Chapter 11 Suicide Prevention

Which statement made by a nursing student indicates that learning regarding suicide has been successful? 1. "Suicidal threats and gestures would be considered manipulative and/or attention-seeking." 2. "Suicide is the act of a psychotic person." 3. "All suicidal individuals are mentally ill." 4. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

Answer: 4 Rationale: 1 This statement is inaccurate regarding suicide and would not help the student provide care to clients. 2 This statement is untrue regarding suicide. 3 This statement is a common myth about suicide. Although many who attempt suicide are extremely unhappy, or clinical depressed, they are not all mentally ill. 4 It is true that between 50 and 80 percent of all people who kill themselves have a history with a previous attempt.

Which statement best describes the classification of suicide? 1. Suicide is a DSM-5 diagnosis. 2. Suicide is a mental disorder. 3. Suicide is a behavior. 4. Suicide is an antisocial affliction.

Answer: 3 Rationale: 1 Suicide is not a diagnosis that is found in DSM-5. 2 Suicide is not considered a mental disorder. 3 Suicide is considered a behavior. It is defined as the act of taking one's own life. 4 Suicide is not an affliction.

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? 1. The more specific the plan is, the more likely the client will attempt suicide. 2. Clients who talk about suicide rarely actually commit it. 3. Clients who threaten suicide should be observed every 15 minutes 4. After a brief assessment, the nurse would avoid the topic of suicide.

Answer: 1 Rationale: 1 Clients who have specific plans are at greater risk for suicide. 2 Clients who talk about suicide should be taken seriously; a client who has a plan is more likely to carry out the plan. 3 One-to-one supervision would be provided for any client who threatens suicide, not an every 15 minute check in 4 The nurse should be direct and upfront when discussing suicide with clients and their families.

Which strategy is most important to implement initially with a suicidal client? 1. Ask a direct question such as, "Do you ever think about killing yourself?" 2. Ask the client, "Please rate your mood on a scale from 1 to 10." 3. Establish a trusting nurse-client relationship. 4. Apply the nursing process to the planning of client care.

Answer: 1 Rationale: 1 The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. 2 Asking client to rate mood does not help assess suicide risk. 3 Establishing a nurse-client relationship does not help assess suicide risk. 4 Applying the nursing process to planning does not help assess suicide risk.

A father finds his teenage child has carried out suicide by hanging the morning after they have an argument. Which paternal grief responses would a nurse anticipate? (Select all that apply.) 1. "I can't believe this is happening." 2. "If only I had been more understanding." 3. "How dare he do this to me!" 4. "I'm just going to have to accept that he was gay." 5. "Well, that was a selfish thing to do."

Answer: 1, 2, 3 Rationale: 1 Suicide of a family member can induce a whole gamut of feelings in the survivors, including this response of shock. 2 Suicide of a family member can induce a whole gamut of feelings in the survivors, including guilt, such as the sentiment expressed here. 3 This response exemplifies an anger response. Suicide of a family member can induce a whole gamut of feelings in the survivors, including anger. 4 Stating, "I'm just going to have to accept that he was gay," reflects acceptance and understanding. 5 Stating, "Well, that was a selfish thing to do," reflects acceptance and understanding.

A stockbroker commits suicide after being convicted of insider trading. In 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 work with the health-care provider to 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."

Answer: 2 Rationale: 1 All individuals grieve differently. It is not appropriate for the nurse to say when an individual's grief will subside, and it is not within the nurse's scope of practice to recommend medications. 2 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. 3 It is not appropriate for the nurse to recommend appropriate actions for the client to take, such as writing a letter to the firm to express anger. 4 It may be beneficial for the family to discuss the suicide with a grief counselor. However, it is outside the nurse's scope of practice to provide referrals.

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 four. 3. The client will reveal a suicide plan. 4. The client will establish a trusting relationship.

Answer: 2 Rationale: 1 This outcome may take time for the client to commit to. 2 Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes would be client-centered, specific, realistic, and measurable and contain a time frame. 3 This outcome may be a big step for the client. 4 This outcome may not be realistic right away for the client.

Which information would the nursing instructor include about suicide in the elderly population when teaching nursing students? 1. Elderly people use less lethal means to commit suicide. 2. Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3. Suicide is the second leading cause of death among the elderly. 4. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

Answer: 2 Rationale: The elderly do not necessarily use less lethal means of committing suicide. 2 Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3 Suicide is not the second leading cause of death among the elderly. 4 An expressed desire to die is not normal in any age group.

After years of dialysis, an 84-year-old client states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question would the nurse ask the client's spouse when preparing a discharge plan of care? 1. "Have there been any changes in 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 would you characterize your relationship with your spouse?"

Answer: 2 Rationale: 1 Changes in appetite or sleep do not accurately indicate risk for suicide. 2 This client has many risk factors for suicide. The client would have increased supervision to decrease likelihood of self-harm. 3 Asking about diet and exercise do not assess risk for suicide. 4 Asking about the client's relationship with his spouse does not accurately assess the risk for suicide.

A client is admitted to an inpatient unit after a suicide attempt. The health-care provider prescribes amitriptyline (Elavil) for the client. Which would the nurse expect to 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 contingent on follow-up appointments. 3. Provide a pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

Answer: 2 Rationale: 1 This amount of medication may be enough for the client to overdose. 2 The health-care provider would provide no more than a 3-day supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential. In addition, clients may gain energy to carry out a suicide once they begin to have more energy from taking the antidepressants. 3 Providing a pill dispenser will not prevent suicide. 4 Educating the patient about foods containing tyramine will not prevent an overdose.

Which client data indicates that a suicidal client is participating in a plan for safety? 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 nurse

Answer: 3 Rationale: 1 Compliance with antidepressant therapy does not indicate the client participating in a plan for safety. 2 A mood rating of 9/10 does not indicate the client participating in a plan for safety. 3 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. 4 Expressing feelings of hopelessness do not indicate the client participating in a plan for safety.

A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse would conclude which client would potentially be at higher risk for suicide than the other clients? 1. Roman Catholic 2. Protestant 3. Atheist 4. Muslim

Answer: 3 Rationale: 1 Depressed men and women who consider themselves affiliated with a religion such as Roman Catholicism, may be less likely to attempt suicide than their nonreligious counterparts. 2 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts. 3 According to studies, depressed individuals who are associated with a religion are less likely to attempt suicide than their nonreligious counterparts, such as those associated with atheism. Therefore, this client may be at higher risk than the other clients. 4 Depressed clients with religious affiliation are less likely to attempt suicide than their nonreligious counterparts.

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

Answer: 3 Rationale: 1 Encouraging participation does not best lower the client's risk for suicide. 2 Developing a personal relationship with the client does not best lower the client's risk for suicide. 3 The nurse would observe the actively suicidal client continuously for the first hour after admission. After a full assessment, the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors. 4 Encouraging and redirecting the client does not best lower the client's risk for suicide.

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

Answer: 3 Rationale: 1 Family history of depression is not critical to determining risk for suicide. 2 Client's orientation to reality not critical to determining risk for suicide. 3 A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client's risk. Of those who commit suicide, 50-80 percent had a previous attempt. 4 Family support systems are not critical to determining risk for suicide.

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 would be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until 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 the client to express feelings related to suicide

Answer: 3 Rationale: 1 Seclusion may be excessive for this client. 2 Checks every 15 minutes would be inadequate for this client. 3 The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation. 4 Although it is important to encourage the client to express their feelings, the client's physical safety is the priority.

The nurse discovers a client's suicide note that details the time, place, and means to commit suicide. Which would be the priority nursing intervention and the 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

Answer: 3 Rationale: 1 This action would not be appropriate and could be considered a restraint. 2 Establishing room restrictions does not keep the client safe in the immediate situation. 3 The priority nursing action would be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide. 4 The client's immediate safety is a priority; this action may be appropriate at a later time.

According to statistics, which ethnic group is at highest risk for suicide? 1. African American 2. Alaskan Native 3. Asian 4. White

Answer: 4 Rationale: 1 African Americans are at third highest risk for suicide, following whites and American Indians/Alaska Natives 2 Alaska Natives (and American Indians) are at second highest risk for suicide, following whites. 3 Asians are at fifth highest risk for suicide, following whites, American Indians/Alaska Natives, African Americans, and Hispanic Americans. 4 Statistics show whites are at highest risk for suicide.

Which documented intervention would the nurse implement first when caring for a severely depressed client? 1. Communicate therapeutically. 2. Observe the client. 3. Provide a hazard-free environment. 4. Assess suicide risk.

Answer: 4 Rationale: 1 After assessing suicide risk, the nurse can communicate therapeutically. 2 After assessing suicide risk, the nurse can observe the client. 3 After assessing suicide risk, the nurse can provide a hazard-free environment. 4 Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment would always be the first step taken when working with depressed or suicidal clients.

During a one-to-one session with a client, the client states, "Nothing will ever get better," and, "Nobody can help me." Which nursing diagnosis is most appropriate for this client? 1. Powerlessness R/T altered mood 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

Answer: 4 Rationale: 1 The client is experiencing hopelessness. This diagnosis would be inappropriate. 2 Risk for injury has not been identified based on the client's statement. 3 Risk for suicide has not been identified. 4 The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the client's suicidal ideations and intent would be necessary.

A suicidal client says to the nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? 1. "Why don't you consider doing volunteer work in a homeless shelter?" 2. "Let's discuss the negative aspects of your life." 3. "Things will look better in the morning." 4. "It sounds like you are feeling pretty hopeless."

Answer: 4 Rationale: 1 This question does not help the client open up about feelings. 2 This statement does not help the client discuss feelings 3 This statement may be degrading to the client's feelings. 4 This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information would the nurse provide? 1. Address only serious suicide threats to avoid the possibility of secondary gain. 2. Promote trust by verbalizing a promise to keep suicide attempt information within 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 feelings.

Answer: 4 Rationale: 1 Addressing only serious suicide threats would not be helpful to the client. 2 Keeping suicide attempts a secret in the family does not help the client. 3 Providing alone time does not help the client. 4 Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? 1. No previous admissions for major depressive disorder 2. Vital signs stable; no psychosis noted 3. Adheres to medication regimen; able to problem-solve life issues 4. Participates in a plan for safety; family agrees to constant observation

Answer: 4 Rationale: 1 History of admissions does not focus on suicide prevention. 2 Assessment of vital signs does not focus on suicide prevention. 3 Compliance with medication regimen does not focus on suicide prevention. 4 Participation in a plan of safety and constant family observation will decrease the risk for self-harm.

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

Answer: 4 Rationale: 1 This answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, realistic, and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated. 2 This option may take longer to achieve and therefore not be the nurse's first priority. 3 This option is important, but safety must be established first. 4 The nurse's priority would be that the client will remain safe during the hospital stay. Client safety would always be the nurse's priority.

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, rates mood at 9/10, and is much more communicative. Which action would 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 that the psychiatrist reevaluate the current medication protocol.

Answer:3 Rationale: 1 The client would not be given off-unit privileges, as this could be unsafe. 2 Group involvement is important, but client safety must take priority. 3 The nurse would be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation would be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication. 4 Medication can be reevaluated after client safety has been established.