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A staff nurse tells another nurse, 'I evaluated a new patient using the modified SAD PERSONS scale and got a score of 10. I'm wondering if I should send the patient home.' Select the best reply by the second nurse.
- A. That action would seem appropriate.'
- B. A score over 8 requires immediate hospitalization.'
- C. I think you should strongly consider hospitalization for this patient.'
- D. Give the patient a follow-up appointment. Hospitalization may be needed soon.'
Correct Answer: B
Rationale: The modified SAD PERSONS scale score of 0 to 5 suggests home care with follow-up. A score of 6 to 8 requires psychiatric consultation. A score over 8 calls for hospitalization.
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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.
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.
A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond, 'There must be a mistake. This could not have happened. We've given our child everything.' What emotional response does the parents' reaction reflect?
- A. Denial
- B. Anger
- C. Anxiety
- D. Projection
Correct Answer: A
Rationale: The parents' statements indicate denial. Denial or minimization of suicidal ideation or attempts is a defense against uncomfortable feelings. Family members are often unable to acknowledge suicidal ideation in someone close to them. The feelings suggested in the distractors are not clearly described in the scenario.
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.
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.