Deck 17: The Suicidal Client

Question 1

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm.The client refuses to commit to developing a plan for safety.What should be the nurse's priority intervention at this time?

A) Obtaining an order for locked seclusion until client is no longer suicidal
B) Conducting 15-minute checks to ensure safety
C) Placing the client on one-to-one observation while monitoring suicidal ideations
D) Encouraging client to express feelings related to suicide

Answer 1

Placing the client on one-to-one observation while monitoring suicidal ideations

Question 2

A new nursing graduate asks the psychiatric nurse manager how to best classify suicide.Which is the nurse manager's best reply?

A) "Suicide is a DSM-5 diagnosis."
B) "Suicide is a mental disorder."
C) "Suicide is a behavior."
D) "Suicide is an antisocial affliction."

Answer 2

"Suicide is a behavior."

Question 3

During a one-to-one session with a client,the client states,"Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time?

A) Powerlessness R/T altered mood AEB client statements
B) Risk for injury R/T altered mood AEB client statements
C) Risk for suicide R/T altered mood AEB client statements
D) Hopelessness R/T altered mood AEB client statements

Answer 3

Hopelessness R/T altered mood AEB client statements

Question 4

Which nursing intervention strategy is most appropriate to implement initially with a suicidal client?

A) Ask a direct question such as, "Do you ever think about killing yourself?"
B) Ask client, "Please rate your mood on a scale from 1 to 10."
C) Establish a trusting nurse-client relationship.
D) Apply the nursing process to the planning of client care.

Question 5

A nursing instructor is teaching about suicide.Which student statement indicates that learning has occurred?

A) "Suicidal threats and gestures should be considered manipulative and/or attention-seeking."
B) "Suicide is the act of a psychotic person."
C) "All suicidal individuals are mentally ill."
D) "Fifty to eighty percent of all people who kill themselves have a history of a previous attempt."

Question 6

During the planning of care for a suicidal client,which correctly written outcome should be a nurse's first priority?

A) The client will not physically harm self.
B) The client will express hope for the future by day 3.
C) The client will establish a trusting relationship with the nurse.
D) The client will remain safe during the hospital stay.

Question 7

A nursing student is developing a plan of care for a suicidal client.Which documented intervention should the student implement first?

A) Communicate therapeutically.
B) Observe the client.
C) Provide a hazard-free environment.
D) Assess suicide risk.

Question 8

A nurse is caring for a client who has threatened to commit suicide by hanging.The client states,"I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client?

A) The more specific the plan is, the more likely the client will attempt suicide.
B) Clients who talk about suicide never actually commit it.
C) Clients who threaten suicide should be observed every 15 minutes.
D) After a brief assessment, the nurse should avoid the topic of suicide.

Question 9

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge.Which information should the nurse provide?

A) Address only serious suicide threats to avoid the possibility of secondary gain.
B) Promote trust by verbalizing a promise to keep suicide attempt information within the family.
C) Offer a private environment to provide needed time alone at least once a day.
D) Be available to actively listen, support, and accept feelings.

Question 10

A nurse discovers a client's suicide note that details the time,place,and means to commit suicide.What should be the priority nursing intervention and the rationale for this action?

A) Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note
B) Establishing room restrictions, because the client's threat is an attempt to manipulate the staff
C) Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide
D) Calling an emergency treatment team meeting, because the client's threat must be addressed

Question 11

A stockbroker commits suicide after being convicted of insider trading.In speaking with the family,which statement by the nurse demonstrates accurate and appropriate sharing of information?

A) "Your grieving will subside within 1 year; until then I recommend antidepressants."
B) "Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area."
C) "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them."
D) "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

Question 12

Which is a correctly written,appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self?

A) The client will not physically harm self.
B) The client will express three positive self-attributes by day 4.
C) The client will reveal a suicide plan.
D) The client will establish a trusting relationship.

Question 13

A client with a history of three suicide attempts has been taking fluoxetine (Prozac)for 1 month.The client suddenly presents with a bright affect,rates mood at 9/10,and is much more communicative.Which action should be the nurse's priority at this time?

A) Give the client off-unit privileges as positive reinforcement.
B) Encourage the client to share mood improvement in group.
C) Increase frequency of client observation.
D) Request that the psychiatrist reevaluate the current medication protocol.

Question 14

A nursing instructor is teaching about suicide in the elderly population.Which information should the instructor include?

A) Elderly people use less lethal means to commit suicide.
B) Although the elderly make up less than 13% of the population, they account for 16% of all suicides.
C) Suicide is the second leading cause of death among the elderly.
D) It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

Question 15

A client is newly committed to an inpatient psychiatric unit.Which nursing intervention best lowers this client's risk for suicide?

A) Encouraging participation in the milieu to promote hope
B) Developing a strong personal relationship with the client
C) Observing the client at intervals determined by assessed data
D) Encouraging and redirecting the client to concentrate on happier times

Question 16

After years of dialysis,an 84-year-old states,"I'm exhausted,depressed,and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care?

A) "Have there been any changes in appetite or sleep?"
B) "How often is your spouse left alone?"
C) "Has your spouse been following a diet and exercise program consistently?"
D) "How would you characterize your relationship with your spouse?"

Question 17

A nurse recently admitted a client to an inpatient unit after a suicide attempt.A health-care provider orders amitriptyline (Elavil)for the client.Which intervention related to this medication should be initiated to maintain this client's safety upon discharge?

A) Provide a 6-month supply of Elavil to ensure long-term compliance.
B) Provide a 1-week supply of Elavil with refills contingent on follow-up appointments.
C) Provide a pill dispenser as a memory aid.
D) Provide education regarding the avoidance of foods containing tyramine.

Question 18

The treatment team is making a discharge decision regarding a previously suicidal client.Which client assessment information should a nurse recognize as contributing to the team's decision?

A) No previous admissions for major depressive disorder
B) Vital signs stable; no psychosis noted
C) Able to comply with medication regimen; able to problem-solve life issues
D) Able to participate in a plan for safety; family agrees to constant observation

Question 19

A nurse is caring for four clients diagnosed with major depressive disorder.When considering each client's belief system,the nurse should conclude which client would potentially be at highest risk for suicide?

A) Roman Catholic
B) Protestant
C) Atheist
D) Muslim

Question 20

A suicidal client says to a nurse,"There's nothing to live for anymore." Which is the most appropriate nursing reply?

A) "Why don't you consider doing volunteer work in a homeless shelter?"
B) "Let's discuss the negative aspects of your life."
C) "Things will look better in the morning."
D) "It sounds like you are feeling pretty hopeless."

Question 21

A nursing student is developing a study guide related to historical facts about suicide.Which of the following facts should the student include? Select all that apply.

A) In the Middle Ages, suicide was viewed as a selfish and criminal act.
B) During the Roman Empire, suicide was followed by incineration of the body.
C) Suicide was an offense in ancient Greece, and a common-site burial was denied.
D) During the Renaissance, suicide was discussed and viewed more philosophically.
E) Old Norse traditionally set a person who committed suicide adrift in the North Sea.

Question 22

Which client data indicate that a suicidal client is participating in a plan for safety?

A) Compliance with antidepressant therapy
B) A mood rating of 9/10
C) Disclosing a plan for suicide to staff
D) Expressing feelings of hopelessness to nurse

Question 23

A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD).The client has a history of a suicide attempt 1 year ago.Which nursing intervention would take priority in this situation?

A) Assessing the client's pulse oximetry and vital signs
B) Developing a plan for safety for the client
C) Assessing the client for suicidal ideations
D) Establishing a trusting nurse-client relationship

Question 24

A client is newly admitted to an inpatient psychiatric unit.Which of the following is most critical to assess when determining risk for suicide?

A) Family history of depression
B) The client's orientation to reality
C) The client's history of suicide attempts
D) Family support systems

Question 25

After a teenager reveals that he is gay,the father responds by beating him.The next morning,the teenager is found hanging in his closet.Which paternal grief responses should a nurse anticipate? Select all that apply.

A) "I can't believe this is happening."
B) "If only I had been more understanding."
C) "How dare he do this to me!"
D) "I'm just going to have to accept that he was gay."
E) "Well, that was a selfish thing to do."

Question 26

Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge?

A) "I must observe you continually for 1 hour in order to keep you safe."
B) "Let's confer with the treatment team about the resources that you may need after discharge."
C) "You must have been very upset to do what you did today."
D) "Are you currently thinking about harming yourself?"