A client is being assessed for nursing diagnoses related to suicidal ideation. Which nursing diagnosis prioritization principle should the nurse apply according to Maslow's hierarchy of needs?

Psychological needs are more important than physiological needs.

Social isolation takes precedence over impaired coping.

Physiological needs are more important than psychological needs.

Grieving is considered the highest priority diagnosis.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Psychological needs are more important than physiological needs. This statement contradicts Maslow's hierarchy of needs. According to Maslow's theory, physiological needs, such as air, water, food, and shelter, are at the base of the hierarchy and must be satisfied before addressing higher-level psychological needs.

Choice B rationale:

Social isolation takes precedence over impaired coping. While social isolation can indeed have a significant impact on a person's well-being, Maslow's hierarchy places physiological needs as the foundation. Without satisfying basic physiological needs, addressing higher-level psychological and social needs becomes less effective.

Choice C rationale:

Physiological needs are more important than psychological needs. This choice aligns with Maslow's hierarchy of needs. The hierarchy starts with physiological needs as the most fundamental, followed by safety, belongingness and love, esteem, and finally, self-actualization. A person's physiological needs (like breathing, food, water, sleep) must be met before psychological needs (such as self-esteem, achievement) can be effectively addressed.

Choice D rationale:

Grieving is considered the highest priority diagnosis. Grieving, while important, isn't necessarily the highest priority diagnosis according to Maslow's hierarchy. It falls under psychological and emotional needs, which are secondary to physiological needs. Urgent physiological needs take precedence over emotional needs in this context.

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Correct Answer is C

Explanation

Choice A rationale:

The importance of isolation during times of distress is not accurate information. Isolation can exacerbate feelings of loneliness and hopelessness, potentially increasing the risk of suicidal thoughts. Encouraging isolation can prevent individuals from seeking help and support when they need it the most.

Choice B rationale:

The role of faith healing in preventing suicidal thoughts is not a universally applicable solution. While faith and spirituality can provide comfort and support to some individuals, it's important to recognize that suicide prevention requires a comprehensive approach that often involves professional intervention and evidence-based strategies. Relying solely on faith healing may neglect other important aspects of mental health care.

Choice C rationale:

Crisis hotline numbers, such as the National Suicide Prevention Lifeline, are crucial resources for individuals in crisis. These hotlines provide immediate access to trained professionals who can offer support, intervention, and referrals to mental health services. Sharing these hotline numbers empowers the client's family to take proactive steps in seeking help during times of crisis.

Choice D rationale:

The necessity of solving all life problems before seeking help is an unrealistic expectation. Mental health challenges, including suicidal thoughts, do not always correlate with external life problems. Waiting until all problems are solved could delay necessary intervention and support. It's essential to encourage seeking help early, even if all problems cannot be immediately resolved.

A. "This scale assesses suicide-related thoughts and behaviors in the past year.". B. "This self-report questionnaire screens for depression and suicidal ideation in the past two weeks.". C. "It guides the evaluation and triage of patients with suicidal ideation or behavior based on five steps.". D. "The C-SSRS measures the severity and intensity of suicidal ideation and behavior in the past month.".

Correct Answer is C

Explanation

Choice A rationale:

This statement is not accurate. The Columbia-Suicide Severity Rating Scale (C-SSRS) is not focused on assessing suicide-related thoughts and behaviors in the past year. Instead, it is designed to assess the severity of suicidal ideation and behavior over a specified time frame.

Choice B rationale:

This statement is not accurate. The C-SSRS is not a self-report questionnaire for depression and suicidal ideation in the past two weeks. It is a structured interview that involves a series of questions and prompts administered by a trained clinician to assess the severity of suicidal ideation and behavior.

Choice C rationale:

This statement is accurate. The Columbia-Suicide Severity Rating Scale (C-SSRS) guides the evaluation and triage of patients with suicidal ideation or behavior based on five steps: Determining the presence of active suicidal ideation. Assessing the intensity of ideation. Examining the presence and severity of any preparatory behavior. Evaluating the level of intent to die. Determining the lethality of the suicide plan. The C-SSRS is widely used in clinical and research settings to assess suicide risk and guide appropriate interventions.

Choice D rationale:

This statement is not accurate. The C-SSRS does not measure the severity and intensity of suicidal ideation and behavior in the past month. It focuses on assessing the severity of suicidal ideation and behavior based on the steps mentioned in choice C.

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A client is being assessed for nursing diagnoses related to suicidal ideation. Which nursing diagnosis prioritization principle should the nurse apply according to Maslow's hierarchy of needs?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client's family about suicide prevention. What information should the nurse emphasize when discussing resources for help and support?

Correct Answer is C

Explanation

A nurse is assessing a patient's suicide risk using standardized tools. Which statement is accurate regarding the Columbia-Suicide Severity Rating Scale (C-SSRS)?

Correct Answer is C

Explanation

A client with a history of suicide attempts is admitted to the hospital. Which statement by the client should the nurse address during the assessment phase?

(Select all that apply): A nurse is analyzing data collected during the assessment phase for a patient at risk for suicide. Which of the following nursing diagnoses are commonly associated with suicidal ideation? Select three.

(Select All That Apply): A client has expressed thoughts of suicide during a therapy session. Which therapeutic interventions should the nurse incorporate into the client's care plan? (Select three.).

A nurse is providing education to a group of healthcare professionals about suicide and suicidal ideation. Which of the following statements accurately describes suicidal ideation?

A nurse is providing care to a client who is displaying warning signs of suicidal ideation. Which interventions should the nurse prioritize to ensure the client's safety? (Select all that apply.).

A nurse is caring for a client who recently attempted suicide and is now stabilized. What is a priority nursing goal for this client?

A nurse is assessing a client for potential suicidal ideation. The client says, "I've been thinking a lot about death lately. I wonder what it's like to not exist anymore." What would be an appropriate response by the nurse?

A nurse is conducting an assessment of a client who may be at risk for suicide. Which of the following are common risk factors associated with suicide and suicidal ideation? (Select All That Apply):