A charge nurse on a mental health unit is describing assessments for suicide risks to a group of newly licensed nurses. Which of the following tests should the nurse include?(Select All that Apply.)

Harvard Implicit Association Test (IAT)

PHQ-9

Altman Self-Rating Mania Scale

SAD PERSONS

SAFE-T

Answer and Explanation

Correct Answer : B,D,E

Rationale:

A. The Harvard Implicit Association Test (IAT) measures implicit biases and is not used specifically for assessing suicide risk.

B. The PHQ-9 (Patient Health Questionnaire-9) is a validated tool for screening, diagnosing, monitoring, and measuring the severity of depression, which is closely related to suicide risk.

C. The Altman Self-Rating Mania Scale is used to assess the severity of manic symptoms in clients with bipolar disorder, not for suicide risk assessment.

D. The SAD PERSONS scale is a tool specifically designed to assess suicide risk based on key risk factors.

E. The SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) is a comprehensive framework for assessing suicide risk, making it an appropriate tool to include in suicide risk assessments.

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Correct Answer is A

Explanation

Rationale:

A. The primary criterion for removing restraints is that the client must be calm and cooperative, indicating that the immediate safety concern has been addressed.

B. Verbalizing remorse is not a requirement for removing restraints; the focus is on the client's behavior and cooperation.

C. The provider does not need to be present for the nurse to assess the client's readiness for removal of restraints, although provider orders and assessments are important.

D. Simply verbalizing anger does not indicate that the restraints can be removed; the client must demonstrate appropriate behavior and cooperation.

A. Contact the provider for directions on how to proceed. B. Support the privacy of the client and do not discuss the loss. C. Stand when speaking to the client with door of the room open. D. Acknowledge and recognize that the client has experienced a loss

Correct Answer is D

Explanation

Rationale:

A. Contacting the provider for directions may be necessary in some cases, but it does not directly demonstrate grief-informed care, which involves understanding and addressing the emotional needs of the grieving client.

B. Supporting the client's privacy is important, but avoiding discussions about the loss may prevent the client from processing their grief, which is not aligned with grief-informed care.

C. Standing while speaking and keeping the door open can make the client feel uncomfortable or unsupported during a vulnerable time. Grief-informed care emphasizes creating a supportive and empathetic environment.

D. Acknowledging and recognizing that the client has experienced a loss is a key component of grief-informed care. It validates the client's feelings and opens the door for further support and therapeutic interventions.

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A charge nurse on a mental health unit is describing assessments for suicide risks to a group of newly licensed nurses. Which of the following tests should the nurse include?(Select All that Apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is in physical restraints after demonstrating aggressive behavior. Which of the following criteria must be met before the nurse can remove the restraints?

Correct Answer is A

Explanation

A nurse is preparing to care for a client who is experiencing complicated grief. Which of the following actions demonstrates grief-informed care?

Correct Answer is D

Explanation

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