25 (Suicide & Non-Suicidal Injury)

Question 1

Which of the following statements is true regarding culture and protective factors against suicide?

a. ) Asian Americans have the highest rates of suicide.
b. ) Religion and the importance of family are protective factors for Hispanic Americans.
c. ) Older women have the highest risk for suicide among African Americans.
d. ) American Indians and Pacific Islanders have the lowest rates of suicide.

Answer 1

b.) Religion and the importance of family are protective factors for Hispanic Americans.

Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

Question 2

You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn’t want to ask her patient about suicidal ideation because “It might put ideas in her head about suicide.” Your best response would be:

a. ) “I’m glad you are thinking that way. She may not have thought of suicide before, and we don’t want to introduce that.”
b. ) “You are right; however, because of professional liability, we have to ask that question.”
c. ) “Actually, it’s a myth that asking about suicide puts ideas into someone’s head.”
d. ) “If I were you, I’d ask Dr. Carmichael to talk to the patient about that subject.”

Answer 2

c.) “Actually, it’s a myth that asking about suicide puts ideas into someone’s head.”

Asking about suicidal thoughts does not “give person ideas” and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions.

Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living.

Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal.

Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety.

Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

Question 3

You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment?

a. ) “I know a lot of people care about me and want me to get better.”
b. ) “I have suicidal thoughts at times, but I don’t have any plan and don’t think I would ever actually hurt myself.”
c. ) “I don’t have a good support system, but I am planning on joining a recovery group.”
d. ) “I think things will be better soon.”

Answer 3

d.) “I think things will be better soon.”

This response may be a covert, or indirect, clue that the patient is thinking of suicide.

The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

Question 4

Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine’s method of using a gun to attempt suicide is considered:

a. ) high risk, or a hard method.
b. ) low risk, or a soft method.
c. ) not an actual suicide attempt because he was intoxicated.
d. ) a nonlethal means.

Answer 4

a.) high risk, or a hard method.

Higher-risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning.

The other responses are incorrect.

Question 5

Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken?

a. ) Closely follow up; consider hospitalization.
b. ) Hospitalize or commit.
c. ) Send home with follow-up.
d. ) Strongly consider hospitalization.

Answer 5

b.) Hospitalize or commit.

A score of 7 to 10 on the SAD PERSONS scale indicates hospitalization or commitment because the person would be considered high risk for suicide.

Closely follow up refers to a score of 3 to 4.

Send home with follow-up refers to a score of 0 to 2.

Strongly consider hospitalization refers to a score of 5 to 6.

Question 6

Which is the greatest protective factor against the risk of suicide?

a. ) One or more previous suicide attempts
b. ) A sense of responsibility to family, including spouse and children
c. ) Fear of dying
d. ) A cultural belief that suicide is a shameful resolution for a dilemma

Answer 6

b.) A sense of responsibility to family, including spouse and children

Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor.

Question 7

An assessment tool that is useful to nurses in rating suicide risk is the

a. ) AIMS scale.
b. ) Sad Persons scale.
c. ) CAGE questionnaire.
d. ) Mini-Mental Status Examination.

Answer 7

b.) Sad Persons scale.

Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk.

The Sad Persons scale is short and easy to use. It thoroughly covers major risk factors and gives guidelines for action to meet the client’s needs.

Question 8

Which statement is a fact about suicide?

a. ) More women than men commit suicide.
b. ) Suicide is the tenth leading cause of death in the United States.
c. ) Native Americans and Alaskan Natives have low suicide rates.
d. ) A client with schizophrenia is at great risk for attempting suicide.

Answer 8

d.) A client with schizophrenia is at great risk for attempting suicide.

Individuals with schizophrenia are 50 times more likely to attempt suicide than is the general public.

Suicide is the eleventh leading cause of death in the United States.

Native Americans and Alaskan Natives have high suicide rates.

More women attempt suicide, but more men are successful.

Question 9

A suicidal individual calls a suicide hot line. This represents the level of intervention classified as

a. ) primary.
b. ) secondary.
c. ) tertiary.
d. ) quaternary.

Answer 9

b.) secondary.

Secondary prevention is essentially treatment.

Question 10

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide?

a. ) γ-Aminobutyric acid
b. ) Dopamine
c. ) Serotonin
d. ) Acetylcholine

Answer 10

c.) Serotonin

Low serotonin levels have been noted among individuals who have committed suicide.

Question 11

When working with a client who may have made a covert reference to suicide, the nurse should

a. ) be careful not to mention the idea of suicide.
b. ) listen carefully to see whether the client mentions it a second time.
c. ) ask about the possibility of suicidal thoughts in a covert way.
d. ) ask the client directly if he or she is thinking of attempting suicide.

Answer 11

d.) ask the client directly if he or she is thinking of attempting suicide.

Covert references should be made overt. The nurse should directly address any suicidal hints given by the client.

Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living.

People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis.

Question 12

Nurses should assess the lethality of the client’s plan for suicide. What factor would be irrelevant to that assessment?

a. ) How long the client has been suicidal
b. ) Whether the plan has specific details
c. ) Whether the method is one that causes death quickly
d. ) Whether the client has the means to implement the plan

Answer 12

a.) How long the client has been suicidal

Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan.

Question 13

The suicide intervention that has the greatest impact on a client’s safety is

a. ) educating visitors about potentially dangerous gifts.
b. ) restricting the client from potentially dangerous areas of the unit.
c. ) one-on-one observation by the staff.
d. ) removal of personal items that might prove harmful.

Answer 13

c.) one-on-one observation by the staff.

One-on-one observation allows for constant supervision, which minimizes the client’s opportunities to cause self-harm.

Question 14

Some of the most important characteristics of staff members who work with suicidal clients are

a. ) the ability to be consistently organized.
b. ) the ability to teach problem-solving skills.
c. ) warmth and consistency when interacting.
d. ) interview and counseling skills.

Answer 14

c.) warmth and consistency when interacting.

Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency.

Question 15

The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises

a. ) never to attempt suicide.
b. ) to alert someone if he or she has made an attempt.
c. ) not to consider suicide for 72 hours.
d. ) not to attempt suicide in the next 24 hours.

Answer 15

d.) not to attempt suicide in the next 24 hours.

A no-suicide contract is quite straightforward in seeking a client’s promise not to attempt to harm oneself within a specified period. When that time expires, a new contract is negotiated.

Question 16

A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is

a. ) hopelessness.
b. ) deficient knowledge.
c. ) chronic low self-esteem.
d. ) compromised family coping.

Answer 16

a.) hopelessness.

The defining characteristics are present for the nursing diagnosis of hopelessness.

Question 17

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will

a. ) reclaim any prized possessions that were given away.
b. ) name three personal strengths.
c. ) seek help when feeling self-destructive.
d. ) participate in a self-help group.

Answer 17

c.) seek help when feeling self-destructive.

Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here.

Question 18

An identical twin recently committed suicide. The parent tells the nurse, “Thank heavens suicide does not run in families. I won’t have to worry about my other son.” The nurse’s response will be based on the understanding that this optimism is

a. ) not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide.
b. ) justified because twin studies suggest no genetic factor is involved in suicide.
c. ) unjustified because the parent has failed to consider the importance of the “copycat” factor.
d. ) likely evidence of her denying the possibility of a parental role in the causation of the suicide.

Answer 18

a.) not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide.

Twin studies, in fact, show that a genetic component of suicide may be present.

Question 19

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted?

a. ) Constant 24-hour, one-to-one observation at arm’s length
b. ) One-to-one observation while client is awake
c. ) Every 15-minute observation around the clock
d. ) Seclusion with 15-minute observation

Answer 19

a.) Constant 24-hour, one-to-one observation at arm’s length

A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch.

Question 20

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray?

a. ) Plastic plate
b. ) Cloth napkin
c. ) Styrofoam cup
d. ) Metal utensils

Answer 20

d.) Metal utensils

In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays.

Question 21

A client on one-to-one supervision at arm’s length indicates a need to go to the bathroom but reports, “I cannot ‘go’ with you standing there.” The nurse should

a. ) say “I understand” and allow the client to close the door.
b. ) keep the door open, but step to the side out of the client’s view.
c. ) leave the client’s room and wait outside in the hall.
d. ) say “For your safety I can be no more than an arm’s length away.”

Answer 21

d.) say “For your safety I can be no more than an arm’s length away.”

This level of suicide watch does not make adjustments based on client preference.

The explanation quoting the protocol and the reason (your safety) is appropriate.

Question 22

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by

a. ) having a staff member sit at the door and check packages as visitors enter.
b. ) having a staff member make frequent rounds during visiting hours to inspect gifts.
c. ) asking all visitors to report to the nurse’s station before visiting a client.
d. ) asking clients to give staff any unsafe item that might have been left by a visitor.

Answer 22

a.) having a staff member sit at the door and check packages as visitors enter.

A number of ways to inspect items are possible.

Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client’s belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client’s room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety.

Question 23

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should

a. ) allow him to use the razor under staff supervision.
b. ) tell him he must use a safety razor provided by the unit.
c. ) suggest that this would be a good time to grow a beard.
d. ) give him the razor and ask him to return it when he is finished.

Answer 23

a.) allow him to use the razor under staff supervision.

Because the razor is cordless, independent use is relatively safe.

Question 24

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority?

a. ) Have the client identify three people to call if he is overwhelmed by hopelessness.
b. ) Make sure the client has food enough to last for 2 to 3 days.
c. ) Arrange for a police visit every 24 hours.
d. ) Provide a 1-week supply of antidepressant medication.

Answer 24

a.) Have the client identify three people to call if he is overwhelmed by hopelessness.

For suicidal clients treated in the community, establishing a network of individuals to whom the client may turn if the suicidal urge becomes great is important.

Question 25

When a colleague committed suicide, the nurse stated “I do not understand why she would take her own life.” This is an expression of

a. ) anger.
b. ) denial.
c. ) confusion.
d. ) sympathy.

Answer 25

b.) denial.

Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as “I cannot understand why anyone would want to take his own life.”