Nokea
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 discuss any thoughts of killing or harming myself with staff.'
- D. I will not kill myself until I call my primary nurse or a member of the staff.'
Correct Answer: C
Rationale: 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.
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A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk?
- A. An 82-year-old white man
- B. A 17-year-old white female adolescent
- C. A 39-year-old African-American man
- D. A 29-year-old African-American woman
- E. A 22-year-old man with a traumatic brain injury
Correct Answer: A,B,E
Rationale: Whites have suicide rates almost twice those of nonwhites, and the rate is particularly high for older adult men, adolescents, and young adults. Other high-risk groups include young African-American men, Native-American men, older Asian Americans, and persons with traumatic brain injury.
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.
Correct Answer: A
Rationale: 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.
When 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
Correct Answer: C
Rationale: This diagnosis is the only one with life-or-death ramifications and is therefore higher in priority than the other options.
An adult after an attempted suicide is hospitalized and takes an antidepressant medication for 5 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.
Correct Answer: A
Rationale: 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. None of the remaining options provides the safety interventions required.
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 focus on what?
- A. Assessing the lethality of any suicide plan
- B. Encouraging expression of anger
- C. Establishing a rapport with the patient
- D. Determining risk factors for suicide
Correct Answer: C
Rationale: 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.