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 was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a covert suicidal message?
"My family will be better off without me."
"Life is not worth living."
"I wish I were dead."
"I have a plan that will fix everything"
The Correct Answer is A
A. "My family will be better off without me" is an indirect or covert suicidal statement (passive ideation) that suggests the patient believes others would be better off if they were gone. Such remarks require immediate assessment of suicide risk (ask directly about thoughts, intent, plan, access to means) and appropriate safety interventions.
B. "Life is not worth living" is an explicit expression of hopelessness and indicates suicidal ideation, but it is more overt than covert. It still warrants urgent assessment, but the question asked specifically for the covert message.
C. "I wish I were dead" is a direct statement of suicidal desire (overt) rather than a covert hint.
D. "I have a plan that will fix everything" is the most concerning because it indicates a specific plan (high lethality risk), but it is overt rather than covert.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Communication disorders involve difficulties with speech, language, or communication (e.g., stuttering, limited vocabulary). The main problem here is hyperactivity, not speech/language impairment.
B. ADHD is characterized by inattention, hyperactivity, and impulsivity. Behaviors such as being in constant motion, excessive talking, lack of sustained interest in activities, and getting up early with energy are hallmark signs of hyperactive/impulsive type ADHD.
C. Intellectual development disorder (formerly mental retardation) involves below-average intellectual functioning and impaired adaptive skills, not constant hyperactivity and excessive talking.
D. Stereotypic movement disorder is repetitive, purposeless motor behavior (e.g., hand flapping, head banging), not generalized hyperactivity and impulsivity.
Correct Answer is D
Explanation
A. "I hate all of you!" –This reflects the patient’s anger and hostility, which is expected after being restrained. While it requires therapeutic communication, it does not signal a medical emergency.
B. "The other patient started the fight." – This statement is defensive and attempts to shift blame. Although it provides insight into the patient’s thought process, it is not urgent from a physiological standpoint.
C. "You wait until I tell my lawyer." – This reflects frustration and a threat of legal action. It is important for documentation and de-escalation but does not require immediate clinical intervention.
D. "My fingers are tingly." – This is the highest priority because it indicates impaired circulation or nerve compression related to the restraints. Tingling, numbness, coolness, or pallor are warning signs that restraints are too tight or causing neurovascular compromise. This can lead to permanent injury if not corrected promptly.
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