Deck 21: Variables Affecting the Therapeutic Environment: Violence and Suicide

Question 1

A tearful patient at the mental health center says, "I should be dead." What is the most important first task for the nurse in assessing this patient?

A) Ascertain the lethality of the suicide plan.
B) Establish a rapport with the patient.
C) Determine the risk factors for suicide.
D) Encourage expression of feelings.

Answer 1

Establish a rapport with the patient.

Question 2

Which emotion experienced by a patient should be assessed by the nurse as most predictive of an increased suicide risk?

A) Anger
B) Elation
C) Sadness
D) Hopelessness

Answer 2

Hopelessness

Question 3

A patient's behavior has continued to escalate despite nursing interventions designed to achieve de-escalation. The patient begins to kick and strike at staff. This behavior evidences which phase of the assault cycle?

A) Triggering
B) Depression
C) Escalation
D) Crisis

Answer 3

Crisis

Question 4

A novice nurse on an inpatient psychiatric unit says to a colleague, "My newest patient has been diagnosed with schizophrenia. At least I won't have to monitor for a suicide risk." Select the colleague's most accurate response.

A) "Our structured milieu provides a safe environment for all patients, regardless of their suicide risk."
B) "Delusions usually protect a patient with schizophrenia from thinking about suicide."
C) "Suicide is a higher risk for adolescents than for patients with schizophrenia."
D) "Any mental illness substantially increases the risk of suicide."

Question 5

Four individuals have suicide plans. Which plan evidences the highest risk for completed suicide?

A) Drinking dishwashing detergent before a family meal.
B) Jumping from a suspension bridge in a rural location late at night.
C) Cutting the wrists in the bathroom while a patient's spouse reads in the next room.
D) Overdosing on acetaminophen (Tylenol) 1 hour before the patient's spouse is expected home from work.

Question 6

A patient has entered the escalation phase of the assault cycle. Select the most appropriate nursing intervention.

A) Direct the patient to the quiet room.
B) Process the incident with the patient.
C) Encourage ventilation of feelings.
D) Place the patient in seclusion.

Question 7

Select the most appropriate comment by the nurse when a depressed patient says, "What's the use in going on?"

A) "Are you thinking about suicide?"
B) "I am not sure I understand what you are saying."
C) "Keep your hope alive. It's always darkest just before light."
D) "Tell me more about your activities before you got depressed."

Question 8

When assessing a patient's plan for suicide, what aspect has priority?

A) Patient's cultural heritage.
B) Patient's insight into suicidal motivation.
C) Availability of means and lethality of method.
D) Quality and access to an intact social support system.

Question 9

The nurse cares for a patient who was verbally aggressive upon admission. Three days later the patient says, "My family put me here. They wanted to get rid of me." When should the nurse be most vigilant for signs of escalating aggression?

A) During one-on-one sessions
B) During group activities
C) During visiting hours
D) In the early morning

Question 10

Which principle guides nursing intervention in the assault cycle?

A) Contagiousness of violence
B) Least restrictive alternative
C) Containment
D) Control

Question 11

A suicide crisis line caller states, "I called to say goodbye to someone." Select the nurse's best response.

A) "You seem ambivalent about committing suicide. Let's talk about that."
B) "You must be feeling a lot of pain. What are you planning to do?"
C) "I hope you realize how much you have to live for."
D) "I think I can help you, if you'll let me."

Question 12

Social-psychological models describe aggression as:

A) intentional harm toward others.
B) an unhealthy way of managing anxiety.
C) a conflict with others expressed aggressively.
D) a response to frustration in the social environment.

Question 13

A patient is becoming increasingly tense, pacing the hall, alternately whispering and shouting. Other patients receive hostile, suspicious glares as they walk by. Which phase of the assault cycle is the patient demonstrating?

A) Crisis phase
B) Triggering phase
C) Escalation phase
D) Depression phase

Question 14

A student tells the school nurse, "My friend threatened to take an overdose of pills." The nurse talks to the friend who verbalized the suicidal threat. Select the most critical question for the nurse to ask.

A) "Why do you want to kill yourself?"
B) "Do you have access to medications?"
C) "Have you been taking drugs and alcohol?"
D) "Did something happen with your parents?"

Question 15

A patient being treated at the mental health center says, "I am having thoughts about suicide." Select the nurse's most therapeutic response.

A) "Thank you for telling me, but there's nothing to worry about. We will handle it together."
B) "Telling me about these feelings is a very positive action on your part."
C) "It's important for you to be hospitalized as soon as possible."
D) "Let's talk about the things you have to live for."

Question 16

A patient is shouting loudly and is verbally aggressive. What analysis should the nurse make about this behavior?

A) It is acceptable if directed toward staff but not toward another patient.
B) It is not harmful and might prevent the patient from physically acting out.
C) It is a significant warning sign that the patient may become physically aggressive.
D) It allows the patient to vent frustration and alleviate stress without hurting anyone.

Question 17

A nurse counsels a patient who made a suicide attempt 3 days ago. Select the nurse's most therapeutic comment.

A) "I'm glad you voluntarily admitted yourself to the hospital. We can help you here."
B) "When you have bad feelings, try to remember the good things about your life."
C) "You must take control of your problems and try to find solutions."
D) "Let's discuss some ways to solve your most important problem."

Question 18

A depressed patient admitted following a suicide attempt by overdose of sedatives states, "I don't feel like signing your papers. My partner should have let me die." What level of suicide precautions should the nurse apply?

A) No precautions because the patient is in a secure setting
B) Routine observation that is appropriate for all patients
C) One-to-one continuous supervision by staff members
D) Observation by staff members every 15 minutes

Question 19

A patient whose behavior has continued to escalate despite nursing interventions begins to kick and strike out at the nurse. What is the priority nursing intervention?

A) Offer an oral PRN medication.
B) Have staff stand by at a distance.
C) Physically control the patient's behavior.
D) Allow the behavior until the patient de-escalates.

Question 20

A patient is increasingly tense, pacing the hall and glaring angrily at others. Select the nurse's best comment to this patient.

A) "It looks as though you are feeling upset. Please tell me what's concerning you."
B) "I can see you are on the verge of losing control. What can I do to help you?"
C) "You must maintain control of your feelings even if you are feeling angry."
D) "I'm going to give you an injection of your medication to prevent loss of control."

Question 21

A psychiatric nurse is suffering from burnout. What effect would be expected on patients under this nurse's care? Patients will probably feel:

A) safe.
B) empowered.
C) impaired trust in the nurse.
D) universality with the nurse.

Question 22

Which nursing intervention for an angry, hostile patient would best contribute to prevention and management of aggression?

A) Loudly calling the patient by name
B) Conveying personal interest in the patient
C) Positioning oneself directly in front of the patient
D) Firmly directing the patient to discontinue the behavior

Question 23

What common themes apply to persons who have suicidal ideation? Select all that apply.

A) Belief that life is meaningless
B) Absolute intention to die
C) Existence of cognitive impairment
D) Experiencing hopelessness
E) Feeling out of control

Question 24

Sequence these expressions of suicidality from least to most acute.

A) Threat
B) Gesture
C) Ideation
D) Attempt
E) Completion

Question 25

Which scenario presents a high risk for violence?

A) A nurse empathizes with a patient who dislikes attending exercise class.
B) A nurse enforces the rule that patients must attend all scheduled activities.
C) A patient spends free time with a group of other patients talking about issues in their lives.
D) A patient with high anxiety is allowed to remain in a quiet room instead of attending a community meeting.

Question 26

An experienced staff nurse describes feeling emotionally burdened and yet engages actively in gossip and spreading rumors about other staff members. The clinical nurse leader can assess these behaviors as consistent with:

A) antisocial personality disorder.
B) mild-to-moderate depression.
C) depersonalization.
D) burnout.

Question 27

A patient has been placed in four-point leather restraints following a violent episode. The nurse establishing the care plan must ensure that the restraints are removed:

A) after a minimum of 12 hours of seclusion.
B) every 2 hours, one restraint at a time, for 10 minutes.
C) to allow the patient to eat, drink, or use the bathroom.
D) after the patient is sedated with antipsychotropic medication.

Question 28

The nurse in charge of a crisis team determines that a patient who has lost control requires restraint. What is the most important factor in the safe and effective use of physical restraint?

A) A calm, well-trained staff
B) Taking the patient off guard
C) Administering an antipsychotic drug
D) Talking to the patient throughout the procedure

Question 29

A nurse who has worked on an acute psychiatric unit for 5 years has begun describing patients in insensitive ways and is less creative when dealing with patient problems. What is the most likely explanation for the nurse's behavior?

A) Marginalization
B) Depersonalization
C) Secondary traumatization
D) Poor conflict management skills

Question 30

A staff nurse tells a peer, "I find it difficult to deal with patients who have personality disorders. They can control their behavior, whereas patients with depression truly need my services." Select the peer's most helpful response.

A) "Even though it's bothering you, the patients seem to like you."
B) "Our clinical nurse specialist is a good resource to help you explore those feelings."
C) "Fortunately, managed care has reduced inpatient services for people with personality disorders."
D) "Your comment tells me you have personal problems. Maybe psychiatric nursing is not the best practice arena for you."

Question 31

Staff members take an aggressive patient to seclusion. Before leaving the patient in the room, the priority action should be:

A) remove potentially harmful objects from the patient.
B) require the patient to use the bathroom.
C) have the patient lie on the bed.
D) offer the patient fluids.

Question 32

Which characteristic of an inpatient unit organizational culture predisposes the highest risk for patient violence and aggression?

A) Staff member behavior authoritarian
B) High degree of structural flexibility
C) Feeling of safety among patients
D) Bland colors used in decor

Question 33

For which situation would clinical supervision be most important?

A) A patient asks to visit with the consumer advocate.
B) A new clinical nurse leader is hired to reorganize the unit.
C) A newly admitted patient makes a nearly lethal suicide attempt.
D) The treatment model for the unit is changed by the psychiatrist in charge.

Question 34

Which management practice should the clinical nurse leader of a psychiatric unit institute to enhance the therapeutic environment?

A) Encourage staff efficiency and time management.
B) Emphasize timely and comprehensive documentation.
C) Prepare a comprehensive policy and procedure manual.
D) Implement positive reinforcement for upholding professional standards.

Question 35

A patient with suicidal impulses is placed on suicide precautions. Which measures will the nurse incorporate into the plan of care? Select all that apply.

A) Allow no glass or metal on meal trays.
B) Remove all potentially harmful objects.
C) Maintain continuous one-on-one nursing observation.
D) Check the patient's whereabouts every 15 minutes, and make frequent verbal contacts.
E) Keep the patient within visual range while he or she is awake, and check every 15 to 30 minutes while asleep.