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A nurse is caring for a client who has expressed suicidal thoughts. Select all the interventions that the nurse should include in the implementation phase of the client's care.

Administering prescribed antidepressant medication.

Creating a hope box for the client.

Teaching relaxation techniques to the client.

Encouraging social isolation to prevent triggers.

Providing crisis hotline numbers to the client.

Answer and Explanation

Correct Answer : A,B,C,E

Choice A:

Administering prescribed antidepressant medication.

Choice B:

Creating a hope box for the client.

Choice C:

Teaching relaxation techniques to the client.

Choice E:

Providing crisis hotline numbers to the client.

Choice A rationale:

Administering prescribed antidepressant medication. This intervention can be included in the implementation phase of care for a client with expressed suicidal thoughts. Antidepressant medication, when prescribed by a healthcare provider, can help alleviate depressive symptoms and improve the client's overall mental state.

Choice B rationale:

Creating a hope box for the client. Creating a hope box, filled with personal mementos, coping strategies, and reminders of positive experiences, can provide the client with a tangible tool for managing moments of despair. This can contribute to the client's emotional well-being and resilience.

Choice C rationale:

Teaching relaxation techniques to the client. Teaching relaxation techniques, such as deep breathing, mindfulness, or progressive muscle relaxation, can equip the client with coping skills to manage anxiety, stress, and overwhelming emotions. These techniques can be valuable in preventing escalation of suicidal thoughts.

Choice D rationale:

Encouraging social isolation to prevent triggers. This choice is not appropriate for a client with expressed suicidal thoughts. Encouraging social isolation can exacerbate feelings of loneliness and hopelessness, potentially increasing the risk of self-harm. Social support and connection are essential protective factors.

Choice E rationale:

Providing crisis hotline numbers to the client. Supplying crisis hotline numbers ensures that the client has access to immediate support during times of distress. This intervention helps the client reach out for help when needed and promotes safety.

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Correct Answer is ["A","B","C"]

Explanation

Choice A:

Risk for suicide.

Choice B:

Ineffective family coping.

Choice C:

Chronic low self-esteem.

Choice A rationale:

This choice aligns with the primary concern of the patient being at risk for suicide, which is the focus of the assessment. Identifying this diagnosis is crucial for implementing appropriate interventions to ensure the patient's safety.

Choice B rationale:

Ineffective family coping could contribute to the patient's stressors and emotional state. It's relevant because the support system plays a significant role in a patient's mental health. However, it might not be as immediate a concern as the risk for suicide itself.

Choice C rationale:

Chronic low self-esteem is relevant to the patient's overall mental health and might contribute to their suicidal ideation. However, it might not directly address the immediate risk and urgency of the situation compared to the diagnosis of "Risk for suicide."

Choice D rationale:

Altered nutrition and risk for infection are not directly related to the primary concern of suicidal ideation and the associated nursing diagnoses. While they may be aspects of the patient's overall health, they are not the most pertinent concerns when addressing the risk of suicide.

A. The importance of isolation during times of distress. B. The role of faith healing in preventing suicidal thoughts. C. Crisis hotline numbers, such as the National Suicide Prevention Lifeline. D. The necessity of solving all life problems before seeking help.

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.

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A nurse is caring for a client who has expressed suicidal thoughts. Select all the interventions that the nurse should include in the implementation phase of the client's care.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

(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.

Correct Answer is ["A","B","C"]

Explanation

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 with suicidal ideation. Which statement made by the patient requires immediate intervention?

A nurse is establishing a therapeutic relationship with a patient at risk for suicide. Which of the following skills should the nurse use to build rapport and trust with the patient? (Select all that apply):

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

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 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 client has been diagnosed with depression and has a history of suicide attempts. What intervention is essential for the nurse to implement?

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?