A nurse is caring for a client 3 days after admission for treatment of depression. The client leaves her current activity, approaches the nurse and states, "There's no reason to go on living. I just want to end it all." Which of the following actions should the nurse take?

Recognize the attempt at manipulation and escort the client back to her activity.

Notify the client's family and request a visitor to stay with the client until thoughts of suicide are gone.

Ask the client if she has a plan to commit suicide.

Assist the client to her room and allow her to rest before resuming activity.

Answer and Explanation

The Correct Answer is C

A.   Dismissing the client's statement as manipulation without proper assessment can be dangerous.
B.   While involving family support is important, this response doesn’t address the immediate safety concerns of the client.
C.   Asking about suicidal plans helps assess the level of risk and informs subsequent actions to ensure the client's safety.
D.   The situation requires more immediate assessment and action due to the expressed suicidal ideation.

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Correct Answer is C

Explanation

A. While staying alone can be concerning, it might not be the strongest indicator of an impending suicide attempt in this scenario.
B. Excessive crying is a potential sign of distress but might not directly point towards an impending suicide attempt.
C. Giving away prized possessions or making significant gifts is often considered a strong indicator of an impending suicide attempt, indicating a sense of "getting affairs in order."
D. Attempting to communicate with family might suggest seeking support rather than indicating an impending suicide attempt.

A. "I am glad you are feeling better. The team will consider your request." B. "Because we are concerned about your safety, we will continue with our plan." C. "I wonder what this sudden change is all about. Please tell me more." D. "You should not try to direct your care. Leave that to the treatment team."

Correct Answer is B

Explanation

A. While acknowledging the patient's feelings is important, ensuring safety is the priority, and the response should emphasize the ongoing concern for safety.
B. Prioritizing patient safety and care is crucial, especially in situations involving suicidal risks.
C. Encouraging the patient to elaborate further is essential; however, the priority is to maintain the safety precautions.
D. Directing the patient to not participate in their care isn't supportive or therapeutic, especially when safety is a concern.

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A nurse is caring for a client 3 days after admission for treatment of depression. The client leaves her current activity, approaches the nurse and states, "There's no reason to go on living. I just want to end it all." Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After failing two tests, a college student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt?

Correct Answer is C

Explanation

A severely depressed patient who has been on suicide precautions tells the nurse, "I am feeling a lot better, so you can stop watching me. I have taken too much of your time already." Which is the nurse's best response?

Correct Answer is B

Explanation

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