BSN 346 – HESI Case Study: Suicide & Nursing Care
| Nightingale College Concepts of Nursing III Study
Guide & Case Study Review 2026/2027 | Suicide: A
Sentinel Event, Suicide Risk Assessment, Mental
Health Nursing, Patient Safety, Therapeutic
Communication, Suicide Prevention, Nursing
Interventions, Risk Factors, Clinical Judgment,
Care Planning, HESI Case Study Practice, Answers
& Detailed Explanations
Question 1: A nurse is assessing a client who has expressed suicidal ideation.
Which of the following findings places the client at the highest risk for a
suicide attempt?
A. A history of one previous suicide attempt
B. Expressing feelings of hopelessness
C. Having a well-defined, detailed plan for suicide
D. A family history of depression
CORRECT ANSWER: C. Having a well-defined, detailed plan for suicide
Rationale: While all options are risk factors, a specific, detailed plan is the most acute
indicator of imminent risk. It demonstrates that the client has moved from ideation to
the action phase, significantly increasing the likelihood of an attempt.
Question 2: A client with major depressive disorder tells the nurse, "I don't
want to be a burden anymore. Everyone would be better off without me." What
is the nurse's priority response?
A. "You have so much to live for, think of your family."
B. "Tell me more about what you're feeling right now."
C. "It's important to focus on the positive aspects of your life."
D. "I'm going to prescribe you an antidepressant to help you feel better."
CORRECT ANSWER: B. "Tell me more about what you're feeling right now."
Rationale: The client's statement indicates suicidal ideation. The priority is to perform a
thorough suicide risk assessment. An open-ended, therapeutic response encourages the
client to elaborate on their feelings, allowing the nurse to assess the severity and intent
of the ideation.
Question 3: A nurse is evaluating the lethality of a client's suicidal plan. Which
factor is the most critical in determining the potential for a fatal outcome?
A. The time of day the plan is to be carried out
B. The client's knowledge of the method
C. The availability and accessibility of the means
D. The client's history of self-harm
,CORRECT ANSWER: C. The availability and accessibility of the means
Rationale: Lethality is determined by the potential of the method to cause death. The
most critical factor is the means' availability. If a highly lethal method is easily accessible
(e.g., a firearm in the home), the risk of a fatal attempt is substantially higher.
Question 4: A nurse is creating a safety plan with a client who has suicidal
ideation. Which of the following is the most important component to include?
A. A list of reasons for living
B. A list of coping strategies and distractions
C. A list of emergency contacts and a 24-hour crisis hotline
D. A schedule of daily activities
CORRECT ANSWER: C. A list of emergency contacts and a 24-hour crisis
hotline
Rationale: A safety plan is a prioritized, written list of coping strategies and sources of
support. While all options are components, the most critical is having immediate access
to professional help for when the client's coping strategies are ineffective and they are at
imminent risk.
Question 5: A client on a psychiatric unit is placed on suicide precautions.
Which of the following nursing interventions is the highest priority?
A. Encouraging the client to participate in group therapy
B. Ensuring the client attends all scheduled meals
C. Maintaining continuous, close observation of the client
D. Promoting client autonomy and independence
CORRECT ANSWER: C. Maintaining continuous, close observation of the client
Rationale: The primary goal of suicide precautions is client safety. Continuous, close
observation is the most effective intervention to prevent a suicide attempt on the unit.
This is often referred to as "one-to-one" observation.
Question 6: A nurse is caring for a client who is at high risk for suicide. What is
the most appropriate way to document the client's behavior?
A. "Client appears to be in a better mood today."
B. "Client is cooperative with unit routine."
C. "Client denies suicidal ideation, but affect is flat."
D. "Client stated, 'I feel like giving up,' and refused to participate in unit activities."
CORRECT ANSWER: D. "Client stated, 'I feel like giving up,' and refused to
participate in unit activities."
Rationale: Documentation must be objective, factual, and based on observable behavior
and direct client statements. Option D provides a specific, direct quote and describes
observable behavior, which is legally and clinically sound.
,Question 7: A client with a history of suicidal behavior is prescribed a tricyclic
antidepressant. The nurse's priority teaching point regarding suicide risk is:
A. "This medication can cause a rapid heart rate."
B. "You must avoid drinking alcohol while on this medication."
C. "The risk of suicide may increase during the first few weeks of therapy."
D. "This medication is highly addictive."
CORRECT ANSWER: C. "The risk of suicide may increase during the first few
weeks of therapy."
Rationale: Antidepressants can cause an initial increase in energy and motivation before
lifting the depressive mood. This can paradoxically increase the risk of suicide as the
client may now have the energy to act on their suicidal thoughts.
Question 8: According to the CDC, which of the following demographic groups
has the highest rate of suicide?
A. Adolescent females
B. Middle-aged White males
C. Elderly females
D. Young adult African American males
CORRECT ANSWER: B. Middle-aged White males
Rationale: While suicide affects all demographics, middle-aged White males consistently
have the highest suicide rates in the United States. This is a key epidemiological finding
for nurses to be aware of for risk assessment.
Question 9: A nurse is assessing a client's risk factors for suicide. Which
psychosocial factor is a significant predictor of suicidal behavior?
A. High socioeconomic status
B. Strong social support network
C. A recent interpersonal loss or divorce
D. A stable employment history
CORRECT ANSWER: C. A recent interpersonal loss or divorce
Rationale: Psychosocial stressors, such as recent loss (of a relationship, job, status), are
significant precipitating factors for suicide. They can overwhelm an individual's coping
mechanisms and increase vulnerability.
Question 10: A client who is being discharged after being treated for suicidal
ideation is prescribed a 30-day supply of a potentially lethal medication. What
is the nurse's best action?
A. Provide the client with the full prescription as ordered.
B. Instruct the client to only take the medication when feeling suicidal.
C. Coordinate with the provider to dispense the medication in smaller, weekly amounts.
D. Tell the client to flush any remaining pills if they feel suicidal.
, CORRECT ANSWER: C. Coordinate with the provider to dispense the
medication in smaller, weekly amounts.
Rationale: To reduce the risk of an impulsive overdose, it is safest to dispense
medication in smaller quantities. This limits the amount of medication the client has
access to at any given time. This requires a collaborative effort with the prescribing
provider.
Question 11: The "SAD PERSONS" scale is used to assess suicide risk. The "P"
in the acronym stands for:
A. Previous suicide attempt
B. Psychiatric illness
C. Parental loss
D. Poor social support
CORRECT ANSWER: A. Previous suicide attempt
Rationale: The SAD PERSONS scale is a mnemonic for risk factors (Sex, Age,
Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports
lacking, Organized plan, No spouse, Sickness). A previous suicide attempt is a major
predictor of future attempts.
Question 12: A nurse is assessing a client who is refusing to eat or take their
medications. They state, "My body is already dead. There's no point." This
statement is most indicative of:
A. A need for physical restraint
B. A normal grieving process
C. A manifestation of hopelessness and potential suicidal intent
D. A side effect of their antipsychotic medication
CORRECT ANSWER: C. A manifestation of hopelessness and potential suicidal
intent
Rationale: Statements of being "dead" or worthless are severe manifestations of
hopelessness, which is a core cognitive component of depression and a very strong
predictor of suicidal intent. This requires immediate assessment and intervention.
Question 13: A nurse is caring for an adolescent who is a victim of bullying
and has expressed suicidal ideation. Which of the following is the nurse's
priority action?
A. Tell the adolescent to ignore the bullying.
B. Report the bullying to the school administration.
C. Reassure the adolescent that things will get better.
D. Focus on building the adolescent's self-esteem.
CORRECT ANSWER: B. Report the bullying to the school administration.
| Nightingale College Concepts of Nursing III Study
Guide & Case Study Review 2026/2027 | Suicide: A
Sentinel Event, Suicide Risk Assessment, Mental
Health Nursing, Patient Safety, Therapeutic
Communication, Suicide Prevention, Nursing
Interventions, Risk Factors, Clinical Judgment,
Care Planning, HESI Case Study Practice, Answers
& Detailed Explanations
Question 1: A nurse is assessing a client who has expressed suicidal ideation.
Which of the following findings places the client at the highest risk for a
suicide attempt?
A. A history of one previous suicide attempt
B. Expressing feelings of hopelessness
C. Having a well-defined, detailed plan for suicide
D. A family history of depression
CORRECT ANSWER: C. Having a well-defined, detailed plan for suicide
Rationale: While all options are risk factors, a specific, detailed plan is the most acute
indicator of imminent risk. It demonstrates that the client has moved from ideation to
the action phase, significantly increasing the likelihood of an attempt.
Question 2: A client with major depressive disorder tells the nurse, "I don't
want to be a burden anymore. Everyone would be better off without me." What
is the nurse's priority response?
A. "You have so much to live for, think of your family."
B. "Tell me more about what you're feeling right now."
C. "It's important to focus on the positive aspects of your life."
D. "I'm going to prescribe you an antidepressant to help you feel better."
CORRECT ANSWER: B. "Tell me more about what you're feeling right now."
Rationale: The client's statement indicates suicidal ideation. The priority is to perform a
thorough suicide risk assessment. An open-ended, therapeutic response encourages the
client to elaborate on their feelings, allowing the nurse to assess the severity and intent
of the ideation.
Question 3: A nurse is evaluating the lethality of a client's suicidal plan. Which
factor is the most critical in determining the potential for a fatal outcome?
A. The time of day the plan is to be carried out
B. The client's knowledge of the method
C. The availability and accessibility of the means
D. The client's history of self-harm
,CORRECT ANSWER: C. The availability and accessibility of the means
Rationale: Lethality is determined by the potential of the method to cause death. The
most critical factor is the means' availability. If a highly lethal method is easily accessible
(e.g., a firearm in the home), the risk of a fatal attempt is substantially higher.
Question 4: A nurse is creating a safety plan with a client who has suicidal
ideation. Which of the following is the most important component to include?
A. A list of reasons for living
B. A list of coping strategies and distractions
C. A list of emergency contacts and a 24-hour crisis hotline
D. A schedule of daily activities
CORRECT ANSWER: C. A list of emergency contacts and a 24-hour crisis
hotline
Rationale: A safety plan is a prioritized, written list of coping strategies and sources of
support. While all options are components, the most critical is having immediate access
to professional help for when the client's coping strategies are ineffective and they are at
imminent risk.
Question 5: A client on a psychiatric unit is placed on suicide precautions.
Which of the following nursing interventions is the highest priority?
A. Encouraging the client to participate in group therapy
B. Ensuring the client attends all scheduled meals
C. Maintaining continuous, close observation of the client
D. Promoting client autonomy and independence
CORRECT ANSWER: C. Maintaining continuous, close observation of the client
Rationale: The primary goal of suicide precautions is client safety. Continuous, close
observation is the most effective intervention to prevent a suicide attempt on the unit.
This is often referred to as "one-to-one" observation.
Question 6: A nurse is caring for a client who is at high risk for suicide. What is
the most appropriate way to document the client's behavior?
A. "Client appears to be in a better mood today."
B. "Client is cooperative with unit routine."
C. "Client denies suicidal ideation, but affect is flat."
D. "Client stated, 'I feel like giving up,' and refused to participate in unit activities."
CORRECT ANSWER: D. "Client stated, 'I feel like giving up,' and refused to
participate in unit activities."
Rationale: Documentation must be objective, factual, and based on observable behavior
and direct client statements. Option D provides a specific, direct quote and describes
observable behavior, which is legally and clinically sound.
,Question 7: A client with a history of suicidal behavior is prescribed a tricyclic
antidepressant. The nurse's priority teaching point regarding suicide risk is:
A. "This medication can cause a rapid heart rate."
B. "You must avoid drinking alcohol while on this medication."
C. "The risk of suicide may increase during the first few weeks of therapy."
D. "This medication is highly addictive."
CORRECT ANSWER: C. "The risk of suicide may increase during the first few
weeks of therapy."
Rationale: Antidepressants can cause an initial increase in energy and motivation before
lifting the depressive mood. This can paradoxically increase the risk of suicide as the
client may now have the energy to act on their suicidal thoughts.
Question 8: According to the CDC, which of the following demographic groups
has the highest rate of suicide?
A. Adolescent females
B. Middle-aged White males
C. Elderly females
D. Young adult African American males
CORRECT ANSWER: B. Middle-aged White males
Rationale: While suicide affects all demographics, middle-aged White males consistently
have the highest suicide rates in the United States. This is a key epidemiological finding
for nurses to be aware of for risk assessment.
Question 9: A nurse is assessing a client's risk factors for suicide. Which
psychosocial factor is a significant predictor of suicidal behavior?
A. High socioeconomic status
B. Strong social support network
C. A recent interpersonal loss or divorce
D. A stable employment history
CORRECT ANSWER: C. A recent interpersonal loss or divorce
Rationale: Psychosocial stressors, such as recent loss (of a relationship, job, status), are
significant precipitating factors for suicide. They can overwhelm an individual's coping
mechanisms and increase vulnerability.
Question 10: A client who is being discharged after being treated for suicidal
ideation is prescribed a 30-day supply of a potentially lethal medication. What
is the nurse's best action?
A. Provide the client with the full prescription as ordered.
B. Instruct the client to only take the medication when feeling suicidal.
C. Coordinate with the provider to dispense the medication in smaller, weekly amounts.
D. Tell the client to flush any remaining pills if they feel suicidal.
, CORRECT ANSWER: C. Coordinate with the provider to dispense the
medication in smaller, weekly amounts.
Rationale: To reduce the risk of an impulsive overdose, it is safest to dispense
medication in smaller quantities. This limits the amount of medication the client has
access to at any given time. This requires a collaborative effort with the prescribing
provider.
Question 11: The "SAD PERSONS" scale is used to assess suicide risk. The "P"
in the acronym stands for:
A. Previous suicide attempt
B. Psychiatric illness
C. Parental loss
D. Poor social support
CORRECT ANSWER: A. Previous suicide attempt
Rationale: The SAD PERSONS scale is a mnemonic for risk factors (Sex, Age,
Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports
lacking, Organized plan, No spouse, Sickness). A previous suicide attempt is a major
predictor of future attempts.
Question 12: A nurse is assessing a client who is refusing to eat or take their
medications. They state, "My body is already dead. There's no point." This
statement is most indicative of:
A. A need for physical restraint
B. A normal grieving process
C. A manifestation of hopelessness and potential suicidal intent
D. A side effect of their antipsychotic medication
CORRECT ANSWER: C. A manifestation of hopelessness and potential suicidal
intent
Rationale: Statements of being "dead" or worthless are severe manifestations of
hopelessness, which is a core cognitive component of depression and a very strong
predictor of suicidal intent. This requires immediate assessment and intervention.
Question 13: A nurse is caring for an adolescent who is a victim of bullying
and has expressed suicidal ideation. Which of the following is the nurse's
priority action?
A. Tell the adolescent to ignore the bullying.
B. Report the bullying to the school administration.
C. Reassure the adolescent that things will get better.
D. Focus on building the adolescent's self-esteem.
CORRECT ANSWER: B. Report the bullying to the school administration.
