Question 1

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."

Accepted Answer

When a patient seeks to have precautions lifted by professing to feel better, the patient may be seeking greater freedom in which to attempt suicide. Changing the treatment plan requires careful evaluation of outcome indicators by the staff. The incorrect options will not cause the patient to admit to a suicidal plan, do not convey concern for the patient, or suggest that the patient is not a partner in the care process.

Question 2

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.

Accepted Answer

One-on-one observation is necessary for anyone who has limited control over suicidal impulses. Plastic dishes on trays and the removal of potentially harmful objects from the patient's possession are measures included in any level of suicide precautions. The remaining options are used in less stringent levels of suicide precautions.

Question 3

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

Accepted Answer

The patient has a highly detailed plan, a highly lethal method, the means to carry it out, lowered impulse control because of alcohol ingestion, and a low potential for rescue.

Question 4

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

Accepted Answer

The incidence of TBI is very high in veterans and this problem is associated with an increased risk of dying by suicide compared with people without brain injuries.Many soldiers also have posttraumatic stress disorder, which contributes to increased suicide risk. The incidence of disorders identified in the distractors would be expected to parallel the general population.

Question 5

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

Accepted Answer

Whites have suicide rates almost twice those of nonwhites, and the rate is particularly high for older adult men, adolescents, and young adults. Other high-risk groups include young African-American men, Native-American men, older Asian Americans, and persons with traumatic brain injury.

Question 6

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

Accepted Answer

Failing examinations in the academic major constitutes a recent stressful life event. Shame and humiliation related to the failure can be hypothesized. The inability to contact parents can be seen as a recent lack of social support, as can the roommate's absence from the dormitory. Terminating access to one's social networking site represents self-imposed isolation. This scenario does not provide data regarding a history of an earlier suicide attempt, a family history of suicide, or of co-occurring medical illness.

Question 7

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.

Accepted Answer

Interventions should be aimed at helping the staff and patients come to terms with the loss and to grow because of the incident. Then, a community meeting should be scheduled to allow other patients to express their feelings and request help. Staff members should be prepared to provide additional support and reassurance to patients and should seek opportunities for peer support. The incorrect options will not control information or may result in unsafe care.

Question 8

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

Accepted Answer

High risk factors include being an older adult, single, and male and having a co-occurring medical illness. Cancer is one of the somatic conditions associated with increased suicide risk. Protective factors for African-American women and Hispanic individuals include strong religious and family ties. Asian Americans have a suicide rate that increases with age.

Question 9

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."

Accepted Answer

Epidemiological surveys have demonstrated that 90% of suicide completers had a diagnosable psychiatric condition at the time of the event. People with mood disorders, especially major depressive disorder and bipolar disorder, are responsible for approximately 50% of completed suicides. The correct response is the most global answer.

Question 10

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."

Accepted Answer

The modified SAD PERSONS scale score of 0 to 5 suggests home care with follow-up. A score of 6 to 8 requires psychiatric consultation. A score over 8 calls for hospitalization.

Question 11

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."

Accepted Answer

Twin studies suggest the presence of genetic factors in suicide; however, separating genetic predisposition to suicide from predisposition to depression or alcoholism is difficult. Primary interventions can be helpful in promoting and maintaining health and possibly counteracting the genetic load. The incorrect options are untrue statements or oversimplifications.

Question 12

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

Accepted Answer

This is a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential.

Quiz 23: Suicidal Thoughts and Behavior

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

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 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?

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

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 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.

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?

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