NURS 340: UNIT 9 - DEPRESSIVE DISORDERS & SUICIDE

A client cuts their arm when overwhelmed by anxiety but denies wanting to die. What is this behavior, and why does it occur?

NSSI—intentional self-injury without suicidal intent, used to relieve emotional pain or interrupt numbness.

A client repeatedly self-injures because it temporarily relieves distress. Why can this become a chronic pattern?

Negative reinforcement: temporary relief reinforces self-injury as a coping mechanism, increasing dependence and potential injury severity.

A client says cutting helps them feel something when emotionally numb. What does this suggest?

NSSI may be used to interrupt emotional numbness or create physical sensation.

A nurse notices unexplained scars, hidden sharp objects, and long sleeves in hot weather. What should the nurse assess?

Possible NSSI; assess injuries, triggers, emotional distress, coping patterns, and suicide risk.

Why should nurses avoid labeling NSSI as attention-seeking or manipulative?

NSSI reflects genuine emotional distress; judgment can damage trust and discourage disclosure.

A client presents with superficial cuts. What question helps identify the trigger?

“What was happening before you injured yourself?”

Which question best explores the emotional function of NSSI?

“What do you feel before and after you hurt yourself?”

What laboratory test confirms NSSI?

None. Diagnosis is clinical, based on the behavior's pattern, frequency, intent, and function.

Why assess suicide risk when a client denies suicidal intent?

NSSI is associated with increased future suicide-attempt risk; assess suicidal thoughts, intent, plans, access to lethal means, and history.

A client arrives with a fresh self-inflicted wound. What is the priority?

Assess and stabilize the injury, control bleeding, then assess immediate safety and suicide risk.

A client's self-injury urges follow family arguments. What should the nurse develop with the client?

A safety plan identifying triggers, warning signs, coping strategies, support contacts, and professional resources.

What safer coping strategies can the nurse recommend when self-injury urges arise?

Contact a trusted person or professional; try journaling, drawing, coloring, exercise, or meaningful activities.

Which therapy is especially useful for NSSI associated with emotional dysregulation?

DBT, which teaches emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness.

A client with NSSI also has depression and anxiety. What medications may help?

SSRIs/SNRIs for underlying mood or anxiety symptoms; naltrexone has been used in selected cases to target a proposed opioid-reinforcement mechanism.

A client feels ashamed and refuses to discuss NSSI. What should the nurse do?

Build trust through empathy, consistency, nonjudgmental communication, and appropriate support resources.

A client believes superficial cutting is harmless. What complications should the nurse explain?

Infection, scarring, excessive bleeding, shame, guilt, social isolation, and potentially more severe injuries.

Which comorbidities are associated with NSSI?

Depression, anxiety disorders, borderline personality disorder, substance use disorders, and eating disorders.

An adolescent experiences bullying, family conflict, and school pressure. How are these relevant to NSSI?

They are potential psychosocial stressors and triggers; assess coping, support systems, abuse or neglect when indicated, and mental health symptoms.

Why is suicide-risk monitoring essential even when a client denies suicidal intent?

NSSI is associated with roughly twice the risk of a future suicide attempt; denial of current intent does not eliminate future risk.

A client says, “I cut myself when my emotions get too intense. I am not trying to die.” What best explains this behavior?

A. The client is necessarily attempting suicide.
B. The client is regulating emotional distress through physical pain.
C. The client is experiencing psychosis.
D. The client is manipulating staff.

B. The client is regulating emotional distress through physical pain

A client presents with recent self-inflicted cuts. What should the nurse do first?

A. Teach journaling.
B. Explore childhood stressors.
C. Assess the wounds and control active bleeding.
D. Refer the client for DBT.

C. Assess the wounds and control active bleeding.

Which statement is most appropriate?

A. “You need to stop doing this.”
B. “Are you doing this for attention?”
C. “What was happening before you felt the urge to hurt yourself?”
D. “You know this won't solve anything.”

C. “What was happening before you felt the urge to hurt yourself?”

Which therapy is especially useful for emotional dysregulation associated with NSSI?

A. DBT
B. Avoiding emotional triggers
C. Punishment after self-injury
D. Coping alone

A. DBT

A client says, “I've never wanted to die, so you don't need to ask about suicide.” What is the nurse's best response?

A. “You're right; NSSI carries no suicide risk.”
B. “NSSI increases future suicide risk, so I need to assess your safety.”
C. “I'll ask only if your injuries worsen.”
D. “I'll document your denial and stop assessing.”

B. “NSSI increases future suicide risk, so I need to assess your safety.”

Which findings may indicate NSSI? Select all that apply.

A. Unexplained scars or burns
B. Hidden sharp objects
C. Long sleeves despite hot weather
D. Worthlessness or hopelessness
E. A normal laboratory result

A. Unexplained scars or burns
B. Hidden sharp objects
C. Long sleeves despite hot weather
D. Worthlessness or hopelessness

A client experiences self-injury urges after arguments. Which intervention is best?

A. Identify triggers, coping strategies, and support contacts.
B. Avoid discussing the arguments.
C. Require a promise never to self-injure again.
D. Encourage hiding the urges.

A. Identify triggers, coping strategies, and support contacts.

Which statement about medication treatment is accurate?

A. Medication alone reliably eliminates NSSI.
B. SSRIs/SNRIs may help when depression or anxiety coexists.
C. Naltrexone is required for every client.
D. Antidepressants eliminate suicide-risk assessment.

B. SSRIs/SNRIs may help when depression or anxiety coexists.

A client with severe depression says, “I cannot live with this pain anymore. Death seems like my only way out.” What underlying mechanism may explain the client's suicidal thinking?

A crisis response in which unbearable distress makes suicide seem like the only available solution.

A client with depression reports suicidal thoughts after losing their job. How should the nurse interpret this situation?

Suicide risk may arise from treatable mental illness combined with situational stress; assess immediate safety and contributing factors.

A client says, “I won't be a burden much longer.” What should the nurse do?

Ask directly about suicidal thoughts, intent, plan, and access to lethal means.

A previously severely depressed client suddenly becomes calm, gives away possessions, and says goodbye to family. Why is this concerning?

These may be warning signs of suicide risk; assess immediately rather than assuming the client is recovering.

A client denies suicidal thoughts but begins putting financial affairs in order and giving away valued belongings. What should the nurse recognize?

Indirect or nonverbal suicide warning signs can occur without verbal disclosure; perform a direct suicide-risk assessment.

A nurse learns that a client has been exposed to extensive media coverage of a celebrity's suicide and is now expressing suicidal thoughts. What phenomenon may be relevant?

Cluster or copycat suicide risk, in which exposure may influence vulnerable individuals.

A client with schizophrenia expresses hopelessness and suicidal thoughts. Why is this particularly concerning?

Suicide is a major cause of premature death in schizophrenia; assess acute risk and initiate appropriate safety measures.

A client admits to suicidal thoughts. Which three questions should the nurse prioritize when evaluating immediate risk?

• Do you have a plan?

• How lethal is it?

• Do you have access to the means?

A client describes a specific suicide plan and confirms immediate access to the intended means. How should the nurse interpret this finding?

High acute suicide risk requiring immediate safety measures and urgent psychiatric evaluation.

A nurse hesitates to ask a depressed client, “Are you thinking about killing yourself?” What should the nurse understand?

Direct questioning does not increase suicide risk; it creates an opportunity to identify danger and intervene.

A client reports suicidal thoughts but denies having a plan. Can the nurse conclude that the client is safe?

No. Assess intent, access to means, previous attempts, mental state, substance use, supports, and other risk factors.

A client has a previous suicide attempt, depression, substance use, and limited social support. How should the nurse interpret these findings?

Multiple suicide-risk factors increase concern and require a comprehensive assessment; do not rely on a checklist score alone.

A nurse uses the Columbia-Suicide Severity Rating Scale (C-SSRS) or SAFE-T protocol. What is the purpose?

To structure suicide-risk assessment and guide appropriate triage and intervention.

A client has a high SAD PERSONS score but denies current suicidal intent. Should the nurse rely on the score alone?

No. Use clinical assessment of current thoughts, intent, plan, access, history, and protective factors; a screening score cannot independently determine safety.

A hospitalized client says they intend to kill themselves and has access to a potentially lethal object. What is the nurse's priority?

Protect the client immediately: stay with the client, prevent access to the means, summon appropriate assistance, and initiate emergency safety procedures.

A client expresses suicidal thoughts but has no identified immediate intent or plan. What should the nurse do?

Complete a comprehensive assessment and develop a collaborative safety plan, escalating observation or care according to the assessed risk.

A client at elevated suicide risk is admitted to a psychiatric unit. Which environmental interventions are appropriate?

Remove or secure potential means of self-harm, assess the room and belongings, supervise personal items as indicated, and implement prescribed observation precautions.

A client is distressed but willing to discuss safety and collaborate with the nurse. Which approach should the nurse initially favor when clinically safe?

Collaborative, least-restrictive interventions with close monitoring; increase restrictions or observation if the risk warrants them.

A nurse is caring for a client who recently disclosed suicidal thoughts. Why are consistent contact and empathetic communication important?

They build trust, encourage disclosure, and support ongoing safety assessment; never minimize the client's distress.

A nurse helps a client create a suicide safety plan. Which elements should be included?

Warning signs, internal coping strategies, distracting people or places, trusted support contacts, professional resources, and restricting access to lethal means.

A client with chronic depression and recurrent suicidal thoughts is discharged. What outpatient intervention supports continuity of care?

Case management to coordinate mental health follow-up, medication management, psychosocial support, and ongoing risk monitoring.

A client says spiritual beliefs help them cope with suicidal thoughts. What should the nurse offer?

With the client's consent, connect them with desired spiritual or religious support while continuing clinical safety interventions.

A community nurse teaches residents to recognize suicide warning signs and connect people with help before a crisis develops. Which prevention level is this?

Primary prevention, such as QPR (Question, Persuade, Refer) education.

A clinic routinely screens clients for depression to identify suicide risk early. Which prevention level is this?

Secondary prevention—early identification and intervention.

A community program provides counseling and support to family members after a suicide death. Which prevention level is this?

Tertiary prevention, supporting suicide-loss survivors and addressing ongoing effects.

A client survives a suicide attempt and feels ashamed. What should the nurse prioritize beyond physical treatment?

Ongoing risk assessment, compassionate mental health care, safety planning, and follow-up support.

A male veteran with substance misuse withdraws from family and expresses hopelessness. What should the nurse do?

Recognize elevated risk factors, assess suicide risk directly, and connect the client with appropriate support and treatment.

An LGBTQ+ adolescent reports discrimination, rejection, and suicidal thoughts. What should guide the nurse's response?

Provide affirming, nonjudgmental care; assess safety, minority stress, and available supportive relationships.

A client with depression has strong family relationships and meaningful spiritual involvement. How should the nurse interpret these findings?

These are protective factors that may reduce risk but do not eliminate the need for assessment.

A client with an eating disorder, anxiety, and a trauma history reports hopelessness. Why is a comprehensive assessment necessary?

Psychiatric comorbidities and trauma may compound suicide risk; assess current ideation, intent, plan, access, history, and supports.

A nurse hesitates to ask a depressed client directly about suicide because of concern that the question may introduce the idea. Which action is appropriate?

A. Wait until the client mentions suicide.
B. Avoid the topic to prevent distress.
C. Ask directly and nonjudgmentally about suicidal thoughts.
D. Ask only about depression symptoms.

C. Ask directly and nonjudgmentally about suicidal thoughts.

Which client requires the most immediate safety intervention?

A. A client reporting loneliness who requests counseling.
B. A client with depression who reports fatigue.
C. A client expressing suicidal intent with a specific lethal plan and immediate access to the means.
D. A client reporting occasional hopelessness without suicidal thoughts.

C. A client expressing suicidal intent with a specific lethal plan and immediate access to the means.

A client reports suicidal thoughts. Which additional information should the nurse assess? Select all that apply.

A. Previous suicide attempts
B. Current intent and plan
C. Access to lethal means
D. Substance use and mental health symptoms
E. Protective factors and social support
F. Current mood only

A. Previous suicide attempts
B. Current intent and plan
C. Access to lethal means
D. Substance use and mental health symptoms
E. Protective factors and social support

A client with depression denies current suicidal intent but has a previous attempt and increasing alcohol misuse. What should the nurse do?

A. Conclude the client is safe because intent is denied.
B. Rely exclusively on the screening score.
C. Complete a comprehensive assessment and determine the appropriate level of intervention.
D. Assess alcohol use but not suicide risk.

C. Complete a comprehensive assessment and determine the appropriate level of intervention.

A suicidal client refuses to promise they will not harm themselves. What is the nurse's best action?

A. Require the client to sign a promise before providing care.
B. Continue risk assessment and implement appropriate safety interventions.
C. Assume the client will attempt suicide.
D. Discontinue the assessment.

B. Continue risk assessment and implement appropriate safety interventions.

A nurse is reviewing the behavior of a client who has recently become socially withdrawn and has begun putting personal affairs in order. Which interpretation is most appropriate?

A. The client is necessarily recovering from depression.
B. The behaviors warrant assessment for possible suicide risk.
C. The behaviors confirm a suicide attempt will occur.
D. The behaviors are unrelated to mental health.

B. The behaviors warrant assessment for possible suicide risk.

A client with depression identifies supportive friends, meaningful family relationships, and spiritual beliefs. What is the best nursing interpretation?

A. These factors eliminate suicide risk.
B. The client no longer needs follow-up.
C. These factors may reduce risk and should be incorporated into care.
D. Spiritual beliefs are sufficient treatment.

C. These factors may reduce risk and should be incorporated into care.

A community nurse organizes a program to help residents recognize warning signs and connect people at risk with appropriate help. Which intervention is being implemented?

A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Rehabilitation after injury

A. Primary prevention

A client reports feeling mildly depressed almost every day for 3 years and says, “I've always been this way.” Which disorder should the nurse suspect?

Persistent depressive disorder (dysthymia)—depressed mood lasting at least 2 years in adults or 1 year in children/adolescents.

A client with long-standing dysthymia reports a sudden increase in hopelessness, severe fatigue, and loss of interest. What should the nurse suspect?

A possible superimposed major depressive episode (“double depression”).

A client says their chronic low mood is normal and does not require treatment. What should the nurse explain?

Chronic depression can impair functioning even when symptoms seem familiar; persistent symptoms warrant assessment and treatment.

A client develops depressive symptoms every fall, improves in spring, and reports reduced energy during shorter days. What disorder is most likely?

Seasonal affective disorder (SAD)—depression with a recurring seasonal pattern, often associated with reduced daylight.

A client with winter-pattern SAD asks about a treatment that uses a bright-light box. What should the nurse explain?

Bright-light therapy is a first-line adjunct for seasonal depression and may be combined with medication or psychotherapy.

A client with SAD begins light therapy. What teaching is important?

Follow the prescribed timing, duration, and device instructions; consult the provider about eye conditions, bipolar symptoms, or medications that increase light sensitivity.

A client experiences severe irritability, anxiety, and depressed mood before menstruation, with symptoms resolving shortly after menstruation begins. What should the nurse suspect?

Premenstrual dysphoric disorder (PMDD)—severe cycle-related mood symptoms that impair functioning.

A client reports premenstrual mood changes that are severe enough to disrupt work and relationships. How can the nurse distinguish PMDD from typical PMS?

PMDD causes significant mood symptoms and functional impairment beyond typical premenstrual symptoms.

A client reports mood symptoms throughout the entire month rather than mainly before menstruation. What should the nurse consider?

Assess for another mood disorder or a premenstrual exacerbation of an existing condition; PMDD symptoms are cyclic and typically improve after menstruation begins.

A new mother develops persistent sadness, loss of interest, and difficulty functioning after delivery. What should the nurse assess for?

Postpartum depression, including symptom severity, onset, functioning, and suicide risk.

A postpartum client has a personal history of depression, limited family support, and a difficult delivery. How should the nurse interpret these findings?

These are risk factors for postpartum depression and indicate the need for screening and support.

A mother appears withdrawn and reports feeling overwhelmed during a well-child visit. What should the nurse do?

Screen for postpartum depression, assess safety and functioning, and connect the mother with appropriate treatment and support.

A postpartum client reports persistent depressive symptoms and difficulty bonding with the infant. What interventions can the nurse encourage?

Mental health treatment, practical and emotional support, and follow-up care; assess maternal and infant safety.

A new mother reports hearing voices and believing her infant is possessed. What is the nurse's priority?

Treat as postpartum psychosis—a psychiatric emergency; protect the mother and infant and arrange immediate psychiatric evaluation.

A postpartum client expresses delusions and thoughts of harming the infant. What should the nurse do?

Ensure immediate infant and maternal safety, do not leave the client alone with the infant, and initiate emergency psychiatric intervention.

A family member says a new mother's hallucinations are probably normal postpartum stress. What should the nurse explain?

Hallucinations and delusions are not typical postpartum depression symptoms; they may indicate postpartum psychosis requiring emergency treatment.

A postpartum client develops psychotic symptoms rapidly after delivery. Why is routine outpatient follow-up insufficient?

Postpartum psychosis carries a risk of suicide and infanticide and requires immediate stabilization, often including psychiatric hospitalization.

A client with a depressive disorder subtype asks whether treatment is different from treatment for other depression. What should the nurse explain?

Treatment is individualized to the subtype and trigger and may include antidepressants, psychotherapy, and targeted interventions such as light therapy for SAD.

A postpartum client is prescribed brexanolone or zuranolone. What should the nurse recognize?

These medications are specifically used for postpartum depression; brexanolone is administered IV, while zuranolone is oral.

A nurse cares for a client with recurrent depression related to hormonal changes or seasonal patterns. What information is useful for treatment planning?

Track symptom timing, duration, severity, functional impact, and recurrence to identify patterns and guide individualized treatment.

A client reports depressed mood on most days for 30 months but continues working and caring for family. Which disorder best fits this history?

A. Postpartum psychosis
B. Persistent depressive disorder
C. Premenstrual dysphoric disorder
D. Seasonal affective disorder

B. Persistent depressive disorder

A client with chronic low-grade depression develops severe hopelessness, marked anhedonia, and worsening functional impairment. What should the nurse suspect?

A. Normal progression of aging
B. Seasonal affective disorder
C. A superimposed major depressive episode
D. Postpartum psychosis

C. A superimposed major depressive episode

A client develops depression every winter and improves during spring. Which intervention should the nurse anticipate?

A. Bright-light therapy
B. Emergency psychiatric hospitalization for all cases
C. Avoiding daylight
D. Restricting social interaction

A. Bright-light therapy

A client experiences severe premenstrual irritability and depressed mood that disrupt work and relationships but improve shortly after menstruation begins. Which condition is most likely?

A. Persistent depressive disorder
B. Postpartum depression
C. Premenstrual dysphoric disorder
D. Seasonal affective disorder

C. Premenstrual dysphoric disorder

A mother 1 week after delivery reports hearing voices instructing her to harm her infant. What is the nurse's priority?

A. Schedule routine postpartum screening.
B. Ensure immediate safety and arrange emergency psychiatric evaluation.
C. Encourage the mother to rest and reassess tomorrow.
D. Reassure the mother that this is a normal hormonal change.

B. Ensure immediate safety and arrange emergency psychiatric evaluation.

A mother reports persistent sadness, loss of interest, and difficulty functioning after delivery. She denies hallucinations or delusions. What is the best nursing action?

A. Assume these symptoms are normal and require no follow-up.
B. Screen for postpartum depression, assess safety, and arrange appropriate treatment.
C. Immediately diagnose postpartum psychosis.
D. Recommend avoiding all contact with supportive family members.

B. Screen for postpartum depression, assess safety, and arrange appropriate treatment.

A postpartum client asks about prescribed zuranolone. Which statement is accurate?

A. It is an oral medication used for postpartum depression.
B. It is a light-therapy device.
C. It is used only to treat seasonal affective disorder.
D. It eliminates the need for safety monitoring.

A. It is an oral medication used for postpartum depression.

Which client requires the most immediate intervention?

A. An adult with chronic mild depressive symptoms for 3 years.
B. A client with winter-pattern depression asking about light therapy.
C. A client with PMDD whose symptoms interfere with work.
D. A postpartum client experiencing delusions involving the infant.

D. A postpartum client experiencing delusions involving the infant.

A client with a family history of depression develops MDD after losing a job. Which model best explains why the episode occurred?

Diathesis-stress model: biological predisposition combined with a stressor triggers depression.

A client with MDD asks why antidepressants affect serotonin and norepinephrine. What should the nurse explain?

Depression is associated with dysregulation of serotonin, norepinephrine, and/or dopamine; antidepressants target specific neurotransmitter systems.

A client with chronic stress develops depressive symptoms. Which hormonal mechanism may contribute?

HPA-axis dysregulation and chronically elevated cortisol are associated with depression.

A client with a history of childhood abuse develops depression in adulthood. How is this history relevant?

Adverse childhood experiences increase lifetime depression risk, particularly when combined with other vulnerabilities.

A client has depressive symptoms and takes corticosteroids. What should the nurse consider before attributing the symptoms to primary MDD?

Medication-induced depression; review medications and assess other potential causes.

An older adult develops fatigue, low mood, and slowed thinking alongside hypothyroidism. What should the nurse suspect?

A medical condition contributing to or mimicking depression; assess and address secondary causes.

A client reports depressed mood, fatigue, insomnia, and guilt for 3 weeks. Does this automatically meet MDD criteria?

No. MDD requires at least 5 of 9 symptoms during the same 2-week period, including depressed mood or anhedonia, plus clinically significant distress or impairment.