Chapter 11 Practice Questions Flashcards
Which changes in brain biochemical function is most associated with suicidal behavior?
A) Dopamine excess
B) Serotonin deficiency
C) Acetylcholine excess
D) Gamma-aminobutyric acid deficiency
ANS: B
Research suggests that low levels of serotonin may play a role in the decision to commit suicide. The other neurotransmitter alterations have not been implicated in suicidal crises.
A college student failed two tests. Afterward, the student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. 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 a dorm room
ANS: C
Giving away prized possessions may signal that the individual thinks he or she will have no further need for the items, such as when a suicide plan has been formulated. Calling parents and crying do not provide clues to suicide, in and of themselves. Remaining in the dormitory would be an expected behavior because the student has nowhere else to go.
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.
ANS: C
The SAD PERSONS tool evaluates 10 major risk factors in suicide potential: sex, age, depression, previous attempt, ethanol use, rational thinking loss, social supports lacking, organized plan, no spouse, and sickness. The tool does not have appropriate categories to provide information on the other options listed.
- A person intentionally overdoses on antidepressant drugs. Which nursing diagnosis has the highest priority?
a. Powerlessness
b. Social isolation
c. Risk for suicide
d. Ineffective management of the therapeutic regimen
ANS: C
This diagnosis is the only one with life-or-death ramifications and is therefore higher in priority than the other options.
A person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial outcome? 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 gestures or attempts to kill self for 24 hours.
ANS: D
Suicide self-restraint relates most directly to the priority problem of risk for self-directed violence. The other outcomes are related to hope, coping, and self-esteem.
A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond, There must be a mistake. This could not have happened. Weve given our child everything. The parents reaction reflects:
a. denial.
b. anger.
c. anxiety.
d. rescue feelings.
ANS: A
The parents statements indicate denial. Denial or minimization of suicidal ideation or attempts is a defense against uncomfortable feelings. Family members are often unable to acknowledge suicidal ideation in someone close to them. The feelings suggested in the distractors are not clearly described in the scenario.
An adolescent tells the school nurse, My friend threatened to take an overdose of pills. The nurse talks to the friend who verbalized the suicide threat. The most critical question for the nurse to ask would be:
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?
ANS: B
The nurse must assess the patients access to the means to carry out the plan and, if there is access, alert the parents to remove them from the home. The other questions may be important to ask but are not the most critical.
An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. 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 the discontinuation of suicide precautions.
ANS: A
The patient now has more energy and may have decided on suicide, especially considering the history of the prior suicide attempt. The patient is still a suicide risk; therefore, continuous supervision is indicated.
A nurse and patient construct a no-suicide contract. Select the preferable wording for the contract.
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 kill or harm myself in any way.
d. I will not kill myself until I call my primary nurse or a member of the staff.
ANS: C
The correct answer leaves no loopholes. The wording about not harming oneself and not making an attempt leaves loopholes or can be ignored by the patient who thinks, I am not going to harm myself, I am going to kill myself, or I am not going to attempt suicide, I am going to commit suicide. A patient may call a therapist and leave the telephone to carry out the suicidal plan.
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 the lethality of a suicide plan.
b. encourage expression of anger.
c. establish a rapport with the patient.
d. determine risk factors for suicide.
ANS: C
Establishing rapport will allow the nurse to obtain relevant assessment data such as the presence of a suicide plan, the lethality of a suicide plan, and the presence of risk factors for suicide.
Select the most helpful response for a nurse to make when a patient being treated as an outpatient states, I am considering suicide.
a. Im glad you shared this. Please do not worry. We will handle it together.
b. I think you should admit yourself to the hospital to get help.
c. We need to talk about the good things you have to live for.
d. Bringing this up is a very positive action on your part.
ANS: D
This response gives the patient reinforcement and validation for making a positive response rather than acting out the suicidal impulse. It gives neither advice nor false reassurance, and it does not imply stereotypes such as, You have a lot to live for. It uses the patients ambivalence and sets the stage for more realistic problem-solving strategies.
Which intervention should a nurse recommend for the distressed family and friends of someone who has committed suicide?
a. Participating in reminiscence therapy
b. Attending a self-help group for survivors
c. Contracting for two sessions of group therapy
d. Completing a psychological postmortem assessment
ANS: B
Survivors need outlets for their feelings about the loss and the deceased person. Self-help groups provide peer support while survivors work through feelings of loss, anger, and guilt. Psychological postmortem assessment would not provide the support necessary to work through feelings of loss associated with the suicide of a family member. Reminiscence therapy is not geared to loss resolution. Contracting for two sessions of group therapy would probably not provide sufficient time to work through the issues associated with a death by suicide.
Which statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy?
a. As depression lifts, physical energy becomes available to carry out suicide.
b. Suicide may be precipitated by a variety of internal and external events.
c. Suicidal patients have difficulty using social supports.
d. Suicide is an impulsive act.
ANS: A
Antidepressant medication has the objective of relieving depression. The risk for suicide is greater as the depression lifts, primarily because the patient has more physical energy at a time when he or she may still have suicidal ideation. The other options have little to do with nursing interventions relating to antidepressant medication therapy.
A nurse assesses a patient who reports a 3-week history of depression and crying spells. 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.
ANS: C
Verbal clues to suicide may be overt or covert. The incorrect options are overt references to suicide. The correct option is more veiled. It alludes to the patients suicide as being a way to fix everything but does not say it outright.
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 began feeling depressed.
ANS: A
The nurse must make overt what is covert; that is, the possibility of suicide must be openly addressed. Often, patients feel relieved to be able to talk about suicidal ideation.
