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A patient who has attempted suicide has an underlying diagnosis of depression. Which of the following would the nurse anticipate being ordered for the patient?
- A. Selective serotonin reuptake inhibitor
- B. Mood stabilizer
- C. Tricyclic antidepressant
- D. Atypical antipsychotic
Correct Answer: A
Rationale: Selective serotonin reuptake inhibitors (SSRIs) (A) are first-line treatments for depression due to their efficacy and favorable side-effect profile. Mood stabilizers (B) are used for bipolar disorder, tricyclic antidepressants (C) are less commonly used due to side effects, and atypical antipsychotics (D) are not primary treatments for depression.
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A nurse is with an adolescent who tells the nurse that she has nothing to live for and she just wishes she was dead. Which nursing action would be the priority?
- A. Going to the patient?s psychiatrist to tell him of the girl?s suicidal ideation
- B. Staying with the patient to explore more of her thoughts about suicide
- C. Putting the patient in seclusion with a staff assigned to watch her at all times
- D. Ascertaining the client?s beliefs about what happens when you die
Correct Answer: B
Rationale: The priority is to ensure the patient?s safety by staying with her and exploring her suicidal thoughts (B), which allows for immediate risk assessment and therapeutic engagement. Notifying the psychiatrist (A) is important but secondary to direct patient contact. Seclusion (C) is inappropriate unless the patient poses an immediate danger, and exploring beliefs about death (D) is less urgent than assessing current risk.
A nurse is presenting a discussion for a local community group about suicide. Which comment from an audience member indicates the need to clarify the information?
- A. Warning signs about the person?s intention often occur.
- B. People who are suicidal are undecided about living or dying.
- C. Suicides more often occur during the holiday seasons.
- D. People who talk about suicide need to be taken seriously.
Correct Answer: C
Rationale: The comment that suicides more often occur during the holiday seasons (C) is a common myth. Research shows no consistent increase in suicides during holidays; risk is more tied to individual factors. The other comments (A, B, D) are accurate: warning signs are common, suicidal individuals are often ambivalent, and suicide talk must be taken seriously.
A nurse is completing an admission assessment of a young adult woman who has a history of depression and who was brought to the hospital by her boyfriend. In response to the nurse?s question regarding suicidal ideation, the patient discloses that she is thinking about killing herself. Which question would be most appropriate for the nurse to ask next?
- A. What does your boyfriend think about your desire to kill yourself?
- B. What are your spiritual beliefs about suicide?
- C. What will killing yourself accomplish?
- D. What thoughts have you had about how you would kill yourself?
Correct Answer: D
Rationale: When a patient expresses suicidal ideation, the nurse?s priority is to assess the specificity and immediacy of the risk by inquiring about a plan, as this indicates the degree of intent and potential lethality. Asking about specific thoughts on how the patient would kill herself (D) is critical for risk assessment. Options A, B, and C, while potentially relevant later, do not directly assess the immediate risk or plan.
A nurse is performing an assessment of a patient with suicidal ideation. Which question would the nurse most likely ask to determine the degree of planning?
- A. How seriously do you want to die?
- B. Have you attempted suicide before?
- C. Could you stop yourself from killing yourself?
- D. How much do the thoughts distress you?
Correct Answer: C
Rationale: Asking if the patient could stop themselves from killing themselves (C) directly assesses the degree of control and planning, indicating the specificity of their suicidal intent. Other options (A, B, D) provide related information but do not specifically address the plan?s feasibility.
A nurse is reviewing the medical record of a patient who has attempted suicide. Which of the following would the nurse identify as relating to a psychological cause?
- A. History of childhood trauma
- B. Cluster B personality disorder
- C. Social isolation
- D. Suicide contagion
Correct Answer: B
Rationale: Cluster B personality disorder (B), such as borderline or antisocial personality disorder, is a psychological cause of suicide risk due to emotional instability and impulsivity. Childhood trauma (A) is a historical or environmental factor, social isolation (C) is a social factor, and suicide contagion (D) is an external influence, not a psychological cause.