Answer Options:
a. Hopelessness
b. Sadness
c. Anxiety
d. Anger
Answer: a. Hopelessness
Question: Which statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy?
Answer Options:
a. As depression lifts, physical energy becomes available to carry out suicide.
b. Suicide may be precipitated by a variety of internal and external events.
c. Suicidal patients have difficulty using social supports.
d. Suicide is an impulsive act.
Answer: a. As depression lifts, physical energy becomes available to carry out suicide.
Question: A new nurse says to a peer, “My new patient is diagnosed with bipolar disorder. At least I won’t have to worry about suicide risk.” Which response by the peer would be most helpful?
Answer Options:
a. “Let’s reconsider your plan. Suicide risk is high in patients diagnosed with bipolar disorder.”
b. “Suicide is a risk for any patient diagnosed with bipolar disorder who uses alcohol or drugs.”
c. “The thought processes of patients diagnosed with bipolar disorder are usually too disorganized to attempt suicide.”
d. “Racing thoughts during mania often prompt suicide among patients diagnosed with bipolar disorder.”
Answer: a. “Let’s reconsider your plan. Suicide risk is high in patients diagnosed with bipolar disorder.”
Question: An 82-year-old resident at a long-term care facility says, “I guess it’s about time for me to die. My friends are all dead. My money is running out, and the children are too busy. How should the nurse analyze this comment?
a. Normal negativity of older adults
b. Evidence of suicide risk
c. A cry for sympathy
d. Normal grieving
Answer: B
Question: After failing two tests, a college student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt?
Answer Options:
a. Calling parents
b. Excessive crying
c. Giving away sweaters
d. Staying in a dormitory
Answer: c. Giving away sweaters
Question: 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.
Answer Options:
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 for hospitalization that may be needed soon.”
Answer: b. “A score over 8 requires immediate hospitalization.”
Question: A victim of a violent rape has been in the emergency department for 3 hours. Evidence collection is complete. As discharge counseling begins, the victim says softly, “I will never be the same again. I can’t face my friends. There is no sense of trying to go on.” Select the nurse’s most important response.
Answer Options:
a. “Are you thinking of suicide?”
b. “It will take time, but you will feel the same as before.”
c. “Your friends will understand when you tell them.”
d. “You will be able to find meaning in this experience as time goes on.”
Answer: a. “Are you thinking of suicide?”
Question: Which understanding about individuals who attempt suicide will help a nurse plan the care for a suicidal patient?
Answer Options:
a. Every suicidal person is mentally ill.
b. Every suicidal person is intent on dying.
c. Every suicidal person is conveying impulsive behavior.
d. Every suicidal person experiencing hopelessness.
Answer: d. Every suicidal person experiencing hopelessness.
Question: What is the most helpful response for a nurse to make when a patient being treated as an outpatient states, “I am considering suicide.”?
Answer Options:
a. “I’m glad you shared this. Please do not worry. We will handle it together.”
b. “I think you should admit yourself to the hospital to get help.”
c. “We need to talk about the good things you have to live for.”
d. “Bringing this up is a very positive action on your part.”
Answer: d. “Bringing this up is a very positive action on your part.”
Question: Which statement by a patient during an assessment interview should alert the nurse to the patient’s need for immediate, active intervention?
Answer Options:
a. “I am mixed up, but I know I need help.”
b. “I have no one for help or support.”
c. “It is worse when you are a person of color.”
d. “I tried to get attention before I shot myself.”
Answer: b. “I have no one for help or support.”
Question: Which is an important nursing intervention when giving care to a patient withdrawing from a central nervous system (CNS) stimulant?
Answer Options:
a. Offer frequent touch to the patient.
b. Maintain absolute quiet in the environment.
c. Avoid manipulation by denying the patient’s requests.
d. Observe for depression and suicidal ideation.
Answer: d. Observe for depression and suicidal ideation.
Question: An older adult patient tells the nurse, “I’ve been feeling so tense lately. My hands and muscles are at ready. My money is running out, and the children are too busy. How should the nurse analyze this comment?
a. Normal negativity of older adults
b. Evidence of suicide risk
c. A cry for sympathy
d. Normal grieving
Answer: B
Question: The parents of identical twins ask a nurse for advice when one twin committed suicide a month ago. Now the parents are concerned that the other twin may also have suicidal tendencies. Which comment by the nurse is accurate?
Answer Options:
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.”
Answer: a. “Genetics are associated with suicide risk. Monitoring and support are important.”
Question: When assessing a patient’s plan for suicide, what aspect has priority?
Answer Options:
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
Answer: c. Availability of means and lethality of method
Question: A patient tells the nurse of the recent deaths of a spouse of 50 years as well as an adult child in an automobile accident. The patient has no other family and only a few friends in the community. What is the priority nursing diagnosis?
a. Spiritual distress, related to being angry with God for taking the family
b. Risk for suicide, related to recent deaths of significant others
c. Anxiety, related to sudden and abrupt lifestyle changes
d. Social isolation, related to loss of existing family
Answer: B