Chapter 22 NURS 2547

1. An adult outpatient diagnosed with major depression has a history of several suicide
   attempts by overdose. Given this patient’s history and diagnosis, which antidepressant
   medication would the nurse expect to be prescribed?
   a. Amitriptyline (Elavil), a sedating tricyclic medication
   b. Fluoxetine (Prozac), a selective serotonin reuptake inhibitor
   c. Desipramine (Norpramin), a stimulating tricyclic medication
   d. Tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor

b. Fluoxetine (Prozac), a selective serotonin reuptake inhibitor

2. Considering all suicide plans pose a significant risk, which of the following suicide plans
   would be identified as the highest risk during a risk assessment?
   a. Turning on the oven and letting gas escape into the apartment during the night
   b. Cutting wrists in the bathroom while the spouse reads in the next room
   c. Overdosing on aspirin with codeine while the spouse is out with friends
   d. Access and intent to use a shotgun that spouse keeps in the bedroom

d. Access and intent to use a shotgun that spouse keeps in the bedroom

3. Which measure would be considered a form of primary intervention for suicide?
   a. Psychiatric hospitalization of a suicidal patient
   b. Referral of a formerly suicidal patient to a support group
   c. Suicide precautions for 24 hours for newly admitted patients
   d. Helping school children learn to manage stress and be resilient

d. Helping school children learn to manage stress and be resilient

4. Which change in the brain’s biochemical function is most associated with suicidal
   behaviour?
   a. Dopamine excess
   b. Serotonin deficiency
   c. Acetylcholine excess
   d. Gamma-aminobutyric acid deficiency

b. Serotonin deficiency

5. A college student who failed two tests cried for hours and then tried to telephone a parent
   but got no answer. The student then gave several expensive sweaters to a roommate and
   asked to be left alone for a few hours. Which provides the greatest concern during a risk
   assessment?
   a. Calling parents
   b. Excessive crying
   c. Remaining in a dorm room alone
   d. Giving away sweaters to her roommate

d. Giving away sweaters to her roommate

6. A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data
   relevant to which of the following?
   a. Current stress level
   b. Mood disturbance
   c. Suicide potential
   d. Level of anxiety

c. Suicide potential

7. A person intentionally overdosed on antidepressants. Which nursing diagnosis has the
   highest priority?
   a. Powerlessness
   b. Social isolation
   c. Risk for suicide
   d. Compromised family coping

c. Risk for suicide

8. A college student who attempted suicide by overdose was hospitalized. When the parents
   were contacted, they responded, “We should have seen this coming. We did not do
   enough.” The parents’ reaction reflects which of the following?
   a. Guilt
   b. Denial
   c. Shame
   d. Rescue feelings

a. Guilt

9. Which is the most critical question for the nurse to ask an adolescent who is struggling
   with active thoughts of suicide by overdose of medication?
   a. “Why do you want to kill yourself?”
   b. “Do you have access to medications?”
   c. “Have you been taking drugs and alcohol?”
   d. “Did something happen with your parents?”

b. “Do you have access to medications?”

10. It has been 3 days since a patient struggling with thoughts of suicide was hospitalized and
    prescribed an antidepressant medication. They are now more talkative and show increased
    energy. Which is the highest priority nursing intervention for this patient?
    a. Supervise the patient 24 hours a day.
    b. Begin discharge planning for the patient.
    c. Refer the patient to art and music therapists.
    d. Consider discontinuation of suicide precautions.

a. Supervise the patient 24 hours a day.

11. Which is the key element when the nurse is providing follow-up counselling to a patient
    discharged home following a suicide attempt?
    a. Maintain 24-hour observation.
    b. Administer antidepressant medication as ordered.
    c. Establish a working alliance to encourage realistic problem solving.
    d. Offer solutions to problems related to the stigma associated with a suicide attempt.

c. Establish a working alliance to encourage realistic problem solving.

12. A tearful, anxious patient at the outpatient clinic reports, “I should be dead.” The initial
    task of the nurse conducting the assessment interview is to do which of the following?
    a. Assess lethality of suicide plan.
    b. Encourage expression of anger.
    c. Establish rapport with the patient.
    d. Determine risk factors for suicide.

c. Establish rapport with the patient.

13. During a conversation with an outpatient who has a history of multiple suicide attempts.
    The patient states, “I am considering suicide.”
    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 keep you safe.”
    c. “Bringing up these feelings is a very positive action on your part.”
    d. “We need to talk about the good things you have to live for.”

c. “Bringing up these feelings is a very positive action on your part.”

14. Which intervention will the nurse recommend for the distressed family and friends of
    someone who has died by suicide?
    a. Participating in reminiscence therapy
    b. Psychological post-mortem assessment
    c. Attending a self-help group for survivors
    d. Contracting for at least two sessions of group therapy

c. Attending a self-help group for survivors

15. Which statement provides the best rationale for closely monitoring a severely depressed
    patient during antidepressant medication therapy?
    a. As depression lifts, physical energy becomes available to carry out suicide.
    b. Patients who previously had suicidal thoughts need to discuss their feelings.
    c. For most patients, antidepressant medication results in increased suicidal thinking.
    d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

a. As depression lifts, physical energy becomes available to carry out suicide.

16. A nurse assesses a patient who reports a 3-week history of depression and periods of
    uncontrolled crying. The patient says, “My business is bankrupt, and I was served with
    divorce papers.” Which subsequent statement by the patient alerts the nurse to a concealed
    suicidal message?
    a. “I wish I were dead.”
    b. “Life is not worth living.”
    c. “I have a plan that will fix everything.”
    d. “My family will be better off without me.”

c. “I have a plan that will fix everything.”

17. A patient experiencing depression says, “Nothing matters anymore.” Which is the most
    appropriate response by the nurse?
    a. “Are you having thoughts of suicide?”
    b. “I am not sure I understand what you are trying to say.”
    c. “Try to stay hopeful. Things have a way of working out.”
    d. “Tell me more about what interested you before you became depressed.”

a. “Are you having thoughts of suicide?”

18. 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.”

d. “Let’s consider which problems are very important and which are less important.”

19. When assessing a patient’s plan for suicide, which aspect has priority?
    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

c. Availability of means and lethality of method

20. 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.

a. hopelessness.

21. Which statement by a depressed patient will alert the nurse to the patient’s need for
    immediate, active intervention?
    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 colour.”
    d. “I tried to get attention before I cut myself last time.”

b. “I have no one to turn to for help or support.”

22. A patient hospitalized for 2 weeks died by suicide during the night. Which initial nursing
    measure will be most important regarding this event?
    a. Ask the information technology manager to verify that the hospital information
    system is secure.
    b. Hold a staff meeting to express feelings and plan care for the other patients.
    c. Ask the patient’s roommate not to discuss the event with other patients.
    d. Prepare a report of a sentinel event.

b. Hold a staff meeting to express feelings and plan care for the other patients.

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

a. “Genetics are associated with suicide risk. Monitoring and support are important.”

24. Which individual in the emergency department should be considered at highest risk for
    completing suicide?
    a. An adolescent girl with superior athletic and academic skills who has asthma
    b. A 38-year-old single female church member with fibrocystic breast disease
    c. A 60-year-old married 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

d. A 79-year-old single, White male diagnosed recently with terminal cancer of the
prostate

25. According to Canadian statistics, suicide is the _ leading cause of death among young
    adults (15 to 34 years).
    a. first
    b. second
    c. third
    d. fourth

b. second

26. In Canada suicide is which leading cause of death for all ages?
    a. Second
    b. Fourth
    c. Seventh
    d. Ninth

d. Ninth

27. Suicide is described as which of the following?
    a. A psychiatric disorder
    b. A manifestation of auditory hallucinations
    c. A manifestation of inner pain, hopelessness, and helplessness
    d. A manifestation of dark fears, delusions, and social networking

c. A manifestation of inner pain, hopelessness, and helplessness

28. Suicide risk is ____ times higher among people diagnosed with schizophrenia?
    a. 10
    b. 20
    c. 40
    d. 50

d. 50

1. Which is a warning sign of potential suicide? (Select all that apply.)
   a. Feelings of hopelessness
   b. Loss of independence
   c. Increased use of substances
   d. Experiencing a life crisis

e. Chronic pain and illness

ABC

2. 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 Inuit male
   e. 39-year-old African Canadian male

ABD

3. Which nursing interventions will be implemented for a patient who is expressing they are
   actively suicidal? (Select all that apply.)
   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.
   d. Remove the patient’s eyeglasses to prevent self-injury.
   e. Interact with the patient every 15 minutes.

ABC

4. A college student is extremely upset after failing two examinations. The student said, “No
   one understands how this will hurt my chances of getting into medical school.” The
   student then suspends access to their social networking Web site and turns off cell phone.
   Which suicide risk factors are evident? (Select all that apply.)
   a. Shame
   b. Panic attack
   c. Humiliation
   d. Self-imposed isolation
   e. Recent stressful life event

ACDE\