Deck 25: Suicide

Question 1

A college student who failed two tests cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate and asked to be left alone for a few hours. Which behaviour provides the strongest clue of an impending suicide attempt?

A) Calling parents
B) Excessive crying
C) Remaining in a dorm room alone
D) Giving away sweaters to her roommate.

Answer 1

Giving away sweaters to her roommate.

Question 2

A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority?

A) Powerlessness
B) Social isolation
C) Risk for suicide
D) Compromised family coping

Answer 2

Risk for suicide

Question 3

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

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

Answer 3

Attending a self-help group for survivors

Question 4

What is the key element when the nurse is providing follow-up counselling to a patient that has been discharged to home following a suicide attempt?

A) Maintain 24 hour observation.
B) Administer antidepressant medication as ordered.
C) Establish a working alliance to encourage realistic problem solving.
D) Offer solutions to problems related to the stigma associated with a suicide attempt.

Question 5

A nurse interacts with an outpatient who has a history of multiple suicide attempts. Select the most helpful response for a nurse to make when the patient states, "I am considering committing 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 keep you safe."
C) "Bringing up these feelings is a very positive action on your part."
D) "We need to talk about the good things you have to live for."

Question 6

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

Question 7

A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to which of the following?

A) Current stress level
B) Mood disturbance
C) Suicide potential
D) Level of anxiety

Question 8

Which change in the brain's biochemical function is most associated with suicidal behaviour?

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

Question 9

Which statement provides the best rationale for closely monitoring a severely depressed patient during antidepressant medication therapy?

A) As depression lifts, physical energy becomes available to carry out suicide.
B) Patients who previously had suicidal thoughts need to discuss their feelings.
C) For most patients, antidepressant medication results in increased suicidal thinking.
D) Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

Question 10

A college student who attempted suicide by overdose was hospitalized. When the parents were contacted, they responded, "We should have seen this coming. We did not do enough." The parents' reaction reflects which of the following?

A) Guilt
B) Denial
C) Shame
D) Rescue feelings

Question 11

A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. The initial outcome is that the patient will do which of the following?

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 the first week of hospitalization
D) Refrain from attempts to harm self for 24 hours

Question 12

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 became depressed."

Question 13

Select the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills.

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 14

It has been 3 days since a suicidal patient was hospitalized and prescribed an antidepressant medication. 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 discontinuation of suicide precautions.

Question 15

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 very important and which are less important."

Question 16

Which measure would be considered a form of primary intervention for suicide?

A) Psychiatric hospitalization of a suicidal patient
B) Referral of a formerly suicidal patient to a support group
C) Suicide precautions for 24 hours for newly admitted patients
D) Helping school children learn to manage stress and be resilient

Question 17

An adult outpatient diagnosed with major depression has a history of several suicide attempts by overdose. Given this patient's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed?

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

Question 18

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 do which of the following?

A) Assess lethality of suicide plan
B) Encourage expression of anger
C) Establish rapport with the patient
D) Determine risk factors for suicide

Question 19

A nurse assesses a patient who reports a 3-week history of depression and periods of uncontrolled crying. 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 20

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

A) Turning on the oven and letting gas escape into the apartment during the night
B) Cutting the wrists in the bathroom while the spouse reads in the next room
C) Overdosing on aspirin with codeine while the spouse is out with friends
D) Shooting in the head with a firearm that spouse keeps in the bedroom

Question 21

After one of their identical twin daughters commits suicide, the parents express concern that the other twin may also have suicidal tendencies. Which reply should the nurse provide?

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 22

Which statement by a depressed patient will 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 to turn to for help or support."
C) "It is worse when you are a person of colour."
D) "I tried to get attention before I cut myself last time."

Question 23

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

A) 82-year-old White male
B) 17-year-old White female
C) 22-year-old Hispanic male
D) 19-year-old Inuit male
E) 39-year-old African Canadian male

Question 24

A college student is extremely upset after failing two examinations. The student said, "No one understands how this will hurt my chances of getting into medical school." The student then suspends access to his social networking Web site and turns off his cell phone. Which suicide risk factors are evident? Select all that apply.

A) Shame
B) Panic attack
C) Humiliation
D) Self-imposed isolation
E) Recent stressful life event

Question 25

Which nursing interventions will 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) Check all items brought by visitors and remove risk items.
C) Use plastic eating utensils; count utensils upon collection.
D) Remove the patient's eyeglasses to prevent self-injury.
E) Interact with the patient every 15 minutes.

Question 26

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 27

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

A) An adolescent girl with superior athletic and academic skills who has asthma
B) A 38-year-old single female church member with fibrocystic breast disease
C) A 60-year-old married man with twelve grandchildren who has type 2 diabetes
D) A 79-year-old single, White male diagnosed recently with terminal cancer of the prostate

Question 28

A patient hospitalized for 2 weeks committed suicide during the night. Which initial nursing measure will be most important regarding this event?

A) Ask the information technology manager to verify that the hospital information system is secure.
B) Hold a staff meeting to express feelings and plan care for the other patients.
C) Ask the patient's roommate not to discuss the event with other patients.
D) Prepare a report of a sentinel event.