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19. 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 very important and which are less important.”

ANS: D

The nurse helps the patient develop effective coping skills. Assist the patient to reduce the overwhelming effects of problems by prioritizing them. The incorrect options continue to present overwhelming approaches to problem solving.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 25-18 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Patient’s financial and educational status b. Patient’s insight into suicidal motivation c. Availability of means and lethality of method d. Quality and availability of patient’s social support

20. When assessing a patient’s plan for suicide, what aspect has priority?

ANS: C

If a person has plans that include choosing a method of suicide readily available and if the method is one that is lethal (i.e., will cause the person to die with little probability for intervention), the suicide risk is high. These areas provide a better indication of risk than the areas mentioned in the other options. See relationship to audience response question.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 25-15, 16

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

21. The feeling experienced by a patient that should be assessed by the nurse as most predictive of elevated suicide risk is a. hopelessness. b. sadness. c. elation. d. anger.

ANS: A

Of the feelings listed, hopelessness is most closely associated with increased suicide risk. Depression, aggression, impulsivity, and shame are other feelings noted as risk factors for suicide.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 25-4, 7, 16, 17, 18 (Case Study and Nursing Care Plan), 47 (Table 25-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. “I am mixed up, but I know I need help.” b. “I have no one to turn to for help or support.” c. “It is worse when you are a person of color.” d. “I tried to get attention before I cut myself last time.”

22. Which statement by a depressed patient will alert the nurse to the patient’s need for immediate, active intervention?

ANS: B

Hopelessness is evident. Lack of social support and social isolation increases the suicide risk. Willingness to seek help lowers risk. Being a person of color does not suggest higher risk because more whites commit suicide than do individuals of other racial groups. Attention seeking is not correlated with higher suicide risk.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 25-4, 5, 16, 17, 18 (Case Study and Nursing Care Plan), 47 (Table 25-2)

TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment a. Request the information technology manager to verify the patient’s medical record is secure in the hospital information system. b. Hold a meeting for staff to provide support, express feelings, and identify overlooked clues or faulty judgments. c. Consult the hospital’s legal department regarding potential consequences of the event. d. Document a report of a sentinel event in the patient’s medical record.

23. A patient previously hospitalized for 2 weeks committed suicide the day after discharge. Which initial nursing measure will be most important regarding this event?

ANS: B

Support and an opportunity for staff to safely express feelings about the event should occur first. Interventions should help the staff come to terms with the loss and grow because of the incident. Identifying overlooked clues or faulty judgments will provide the groundwork for identifying changes needed in policies and procedures for future patients. Consulting the legal department is not an initial measure. A sentinel event report is not part of the medical record and can be prepared later. The other incorrect options will not control information or would result in unsafe care.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 25-31, 32

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. “Genetics are associated with suicide risk. Monitoring and support are important.” b. “Apathy underlies suicide. Instilling motivation is the key to health maintenance.” c. “Your child is unlikely to act out suicide when identifying with a suicide victim.” d. “Fraternal twins are at higher risk for suicide than identical twins.”

24. After one of their identical twin daughters commits suicide, the parents express concern that the other twin may also have suicidal tendencies. Which reply should the nurse provide?

ANS: A

Twin studies suggest the presence of genetic factors in suicide; however, separating genetic predisposition to suicide from predisposition to depression or alcoholism is difficult. Primary interventions can be helpful in promoting and maintaining health and possibly counteracting genetic load. The incorrect options are untrue statements or an oversimplification.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 25-6, 7

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation eBay: testbanks_and_xanax 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 male diagnosed recently with terminal cancer of the prostate

25. Which individual in the emergency department should be considered at highest risk for completing suicide?

ANS: D

High-risk factors include being an older adult, single, 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.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 25-5, 6, 50 (Box 25-1), 52 (Box 25-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk? (Select all that apply.)

a. 82-year-old white male b. 17-year-old white female c. 22-year-old Hispanic male d. 19-year-old Native American male e. 39-year-old African American male

ANS: A, B, D

Whites have suicide rates almost twice those of nonwhites, and the rate is particularly high for older adult males, adolescents, and young adults. Other high-risk groups include young African American males, Native American males, and older Asian Americans. Rates are not high for Hispanic males.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 25-5, 6, 50 (Box 25-1), 52 (Box 25-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Maintain arm’s length, one-on-one direct observation at all times. b. Check all items brought by visitors and remove risk items. c. Use plastic eating utensils; count utensils upon collection.

2. Which nursing interventions will be implemented for a patient who is actively suicidal? (Select all that apply.)