Chapter 25 - Suicide (Psych) EAQ's

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

2 The patient is contemplating suicide. The factors that put this patient at higher risk of suicide include age, gender, lack of social support, lack of spouse, and a chronic medical condition. When such a patient makes a covert statement like "I won't be a problem much longer," the nurse should understand that the patient is contemplating suicide. In such situations, the nurse should ask the patient directly about suicidal ideation and whether he or she has thoughts of suicide or has developed a plan. The patient is in pain and thus would not be in a happy mood. The patient has not fully recovered yet and may not be discharged soon. Further treatment is required for the patient unless the patient has fully recovered. Text Reference - p. 479

The nurse meets with a 13-year-old adolescent who has depression and whose parents report the patient "has stopped wanting to go to school." Which statement made by the adolescent most makes the nurse believe that the child is at risk for suicide? 1 "All my friends use drugs, and I don't want to be around people like that at school." 2 "Classrooms make me nervous because they are small, and there are too many kids in one room." 3 "I don't like my teachers because they call on me all the time, and I feel nervous and embarrassed." 4 "The kids at school either call me names or make up stories about me to get my friends to not like me anymore."

4 "The kids at school either call me names or make up stories about me to get my friends to not like me anymore." When the adolescent expresses that classmates bully him or her, the nurse knows this is a risk factor for suicide among youths. Not wanting to use drugs at school, feeling anxious in the classroom, and not liking teachers are not statements that indicate risk for suicide. Text Reference - p. 477

The nurse is caring for a patient who is going through a divorce. Which is an overt statement made by the patient that may indicate a risk for suicide? 1 "I can't take my life anymore. I can't handle this." 2 "Nothing feels good anymore. I'm not able to enjoy anything." 3 "Things never seem to work out for me, even when times seem good." 4 "I'm sure everything will be fine eventually. That's what everyone says."

1 "I can't take my life anymore. I can't handle this." Overt statements that indicate risk for suicide include remarks like "I can't take it anymore" and "Life isn't worth living anymore." Therefore, the nurse identifies "I can't take my life anymore" as an overt statement made by the patient that indicates suicide risk. "Things never work out for me," "Nothing feels good anymore," and "I'm sure everything will be fine eventually" are covert statements, not overt statements. Text Reference - p. 479

A patient with diagnoses of borderline personality disorder, depression, and a high risk of suicide is stabilized and is getting discharged. The nurse interacts with this patient. Which response by the patient indicates effective treatment? 1 "I promise you I will lead a happy life." 2 "Sorry, I don't feel like talking with you." 3 "I can help myself; I don't need your assistance." 4 "Let me get discharged; I will put an end to everything."

1 "I promise you I will lead a happy life." Patients with borderline personality disorder, depression, and suicidal ideation are at risk of suicide and injury to self or others. The treatment outcomes include the patient would remain free from injury, have a will to live, and would refrain from attempting suicide. In the statement that the patient promises to lead a happy life, the patient expresses the will to live. The statement suggests that the treatment is effective. The patient doesn't feel like talking to the nurse indicates that the patient is still depressed and prefers to be isolated. The statement suggests that treatment is not effective. In the statement that the patient does not need the nurse's assistance, the patient is denying the help. It indicates that the patient prefers to be alone and believes that no one would be able to help. The statement that the patient would put an end to everything once discharged is a covert statement. The patient is having suicide ideation, and the treatment is ineffective. Text Reference - p. 480, Table 25.2

The nurse assesses a patient who participates in non-suicidal self-injury behaviors. What questions will the nurse include in the assessment? Select all that apply. 1 "What kind of self-injury do you perform?" 2 "How often do you engage in self-injury?" 3 "What triggers your desire to hurt yourself?" 4 "How do you think this makes other people feel?" 5 "Is there anything that has helped these behaviors in the past?" 6 "Can you think of a time when you didn't want to injure yourself?"

1 "What kind of self-injury do you perform?" 2 "How often do you engage in self-injury?" 3 "What triggers your desire to hurt yourself?" 5 "Is there anything that has helped these behaviors in the past?" When performing an assessment on a patient who engages in non-suicidal self-injurious behaviors, the nurse should try to find out about the types of self-injury, what helps the behavior, triggers for the behavior, and frequency of the behavior. It is not therapeutic to ask about the patient's effects on other people, or to think of a time when the behaviors were nonexistent. Text Reference - p. 487

A nurse assesses five new patients admitted to a psychiatric unit. Which patients have the highest risk for suicide? Select all that apply. 1 88-year-old Caucasian male 2 65-year-old Caucasian female 3 26-year-old Alaskan Native male 4 36-year-old African American male 5 17-year-old African American female

1 88-year-old Caucasian male 3 26-year-old Alaskan Native male 5 17-year-old African American female Men, particularly white men of advanced age, have a higher risk than women for suicide. Among American Indians/Alaska Natives aged 15 to 34 years, suicide is the second-leading cause of death. Hispanic and Black, non-Hispanic female high-school students in grades 9 to 12 have higher percentages of suicide attempts than White, non-Hispanics. Among females, those in their 40s and 50s have the highest rate of suicide. Text Reference - pp. 476, 478, Box 25.1

Based upon current information regarding successful suicide attempts among the male population, which factor is relevant? Select all that apply. 1 Access to firearms 2 75 years of age and older 3 History of alcohol consumption 4 American Indian and Alaskan natives 5 History of antidepressant medication therapy

1 Access to firearms 2 75 years of age and older 3 History of alcohol consumption 4 American Indian and Alaskan natives The National Violent Death Reporting System examined toxicology tests of those who committed suicide in 16 states: 33.3% tested positive for alcohol and 20% for opiates or prescription pain killers. Among males, adults aged 75 years and older have the highest rate of suicide (nearly 36.1 per 100,000 population). Firearms are the most commonly used method of suicide among males (approximately 55.7%). Among American Indians and Alaska natives aged 15 to 34 years, suicide is the second-leading cause of death. Antidepressants are not noted often. Text Reference - p. 476, Box 25.1

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

1 Assess the patient's risk for suicide. The patient is at risk for suicide, so safety is the highest priority. The patient will need support, medication education, and counseling at some point, but this is not the highest priority. Text Reference - pp. 478-479

What situation is a risk factor for a completed or successful suicide? Select all that apply. 1 Being a lawyer or police officer 2 Recent diagnosis of schizophrenia 3 History of impulsive decision making 4 The depressed phase of bipolar disorder 5 Identifying with the Roman Catholic religion

1 Being a lawyer or police officer 2 Recent diagnosis of schizophrenia 3 History of impulsive decision making 4 The depressed phase of bipolar disorder It is estimated that two thirds of people who complete suicide are experiencing depression at the time. About 15% of patients who have major depression or bipolar disorder (during the depressed phase) will complete suicide. Loss of relationships, financial difficulty, and impulsivity are factors in this population. Suicide is more than 50 times higher among patients with schizophrenia than that of the general population, especially during the first few years of the illness. Law enforcement personnel, dentists, artists, mechanics, insurance agents, and lawyers are also at higher risk. Religiosity is associated with decreased rates of suicide. Protestants and Jews have higher rates of suicide than Roman Catholics. Text Reference - pp. 476-478

A registered nurse was appointed in charge of a psychiatric ward. What appropriate actions does the nurse take to keep patients safe in the ward? Select all that apply. 1 Count the kitchen utensils daily 2 Lock the utility rooms, kitchen, and office 3 Install unbreakable shower rods in the bathroom 4 Ensure that the windows remain open in the morning 5 Decorate the ward with flowers in beautiful glass vases

1 Count the kitchen utensils daily 2 Lock the utility rooms, kitchen, and office The nurse should lock the utility rooms, kitchen, and offices and instruct all the staff members to do so. The nurse should count the number of utensils daily to ensure that the patients don't take harmful objects from the kitchen. The ward must be kept free of harmful objects, like glass vases and nails. The nurse should close the windows to prevent the patients from escaping. The bathrooms must be made jump-proof and hanging-proof by installing breakaway showers. Text Reference - p. 484, Box 25.4

The nurse is conducting community teaching to groups of parents about suicide prevention. What will the nurse include in the teaching? Select all that apply. 1 Explaining that strong community and family support is critical 2 Encouraging parents to keep their children at home as much as possible to watch them 3 Advising parents to not let their kids use the Internet, particularly social media sites 4 Teaching parents how to use problem-solving and conflict resolution skills in the home 5 Emphasizing that access to mental healthcare services can help mitigate suicidal ideation

1 Explaining that strong community and family support is critical 4 Teaching parents how to use problem-solving and conflict resolution skills in the home 5 Emphasizing that access to mental healthcare services can help mitigate suicidal ideation Effective mental health services, strong connections to family and community, and problem-solving and conflict resolution skills are protective factors that make it less likely for children to consider, attempt, or die by suicide. Encouraging parents to keep children at home to watch them is not appropriate or feasible. Advising parents to not let their kids use the Internet is also unrealistic. Text Reference - p. 478

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

1 Give adequate support to the staff of the unit. 2 Review the events to find the overlooked clues. 3 Recommend conducting psychological postmortem. The staff may experience post-traumatic stress disorder if a patient commits suicide at the hospital under their watch. A review of the events must be done to find the overlooked clues in the patient's behavior. This helps to avoid future mistakes and improve the quality of treatment. The nurse should support the staff to help them cope with the event. A thorough psychological postmortem should be done to determine any faulty judgment of the staff and to improve the treatment protocol. The staff should not be suspended. The patient's family must be informed immediately. Text Reference - p. 485

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by 1 Having a staff member sit at the door and check packages as visitors enter 2 Asking all visitors to report to the nurse's station before visiting a patient 3 Having a staff member make frequent rounds during visiting hours to inspect gifts 4 Asking patients to give staff any unsafe item that might have been left by a visitor

1 Having a staff member sit at the door and check packages as visitors enter A number of ways to inspect items are possible. Taking all potentially harmful gifts from visitors before allowing them to see patients, going through patient's belongings (with patient present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the patient's room, and searching patients for harmful objects on return from pass are all effective methods to ensure a high rate of patient safety. Text Reference - p. 484, Box 25.4

What measures taken in a community can reduce the suicide rate among lesbian, gay, bisexual, and transgender (LGBT) adolescents? Select all that apply. 1 Having registered Democrats in a community 2 Having a higher number of same-sex couples 3 The presence of gay-straight alliances in schools 4 Having equal numbers of male and female students 5 Asking gay adolescents to undergo sex change surgeries

1 Having registered Democrats in a community 2 Having a higher number of same-sex couples 3 The presence of gay-straight alliances in schools Research indicates that an environment that is supportive of lesbian, gay, bisexual, and transgender (LGBT) people results in lower rates of suicide. Having a higher number of same-sex couples, registered Democrats, and the presence of gay-straight alliances in schools can result in lower rates of suicide. Asking gay adolescents to have sex change surgery may make them feel awkward and unaccepted in the community and may increase the suicide rates of gay adolescents. Having equal numbers of male and female students does not have any effect on suicide rates of LGBT adolescents. Text Reference - p. 477

Which statement is true regarding nonsuicidal self-injury? Select all that apply. 1 Homosexuality may be a trigger for these behaviors. 2 The injuries can be a self-inflected means of punishment. 3 Cutting and biting are common manifestations of this disorder. 4 The patient generally has more than one method to inflict injury. 5 The peak for this type of behavior is between 25-29 years of age.

1 Homosexuality may be a trigger for these behaviors. 2 The injuries can be a self-inflected means of punishment. 3 Cutting and biting are common manifestations of this disorder. 4 The patient generally has more than one method to inflict injury. These behaviors most commonly consist of cutting/carving, burning, scraping/scratching skin, biting, hitting, skin picking, and interfering with wound healing. Half of self-injurers report multiple methods. These actions can be used to punish themselves, to connect with others, to get attention, to escape a responsibility, or to avoid a situation. Risk factors for nonsuicidal self-injury include depression in either parent, non-heterosexual orientation, and depression. Non-suicidal self-injury begins between 10 and 15 years of age, peaking in the late teens. Hospital admission data confirms a decline in the behavior between 25 to 29 years of age. Text Reference - p. 486

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

1 Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness. Text Reference - p. 480, Table 25.2

The nurse develops a safety plan for a suicidal patient. Which interventions will the nurse include in the plan? Select all that apply. 1 Identifying warning signs of a crisis 2 Avoiding issues that trigger suicidal ideation 3 Telling oneself that negative emotions are not "real" 4 Making lists of things that are most important to the patient 5 Calling on friends and other people who provide distractions

1 Identifying warning signs of a crisis 4 Making lists of things that are most important to the patient 5 Calling on friends and other people who provide distractions Safety plans for patients who are suicidal include identifying warning signs of a crisis, identifying things that are most important and worth living for, and calling on friends and others for support and to provide distraction. Avoiding issues that trigger suicidal ideation and telling oneself that negative emotions are not "real" are ineffective psychosocial interventions and are not part of the safety plan. Patients who attempted suicide or have suicidal ideation must be encouraged to create and use internal coping strategies with triggers and negative emotions. Text Reference - p. 482

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

1 Keep electrical cords to a minimal length. 2 Use plastic utensils for serving food to the patient. 5 Install breakaway shower rods and recessed shower nozzles. The history of the patient indicates a high risk of suicide. Therefore, the nurse should take all measures to minimize suicidal behavior in the patient. Some of the steps to be taken include using plastic utensils for serving food, keeping electrical cords to a minimal length, and installing breakaway shower rods and recessed shower nozzles. This patient should not be assigned a private room, and the door of the room should always be kept open. It is important for the nurse to go through the belongings of the patient in his presence and remove all potentially harmful objects. Text Reference - p. 487

A pregnant woman seeks counseling after losing a parent. She informs the nurse that she has lost her job a few days ago and is aware of her responsibility for her family. Which factors put her at greater risk of suicide? Select all that apply. 1 Losing a job 2 Being pregnant 3 Accessing health care 4 The death of her parent 5 Being responsible for her family

1 Losing a job 4 The death of her parent The nurse should know about the risk factors of suicide. Unemployment and death of a loved one are two of the risk factors. However, pregnancy, access to health care, and a sense of responsibility for the family are protective factors for suicide. Text Reference - p. 477

When creating a suicide prevention plan for males, which intervention will be included? Select all that apply. 1 Minimizing access to firearms 2 Focus depression screenings on the 25- to 40-year-old age group 3 Publicizing community-based suicide prevention service facilities 4 Providing community educational focusing on the identification of warning signs 5 Identify strategies to minimize the stigma attached to seeking mental health services

1 Minimizing access to firearms 3 Publicizing community-based suicide prevention service facilities 4 Providing community educational focusing on the identification of warning signs 5 Identify strategies to minimize the stigma attached to seeking mental health services Goals for suicide prevention include developing and implementing strategies to reduce the stigma associated with substance abuse, being a consumer of mental health, and suicide-prevention services; promoting efforts to reduce access to lethal means and methods of self-harm (males use firearms quite frequently to commit suicide); implementing training for recognition of at-risk behaviors; and improving access to mental health and substance abuse services. Screening should include all males, but teens and males over 75 are at high risk. Text Reference - p. 482, Box 25.3

Which suicide intervention has the greatest impact on a patient's safety? 1 One-on-one observation by the staff. 2 Educating visitors about potentially dangerous gifts. 3 Removal of personal items that might prove harmful. 4 Restricting the patient from potentially dangerous areas of the unit.

1 One-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the patient's opportunities to cause self-harm. Although educating visitors about potentially dangerous gifts, restricting the patient from potentially dangerous areas of the unit, and removal of personal items that might prove harmful are appropriate, they do not have the impact that one-on-one observation has. Text Reference - p. 484, Table 25.3

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

1 Patient with anorexia 3 Patient with depression 5 Patient with posttraumatic stress disorder Patients with depression, anorexia, and posttraumatic stress disorder are at a greater risk of suicide, as suicidal ideation is the result of inner pain, sadness, helplessness, and hopelessness. Attention deficit disorder and psychosis are not comorbidity factors that put patients at risk for suicide. Text Reference - p. 476

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

1 Remain neutral and do not react angrily to the patient. Patients who are at high risk of suicide can show anger. In such a situation, the nurse should remain neutral and not react. This reduces power struggles and also discourages the acting-out behavior. Restraining the patient will not help. It is not required to call security at this stage. It is also inappropriate to tell the patient that all other patients get the same meals as this may aggravate the situation. Text Reference - p. 480

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

1 Staff must remain within arm's length of the patient at all times 2 Assure that the patient has no access to glass or metal objects. 3 Assess the patient's mouth after each medication administration. 5 Documentation should include the patient's verbatim statements. Nursing staff responsibilities when a patient is prescribed one-to-one observation include remaining within arm's reach of the patient at all times, charting the patient's verbatim statements, ensuring the patient has no access to glass or metal objects, and assuring that the patient is swallowing medication and not "cheeking" it for the purpose of overdosing. Even when asleep, the patient's hands must always be visible. Text Reference - p. 484, Table 25.3

Which fact concerning the needs and wishes of suicide survivors should be considered when formulating interventions for this population? Select all that apply. 1 Suicide often is considered a taboo subject by society. 2 Surviving family and friends may experience both shame and guilt. 3 Talking about a loved one increases the survivor's feelings of grief. 4 A family history of suicide is a strong risk factor for future suicide attempts. 5 Most surviving friends and relatives will not seek treatment despite their suffering.

1 Suicide often is considered a taboo subject by society. 2 Surviving family and friends may experience both shame and guilt. 4 A family history of suicide is a strong risk factor for future suicide attempts. 5 Most surviving friends and relatives will not seek treatment despite their suffering. Surviving family and friends may experience overwhelming guilt and shame, compounded by the difficulty of discussing the frequently taboo subject of suicide. Adolescent friends who suffer traumatic grief are more likely to report suicidal ideation within 6 years of the suicide. Family members of individuals who complete suicide develop a 4.5-times greater risk of suicide than those in families in which no suicide occurred. Despite their suffering, only approximately 25% of survivors seek treatment. It has been reported repeatedly that the worst thing possible is to avoid mention of the lost loved one. Text Reference - pp. 484-485

The nurse is teaching the nursing students about different risk factors for suicide. Which statement appropriately describes the risk factors? Select all that apply. 1 Suicide rates peak in men after the age of 45. 2 Suicide rates peak in men after the age of 55. 3 Suicide rates peak in women after the age of 45. 4 Suicide rates peak in women after the age of 55. 5 Suicides rates in men are 4 times higher than in women. 6 Suicides rates in women are 4 times higher than in men.

1 Suicide rates peak in men after the age of 45. 4 Suicide rates peak in women after the age of 55. 5 Suicides rates in men are 4 times higher than in women. There are many risk factors for suicide. Age and gender are two of the factors influencing suicidal ideation. Research shows that suicide rates peak after the age of 45 in men and 55 in women. There is also evidence showing that men commit suicide 4 times more often than women. The suicide rates in men peak after 45 years, not 55 years. Suicide rates are greater in women age 55 and above. It is less common in women around the age of 45. Men have a greater suicide rate than women. Text Reference - p. 478

A nurse is giving postvention to the wife of a depressive patient who committed suicide. What statements indicate that the nurse understands postvention? Select all that apply. 1 "You should be strong for your family." 2 "Don't be afraid to talk about your husband." 3 "Donating your husband's belongings may help you let go." 4 "I can't allow you to meet your husband's primary health care provider." 5 "Why didn't you admit your husband immediately for treatment of his depression?"

2 "Don't be afraid to talk about your husband." 3 "Donating your husband's belongings may help you let go." Postvention or tertiary intervention refers to counseling given to the relatives and family of a person who has committed suicide. The nurse should have an understanding of grief and loss counseling, such as the need for the family to talk about the loss openly. Families often keep the belongings of the patient, which can prevent them from overcoming their loss and grief. The nurse should suggest donating all the belongings of the patient as part of the process of letting go. The nurse should not blame or interrogate the family, as it can make them feel rejected. The nurse should allow the family to meet the primary health care provider if they have questions about the patient's condition before the suicide. They may gain a better understanding, which will help them move through the grieving process. Stating that the wife should be strong for her family is not appropriate or helpful because it dismisses her grief. Text Reference - pp. 484-485

One week ago, a patient attempted suicide. When counseling this patient, which comment by the nurse is most therapeutic? 1 "As you look back on the past week, why do you think you tried to hurt yourself?" 2 "I'd like to hear about how you are feeling now and the image you have of yourself." 3 "You've made so much progress in one week. Do you think you're ready to go home?" 4 "When you begin to have negative feelings, try to focus on something more positive."

2 "I'd like to hear about how you are feeling now and the image you have of yourself." The nurse should give frequent opportunities for discussion of feelings through verbal invitation and stated concern. These topics are pertinent to the care of the suicidal patient: suicide prevention, hope instillation, coping enhancement, self-esteem enhancement, family mobilization, and support system enhancement. "Why" questions are probing and nontherapeutic communication techniques. While giving recognition is a therapeutic communication technique, asking a yes or no question about the patient's readiness for discharge does not invite further dialogue. Giving advice is a nontherapeutic technique. Text Reference - p. 479

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

2 Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself. Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life, such as giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the patient on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the patient that he will need his shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is nonconclusive and subjective. Text Reference - p. 479

A 42-year-old patient was diagnosed with schizophrenia at age 22. The patient has taken prescribed medications consistently and participated in outpatient programming. Today, the patient says, "I'm not sure if I'll ever be a success." Which response should the nurse provide first? 1 Ask the patient, "What are your goals for the future?" 2 Ask the patient, "Do you have any thoughts of harming yourself?" 3 Say to the patient, "Schizophrenia can be a very discouraging illness." 4 Say to the patient, "You've done a good job of following your treatment plan."

2 Ask the patient, "Do you have any thoughts of harming yourself?" The patient's comment suggests that hopelessness may be present. The nurse's first action is to assess suicidal thinking and intent. Suicide is more than 50 times higher among patients diagnosed with schizophrenia than that of the general population and is the leading cause of early death in this population. About 40% of patients diagnosed with schizophrenia attempt suicide at least once. Giving recognition for adherence to the treatment plan, reflecting, and exploring the patient's future goals are actions that may occur later. Text Reference - p. 479

The nurse provides care to a suicidal patient with bipolar manic episodes. The patient's family expresses concern regarding pharmacologic interventions and the side effects they cause. Which medication does the nurse expect to be prescribed to the patient? 1 Fluoxetine 2 Clozapine 3 Haloperidol 4 Diazepam

2 Clozapine Antipsychotics may be prescribed to suicidal patients who experience psychotic or bipolar manic episodes. Since the patient's family expressed concern regarding side effects, the patient is most likely to be prescribed a second-generation antipsychotic, such as clozapine, with a lower risk of side effects than first-generation antipsychotics. Fluoxetine is an antidepressant, which would not be prescribed to this patient. Haloperidol is a first-generation antipsychotic with a greater risk for adverse side effects. Diazepam is an antianxiety medication, which would not be prescribed to this patient. Text Reference - p. 482

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

2 Clozapine Clozapine decreases the risk of suicide in patients with schizophrenia. However, these patients should be regularly monitored for severe side effects of clozapine, like agranulocytosis, myocarditis, and altered glucose metabolism. A common side effect of metformin is gastrointestinal disturbance; cetirizine can cause drowsiness; and paracetamol in large amounts can lead to liver toxicity. Text Reference - p. 482

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

2 Decreased serotonin activity in the brainstem and prefrontal cortex. Low serotonin levels are related to depressed mood and depression is commonly associated with suicide. Postmortem examinations of individuals who complete suicide also reveal a low level of serotonin in the brainstem or the frontal cortex. GABA is associated with anxiety. Increased norepinephrine is associated with stimulation of the sympathetic nervous system. Text Reference - pp. 476-477

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

2 Identify the problems experienced by the patient. The nurse should try to identify the problems experienced by the patient and his or her feelings toward it. It helps to explore alternative ways of helping the patient and decrease hopelessness in the patient. The patient could develop a positive orientation toward the future. The nurse should encourage the patient to interact verbally. When the feelings are conveyed verbally, the actions to show aggression will be reduced, which decreases physical harm. Though the patients deny a suicide idea, they may have a future plan of committing suicide. The nurse should not connect emotionally with the patient's situation as it can distract his or her attention and can lead to counter transference. The nurse should remain neutral to avoid arguments and sympathy with the patient. Text Reference - p. 480

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

2 Instruct the staff to observe the patient 24 hours a day. The patient is clearly communicating suicidal intentions. The staff should observe the patient 24 hours a day. The nurse should be around the patient and record his or her mood and behavior every 15-30 minutes. One-to-one nursing interaction must be done with the patient 24 hours a day. The patient should not be allowed to mingle with other patients as the patient can harm them. The nurse is supposed to chart the patient's whereabouts and record the mood and behavior every 15-30 minutes, not every 5 hours. Text Reference - p. 484, Table 25.3

The nurse is assessing a patient who attempted suicide once. Which method used by the patient in the previous suicide attempt would put the patient at higher risk? 1 Slashing the wrists 2 Staging a car crash 3 Inhaling natural gas 4 Ingesting sleeping pills

2 Staging a car crash A method can be considered high or low risk based on the lethality, that is, how quickly a person can die using that particular method. Therefore, staging a car crash would put the patient at higher risk. Ingesting pills, inhaling natural gas, and slashing one's wrists are considered low-risk methods. If the patient uses these methods to commit suicide, there may be time to rescue the patient from dying. Text Reference - p. 479

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

2 This student has a higher suicide risk than his or her heterosexual peers. Suicide is the third leading cause of death among lesbian, gay, bisexual, and transgender (LGBT) youth in the United States. Informing the family may or may not change the risk. LGBT youth are more likely to attempt suicide than their heterosexual peers. Text Reference - p. 477

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

3 "A few weeks ago, one of my son's classmates also attempted suicide in the same way." Copycat suicide is commonly seen during adolescence. Adolescents may glamorize the suicides of peers and classmates and perform copycat suicide due to immature reasoning and the function of an underdeveloped prefrontal cortex. The statement that the patient was worried about his poor performance on school exams indicates that academic performance was one of the probable reasons for attempting suicide. The statement that the patient's classmates are responsible for the suicide indicates that the patient's mother is blaming others, or that the patient has been the victim of bullying but it does not indicate risk for copycat suicide. The statement that the patient fought with his parents about school does not indicate a risk for copycat suicide. Text Reference - p. 477

A divorced woman is treated with antidepressants in an inpatient setting. The patient expresses to the nurse, "My depression is gone. I feel very energetic today. Soon everything will be fine." What would be the most appropriate response for the nurse? 1 "Yes, I will surely plan for your discharge." 2 "Congrats! You seem to have recovered well." 3 "Do you have any sort of suicidal ideas or plans?" 4 "I am happy to see you recover from depression."

3 "Do you have any sort of suicidal ideas or plans?" It is important for the nurse to be aware of verbal and nonverbal hints of suicide by a patient to prevent suicide. When there is a sudden rise in the mood and energy of a depressed patient, the nurse should understand that the patient may have suicidal ideation. These behavioral changes may be the patient's attempt to mask suicidal intent. In such situations, the nurse should ask the patient directly about suicidal ideation. The patient should not be discharged as the patient is not safe. The patient should not be congratulated for recovery from depression because the patient is still not mentally stable. The patient does not seem to have recovered from depression. Therefore the nurse should not express satisfaction with the patient's recovery. Text Reference - p. 479

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

3 After a highly publicized suicide of a public figure Theories of suicide have recently focused on a combination of suicidal fantasies with loss of job, rage, guilt, or identification with an individual who has committed suicide. A person commits copycat suicide after a highly publicized suicide of a public figure or an idol or a peer in the community. Losing a job, losing self-esteem due to various reasons, and feeling trapped in a jail may also be reasons for committing suicide, but they are not the reasons for a copycat suicide. Text Reference - p. 477

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

3 Ask if the patient has any plans to commit suicide. It is important for the nurse to directly ask patients if they have any plans to commit suicide. Research shows that asking about suicidal ideation does not induce ideas of suicide in a person, and in fact it is a professional responsibility of a nurse to do so. Talking about it can lead to problem-solving alternatives and decrease isolation in a patient. Asking the patient about plans to commit suicide is priority, and once this is confirmed, the health care provider and security staff may be informed. Ignoring the patient may put the patient at high risk of self-harm. Text Reference - p. 479

When working with a patient who may have made a covert reference to suicide, the nurse will implement which intervention? 1 Being careful not to mention the idea of suicide. 2 Asking about the possibility of suicidal thoughts in a covert way. 3 Asking the patient directly if he or she is thinking of attempting suicide. 4 Listening carefully to see whether the patient mentions it a second time.

3 Asking the patient directly if he or she is thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the patient. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. Text Reference - p. 479

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

3 Check the patient's mouth after providing doses of the medication. 5 Advise the patient's family to closely monitor the medication if the dose is taken at home. A tricyclic antidepressant, such as desipramine, can be prescribed to treat depressed patients but the doses should be carefully monitored in suicidal patients. Overdosing on a tricyclic antidepressant can be fatal due to its potent side effects and many suicidal patients attempt suicide by overdose of pills. The nurse should ensure that the patient swallows the tablet by checking the mouth. This will ensure that patients are not hoarding doses of medication with the intention to overdose later. The patient must be given medication only under the supervision of the nurse or the family to avoid overdose. Suggesting the patient increase the dose is not an acceptable option because dosage can only be changed by the primary health care provider and this is not necessarily an action to prevent suicide. The nurse should not give the complete course of medication at one time to the patient as the patient could abuse the drug. Patients must be given a limited day supply of medication so that they cannot consume all the tablets at a time. The nurse should not reduce the dose unless the primary health care provider prescribes it. Text Reference - p. 482

The nurse evaluates a patient who had been engaging in non-suicidal self-harm behaviors. What does the nurse include in the evaluation? Select all that apply. 1 Determining if the patient is enjoying life again 2 Determining if the patient is engaging in self-harm 3 Determining if the patient is using appropriate coping skills 4 Determining if the patient is becoming more aware of prevention strategies 5 Determining if the patient is communicating thoughts and feelings accurately

3 Determining if the patient is using appropriate coping skills 5 Determining if the patient is communicating thoughts and feelings accurately Evaluation of non-suicidal patients engaging in self-harm includes determining whether the patient is communicating thoughts and feelings accurately and whether the patient's perception is that harmful behaviors are being replaced with appropriate coping skills. If the patient is replacing harmful behaviors, he or she will not be participating in the harmful behaviors. The purpose of the evaluation is not to determine whether the patient is enjoying life again or whether the patient is becoming more aware of prevention strategies. These may be more appropriate outcomes for different nursing diagnoses. Text Reference - p. 487

A patient is at very high risk of suicide, and assessment shows that the patient will most likely follow a plan of self-harm. How often should the nurse chart the patient's whereabouts and record mood, verbatim statements, and behavior? 1 Every other day 2 Three times a day 3 Every 15-30 minutes 4 Every 60-120 minutes

3 Every 15-30 minutes When patients are at high risk of suicide and assessment shows that they may follow a plan of self-harm, the nurse should keep them under 24-hour surveillance. The nurse should chart the patient's whereabouts and record his or her mood, verbatim statements, and behavior every 15-30 minutes. The patients may cause self-harm if the interval between two checks is large, such as thrice a day, every 60-120 minutes, or every other day. Text Reference - p. 484, Table 25.3

The nurse is developing a treatment plan for a patient with a nursing diagnosis of hopelessness. What is an appropriate outcome for this patient? 1 Remains free from injury 2 Describes feelings of self-worth 3 Expresses willingness to call on others for help 4 Identifies coping mechanisms to assist in crises

3 Expresses willingness to call on others for help The patient lacks hope for the future, so an appropriate outcome for this patient is expressing willingness to call on others for help. Describing feelings of self-worth would be more appropriate for a patient with chronic low self-esteem. Remaining free from injury would be more appropriate for a patient with a nursing diagnosis of risk for suicide. Identifying coping mechanisms to assist in crises would be more appropriate for a patient with a nursing diagnosis of Ineffective coping. Text Reference - p. 480

A patient has lost a job and has started drinking alcohol. The patient tells the nurse, "I am an experienced nursing assistant, and I am jobless. I am totally stressed out. I desperately need a job." The nurse learns that the patient has been going to religious places to relieve stress. What is the most appropriate nursing diagnosis for this patient? 1 Risk of suicide 2 Spiritual distress 3 Ineffective coping 4 Chronic low self-esteem

3 Ineffective coping The patient is overwhelmed with stress and consumes alcohol to cope with it. Therefore, the most appropriate nursing diagnosis is ineffective coping with stress. The patient did not give any hints indicating suicide risk. The patient has been going to religious places to relieve stress, which indicates that the patient is not in spiritual distress. The patient is also trying to get a new job and, therefore, has good self-esteem. Text Reference - p. 480, Table 25.2

A student nurse is observing a patient in the psychiatric ward. The student nurse assumes that the patient had parasuicidal behavior in the past. What appropriate signs does the student nurse find in the patient? Select all that apply. 1 Lack of hygiene 2 Extreme happiness 3 Ineffective wound healing 4 Need for assistance while eating 5 Presence of scratches on the skin 6 Impaired nonverbal communication

3 Ineffective wound healing 5 Presence of scratches on the skin Parasuicide is also known as nonsuicidal self-injury. The patient tries to cause bodily harm by scratching the skin, biting, and interfering with wound healing. The presence of scratched skin and ineffective wound healing indicates that the patient had nonsuicidal self-injuring behavior. The presence of extreme happiness is a covert emotion and indicates that the patient has suicidal intention. Impaired nonverbal communication, the need for assistance while eating, and lack of hygiene are seen commonly in most psychiatric patients. They don't indicate parasuicidal behavior. Text Reference - p. 486

The nurse is conducting a suicide prevention program in a community. One of the patients, who is chronically depressed and lost his wife to an accident 2 weeks ago, asks the nurse, "How can I give my body to the anatomy department of the medical college?" What kind of intervention should the nurse consider in this patient? 1 Primary 2 Tertiary 3 Secondary 4 Postvention

3 Secondary This patient wishes to donate his dead body for medical studies, which indicates that he is having suicidal ideation. Secondary intervention is considered with patients who have suicidal ideation. Secondary intervention is practiced in clinics, hospitals, jails, and on telephone hotlines. Primary interventions are considered in a community to prevent suicide rates, whereas tertiary interventions are conducted with suicide survivors. Postvention is another term for tertiary intervention. Text Reference - p. 482

A nurse interacts with a depressive patient. The patient says, "Can you get me carbon monoxide tomorrow? I want to kill myself." What conclusion should the nurse make from the patient's response? 1 The patient has delusions. 2 The patient is socially withdrawn. 3 The patient is at higher risk of suicide. 4 The patient can cause harm to others.

3 The patient is at higher risk of suicide. The nurse should appropriately evaluate the suicide plan of the patient. Patients with definite intention and time are at high risk. Based on the method of lethality, patients can be classified as higher risk and lower risk. Carbon monoxide poisoning, using a gun, jumping off a high place, or car crash indicate high risk. Depressive patients normally feel rejected and avoid social gatherings. The statement by the nurse does not indicate that the client is socially withdrawn. Although delusions are not a high risk of suicide, they can result in suicide. The patient does not have manifestations of delusions. The patient is depressed and sad but not aggressive, so there is no harm to others. Text Reference - p. 479

Which situation supports the fact that a patient has a lethal suicide plan? Select all that apply. 1 Plan involves taking an overdose of pills with a friend. 2 Has decided on slashing her wrists if her boyfriend leaves her 3 The woods behind the house is where the suicide will take place. 4 Patient plans to activate the plan on the anniversary of his divorce. 5 Jumping from the bridge the next time her voices tell her to kill herself

3 The woods behind the house is where the suicide will take place. 4 Patient plans to activate the plan on the anniversary of his divorce. 5 Jumping from the bridge the next time her voices tell her to kill herself The evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. Three main elements must be considered when evaluating lethality: Is there a specific plan with details? How lethal is the proposed method? Is there access to the planned method? People who have definite plans for the time, place, and means are at high risk. Methods that include overdose and wrist slashing are considered soft or low-risk methods, thus decreasing the lethality of the plan. Text Reference - p. 479

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

4 Ask the patient open-ended questions about the incident. Risk of suicide in a family member of a person who has committed suicide is 4.5 times higher than in the general population. Therefore, it is important to ask open-ended questions about the incident and review the current situation of the patient. Mentioning or talking about the daughter can reduce hurt, stigma, and isolation in the patient. Survivors always want their loved ones to be remembered, so it would be inappropriate to ask the patient not to think about his or her child anymore. The nurse should always encourage the patient to express feelings about the traumatic event. This will make the patient feel comforted. Text Reference - p. 485

What is the most important characteristic of staff members who work with suicidal patients? 1 Interview and counseling skills 2 The ability to be consistently organized 3 The ability to teach problem-solving skills 4 Warmth and consistency when interacting

4 Warmth and consistency when interacting Crucial characteristics of staff members who work with suicidal patients include warmth, sensitivity, interest, and consistency. The ability to be consistently organized and the ability to teach problem solving, interview, and counseling skills, although appropriate, are not as important in this situation as consistency. Text Reference - p. 482

The morning after he was admitted, a suicidal male patient wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should 1 Allow him to use the razor under staff supervision 2 Tell him he must use a safety razor provided by the unit 3 Suggest that this would be a good time to grow a beard 4 Give him the razor and ask him to return it when he is finished

1 Allow him to use the razor under staff supervision Because the razor is cordless, independent use is relatively safe. Text Reference - p. 484, Box 25.4

The nurse is providing suicide awareness and prevention training for members of the community. What does the nurse include when teaching about nonverbal behavioral clues to watch out for in a person who may be suicidal? 1 Giving away possessions 2 Going to the doctor more frequently 3 Finding excuses to not leave the house 4 Looking through old, sentimental belongings

1 Giving away possessions Giving away possessions, as well as writing letters and organizing financial affairs, is an example of nonverbal behaviors of a person who might be suicidal. Going to the doctor more frequently, finding excuses to not leave the house, and looking through sentimental belongings are not always associated with suicide. Text Reference - p. 470

The nurse observes the meal tray about to be served to a suicidal patient. Which item should be removed from the tray? 1 Plastic plate 2 Cloth napkin 3 Metal utensils 4 Styrofoam cup

3 Metal utensils In most health care agencies, suicidal patients receive plastic dinnerware on their meal trays. Text Reference - p. 484, Box 25.4

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

4 Have the patient identify three people to call if the patient is overwhelmed by hopelessness. For suicidal patients treated in the community, establishing a network of individuals to whom the patient may turn if the suicidal urge becomes great is important. Text Reference - p. 480, Table 25.2

The nurse is assessing a group of people for the risk of suicide. These patients have lost their loved ones recently. One of the patients is very religious and another is under chemotherapy for breast cancer. Another patient is on clozapine for schizophrenia, and the last patient is on lithium for a mood disorder. Which of these patients is at greatest risk of suicide? 1 The patient in a religious environment 2 The patient on lithium for a mood disorder 3 The patient on clozapine for schizophrenia 4 The patient on chemotherapy for breast cancer

4 The patient on chemotherapy for breast cancer The nurse should be aware of risk factors and protective factors for suicide. Having a chronic illness like cancer is a risk factor for suicide. A patient who is undergoing treatment for a critical illness like breast cancer is at a high risk of committing suicide. Religious environment acts as a protective factor. Clozapine reduces the risk of suicide in patients with schizophrenia, and lithium reduces the risk in patients with mood disorders. Text Reference - p. 478

The nurse is talking with a patient admitted with depression. Which statement by a patient admitted with a diagnosis of chronic depression indicates the need for further assessment? 1 "I think things will be better soon." 2 "I know a lot of people care about me and want me to get better." 3 "I don't have a good support system, but I am planning on joining a recovery group." 4 "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself."

1 "I think things will be better soon." The response "I think things will be better soon" may be a covert, or indirect, clue that the patient is thinking of suicide. "I know a lot of people care about me and want me to get better," "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself," and "I don't have a good support system, but I am planning on joining a recovery group" are all statements that, while they may be discussed further, are not clues to suicide but rather clear communication. Text Reference - p. 479

A novice nurse tells the nurse manager, "I don't want to ask my patients about suicidal ideation because 'It might put ideas in their heads about suicide.'" How will the nurse manager respond? 1 "Actually, it's a myth that asking about suicide puts ideas into someone's head." 2 "If I were you, I'd ask the health care provider to talk to the patient about that subject." 3 "You are right; however, because of professional liability, we have to ask that question." 4 "I'm glad you are thinking that way. The patient may not have thought of suicide before, and we don't want to introduce that."

1 "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients usually have been thinking about suicide already; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason to ask patients about suicidal thoughts or plans; it is for patient safety. Asking the health care provider to speak to the patient on that subject does not educate the student nurse regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe. Text Reference - p. 479

Which patient statement indicates a possible plea for help? Select all that apply. 1 "I can't keep relying on alcohol." 2 "I know how to make it all better." 3 "I just can't stand this pain any longer." 4 "I won't be a burden on anyone anymore." 5 "I don't know where to go or who to talk to."

1 "I can't keep relying on alcohol." 5 "I don't know where to go or who to talk to." Stating "I don't know where to go or who to talk to" or "I can't keep relying on alcohol" indicate self-reflection and an understanding that change may still be possible. The realization that help may be available and that alcohol isn't a good coping strategy shows hope. Saying "I won't be a burden on anyone anymore," "I just can't stand this pain any longer," and "I know how to make it all better" are statements lacking in hope. Text Reference - p. 480, Table 25.2

Which situation is considered a protective factor against suicide? Select all that apply. 1 The patient is 5 months pregnant. 2 The patient is economically secure. 3 The patient has strong religious beliefs. 4 The patient has a college-level education. 5 The patient has coped with the loss of a loved one.

1 The patient is 5 months pregnant. 3 The patient has strong religious beliefs. 5 The patient has coped with the loss of a loved one. Protective factors against suicide include pregnancy, religious beliefs, and effective coping skills. Education and financial security are not protective factors in this situation. Text Reference - p. 478, Box 25.2

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

3 Suicidal ideation Suicidal ideation is the term used to describe thinking about death, wishes to die, and methods of accomplishing death. Suicide is not a formal term used in the medical record. It describes the intentional act of killing oneself by any means. Suicide attempt is the behavior of carrying out acts with the intention of death. Completed suicide is a term used to describe actions committed by an individual that lead to death. Text Reference - p. 475

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? 1 Dopamine 2 Serotonin 3 Acetylcholine 4 γ-aminobutyric acid

2 Serotonin Low serotonin levels have been noted among individuals who have committed suicide. While γ-aminobutyric acid, dopamine and acetylcholine are neurotransmitters they are not believed to be associated with suicidal ideations. Text Reference - p. 476

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

3 The majority of African Americans have religious beliefs against suicide. The protective factor among African Americans includes religion and the extended family. They consider suicide a sin. Hispanics follow a philosophy of fatalismo; it is the protective factor in the community. Hispanics don't blame themselves for adverse events but accept them as their misfortune. The suicide rates increase with age among Asian Americans. Text Reference - p. 477