1st_Ed Test Bank Essentials of Psychiatric Nursing by Mary Ann Boyd
Origin: Chapter 15, 1
1. A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt?
A) Man with bipolar I disorder
B) Woman with acute stress disorder
C) Man with major depressive disorder
D) Woman with somatoform disorder
Men have a higher suicide completion rate than women. For men, suicide is the eighth leading cause of death, with a rate of 17.5 per 100,000, more than four times the rate in women. White men complete 73% of all suicides; 80% of these deaths are by firearms. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance abuse.
Origin: Chapter 15, 2
2. A nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide?
A) Divorced man
B) Widowed woman
C) Single woman
D) Married man
The nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. Marriage has been identified as a protective factor against mental disorders in older adults.
Origin: Chapter 15, 3
3. A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, “What might predict the possibility of future suicide attempts?” Which of the following would the nurse include in the response?
B) Death of a spouse
C) Previous suicide attempt
D) Polydrug use
Although factors such as unemployment, death of a spouse, and polydrug use can contribute to depression and suicidal ideation, one of the best predictors for suicide during adolescence is a previous attempt.
Origin: Chapter 15, 4
4. A nurse is completing an admission assessment of a young adult woman who has a history of depression, and who was brought to the hospital by her boyfriend. In response to the nurse’s question regarding suicidal ideation, the client discloses that she is thinking about killing herself. Which question would be most appropriate for the nurse to ask next?
A) “What does your boyfriend think about your desire to kill yourself?”
B) “What are your spiritual beliefs about suicide?”
C) “What will killing yourself accomplish?”
D) “What thoughts have you had about how you would kill yourself?”
Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt(s), suicide planning and implementation, and availability and lethality of the suicide method. Risk assessment also includes the patient’s resources, including coping skills and social supports, that can be used to counter suicidal impulses.
Origin: Chapter 15, 5
5. A nurse is caring for a white man age 30 years whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important?
A) Refer the client for long-term psychotherapy.
B) Determine the client’s risk of psychosis.
C) Determine whether anyone in the client’s family has had depression.
D) Ask the client whether he is thinking about killing himself.
The nurse should first ask whether the client is thinking about killing himself, because statistics show that among young, recently widowed white men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in that same age group. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.
Origin: Chapter 15, 6
6. A nurse is providing a presentation about suicide to a group of health professionals. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men?
A) Substance abuse
B) Media influences
C) Lack of conflict resolution skills
D) Parenting practices
Substance abuse, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, just under 50% of suicide attempts among men between the ages of 42 and 77 years involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role but are not considered major factors.
Origin: Chapter 15, 7
7. A nurse has just completed a suicide risk assessment of a widowed man 76 years of age. In addition to documenting the presence or absence of suicidal thoughts, a suicide plan, and the client’s available means, the nurse would also document which of the following?
A) Use of substances 6 hours before the assessment
B) Speech patterns
C) Availability of support resources
D) Amount of sleep in past 24 hours
The nurse should document the presence or absence of suicidal thoughts, intent, plan, and available means to illustrate current and ongoing suicide risk. If the client denies any suicidal ideation, it is important that the denial is documented. Documentation must include any use of drugs, alcohol, or prescription medications by the client during the 6 hours before the assessment. It should include the use of antidepressants that are especially lethal (e.g., tricyclics), as well as any medication that might impair the client’s judgment (e.g., a sleep medication). Notes should reflect the level of the client’s judgment and ability to be a partner in treatment.
Origin: Chapter 15, 8
8. A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which nursing intervention would be most appropriate at this time?
A) Assigning nursing staff to stay with him during his suicidal crisis
B) Developing a personal plan for managing suicidal thoughts when they occur
C) Advising the client that he should consider electroconvulsive therapy treatments
D) Administering psychotropic drugs that decrease the client’s serotonin levels
The client’s immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like he is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.
Origin: Chapter 15, 9
9. A nurse is presenting a discussion about suicide to a local community group. Which comment from an audience member indicates the need to clarify the information?
A) “Warning signs about the person’s intention often occur.”
B) “People who are suicidal are undecided about living or dying.”
C) “Suicides more often occur during the holiday seasons.”
D) “People who talk about suicide need to be taken seriously.”
The comment about suicides occurring more frequently during holiday seasons is a myth that requires clarification. Warning signs, indecision about living and dying, and taking individuals seriously when they discuss suicide are accurate facts.
Origin: Chapter 15, 10
10. A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when they identify which of the following as the probability that a person will successfully complete suicide?
B) Suicidal ideation
Lethality refers to the probability that a person will successfully complete suicide. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death (e.g., taking a sublethal drug). The term suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide, and suicide ideation. Suicidal ideation is thinking about and planning one’s own death.
Origin: Chapter 15, 11
11. After educating a class on factors that enhance the risk of suicide, the instructor determines the need for additional education when the class identifies which of the following?
A) Family member committing suicide
Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.
Origin: Chapter 15, 12
12. A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being “down.” When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply.
A) “I’ve been drinking about three or four more beers every night.”
B) “I’ve been going out with my friends about once or twice a week.”
C) “I’m so tired that all I ever want to do is sleep all the time.”
D) “Most times, I feel like I’m trapped with no way out.”
E) “I’m looking for a new job because my job is so stressful.”
Ans: A, C, D
Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
Origin: Chapter 15, 13
13. A nurse determines that a client is at imminent risk for suicide. Which of the following would be least appropriate to include in the client’s plan of care?
A) Listening intently and nonjudgmentally
B) Validating the client’s feelings and experience
C) Instituting strict restriction on the client’s activity
D) Using cognitive interventions to foster hope
There are three urgent priorities for care of a person who is at imminent risk for suicide: (1) reconnecting the client to other people and instilling hope, (2) restoring emotional stability and reducing suicidal behavior, and (3) ensuring safety. Reconnecting the client interpersonally includes listening intently and without judgment to the client’s thoughts and feelings, and validating the client’s experience and suffering. This intervention directly challenges the client’s belief that no one cares. Using cognitive interventions can help the client to regain hope. Restricting a client’s activity can be very upsetting. Rather, the nurse should reduce the client’s stress while ensuring safety by intruding as little as possible on the client’s exercise of free will.
Origin: Chapter 15, 14
14. A client who has attempted suicide has an underlying diagnosis of depression. Which of the following would the nurse anticipate being ordered for the client?
A) Selective serotonin reuptake inhibitor
B) Mood stabilizer
C) Tricyclic antidepressant
D) Atypical antipsychotic
Medication management focuses on treating the underlying psychiatric disorder. For depression, a nonlethal antidepressant (e.g., selective serotonin reuptake inhibitor) usually is prescribed. For clients with schizophrenia and schizoaffective disorder, antipsychotics may be used; however, only clozapine, an atypical antipsychotic, has been shown to be effective.
Origin: Chapter 15, 15
15. A nurse is working with a client who will be signing a commitment to treatment statement. After teaching the client about this statement, the nurse determines the need for additional instruction when the client states which of the following?
A) “Signing this statement means that I will not commit suicide.”
B) “I am agreeing to get emergency treatment if I have suicidal thoughts.”
C) “I will be open and honest about my feelings about treatment.”
D) “I am agreeing to participate in the necessary treatment for my condition.”
Clients are usually ambivalent about wanting to die. The Commitment to Treatment Statement (CTS) directly addresses ambivalence about treatment by asking the client to make a commitment to treatment. Different from the no-suicide contract, the CTS does not restrict the client’s rights regarding the option of suicide. Instead, the client agrees to engage in treatment and access emergency service if needed. Underlying the CTS is the expectation that the client will communicate openly and honestly about all aspects of treatment, including suicide. This commitment is written and signed by the client.
Origin: Chapter 15, 16
16. A nurse is performing an assessment of a client with suicidal ideation. Which question would the nurse most likely ask to determine the degree of planning?
A) “How seriously do you want to die?”
B) “Have you attempted suicide before?”
C) “Could you stop yourself from killing yourself?”
D) “How much do the thoughts distress you?”
The question about stopping oneself from suicide reflects the degree of planning. Asking the client about how seriously he wants to die and about previous attempts of suicide reflect the client’s intent to die. Asking about how much the thoughts are distressing reflects the severity of the ideation.
Origin: Chapter 15, 17
17. A nurse determines that a client has poor social skills that have interfered with his ability to engage others, which has contributed to his feelings of purposelessness, hopelessness, and withdrawal. Which of the following would be most important for the nurse to recommend in order to help the client begin to develop social skills?
A) Self-help group
B) Recovery group
C) Nurse–client relationship
D) Limit setting
Poor social skills may interfere with the client’s ability to engage others. The nurse should assess the client’s social capability early in treatment and make necessary provisions for social skills training. The interpersonal relationship with the nurse is an ideal place to begin shaping social behaviors that will help the client establish a social network that will sustain him during periods of discouragement or crisis. Thereafter, participation in support networks such as recovery groups, clubhouses, drop-in centers, self-help groups, or other therapeutic social engagements will help the client become connected to others.
Origin: Chapter 15, 18
18. After educating a group of students on the various concepts involving suicide, the instructor determines that the education was successful when the students describe parasuicide as which of the following?
A) Voluntary act of killing oneself
B) All suicide-related behaviors and suicidal thoughts
C) Nonfatal act with the intent to die
D) Voluntary attempt without death as the aim
Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death. Suicide is the voluntary act of killing oneself. It is a fatal, self-inflicted destructive act with explicit or inferred intent to die. Suicidality is all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. A suicide attempt is a nonfatal, self-inflicted destructive act with explicit or implicit intent to die.
Origin: Chapter 15, 19
19. A nurse is with an adolescent who tells the nurse that she has nothing to live for and she just wishes she was dead. Which nursing action would be the priority?
A) Going to the client’s psychiatrist to tell him of the girl’s suicidal ideation
B) Staying with the client to explore more of her thoughts about suicide
C) Putting the client in seclusion with a staff assigned to watch her at all times
D) Ascertaining the client’s beliefs about what happens when you die
A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. The first priority is to provide for the client’s safety while initiating the least restrictive care possible. Staying with the client and further exploring her thoughts about suicide will enhance safety and allow the nurse to more thoroughly understand the extent of the client’s suicidal risk. It would not be appropriate to leave the client alone while the nurse goes to talk with the psychiatrist. Seclusion would be used only as a last resort because it is not the least restrictive environment. Determining the client’s beliefs about death would be a topic to be addressed much later in the process.
1st_Ed Test Bank Essentials of Psychiatric Nursing by Mary Ann Boyd