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

Isolating the client from friends and family to prevent further emotional distress.

Encouraging the client to keep their feelings and experiences private.

Collaborating with the client to develop a comprehensive aftercare plan.

Discharging the client home as soon as possible to resume their daily routine.

Answer and Explanation

The Correct Answer is C

Choice C rationale:

Collaborating with the client to develop a comprehensive aftercare plan is a priority nursing goal for a client who has recently attempted suicide and is now stabilized. Aftercare planning involves creating a structured plan that addresses the client's ongoing psychological, emotional, and social needs. This includes arranging follow-up therapy sessions, connecting with appropriate community resources, and involving the client in decisions regarding their care. Developing an aftercare plan aims to prevent further episodes of suicidal ideation and support the client's overall well-being. Isolating the client from friends and family, as mentioned in choice A, would be counterproductive. Isolation can exacerbate feelings of loneliness and hopelessness, potentially increasing the risk of further emotional distress. Encouraging the client to keep their feelings and experiences private, as suggested in choice B, is not in line with therapeutic practice. Open communication and sharing emotions with appropriate support systems are crucial for the client's healing process. Discharging the client home as soon as possible, as mentioned in choice D, without addressing the underlying issues and providing a comprehensive aftercare plan, could lead to a recurrence of suicidal thoughts and behaviors. It is essential to ensure the client's safety and well-being before considering discharge.

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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.

A. Encourage isolation to minimize potential stressors. B. Assist the client in creating a safety plan. C. Teach the client relaxation techniques. D. Focus solely on the client's past failures.

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.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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 nurse is working with a client who has suicidal ideation. Which intervention should the nurse implement to promote hope in the client?

Correct Answer is B

Explanation

A nurse is providing education to a client and their family about suicide prevention. Which information should the nurse prioritize in the education?

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):

A nurse is evaluating the effectiveness of the plan of care for a patient with suicidal ideation. What action should the nurse take during the evaluation phase?

A nurse is assessing a patient with suicidal ideation. Which statement made by the patient requires immediate intervention?

(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.

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):

A client is diagnosed with "Hopelessness." How would the nurse define this nursing diagnosis for a patient with suicidal ideation?

A nurse is conducting an assessment for a patient with suicidal ideation. Which skill involves acknowledging the patient's feelings and thoughts as real and understandable without agreeing or disagreeing with them?