A nurse is assessing a patient with suicidal ideation. Which statement made by the patient requires immediate intervention?
"Sometimes, I just wish all of this would end.".
"I have been feeling really down lately.".
"I've been making a list of things I want to do before I die.".
"I think things might get better if I reach out to my friends.".
The Correct Answer is A
Choice A rationale:
This statement indicates a clear and direct expression of suicidal ideation. The phrase "wish all of this would end" strongly implies a desire for one's life to end, which is a significant concern in assessing a patient with suicidal thoughts. Immediate intervention is necessary to ensure the patient's safety and address their emotional distress.
Choice B rationale:
This statement, "I have been feeling really down lately," expresses a general sense of sadness and low mood. While it suggests emotional distress, it does not explicitly convey a direct intention for self-harm or suicide. However, it should not be ignored and should be explored further during the assessment.
Choice C rationale:
"I've been making a list of things I want to do before I die" is a statement that may have different implications. While it could relate to the patient's interests and goals, it does not necessarily indicate a current intent for suicide. It is important to clarify the context and content of the list before drawing any conclusions.
Choice D rationale:
"I think things might get better if I reach out to my friends" suggests that the patient is considering seeking support from friends, which is generally a positive coping strategy. This statement does not express an immediate risk of self-harm or suicide. However, it's still essential to evaluate the patient's overall emotional state and social support.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Encouraging isolation to minimize potential stressors is not a appropriate intervention for a client with suicidal ideation. Isolation can exacerbate feelings of loneliness and hopelessness, which can further contribute to the client's distress.
Choice B rationale:
Assisting the client in creating a safety plan is a crucial intervention for a client with suicidal ideation. A safety plan helps the client identify strategies and resources to use when they experience overwhelming emotions or thoughts of self-harm. This plan provides a sense of control and practical steps to follow during times of crisis, promoting hope that they can manage their emotions and stay safe.
Choice C rationale:
Teaching the client relaxation techniques is a valuable intervention, but it may not directly address the immediate need for a safety plan. Relaxation techniques can be helpful for managing anxiety and stress, but they might not be sufficient to prevent self-harm or suicide attempts.
Choice D rationale:
Focusing solely on the client's past failures is counterproductive and can further erode the client's self-esteem and hope. It's important to focus on the client's strengths, coping skills, and the potential for positive change rather than dwelling on past difficulties.
Correct Answer is ["C","E"]
Explanation
Choice A rationale:
Being extroverted is not a common risk factor associated with suicide and suicidal ideation. Extroverted individuals typically have strong social interactions and connections, which are often considered protective factors against suicide.
Choice B rationale:
Having strong family support is not a common risk factor for suicide. In fact, strong family support is generally considered a protective factor that can mitigate the risk of suicidal thoughts and behaviors. Close familial relationships can provide emotional support and a sense of belonging.
Choice C rationale:
Experiencing chronic physical illness is a common risk factor for suicide. Chronic physical illness can lead to prolonged suffering, decreased quality of life, and feelings of hopelessness, which are all associated with an increased risk of suicidal ideation.
Choice D rationale:
Having a history of positive life events is not a common risk factor for suicide. Positive life events are more likely to act as protective factors against suicide, as they contribute to an individual's overall well-being and resilience.
Choice E rationale:
Suffering from a substance use disorder is a common risk factor for suicide. Substance abuse can impair judgment, increase impulsivity, exacerbate emotional distress, and weaken the individual's ability to cope effectively, all of which contribute to an elevated risk of suicidal thoughts and behaviors.
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