Deck 24: Suicide

Question 1

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

A) patient financial and educational status.
B) patient insight into his or her suicidal motivation.
C) availability of means and lethality of method.
D) quality and availability of patient social support.

Answer 1

availability of means and lethality of method.

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:

A) acetylcholine excess.
B) serotonin deficiency.
C) dopamine excess.
D) g-aminobutyric acid deficiency.

Answer 2

serotonin deficiency.

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:

A) Powerlessness.
B) Social isolation.
C) Compromised family coping.
D) Risk for self-directed violence.

Answer 3

Risk for self-directed violence.

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:

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

A) He denies that suicide ideation and intent are present.
B) His family agrees to observe him closely at home.
C) His SAD PERSONS score has gone from a 4 to a 2.
D) He focuses on problem solving and hope for the future.

Question 6

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

A) As depression lifts,physical energy and cognitive organization improve and enable the patient to carry out a plan for suicide.
B) Effective therapy involves confronting the depressed patient about inadequacies that the patient has been unwilling to face.
C) Severely depressed persons tend to conceal their feelings and true intentions related to suicide and should not be trusted.
D) Severely depressed persons tend to be labile;their mood can change quickly in response to even the smallest stressors.

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?

A) Search her and her belongings for pills and other dangerous objects,then minimize the attention given to her by staff in order to reduce secondary gains.
B) When medically stable,confront her with her pattern of maladaptive coping,noting that the low lethality of her attempts suggests she is seeking attention.
C) Discuss with her family ways that they can reduce her attention-seeking suicide gestures by keeping all medications locked and not responding to histrionic behavior.
D) Place her on one-to-one observation because her history of previous attempts suggests she is at high risk of suicide;once medically stable,begin intensive psychiatric treatment.

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?

A) Place him on every-15-minute checks while awake.
B) Search the patient and his belongings for dangerous material.
C) Have him sign a no-suicide contract on arrival to the unit.
D) Place him on direct one-to-one observation 24 hours a day.

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:

A) calling her parents.
B) staying in her dorm room.
C) giving away her sweaters.
D) excessive crying.

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?

A) Take the patient to a support group for young persons with mood disorders.
B) Assure that all guns and medications have been locked or taken off premises.
C) Have the patient sign a no-suicide contract agreeing to seek help if in danger.
D) Arrange a pass so he can go to his first outpatient session to meet his counselor.

Question 11

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

A) adherence to antidepressant therapy.
B) agreeing to sign a no-suicide contract.
C) disclosing a plan for suicide to staff.
D) expressing feelings of hopelessness to the nurse.

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:

A) "I am glad you shared this.There is nothing to worry about.We will work it out."
B) "We need to talk more about the things you have to live for,the good in life."
C) "I think you should admit yourself to the hospital to get help with this."
D) "Bringing this up is a very positive action on your part.Tell me more."

Question 13

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

A) "Are you having thoughts about suicide?"
B) "I am not sure I understand what you're saying."
C) "Try to stay hopeful.Things usually work out."
D) "What used to matter,before the depression?"

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:

A) exercise self-control by refraining from attempting to harm herself.
B) verbalize a desire and intent to live by the end of the second hospital day.
C) demonstrate two new coping mechanisms by the fourth hospital day.
D) discuss two personal strengths by the end of first week of hospitalization.

Question 15

Which of these statements about suicide is accurate?

A) The majority of persons who attempt suicide have given overt or covert indications of their intentions to others.
B) A background in health care has a protective effect,leading to a lower rate of suicide among physicians and nurses than in the general public.
C) Most persons with previous suicide attempts survived because they did not truly intend to die;they are at lower risk than those making their first attempt.
D) Use of a low-lethality means or likelihood of being discovered in time to prevent death are merely suicide gestures,not genuine attempts.

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?

A) Amitriptyline (Elavil),a sedating tricyclic medication
B) Desipramine (Norpramin),a stimulating tricyclic medication
C) Fluoxetine (Prozac),a selective serotonin reuptake inhibitor
D) Tranylcypromine sulfate (Parnate),a monoamine oxidase inhibitor

Question 17

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

A) A suicide makes survivors more conscious of risk factors and more motivated to reduce risk in themselves and others,leading to a reduced risk of suicide in survivor groups.
B) The first few weeks after a suicide are the most difficult and are when survivors are at highest risk;the risk then returns quickly to its pre-suicide level as time passes.
C) All survivors are at increased risk,should be assessed for risk at intervals after their loss,and would benefit from ongoing support primary intervention to reduce their risk.
D) Speaking of the dead increases the discomfort of surviving loved ones and should generally be avoided in their presence.

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:

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

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?

A) "You seem very depressed and stressed.What is that like for you? What sort of feelings are you having when you say that?"
B) "Tell me more about what you mean when you say you're at the end of your rope-are you thinking about killing yourself?"
C) "Tell me about your family history.Do you have relatives or ancestors who suffered from depression?"
D) "Tell me about your depression and being at the end of your rope;what are you thinking and feeling?"

Question 20

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

A) intending to kill himself.
B) demonstrating impaired cognition.
C) experiencing a mental illness.
D) experiencing pain and hopelessness.

Question 21

An adolescent attempts suicide several days after a high school peer committed suicide.The student's mother is devastated that this could happen and that the family could be so unable to tell that their child was at risk.Which response by the school nurse best reflects our understanding of suicide in adolescence? Select all that apply.

A) Most persons who attempt suicide conceal their despair and their intent from others quite effectively so no one will interfere with their attempt.
B) Adolescents have an immature prefrontal cortex,leading to greater impulsiveness,impaired judgment,and less ability to tolerate frustration.
C) Serotonin pathways are not fully developed until adulthood,leading to moodiness and sudden onset of depression in children.
D) People,particularly adolescents,sometimes identify with others who have attempted suicide,leading them to decide to attempt suicide as well.
E) The grief following a peer's death,by suicide or otherwise,can itself contribute to depression and a significant increase in suicide risk.

Question 22

The nurse working the telephone suicide crisis line receives a call from a man who tells her he lives alone in a home several miles from his nearest neighbors.He has been considering suicide for 2 months.He has had several drinks and has loaded his shotgun,with which he plans to shoot himself in the chest.How should the nurse assess the lethality of this plan?

A) No risk
B) A low level of lethality
C) A moderate level of lethality
D) A high level of lethality

Question 23

A highly suicidal patient who has been hospitalized for 2 weeks committed suicide during the night.The measure that will be helpful to staff and patients having to deal with the event is:

A) asking the patient's roommate not to discuss the event with other patients.
B) keeping newspapers off the unit and sending the television "out for repair."
C) holding a staff meeting to express feelings and plan care for other patients.
D) discharging the other patients as quickly as possible to prevent copycat attempts.

Question 24

When suicidal patients are admitted to a hospital,objects that can easily be used for self-harm are removed from their possession.The rationale for this intervention is that:

A) the patient's environment must be made completely safe.
B) psychiatric patients cannot be trusted with dangerous objects.
C) it shows staff are alert,so the patient won't even try suicide.
D) removing harmful objects conveys concern and reduces risk.

Question 25

Which suicide plan is most lethal?

A) Jumping from a high,deserted bridge late at night
B) Overdosing on aspirin with codeine while home alone
C) Turning on the oven and letting the gas work during the night
D) Cutting one's wrists 15 to 20 minutes before the spouse returns home

Question 26

The measure that would be considered a form of primary prevention for suicide is:

A) psychiatric hospitalization of a suicidal patient.
B) referral of a formerly suicidal patient to a support group.
C) helping school children learn to manage stress and be resilient.
D) suicide precautions for 24 hours for newly admitted patients.

Question 27

The statement made by the patient during the assessment interview that should alert the nurse to the patient's need for immediate,active intervention is:

A) "I am mixed up,but I know I need help."
B) "I have no one to turn to,you're my last hope."
C) "Why doesn't anyone care anymore?"
D) "It's a long,rough road out there,very hard."

Question 28

A staff nurse tells another nurse,"I just used the SAD PERSONS scale to evaluate a man who sometimes thinks about suicide;his score was 8.I'm wondering if I should send him home after arranging for follow-up." The best reply by the second nurse would be:

A) "That would seem appropriate,but I'd consult the on-call resident first."
B) "Be sure he is followed up closely;he may require hospitalization later on."
C) "I think you should consider hospitalization just to be safe."
D) "A score of 7 or higher usually requires immediate hospitalization."

Question 29

A new nurse mentions to a peer,"My patient has just been diagnosed with schizophrenia.At least I will not have to worry about him being suicidal." The most helpful response by the peer would be:

A) "People with schizophrenia are at high risk,especially early in their illness."
B) "You will need to assess him further,as anyone can commit suicide."
C) "Suicide is a risk for any patient with schizophrenia who uses alcohol or drugs."
D) "Yes,they are too disorganized and delusional to be able to hurt themselves."

Question 30

Which nursing intervention(s)should be implemented for a patient who is actively suicidal? Select all that apply.

A) Maintain arm's-length,one-on-one direct observation at all times.
B) Order finger foods and "no silver or glass" with meals.
C) Check all items brought by visitors,and remove risk items.
D) Check on and interact with the patient every 15 minutes.
E) Place the patient in the living room where others are present.

Question 31

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." The best response for the nurse to make would be:

A) "I wonder what this sudden change is all about.Care to elaborate?"
B) "I am glad you are feeling better.The team will consider what you have said."
C) "You should not try to direct your plan for care.Leave that to the team."
D) "Because we are concerned about your safety,we will continue with our plan."