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Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply.
- A. Negative societal view of suicide
- B. Feeling inadequate and anxious about suicide and/or his or her own mortality
- C. Having personally considered suicide but decided against it and not having dealt with the associated anxiety
- D. Being unaware of his or her own feelings and beliefs about suicide
- E. Implementing nursing interventions to decrease the risk of suicide
Correct Answer: A,B,C,D
Rationale: Negative societal views, personal anxiety, unresolved suicidal thoughts, and lack of self-awareness can impair effective care for suicidal clients.
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A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority?
- A. Hopelessness related to recent divorce.
- B. Ineffective coping related to inadequate stress management.
- C. Spiritual distress related to conflicting thoughts about suicide and sin.
- D. Risk for suicide related to a highly lethal plan.
Correct Answer: D
Rationale: The risk for suicide with a lethal plan is the highest priority, as safety is paramount in this situation.
A client who is depressed begins to cry and states, 'I'm just really sick of feeling this way. Nothing ever seems to go right in my life.' Which would be the most appropriate response by the nurse?
- A. Don't cry. Try to look at the positive side of things.
- B. You are feeling really sad right now. It's a hard time.
- C. Hang in there. Your medication will start helping in a few days.
- D. Nothing ever goes right?
Correct Answer: B
Rationale: Acknowledging the client's sadness validates their feelings, fostering a therapeutic connection without dismissing emotions.
A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at this time?
- A. Confiscate the soda can as a restricted item.
- B. Pour the soda into a plastic cup.
- C. Ask the visitor to place the soda can at the nurse's desk until he or she leaves.
- D. Ask the visitor not to bring outside items on the unit in the future.
Correct Answer: B
Rationale: Pouring the soda into a plastic cup ensures safety by removing a potential self-harm item while allowing the client to enjoy the drink.
Which best explains the neurochemical processes responsible for depression?
- A. Increased activity of dopamine
- B. Decreased glucocorticoid activity
- C. Decreased serotonin and norepinephrine
- D. Potentiation of GABA
Correct Answer: C
Rationale: Decreased levels of serotonin and norepinephrine in the brain are associated with depression, contributing to mood dysregulation.
Which variables represent the highest risk for developing major depressive disorder? Select all that apply.
- A. Male gender
- B. Mood disorder in first-degree relatives
- C. Substance abuse
- D. Divorced
- E. Older adult
Correct Answer: B,D
Rationale: Family history of mood disorders and being single or divorced increase the risk of major depressive disorder.