Nokea
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.'
Correct Answer: C
Rationale: 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 patient's suicide as being a way to 'fix everything' but does not say it outright.
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A college student failed two examinations. The student cried for hours and then tried to call a parent but got no answer. The student then suspended access to his social networking web site. Which suicide risk factors are present?
- A. History of earlier suicide attempt
- B. Co-occurring medical illness
- C. Recent stressful life event
- D. Self-imposed isolation
- E. Shame or humiliation
Correct Answer: C,D,E
Rationale: Failing examinations in the academic major constitutes a recent stressful life event. Shame and humiliation related to the failure can be hypothesized. The inability to contact parents can be seen as a recent lack of social support, as can the roommate's absence from the dormitory. Terminating access to one's social networking site represents self-imposed isolation. This scenario does not provide data regarding a history of an earlier suicide attempt, a family history of suicide, or of co-occurring medical illness.
What is the most helpful response for a nurse to make when a patient being treated as an outpatient states, 'I am considering 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 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.'
Correct Answer: D
Rationale: 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 patient's 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 successfully 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
Correct Answer: B
Rationale: 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.
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.
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.