Deck 23: Suicidal Thoughts and Behavior

Question 1

A nurse uses the modified SAD PERSONS scale to interview a patient. This tool provides data relevant to:

A) current stress level.
B) mood disturbance.
C) suicide potential.
D) level of anxiety.

Answer 1

suicide potential.

Question 2

An adolescent tells the school nurse, "My friend threatened to take an overdose of pills." The nurse talks to the friend who verbalized the suicide threat. The most critical question for the nurse to ask would be:

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?"

Answer 2

"Do you have access to medications?"

Question 3

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

A) Patient's financial and educational status
B) Patient's insight into suicidal motivation
C) Availability of means and lethality of method
D) Quality and availability of patient's social support

Answer 3

Availability of means and lethality of method

Question 4

Which intervention should a nurse recommend for the distressed family and friends of someone who has committed suicide?

A) Participating in reminiscence therapy
B) Attending a self-help group for survivors
C) Contracting for two sessions of group therapy
D) Completing a psychological postmortem assessment

Question 5

A college student failed two tests. Afterward, the student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt?

A) Calling parents
B) Excessive crying
C) Giving away sweaters
D) Staying alone in a dorm room

Question 6

An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention.

A) Supervise the patient 24 hours a day.
B) Begin discharge planning for the patient.
C) Refer the patient to art and music therapists.
D) Consider the discontinuation of suicide precautions.

Question 7

Which change in brain biochemical function is most associated with suicidal behavior?

A) Dopamine excess
B) Serotonin deficiency
C) Acetylcholine excess
D) Gamma-aminobutyric acid deficiency

Question 8

Which understanding about individuals who attempt suicide will help a nurse plan the care for a suicidal patient? Every suicidal person should be considered:

A) mentally ill.
B) intent on dying.
C) cognitively impaired.
D) experiencing hopelessness.

Question 9

A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond, "There must be a mistake. This could not have happened. We've given our child everything." The parents' reaction reflects:

A) denial.
B) anger.
C) anxiety.
D) rescue feelings.

Question 10

The feeling experienced by a patient that should be assessed by the nurse as most predictive of elevated suicide risk is:

A) hopelessness.
B) sadness.
C) elation.
D) anger.

Question 11

A person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial outcome? The patient will:

A) verbalize a will to live by the end of the second hospital day.
B) describe two new coping mechanisms by the end of the third hospital day.
C) accurately delineate personal strengths by the end of first week of hospitalization.
D) exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours.

Question 12

A nurse counsels a patient with recent suicidal ideation. Which is the nurse's most therapeutic comment?

A) "Let's make a list of all your problems and think of solutions for each one."
B) "I'm happy you're taking control of your problems and trying to find solutions."
C) "When you have bad feelings, try to focus on positive experiences from your life."
D) "Let's consider which problems are most important and which are less important."

Question 13

Which statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy?

A) As depression lifts, physical energy becomes available to carry out suicide.
B) Suicide may be precipitated by a variety of internal and external events.
C) Suicidal patients have difficulty using social supports.
D) Suicide is an impulsive act.

Question 14

A nurse assesses a patient who reports a 3-week history of depression and crying spells. The patient says, "My business is bankrupt, and I was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a concealed suicidal message?

A) "I wish I were dead."
B) "Life is not worth living."
C) "I have a plan that will fix everything."
D) "My family will be better off without me."

Question 15

Select the most helpful response for a nurse to make when a patient being treated as an outpatient states, "I am considering suicide."

A) "I'm glad you shared this. Please do not worry. We will handle it together."
B) "I think you should admit yourself to the hospital to get help."
C) "We need to talk about the good things you have to live for."
D) "Bringing this up is a very positive action on your part."

Question 16

A depressed patient says, "Nothing matters anymore." What is the most appropriate response by the nurse?

A) "Are you having thoughts of suicide?"
B) "I am not sure I understand what you are trying to say."
C) "Try to stay hopeful. Things have a way of working out."
D) "Tell me more about what interested you before you began feeling depressed."

Question 17

A person intentionally overdoses on antidepressant drugs. Which nursing diagnosis has the highest priority?

A) Powerlessness
B) Social isolation
C) Risk for suicide
D) Ineffective management of the therapeutic regimen

Question 18

A nurse and patient construct a no-suicide contract. Select the preferable wording for the contract.

A) "I will not try to harm myself during the next 24 hours."
B) "I will not make a suicide attempt while I am hospitalized."
C) "For the next 24 hours, I will not kill or harm myself in any way."
D) "I will not kill myself until I call my primary nurse or a member of the staff."

Question 19

A tearful, anxious patient at the outpatient clinic reports, "I should be dead." The initial task of the nurse conducting the assessment interview is to:

A) assess the lethality of a suicide plan.
B) encourage expression of anger.
C) establish a rapport with the patient.
D) determine risk factors for suicide.

Question 20

Which statement by a patient during an assessment interview should alert the nurse to the patient's need for immediate, active intervention?

A) "I am mixed up, but I know I need help."
B) "I have no one for help or support."
C) "It is worse when you are a person of color."
D) "I tried to get attention before I shot myself."

Question 21

A severely depressed patient who has been on suicide precautions tells the nurse, "I am feeling a lot better, so you can stop watching me. I have taken too much of your time already." Which is the nurse's best response?

A) "I wonder what this sudden change is all about. Please tell me more."
B) "I am glad you are feeling better. The team will consider your request."
C) "You should not try to direct your care. Leave that to the treatment team."
D) "Because we are concerned about your safety, we will continue with our plan."

Question 22

A patient with suicidal impulses is on the highest level of suicide precautions. Which measures should the nurse incorporate into the patient's plan of care? (Select all that apply.)

A) Allow no glass or metal on meal trays.
B) Remove all potentially harmful objects from the patient's possession.
C) Maintain arm's length, one-on-one nursing observation around the clock.
D) Check the patient's whereabouts every hour. Make verbal contact at least three times each shift.
E) Check the patient's whereabouts every 15 minutes, and make frequent verbal contacts.
F) Keep the patient within visual range while he or she is awake. Check every 15 to 30 minutes while the patient is sleeping.

Question 23

A nurse answers a suicide crisis line. A caller says, "I live alone in a home several miles from my nearest neighbors. I have been considering suicide for 2 months. I have had several drinks and now my gun is loaded. I'm going to shoot myself in the heart." How would the nurse assess the lethality of this plan?

A) No risk
B) Low level
C) Moderate level
D) High level

Question 24

A nurse assesses the health status of soldiers returning from a war zone. Screening for which health problems will be a priority? (Select all that apply.)

A) Schizophrenia
B) Eating disorder
C) Traumatic brain injury
D) Oppositional defiant disorder
E) Posttraumatic stress disorder

Question 25

A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk? (Select all that apply.)

A) 82-year-old white man
B) 17-year-old white female adolescent
C) 39-year-old African-American man
D) 29-year-old African-American woman
E) 22-year-old man with a traumatic brain injury

Question 26

A college student failed two examinations. The student cried for hours and then tried to call a parent but got no answer. The student then suspended access to his social networking web site. Which suicide risk factors are present? (Select all that apply.)

A) History of earlier suicide attempt
B) Co-occurring medical illness
C) Recent stressful life event
D) Self-imposed isolation
E) Shame or humiliation

Question 27

A patient recently hospitalized for two weeks committed suicide during the night. Which initial measure will be most helpful for staff members and other patients regarding this event?

A) Request the public information officer to address inquiries from the local media.
B) Hold a staff meeting to express feelings and plan the care for other patients.
C) Ask the patient's roommate not to discuss the event with other patients.
D) Quickly discharge as many patients as possible to prevent panic.

Question 28

Which individual in the emergency department should be considered at the highest risk for completing suicide?

A) An adolescent Asian-American girl with superior athletic and academic skills who has asthma
B) A 38-year-old single African-American female church member with fibrocystic breast disease
C) A 60-year-old married Hispanic man with 12 grandchildren who has type 2 diabetes
D) A 79-year-old single white man with cancer of the prostate gland

Question 29

A new nurse says to a peer, "My new patient is diagnosed with bipolar disorder. At least I won't have to worry about suicide risk." Which response by the peer would be most helpful?

A) "Let's reconsider your plan. Suicide risk is high in patients diagnosed with bipolar disorder."
B) "Suicide is a risk for any patient diagnosed with bipolar disorder who uses alcohol or drugs."
C) "The thought processes of patients diagnosed with bipolar disorder are usually too disorganized to attempt suicide."
D) "Racing thoughts during mania often prompt suicide among patients diagnosed with bipolar disorder."

Question 30

A staff nurse tells another nurse, "I evaluated a new patient using the modified SAD PERSONS scale and got a score of 10. I'm wondering if I should send the patient home." Select the best reply by the second nurse.

A) "That action would seem appropriate."
B) "A score over 8 requires immediate hospitalization."
C) "I think you should strongly consider hospitalization for this patient."
D) "Give the patient a follow-up appointment. Hospitalization may be needed soon."

Question 31

The parents of identical twins ask a nurse for advice. One twin committed suicide a month ago. Now the parents are concerned that the other twin may also have suicidal tendencies. Which comment by the nurse is accurate?

A) "Genetics are associated with suicide risk. Monitoring and support are important."
B) "Apathy underlies suicide. Instilling motivation is the key to health maintenance."
C) "Your child is unlikely to act out suicide when identifying with a suicide victim."
D) "Fraternal twins are at higher risk for suicide than identical twins."

Question 32

Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk?

A) Jumping from a 100-foot-high railroad bridge located in a deserted area late at night
B) Turning on the oven and letting gas escape into the apartment during the night
C) Cutting the wrists in the bathroom while the spouse reads in the next room
D) Overdosing on aspirin with codeine while the spouse is out with friends