Question 1

When assessing a patient's plan for suicide,the priority areas to consider include:

Accepted Answer

If a person has definite plans that include choosing a method of suicide readily available to the person and if the method is one that is lethal (i.e. ,will cause the person to die with little probability for intervention),the suicide risk is considered high.These areas provide a better indication of risk than socioeconomic status,insight,and support systems.

Question 2

The nurse caring for a college student who attempted suicide by overdose believes brain biochemical dysfunction contributes to suicidal behavior.The nurse will be better able to plan necessary health teaching if she identifies the probable neurotransmitter alteration of:

Accepted Answer

Research suggests that low levels of serotonin may play a role in the decision to commit suicide.Knowing this,the nurse would understand the rationale for the use of selective serotonin reuptake inhibitors and plan appropriate health teaching.The other neurotransmitter alterations have not been implicated in suicidal behavior.

Question 3

A college student who attempted suicide by overdose was treated in the emergency department.Because the patient lives in the dorm and her roommate and her parents are away,the decision was made to hospitalize her.The nursing diagnosis of highest priority would be:

Accepted Answer

Risk for self-directed violence is the only one with life-or-death ramifications and is therefore of higher priority than the other options.

Question 4

The nurse uses the SAD PERSONS scale as he interviews a patient who has expressed suicidal ideation.This tool provides data relevant to:

Accepted Answer

The SAD PERSONS tool evaluates 10 major risk factors in suicide potential: sex,age,depression,previous attempt,ethanol use,rational thinking loss,social supports lacking,organized plan,no spouse,and sickness.The tool is not designed to assess depression itself and does not have appropriate categories to provide information about stress or anxiety.

Question 5

An adolescent who attempted suicide and was admitted to an inpatient mental health unit had been assessed as being at high risk of self-harm,but he has shown improvement.His doctor is now considering discharge and asks the nurse's opinion.Which of the following observations most reliably indicates that he may be ready for discharge to outpatient care?

Accepted Answer

Demonstrating effective problem-solving abilities and demonstrating hopefulness and a future orientation (looking forward to what lies ahead)are indicators that the internal turmoil underlying suicide risk is resolving.Denial of suicide ideation and intent may or may not be genuine;patients sometimes deny risk quite convincingly to evade treatment or precautions and resume their efforts to commit suicide.Although his family's willingness to monitor him closely at home will be helpful,it does not mean that the patient himself is ready for discharge.A SAD PERSON score,or any similar rating score,is not in and of itself sufficiently reliable in an individual case to determine that a person is safe.Such assessments are screening tools designed to determine what response should be made at the beginning of treatment,not when a person is safe to discharge.

Question 6

Which statement provides the best rationale for monitoring the severely depressed patient closely as treatment proceeds?

Accepted Answer

Antidepressant medication and other treatment do improve the features of depression.As the depression lifts,the patient regains more physical energy and more organizational ability at a time when he or she may still have suicidal ideation.Treatment does not involve confronting the patient about inadequacies.Severely depressed patients may not always be candid and can experience variations in their mood,but these factors are not the major issues likely to temporarily increase the risk of suicide as the patient begins to get better.

Question 7

A patient who has attempted suicide by taking a handful of ibuprofen (Motrin)is admitted to the mental health unit.She had attempted suicide three times previously,each by overdose on over-the-counter medications,and in each case was found by family or peers in time to prevent her death,eventually being admitted to this mental health unit each time.Which of the following nursing responses would be most appropriate?

Accepted Answer

Most people who complete suicide have made at least one previous attempt,and a history of prior attempts is one of the strongest predictors of future risk.Some attempts may appear unlikely to have succeeded from the outset if the means was of low lethality (e.g. ,choking oneself with socks wrapped around the neck)or because circumstances would have led to them being rescued before harm results (e.g. ,an attempt initiated in front of witnesses).Many lay people and some staff tend to interpret such unlikely-to-succeed attempts as meaning that the person "wasn't really serious about suicide",that it was a (so-called)suicide gesture.In fact,often a depressed or psychotic person simply is too cognitively impaired to plan well to succeed at suicide.Assuming that overdosage on over-the-counter (OTC)medications is a low-lethality means is contradicted by the fact that many OTC meds are quite lethal,including common ones such as aspirin and acetaminophen.Further,identifying a serious attempt as "a gesture" (not serious)can increase the risk of suicide if it is perceived as a challenge or if the person feels they or their attempt are being ridiculed or not taken seriously.The person may respond by intensifying efforts and may succeed in a subsequent attempt.Confronting her with claims that she is attention-seeking suggests a lack of understanding of suicidality,pharmacology,and risk assessment.Speaking with her family as noted indicates that staff do not understand suicidality and do not appreciate the actual degree of risk represented.Although restricting access to means is desirable,OTC meds are readily available in the world,so it is important to understand that locking those meds already in the house does not necessarily mean the patient will be safe.

Question 8

An adolescent whose peer committed suicide attempts suicide himself and is admitted to an inpatient mental health unit and assessed as being at high risk for self-harm.Which of the following nursing actions would be most appropriate to assure his safety during his first few days in the hospital?

Accepted Answer

The most effective way to ensure safety for a person at high risk of self-harm is to observe that person directly at all times.Even when belongings are searched and all dangerous times are kept from the patient,it is still possible to acquire everyday items that can be used as a means for killing oneself,such as blankets,sheets,and the cords from electrical equipment.Checks made every 15 minutes still allow a window of opportunity (the 15 minutes between the checks)that is more than sufficient to permit the completion of suicide,particularly by hanging,the method most often resulting in suicide in inpatient settings.Limiting checks to when the patient is believed to be awake further reduces their effectiveness.The patient need only feign sleep or awaken in the middle of the night to have an opportunity for self-harm without being observed.Research has shown that no-suicide contracts are of limited value;while they may motivate some persons to seek help from staff before acting on suicide ideation,they cannot be counted on to reduce risk.

Question 9

A 20-year-old economics major became severely depressed after failing two examinations in economics.She cried for 2 hours,then called her parents who live in a neighboring state,planning to ask if she could return home.However,her parents were in Europe.When her roommate went home for the weekend,the patient gave her three expensive sweaters to keep.Later,the dormitory resident assistant returned a book to the patient's room and found her unconscious on the floor,with an empty pill bottle nearby.The patient behavior that provided a clue to the suicide attempt was:

Accepted Answer

Giving away prized possessions may signal that the individual thinks he or she will have no further need for the item,such as when a suicide plan has been formulated.Calling her parents would not be a clue in and of itself.Remaining in the dorm would be an expected behavior because the patient had nowhere else to go.Crying does not provide a clue to suicide in and of itself.

Question 10

An adolescent whose peer committed suicide attempts suicide himself but is now ready for discharge to outpatient care.Which of the following actions would be most important to accomplish before the discharge?

Accepted Answer

All of the interventions listed would be reasonable to undertake and could benefit the patient.However,removing potential means for possible future suicide attempts is the priority intervention because it involves safety.Guns in particular should be locked or,better still,removed from the premises because they are highly lethal and are the means most used by males who commit suicide.

Question 11

An indicator that the suicidal patient is exercising suicide self-restraint is:

Accepted Answer

Admitting a plan for suicide to staff is an indicator of self-restraint.By admitting that a plan exists,the patient enables staff to take appropriate measures to prevent the patient from carrying out the plan.Patients may comply with antidepressant therapy and still make suicide attempts and may sign no-suicide contracts,knowing they will make a later suicide attempt.Expressing hopelessness does not indicate suicide self-restraint.

Question 12

The most helpful response for the nurse to make when a patient being treated as an outpatient states,"I am considering committing suicide" is:

Accepted Answer

Stating that the disclosure is a positive step reinforces and validates the patient for making an adaptive response rather than acting on the suicidal impulse.It also encourages the patient to elaborate and provide more specific data on which to assess the patient.It gives neither advice nor false reassurance.It does not involve trite clichés ("the things you have to live for,the good in life")that tend to suggest the patient is wrong or bad for having suicidal ideation,which in turn reduce the patient's willingness to be honest about the ideation.

Question 13

A despondent patient says,"Nothing matters anymore." The most appropriate response by the nurse when would be:

Accepted Answer

The nurse must make overt what is covert,that is,the possibility of suicide must be openly addressed.The patient often feels relieved to be able to talk about suicidal ideation and tends to respond candidly to candid inquiries.Conveying that one does not understand can increase patient despair or self-loathing (for being ineffectual in communications)."Try to stay hopeful" is a cliché that suggests that staff do not appreciate how truly distressed and despondent the patient is feeling.Encouraging hopefulness and focusing on things the patient used to enjoy both serve as obstacles to the patient's efforts to convey his present feelings and interfere with addressing these feelings.

Question 14

A college student who attempted suicide by overdose was treated in the emergency department.Because she had no available social supports,she was hospitalized.An outcome related to the nursing diagnosis Risk for self-directed violence is that the patient will:

Accepted Answer

Refraining from self-harm relates most directly to the priority problem of risk for self-directed violence.The other outcomes are related to hope,coping,and self-esteem.

Question 15

Which of these statements about suicide is accurate?

Accepted Answer

Most persons who later attempt suicide have given some indication of being at risk,of having ideation or intent related to suicide.The suicide rate among physicians and nurses is higher than in the general population;their special knowledge of pharmacology and physiology can make attempts more likely to be lethal.Most people who complete suicide have made at least one previous attempt,and a history of prior attempts is one of the strongest predictors of future risk.Some attempts may appear unlikely to have succeeded from the outset,because the means was one of low lethality (e.g. ,choking oneself with socks wrapped around the neck)or because circumstances would have led to their being rescued before harm resulted (e.g. ,an attempt initiated in front of witnesses).Many tend to interpret such unlikely-to-succeed attempts as meaning that the person "wasn't really serious about suicide," that it was a (so-called)suicide gesture.In fact,often a depressed or psychotic person simply is too cognitively impaired to plan well to succeed at suicide.Further,identifying a serious attempt as "a gesture" (not serious)can increase the risk of suicide if it is perceived as a challenge or if the person feels they or their attempt are being ridiculed or not taken seriously.The person may respond by intensifying efforts and may succeed in a subsequent attempt.

Question 16

A woman with a history of several suicide attempts by overdose is found to have recurrent major depression.Given this patient's history and diagnosis,which of the following antidepressant medications would the nurse expect to be ordered?

Accepted Answer

Selective serotonin reuptake inhibitor antidepressants are very safe in overdosage situations,which is not true of the other medications listed.Given this patient's history of overdosing,it is important that her medication be as safe as possible in case she takes an overdose of her prescribed medication.

Question 17

A student has committed suicide.Which statement(s)about those left behind after suicide is accurate?

Accepted Answer

All survivors,both family and peers,are at higher risk of suicide after their loss.Grief,guilt,despair,and modeling all contribute to this risk,as does the isolation that can sometimes follow because of the shame,discomfort,and stigma often associated with suicide.Although consciousness and preventive efforts (e.g. ,screenings)may increase following a suicide,the overall risk among surviving family members and peers is significantly increased nonetheless.The grief and other factors underlying this increased risk usually lasts for many months or even years,so the risk does not resolve in the weeks after the death.Regular contact to provide support and observe for indicators of risk should be continued for at least a year following the death and for even longer periods around the loved one's birthday,family events,holidays and the anniversary of the loss,or if the risk has continued or independent risk factors exist.Most survivors feel isolated when their loved one is not mentioned.They usually want their loved one to be remembered,and talking about the loss helps reduce the hurt,stigma,and isolation.

Question 18

A tearful,anxious man comes to the clinic with the chief complaint,"I should be dead." The first task of the nurse conducting the assessment interview is to:

Accepted Answer

Establishing rapport is key to developing a therapeutic relationship,which in turn increases the likelihood of candid and helpful responses to the nurse's assessment.The nurse would then assess lethality and risk factors but not encourage the expression of anger during the assessment phase.

Question 19

A patient who has been depressed for the past several months presents in the clinic stating,"I'm at the end of my rope." Which of the following inquiries would be most effective to use for assessing suicide risk?

Accepted Answer

Although broad openings are valuable for eliciting information about a patient's concerns,when the nurse is seeking information about suicide risk,it is important to be candid,specific,and direct.This candidness shows you are concerned and is likely to elicit a more candid response from the patient.Similarly,the more specific the question,the more specific the answer.

Question 20

Every person who thinks about suicide should be considered to be:

Accepted Answer

The experience of intense emotional (and sometimes physical)pain and hopelessness are features which are very characteristic of people contemplating suicide.The other options reflect myths about suicide.Not all who consider or attempt suicide are intent on dying,and one does not have to have impaired thinking or a mental illness to consider suicide.

Quiz 24: Suicide