Chapter 25: Suicide and Nonsuicidal Self-Injury

Question 1

An adult outpatient client diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this client’s history and diagnosis, which antidepressant medication would the nurse expect to be prescribed?

a. Amitriptyline
b. Fluoxetine
c. Desipramine
d. Tranylcypromine sulfate

Answer 1

b. Fluoxetine

Question 2

Which measure would be considered a form of primary prevention for suicide?

a. Psychiatric hospitalization of a suicidal client
b. Referral of a formerly suicidal client to a support group
c. Suicide precautions for 24 hours for newly admitted clients
d. Helping school children learn to manage stress and be resilient

Answer 2

d. Helping school children learn to manage stress and be resilient

Question 3

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

Answer 3

d. Jumping from a railroad bridge located in a deserted area late at night

Question 4

Which change in the brain’s biochemical function is most associated with suicidal behavior?

a. Dopamine excess
b. Serotonin deficiency
c. Acetylcholine excess
d. g-aminobutyric acid deficiency

Answer 4

b. Serotonin deficiency

Question 5

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

Answer 5

c. Giving away sweaters

Question 6

A nurse uses the SAD PERSONS scale to interview a client. This tool provides data relevant to be used for assessing what?

a. current stress level.
b. mood disturbance.
c. suicide potential.
d. level of anxiety.

Answer 6

c. suicide potential.

Question 7

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

Answer 7

c. Risk for suicide

Question 8

A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. What is the initial outcome for this client?

a. verbalizing a will to live by the end of the second hospital day.
b. describing two new coping mechanisms by the end of the third hospital day.
c. accurately delineating personal strengths by the end of first week of
hospitalization.
d. exercising suicide self-restraint by refraining from attempts to harm self for 24
hours.

Answer 8

d. exercising suicide self-restraint by refraining from attempts to harm self for 24
hours.

Question 9

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.” What does the parents’ reaction reflect?

a. guilt.
b. denial.
c. shame.
d. rescue feelings.

Answer 9

a. guilt.

Question 10

What is 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?”

Answer 10

b. “Do you have access to medications?”

Question 11

It has been 5 days since a suicidal client was hospitalized and prescribed an antidepressant medication. The client is now more talkative and shows increased energy. What is the highest priority nursing intervention?

a. Supervise the client 24 hours a day.
b. Begin discharge planning for the client.
c. Refer the client to art and music therapists.
d. Consider discontinuation of suicide precautions.

Answer 11

a. Supervise the client 24 hours a day.

Question 12

A nurse and client are discussing the client’s need to agree not to harm themselves. What is the preferable wording from the client?

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.”

Answer 12

c. “For the next 24 hours, I will not in any way attempt to harm or kill myself.”

Question 13

A nurse interacts with an outclient client who has a history of multiple suicide attempts. What is the most helpful response for a nurse to make when the client 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.”

Answer 13

c. “Bringing up these feelings is a very positive action on your part.”

Question 13

A tearful, anxious client at the outpatient clinic reports, “I should be dead.” What is the initial task the nurse conducting the assessment interview should implement?

a. assess lethality of suicide plan.
b. encourage expression of anger.
c. establish trust with the client.
d. determine risk factors for suicide.

Answer 13

c. establish trust with the client.

Question 14

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

Answer 14

c. Attending a self-help group for survivors

Question 15

Which statement provides the best rationale for closely monitoring a severely depressed client during antidepressant medication therapy?

a. As depression lifts, physical energy becomes available to carry out suicide.
b. Clients who previously had suicidal thoughts need to discuss their feelings.
c. For most clients, antidepressant medication results in increased suicidal thinking.
d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

Answer 15

a. As depression lifts, physical energy becomes available to carry out suicide.

Question 16

A nurse assesses a client who reports a 3-week history of depression and periods of uncontrolled crying. The client says, “My business is bankrupt, and I was served with divorce papers.” Which subsequent statement by the client 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.”

Answer 16

c. “I have a plan that will fix everything.”

Question 17

A depressed client 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.”

Answer 17

a. “Are you having thoughts of suicide?”

Question 18

A nurse counsels a client 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.”

Answer 18

d. “Let’s consider which problems are very important and which are less important.”

Question 19

When assessing a client’s plan for suicide, what aspect has priority?

a. Client’s financial and educational status
b. Client’s insight into suicidal motivation
c. Availability of means and lethality of method
d. Quality and availability of client’s social support

Answer 19

c. Availability of means and lethality of method

Question 20

Which feeling experienced by a client that should be assessed by the nurse as most predictive of elevated suicide risk?
a. hopelessness.
b. sadness.
c. elation.
d. anger.

Answer 20

a. hopelessness.

Question 21

Which statement by a depressed client will alert the nurse to the client’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.”

Answer 21

b. “I have no one to turn to for help or support.”

Question 22

A client previously hospitalized for 2 weeks committed suicide the day after discharge. Which initial nursing measure will be most important regarding this event?

a. Request the information technology manager to verify the client’s medical record is secure in the hospital information system.
b. Hold a meeting for staff to provide support, express feelings, and identify overlooked clues or faulty judgments.
c. Consult the hospital’s legal department regarding potential consequences of the event.
d. Document a report of a sentinel event in the client’s medical record.

Answer 22

b. Hold a meeting for staff to provide support, express feelings, and identify overlooked clues or faulty judgments.

Question 23

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.”

Answer 23

a. “Genetics are associated with suicide risk. Monitoring and support are important.”

Question 24

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 12 grandchildren who has type 2 diabetes
d. A 79-year-old single, white male diagnosed recently with terminal cancer of the prostate

Answer 24

d. A 79-year-old single, white male diagnosed recently with terminal cancer of the prostate

Question 25

A nurse assesses five newly hospitalized clients. Which clients 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

Answer 25

a. 82-year-old white male
b. 17-year-old white female
d. 19-year-old Native American male

Question 26

Which nursing interventions will be implemented for a client 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 client’s eyeglasses to prevent self-injury.
e. Interact with the client every 15 minutes.

Answer 26

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.

Question 27

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

Answer 27

a. Shame
b. Panic attack
c. Humiliation
d. Self-imposed isolation