related to suicide.

B E

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

C

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

C

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

D