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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Offering reassurance without addressing the client's immediate concerns may minimize the severity of the situation and delay necessary interventions.
B. Asking the client about the lethality of their plan is crucial for assessing the level of risk and determining the urgency of the intervention required. This information is essential for planning appropriate care and ensuring the client's safety.
C. Allowing the client to be alone is not appropriate when they have expressed suicidal intent, as this could increase the risk of self-harm.
D. Encouraging the client to focus on the positive aspects of life may be part of long-term therapy, but in the acute phase, the priority is to assess and address the immediate risk of suicide.
Correct Answer is B
Explanation
Rationale:
A. This statement undermines the importance of therapeutic communication, which is essential in building trust and understanding with clients.
B. Therapeutic communication is indeed a fundamental part of mental health nursing and plays a crucial role in establishing a therapeutic relationship that supports the client's emotional and psychological well-being.
C. Therapeutic communication is vital in nurse-client interactions and is integral to effective mental health care, not just nurse-to-nurse communication.
D. Therapeutic communication in healthcare requires specific skills and approaches that differ from everyday conversation, emphasizing the need for sensitivity, empathy, and active listening.
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