Which individual should the nurse consider at highest risk for suicide?

A retired older male whose significant other has passed away.

A nurse who works in a pediatric emergency department.

An adolescent male whose parents recently divorced.

A single working mother with three pre-school aged children.

Answer and Explanation

The Correct Answer is C

A.   While the loss of a significant other can be a risk factor for suicide, retired older males may have developed coping mechanisms over time that could mitigate the risk.
B.   While working in a pediatric emergency department can be stressful, it does not necessarily indicate a higher risk for suicide compared to other factors such as personal life stressors or mental health issues.
C.   Adolescents experiencing significant life changes such as parental divorce are at increased risk for suicide due to the emotional upheaval and lack of coping skills typical of this age group.

D.   While being a single working mother with three preschool-aged children can be stressful, it does not inherently indicate a higher risk for suicide compared to other factors such as social support, coping mechanisms, and mental health status.

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Correct Answer is A

Explanation

A. Nausea and vomiting could indicate potential lithium toxicity, which requires immediate medical attention to prevent serious complications.
B. Short-term memory loss is a known side effect of lithium therapy but may not require immediate medical attention unless severe or persistent.
C. Weight gain is a common side effect of lithium, but a five-pound (2.3 kg) gain may not be considered significant enough to warrant immediate medical attention unless it occurs rapidly or is accompanied by other symptoms.
D. Depressed affect is a symptom of depression and may be related to the client's underlying condition but may not require immediate medical attention unless it poses a risk to the client's safety.

A. Concentrate on and ventilate emotions when distressed. B. Relax and reduce the amount of effort to solve the problem. C. Shift attention from self to the needs and requests of others. D. Focus on small achievable tasks, not taxing problems.

Correct Answer is D

Explanation

A. Ventilating emotions when distressed may be helpful in some situations, but it may not directly address the client's avoidance behavior or assist in building coping skills to manage responsibilities.
B. Relaxing and reducing effort to solve problems may exacerbate feelings of helplessness and avoidance, rather than promoting active coping strategies.
C. Shifting attention from self to the needs and requests of others may be beneficial in certain contexts, but it may not directly address the client's depressive symptoms or avoidance behavior.
D. Focusing on small achievable tasks allows the client to experience a sense of accomplishment and mastery, which can help counteract feelings of helplessness and build confidence in managing responsibilities. This approach aligns with behavioral activation techniques commonly used in the treatment of depression.

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Which individual should the nurse consider at highest risk for suicide?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is admitting a male client who takes lithium carbonate twice a day. Which information should the nurse report to the healthcare provider immediately?

Correct Answer is A

Explanation

A client with depression does not want to communicate with friends, uses television watching as a means of escaping responsibilities, and describes the inability to handle personal circumstances. Which coping strategy should the nurse include in the plan of care?

Correct Answer is D

Explanation

A male client with a recent diagnosis of bipolar disorder takes lithium carbonate daily. The client informed the school nurse of the desire to live away from home to attend college after graduating in one month. Which information is most important for the nurse to provide the client and his family?

A client requests permission for the spouse to remain in the room during the admission assessment. While interviewing the client, the nurse notes a discrepancy between the client's verbal and nonverbal communication. Which action should the nurse take?

A client who has agoraphobia is beginning desensitization with the therapist, and the nurse is reinforcing the process. Which intervention has the highest priority for this client's plan of care?

The nurse wants to teach the client about the long-term phase symptoms of rape-trauma syndrome. What symptoms are consistent with long-term rape trauma? Select all that apply.

The nurse observes a client with a history of psychosis repeatedly looking to the side and mumbling responses to no one present in that direction. Which comment is best for the nurse to make?

A client with schizophrenia returns to the clinic two weeks after receiving a prescription for haloperidol. To assess for neuroleptic malignant syndrome (NMS), which information is most important for the nurse to obtain during this visit?