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PSYCH - Chapter 25: Suicide and Non-Suicidal Self-Injury

Terms in this set (28)

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
B
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. Jumping from a railroad bridge located in a deserted area late at night
D
Which measure would be considered a form of primary prevention 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
D`
Which change in the brain's biochemical function is most associated with suicidal behavior?

a. Dopamine excess
b. Serotonin deficiency
c. Acetylcholine excess
d. Gamma-aminobutyric acid deficiency
B
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 behavior provides the strongest clue of an
impending suicide attempt?

a. Calling parents
b. Excessive crying
c. Giving away sweaters
d. Staying alone in dorm room
C
A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to:

a. current stress level.
b. mood disturbance.
c. suicide potential.
d. level of anxiety.
C
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
C
A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. The initial outcome is that the patient will:

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 first week of hospitalization.
d. exercise suicide self-restraint by refraining from attempts to harm self for 24 hours.
D
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:

a. guilt.
b. denial.
c. shame.
d. rescue feelings.
A
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?"
B
It has been 5 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.
A
A nurse and patient construct a no-suicide contract. Select the preferable wording.

a. "I will not try to harm myself during the next 24 hours."
b. "I will not make a suicide attempt while I am hospitalized."
c. "For the next 24 hours, I will not in any way attempt to harm or kill myself."
d. "I will not kill myself until I call my primary nurse or a member of the staff."
C
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:

a. assess lethality of suicide plan.
b. encourage expression of anger.
c. establish rapport with the patient.
d. determine risk factors for suicide.
C
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."
C
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
C
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.
A
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."
C
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."
A
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."
D
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
C
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.
A
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 color."
d. "I tried to get attention before I cut myself last time."
B
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 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.
B
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."
A
Which individual in the emergency department should be considered at 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 twelve grandchildren who has type 2 diabetes
d. A 79-year-old single, white male diagnosed recently with terminal cancer of the prostate
D
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 Native American male
e. 39-year-old African American male
A, B, D
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.
A, B, C
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 website 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
A, C, D, E
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