Nokea
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.
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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.
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.
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.
A person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial patient outcome?
- A. Will verbalize a will to live by the end of the second hospital day.
- B. Can describe two new coping mechanisms by the end of the third hospital day.
- C. Accurately delineate personal strengths by the end of first week of hospitalization.
- D. Exercise suicide self-restraint by refraining from gestures or attempts to harm self for 24 hours.
Correct Answer: D
Rationale: Suicide self-restraint relates most directly to the priority problem of risk for suicide. The incorrect outcomes are related to hope, coping, and self-esteem.
An adolescent tells the school nurse, 'My friend threatened to take an overdose of pills.' The nurse talks to the friend who verbalized the suicide threat. What is the most critical question for the nurse to ask?
- A. What makes you want to kill yourself?'
- B. Do you have access to medications?'
- C. Have you been taking drugs and alcohol?'
- D. Did something happen with your parents?'
Correct Answer: B
Rationale: The nurse must assess the patient's access to the means to carry out the plan and, if there is access, alert the parents to remove them from the home. The other questions may be important to ask but are not the most critical.