Chapter 18: Intervention with a Suicidal Client Multiple Choice Identify the choice that best completes the statement or answers the question

Question

Chapter 18: Intervention with a Suicidal Client

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1) 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

____ 2. In planning 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.

____ 3. 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

____ 4. 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.

____ 5. 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.

____ 6. 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

____ 7. 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

____ 8. 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.

____ 9. A stockbroker commits suicide after being convicted of insider trading. Which information should a nurse share with the grieving family?

A.	“Keep in mind that your grieving will only last for 1 year.”
B.	“To deal with your grief, try using coping strategies that have worked for you in the past.”
C.	“You need to write a letter to the brokerage firm to express your anger with them.”
D.	“It would be best if you avoid discussing the suicide.”

____ 10. After years of dialysis, an 84-year-old states, “I’m exhausted, depressed, and so over these attempts to keep me alive.” Which question should the nurse ask the spouse when preparing a discharge plan of care?

A.	“Has there been had any appetite or sleep changes?”
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?”

____ 11. 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.	While 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 in the elderly.
D.	It is normal for elderly individuals to express a desire to die because they have come to terms with their mortality.

____ 12. 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.

____ 13. 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.”

____ 14. 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-IV-TR diagnosis.”
B.	“Suicide is a mental disorder.”
C.	“Suicide is a behavior.”
D.	“Suicide is an antisocial affliction.”

____ 15. 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.

____ 16. 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 with the nurse by day 1.

____ 17. 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.	“50% to 80% of all people who kill themselves have a history of a previous attempt.”

____ 18. A nurse is caring for four clients diagnosed with major depression. When considering the client’s belief system, which client would potentially be at highest risk for suicide?

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

____ 19. 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.

____ 20. 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

____ 21. 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

____ 22. Which statement indicates that the nurse is acting as an advocate for a client who has recently made a suicide attempt?

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 triggers to your attempt that we discussed.”
C.	“You must have been very upset to do what you did today.”
D.	“Are you currently thinking about harming yourself?”

____ 23. A client is newly admitted to an inpatient psychiatric unit. Which assessment data are critical in determining an increased risk for suicide?

A.	Monitoring the client continually for 1 hour after admission
B.	Encouraging the client to discuss feelings
C.	Asking the client about any history of suicide attempts
D.	Removing hazardous materials from the environment

____ 24. 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

Multiple Response

Identify one or more choices that best complete the statement or answer the 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 emotions should a nurse anticipate? (Select all that apply.)

A.	Shock and disbelief
B.	Guilt and remorse
C.	Anger and resentment
D.	Bargaining and depression
E.	Denial and rationalization

____ 26. 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 treated 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.