A nurse is assessing an adolescent female client who has anorexia nervosa. Which of the following findings should the nurse expect?

Choice B rationale:

Schizophrenia is a severe mental illness that is characterized by disturbances in thought, perception, emotion, and behavior. It is associated with an increased risk of suicide, with estimates suggesting that up to 10% of individuals with schizophrenia will die by suicide.

Several factors contribute to the increased risk of suicide in individuals with schizophrenia, including:

Hopelessness and despair: Individuals with schizophrenia often experience profound feelings of hopelessness and despair, which can lead to suicidal thoughts and behaviors.

Psychotic symptoms: Psychotic symptoms, such as delusions and hallucinations, can also contribute to suicide risk. For example, an individual with schizophrenia may experience auditory hallucinations that command them to harm themselves.

Impaired judgment: Schizophrenia can impair an individual's judgment and decision-making abilities, which can make it more difficult for them to resist suicidal urges.

Social isolation: Individuals with schizophrenia often experience social isolation, which can further increase their risk of suicide.

Comorbidity with other mental disorders: Schizophrenia is often comorbid with other mental disorders, such as depression and anxiety, which can also increase suicide risk.

Substance abuse: Substance abuse is a common problem among individuals with schizophrenia, and it can further increase suicide risk.

Choice C rationale:

Alcohol use disorder is a chronic, relapsing brain disease characterized by compulsive alcohol use, despite harmful consequences. It is a significant risk factor for suicide, with studies suggesting that individuals with alcohol use disorder are 10-14 times more likely to die by suicide than the general population.

Several factors contribute to the increased risk of suicide in individuals with alcohol use disorder, including: Depression: Alcohol use disorder is often comorbid with depression, which is a major risk factor for suicide. Impulsivity: Alcohol can impair judgment and increase impulsivity, which can lead to suicidal behaviors.

Social isolation: Alcohol use disorder can lead to social isolation, which can increase suicide risk.

Access to lethal means: Individuals with alcohol use disorder may have access to lethal means, such as firearms, which can increase the risk of suicide completion.

Choice D rationale:

Substance use disorder is a chronic, relapsing brain disease characterized by compulsive drug use, despite harmful consequences. It is a significant risk factor for suicide, with studies suggesting that individuals with substance use disorder are 6-12 times more likely to die by suicide than the general population.

Several factors contribute to the increased risk of suicide in individuals with substance use disorder, including: Depression: Substance use disorder is often comorbid with depression, which is a major risk factor for suicide. Impulsivity: Substance use can impair judgment and increase impulsivity, which can lead to suicidal behaviors.

Hopelessness: Individuals with substance use disorder may experience feelings of hopelessness and despair, which can increase suicide risk.

Social isolation: Substance use disorder can lead to social isolation, which can increase suicide risk.

Access to lethal means: Individuals with substance use disorder may have access to lethal means, such as firearms, which can increase the risk of suicide completion.

Choice F rationale:

Age greater than 65 years old is a risk factor for suicide. Suicide rates are highest among older adults, particularly white men over the age of 85.

Several factors contribute to the increased risk of suicide in older adults, including:

Chronic health conditions: Older adults are more likely to experience chronic health conditions, such as pain, disability, and cognitive decline, which can increase suicide risk.

Social isolation: Older adults are more likely to experience social isolation due to factors such as retirement, loss of loved ones, and decreased mobility.

Loss of independence: Older adults may experience a loss of independence due to physical and cognitive decline, which can contribute to suicide risk.

Access to lethal means: Older adults may have access to lethal means, such as firearms or medications, which can increase the risk of suicide completion.

Rationale:

Choice A: While social isolation can be a risk factor for suicide, spending time with close friends can actually be protective. This statement alone does not suggest an increased risk.

Choice B: Religious involvement and participation in religious activities can be protective factors against suicide by providing support, meaning, and a sense of belonging. This statement does not indicate a specific risk.

Choice C: Consistent, healthy sleep patterns are generally associated with positive mental health and are not indicative of suicidal ideation. This statement does not raise concerns for suicide risk.

Choice D: Exposure to suicide, particularly within one's social circle or among individuals one admires, is a significant risk factor for suicide due to the phenomenon of "social contagion." The recent suicide of the adolescent's favorite actor increases his vulnerability and necessitates immediate assessment and intervention.

Social contagion refers to the tendency for suicidal behaviors to spread within a community or group, particularly among adolescents and young adults. Exposure to a suicide can trigger suicidal thoughts and feelings in vulnerable individuals, especially if they identify with the deceased or perceive the suicide as a viable coping mechanism.

The adolescent's age (15 years) is also a crucial factor. Adolescence is a period of heightened emotional vulnerability and increased risk for suicidal ideation and behavior due to various developmental and psychosocial challenges.

The father's concern suggests that the adolescent may be exhibiting other concerning behaviors or changes in mood or behavior. The nurse should gather more information and conduct a comprehensive suicide risk assessment to determine the level of risk and implement appropriate interventions.

Additional considerations:

The nurse should inquire about the nature of the adolescent's relationship with the deceased actor, his emotional state since the suicide, and any other potential stressors or vulnerabilities he may be facing.

The nurse should involve the parents in the assessment and intervention process, providing them with education and resources on suicide prevention and support.

If the assessment indicates a high risk of suicide, the nurse should immediately refer the adolescent to a mental health professional or emergency department for further evaluation and treatment.

Remember: Suicide is a serious public health issue, and early identification and intervention are crucial in preventing tragic outcomes. School nurses play a vital role in recognizing warning signs and providing timely support and resources to adolescents at risk.