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Chapter 17. The Suicidal Client, Study notes of Nursing

Utah Valley University (UVU)Nursing
Prof. Weslie E. Sheldon

AChapter 17. The Suicidal Client nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note Establishing room restrictions, because the client’s threat is an attempt to manipulate the staff Placing this client on one­to­one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide Calling an emergency treatment team meeting, because the client’s threat must be addressed

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2023/2024

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Chapter 17. The Suicidal Client
Chapter 17. The Suicidal Client
Multiple Choice
•A nurse discovers a client’s suicide note that details the time, place, and means to
commit suicide. What should be the priority nursing intervention and the rationale for
this action?
•Administering lorazepam (Ativan) prn, because the client is angry about the
discovery of the note
•Establishing room restrictions, because the client’s threat is an attempt to
manipulate the staff
•Placing this client on onetoone suicide precautions, because the more specific
the plan, the more likely the client will attempt suicide
•Calling an emergency treatment team meeting, because the client’s threat must be
addressed
ANS: C
The priority nursing action should be to place this client on onetoone suicide
precautions, because the more specific the plan, the more likely the client will
attempt suicide. The appropriate nursing diagnosis for this client would be risk for
suicide.
KEY: Cognitive Level: Analysis | Integrated Processes:Nursing Process: Implementation
| Client Need: Safe and Effective Care Environment: Management of Care
•During the planning of care for a suicidal client, which correctly written
outcome should be a nurse’s first priority?
•The client will not physically harm self.
•The client will express hope for the future by day 3.
•The client will establish a trusting relationship with the nurse.
•The client will remain safe during the hospital stay.
ANS: D
The nurse’s priority should be that the client will remain safe during the hospital stay.
Client safety should always be the nurse’s priority. The “A” answer choice is incorrectly
written. Correctly written outcomes must be client focused, measurable, and realistic
and contain a time frame. Without a time frame, an outcome cannot be correctly
evaluated.
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Chapter 17. The Suicidal Client

Chapter 17. The Suicidal Client Multiple Choice

  • A nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action?
  • Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note
  • Establishing room restrictions, because the client’s threat is an attempt to manipulate the staff
  • Placing this client on onetoone suicide precautions, because the more specific the plan, the more likely the client will attempt suicide
  • Calling an emergency treatment team meeting, because the client’s threat must be addressed ANS: C The priority nursing action should be to place this client on onetoone suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care
  • During the planning of care for a suicidal client, which correctly written outcome should be a nurse’s first priority?
  • The client will not physically harm self.
  • The client will express hope for the future by day 3.
  • The client will establish a trusting relationship with the nurse.
  • The client will remain safe during the hospital stay. ANS: D The nurse’s priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse’s priority. The “A” answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, and realistic and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated.

KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment

  • A client diagnosed with major depressive disorder with psychotic features hears voices commanding selfharm. The client refuses to commit to developing a plan for safety. What should be the nurse’s priority intervention at this time?
  • Obtaining an order for locked seclusion until client is no longer suicidal
  • Conducting 15 minute checks to ensure safety
  • Placing the client on onetoone observation while monitoring suicidal ideations
  • Encouraging client to express feelings related to suicide ANS: C The nurse’s priority intervention when a client hears voices commanding selfharm is to place the client on onetoone observation while continuing to monitor suicidal ideation. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care
  • A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse’s priority at this time?
  • Give the client offunit privileges as positive reinforcement.
  • Encourage the client to share mood improvement in group.
  • Increase frequency of client observation.
  • Request that the psychiatrist reevaluate the current medication protocol. ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out selfdestructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care
  • A nurse recently admitted a client to an inpatient unit after a suicide attempt.
  • Vital signs stable; no psychosis noted
  • Able to comply with medication regimen; able to problemsolve life issues
  • Able to participate in a plan for safety; family agrees to constant observation ANS: D Participation in a plan of safety and constant family observation will decrease the risk for selfharm. All other answer choices are not directly focused on suicide prevention and safety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment
  • The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide?
  • Address only serious suicide threats to avoid the possibility of secondary gain.
  • Promote trust by verbalizing a promise to keep suicide attempt information within the family.
  • Offer a private environment to provide needed time alone at least once a day.
  • Be available to actively listen, support, and accept feelings. ANS: D Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity
  • A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information?
  • “Your grieving will subside within 1 year; until then I recommend antidepressants.”
  • “Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area.”
  • “The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them.”
  • “Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone.”

ANS: B

Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

  • After years of dialysis, an 84yearold states, “I’m exhausted, depressed, and done with these attempts to keep me alive.” Which question should the nurse ask the spouse when preparing a discharge plan of care?
  • “Have there been any changes in appetite or sleep?”
  • “How often is your spouse left alone?”
  • “Has your spouse been following a diet and exercise program consistently?”
  • “How would you characterize your relationship with your spouse?” ANS: B This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of selfharm. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment
  • A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include?
  • Elderly people use less lethal means to commit suicide.
  • Although the elderly make up less than 13% of the population, they account for 16% of all suicides.
  • Suicide is the second leading cause of death among the elderly.
  • It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality. ANS: B This factual information should be included in the nursing instructor’s teaching plan. An expressed desire to die is not normal in any age group. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment

ANS: C

Suicide is not a diagnosis, disorder, or affliction. It is a behavior. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

  • A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first?
  • Communicate therapeutically.
  • Observe the client.
  • Provide a hazardfree environment.
  • Assess suicide risk. ANS: D Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. KEY: Cognitive Level: Analysis | Integrated Processes : Nursing Process: Implementation | Client Need: Safe and Effective Care Environment
  • Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low selfesteem by isolating self?
  • The client will not physically harm self.
  • The client will express three positive selfattributes by day 4.
  • The client will reveal a suicide plan.
  • The client will establish a trusting relationship. ANS: B Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low selfesteem. Outcomes should be client centered, specific, realistic, and measureable and contain a time frame. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity
  • A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred?
  • “Suicidal threats and gestures should be considered manipulative and/or attention-

seeking.”

  • “Suicide is the act of a psychotic person.”
  • “All suicidal individuals are mentally ill.”
  • “Fifty to eighty percent of all people who kill themselves have a history of a previous attempt.” ANS: D It is a fact that between 50% and 80% of all people who kill themselves have a history of a previous attempt. All other answer choices are myths about suicide. KEY: Cognitive Level: Application | Integrated Processes: Evaluation | Client Need: Safe and Effective Care Environment
  • A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client’s belief system, the nurse should conclude which client would potentially be at highest risk for suicide?
  • Roman Catholic
  • Protestant
  • Atheist
  • Muslim ANS: C Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Safe and Effective Care Environment
  • Which nursing intervention strategy is most appropriate to implement initially with a suicidal client?
  • Ask a direct question such as, “Do you ever think about killing yourself?”
  • Ask client, “Please rate your mood on a scale from 1 to 10.”
  • Establish a trusting nurse–client relationship.
  • Apply the nursing process to the planning of client care. ANS: A The risk of suicide is greatly increased if the client has suicidal ideations, if the client

discharge?

  • “I must observe you continually for 1 hour in order to keep you safe.”
  • “Let’s confer with the treatment team about the resources that you may need after discharge.”
  • “You must have been very upset to do what you did today.”
  • “Are you currently thinking about harming yourself?” ANS: B The nurse is functioning in an advocacy role when collaborating with the client and treatment team to discuss client problems and needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  • A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide?
  • Family history of depression
  • The client’s orientation to reality
  • The client’s history of suicide attempts
  • Family support systems ANS: C A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client’s risk. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment
  • A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation?
  • Assessing the client’s pulse oximetry and vital signs
  • Developing a plan for safety for the client
  • Assessing the client for suicidal ideations
  • Establishing a trusting nurse–client relationship

ANS: A

It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow’s hierarchy of needs. This client’s problems with oxygenation will take priority over assessing for current suicidal ideations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment Multiple Response

- After a teenager reveals that he is gay, the father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal grief responses should a nurse anticipate? Select all that apply.

  • “I can’t believe this is happening.”
  • “If only I had been more understanding.”
  • “How dare he do this to me!”
  • “I’m just going to have to accept that he was gay.”
  • “Well, that was a selfish thing to do.” ANS: A, B, C Suicide of a family member can induce a whole gamut of feelings in the survivors. Shock, disbelief, guilt, remorse, anger, and resentment are all feelings that may be experienced by this father. The last two possible responses suggest acceptance and understanding. It is far more common for survivors of suicide to have a sense of feeling wounded and as if they will never get over it. KEY: Cognitive Level: Analysis | Integrated Processes : Nursing Process: Assessment | Client Need: Psychosocial Integrity - A nursing student is developing a study guide related to historical facts about suicide. Which of the following facts should the student include? Select all that apply.
  • In the Middle Ages, suicide was viewed as a selfish and criminal act.
  • During the Roman Empire, suicide was followed by incineration of the body.
  • Suicide was an offense in ancient Greece, and a commonsite burial was denied.
  • During the Renaissance, suicide was discussed and viewed more philosophically.
  • Old Norse traditionally set a person who committed suicide adrift in the North Sea.