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A severely depressed patient who has been on suicide precautions tells the nurse, 'I am feeling a lot better, so you can stop watching me. I have taken too much of your time already.' Which is the nurse's best response?
- A. I wonder what this sudden change is all about. Please tell me more.'
- B. I am glad you are feeling better. The team will consider your request.'
- C. You should not try to direct your care. Leave that to the treatment team.'
- D. Because we are concerned about your safety, we will continue with our plan.'
Correct Answer: D
Rationale: When a patient seeks to have precautions lifted by professing to feel better, the patient may be seeking greater freedom in which to attempt suicide. Changing the treatment plan requires careful evaluation of outcome indicators by the staff. The incorrect options will not cause the patient to admit to a suicidal plan, do not convey concern for the patient, or suggest that the patient is not a partner in the care process.
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A patient recently hospitalized for 2 weeks committed suicide during the night. Which initial measure will be most helpful for staff members and other patients regarding this event?
- A. Request the public information officer to address inquiries from the local media.
- B. Hold a staff meeting to express feelings and plan the care for other patients.
- C. Ask the patient's roommate not to discuss the event with other patients.
- D. Quickly discharge as many patients as possible to prevent panic.
Correct Answer: B
Rationale: Interventions should be aimed at helping the staff and patients come to terms with the loss and to grow because of the incident. Then, a community meeting should be scheduled to allow other patients to express their feelings and request help. Staff members should be prepared to provide additional support and reassurance to patients and should seek opportunities for peer support. The incorrect options will not control information or may result in unsafe care.
Which change in brain biochemical function is most associated with suicidal behavior?
- A. Dopamine excess
- B. Serotonin deficiency
- C. Acetylcholine excess
- D. Gamma-aminobutyric acid deficiency
Correct Answer: B
Rationale: 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.
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.
A nurse counsels a patient 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 most important and focus on discussing them.'
Correct Answer: D
Rationale: The nurse helps the patient develop effective coping skills. He or she assists the patient to reduce the overwhelming effects of problems by prioritizing them. The incorrect options continue to present overwhelming approaches to problem solving.
Which individual in the emergency department should be considered at the 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 man with cancer of the prostate gland
Correct Answer: D
Rationale: High risk factors include being an older adult, single, and male and having a co-occurring medical illness. Cancer is one of the somatic conditions associated with increased suicide risk. Protective factors for African-American women and Hispanic individuals include strong religious and family ties. Asian Americans have a suicide rate that increases with age.