Suicide Risk Assessment: Final Exam (Comprehensive) -
Questions with Correct Answers
100 questions
1. Expressions of rage or seeking revenge are listed as warning signs because they:
A. Always mean the person is safe
B. Indicate a medical problem only
C. Can accompany intense psychological pain and impulsive self-directed or outward violence
D. Never relate to suicide
Correct Answer: C. Can accompany intense psychological pain and impulsive self-directed or
outward violence
Rationale: Anger and agitation are associated with acute risk, and some people at risk express
uncontrolled anger after perceived injustice or loss. Assessment should address risk to self and others.
Anger does not mean the person is safe.
2. A patient increases daily drinking after losing his job and says alcohol helps him numb the
pain. This warning sign is important because:
A. Alcohol is protective
B. It shows healthy coping
C. Escalating substance use often accompanies and intensifies a suicidal crisis
D. It means depression has resolved
Correct Answer: C. Escalating substance use often accompanies and intensifies a suicidal
crisis
Rationale: Increased use of alcohol or drugs is part of IS PATH WARM and can reflect attempts to cope
with unbearable feelings while increasing impulsivity. The clinician should assess suicidal ideation and
substance use together. Alcohol is not protective.
3. The ASQ includes a question about past suicide attempts because:
A. It is unrelated to current risk
B. A prior attempt is a strong predictor of future suicide
C. It replaces questions about current thoughts
D. It is required for billing only
Correct Answer: B. A prior attempt is a strong predictor of future suicide
Rationale: Lifetime attempt history adds important risk information beyond current thoughts. The ASQ
asks about wish to be dead, feeling family would be better off, recent thoughts of killing oneself and past
attempts. It does not replace questions about current thoughts.
,4. A limitation of relying only on PHQ-9 item 9 for suicide screening is that it:
A. Is too long
B. Can miss people at risk who deny depressive symptoms and does not distinguish passive from
active ideation
C. Measures only mania
D. Is used only for children
Correct Answer: B. Can miss people at risk who deny depressive symptoms and does not
distinguish passive from active ideation
Rationale: Some people at risk do not endorse depressive symptoms, and item 9 does not assess plan,
intent or behavior. Many organizations therefore use the ASQ or C-SSRS in addition. The PHQ-9 is brief
and used across ages.
5. A comprehensive suicide risk assessment differs from screening in that it:
A. Uses only a few yes or no questions
B. Is done only by family members
C. Explores ideation, plans, intent, behaviors, risk and protective factors, and context to form a
clinical judgment
D. Replaces the need for safety planning
Correct Answer: C. Explores ideation, plans, intent, behaviors, risk and protective factors,
and context to form a clinical judgment
Rationale: Screening identifies who needs further evaluation, while assessment gathers detailed
information to estimate risk and plan care. It leads directly into safety planning. It is performed by trained
clinicians, not family.
6. A clinician feels anxious and wants to end the interview quickly after a patient discloses
suicidal thoughts. This reaction:
A. Means the patient is not at risk
B. Is common and should be recognized so it does not interfere with a thorough assessment
C. Should lead to immediate discharge
D. Is a reason to avoid future assessments
Correct Answer: B. Is common and should be recognized so it does not interfere with a
thorough assessment
Rationale: Strong clinician emotions, including anxiety, frustration or avoidance, can lead to incomplete
assessment or reactive decisions. Supervision and consultation help clinicians manage them. These
feelings do not indicate patient risk level.
,7. When deciding on level of care, clinicians should consider the patient's:
A. Risk level, protective factors, supports, willingness to engage, and access to means
B. Insurance alone
C. Diagnosis alone
D. Age alone
Correct Answer: A. Risk level, protective factors, supports, willingness to engage, and access
to means
Rationale: Disposition depends on the overall formulation, including whether supports can provide
monitoring and whether means can be secured. A single factor such as insurance or diagnosis is
insufficient.
8. A patient at high risk who agrees to admission should generally be offered:
A. Involuntary admission regardless of willingness
B. Discharge home
C. Voluntary admission, which preserves autonomy and engagement
D. No treatment
Correct Answer: C. Voluntary admission, which preserves autonomy and engagement
Rationale: Voluntary admission is preferred when the person has capacity and agrees, supporting
collaboration. Involuntary status is used when the person refuses and meets legal criteria. Discharging a
high-risk patient without a safe plan is unsafe.
9. The Crisis Response Plan developed by Bryan and Rudd differs from a standard safety plan in
that it:
A. Is often written on an index card and emphasizes a narrative of the suicidal crisis to identify
warning signs
B. Is a legal contract
C. Excludes coping strategies
D. Is only used in hospitals
Correct Answer: A. Is often written on an index card and emphasizes a narrative of the
suicidal crisis to identify warning signs
Rationale: The CRP is a brief intervention shown to reduce suicide attempts among military personnel,
using a card format with warning signs, coping strategies, reasons for living and crisis resources. It is not
a contract.
, 10. Medication safety counseling for a person at risk includes:
A. Stockpiling extra supplies
B. Keeping all medications in one easily accessible place
C. Avoiding pharmacist involvement
D. Limiting quantities at home, using a lockbox, and disposing of unused medications
Correct Answer: D. Limiting quantities at home, using a lockbox, and disposing of unused
medications
Rationale: Reducing the amount of medication available limits the harm of an impulsive overdose; family
can hold and dispense medications. Pharmacists can provide blister packs and smaller supplies.
Stockpiling increases risk.
11. Youth suicide prevention gatekeepers in schools include:
A. Only psychiatrists
B. Only parents
C. No school staff
D. Teachers, coaches, counselors, nurses, and other staff trained to recognize warning signs
Correct Answer: D. Teachers, coaches, counselors, nurses, and other staff trained to
recognize warning signs
Rationale: Training school staff increases recognition and referral of at-risk students. School nurses often
see students with somatic complaints that mask distress. Prevention involves the whole school
community.
12. Research has shown rising suicide rates among Black youth in recent years, and
contributing factors may include:
A. Lack of any stressors
B. Higher access to mental health services than other groups
C. Genetic inferiority
D. Racism, discrimination, community violence, and reduced access to culturally responsive care
Correct Answer: D. Racism, discrimination, community violence, and reduced access to
culturally responsive care
Rationale: Black youth, including young children, have shown concerning increases in suicide deaths,
and structural racism and barriers to care contribute. Culturally responsive services and anti-racist
approaches are needed. Genetic explanations are unfounded and harmful.
Questions with Correct Answers
100 questions
1. Expressions of rage or seeking revenge are listed as warning signs because they:
A. Always mean the person is safe
B. Indicate a medical problem only
C. Can accompany intense psychological pain and impulsive self-directed or outward violence
D. Never relate to suicide
Correct Answer: C. Can accompany intense psychological pain and impulsive self-directed or
outward violence
Rationale: Anger and agitation are associated with acute risk, and some people at risk express
uncontrolled anger after perceived injustice or loss. Assessment should address risk to self and others.
Anger does not mean the person is safe.
2. A patient increases daily drinking after losing his job and says alcohol helps him numb the
pain. This warning sign is important because:
A. Alcohol is protective
B. It shows healthy coping
C. Escalating substance use often accompanies and intensifies a suicidal crisis
D. It means depression has resolved
Correct Answer: C. Escalating substance use often accompanies and intensifies a suicidal
crisis
Rationale: Increased use of alcohol or drugs is part of IS PATH WARM and can reflect attempts to cope
with unbearable feelings while increasing impulsivity. The clinician should assess suicidal ideation and
substance use together. Alcohol is not protective.
3. The ASQ includes a question about past suicide attempts because:
A. It is unrelated to current risk
B. A prior attempt is a strong predictor of future suicide
C. It replaces questions about current thoughts
D. It is required for billing only
Correct Answer: B. A prior attempt is a strong predictor of future suicide
Rationale: Lifetime attempt history adds important risk information beyond current thoughts. The ASQ
asks about wish to be dead, feeling family would be better off, recent thoughts of killing oneself and past
attempts. It does not replace questions about current thoughts.
,4. A limitation of relying only on PHQ-9 item 9 for suicide screening is that it:
A. Is too long
B. Can miss people at risk who deny depressive symptoms and does not distinguish passive from
active ideation
C. Measures only mania
D. Is used only for children
Correct Answer: B. Can miss people at risk who deny depressive symptoms and does not
distinguish passive from active ideation
Rationale: Some people at risk do not endorse depressive symptoms, and item 9 does not assess plan,
intent or behavior. Many organizations therefore use the ASQ or C-SSRS in addition. The PHQ-9 is brief
and used across ages.
5. A comprehensive suicide risk assessment differs from screening in that it:
A. Uses only a few yes or no questions
B. Is done only by family members
C. Explores ideation, plans, intent, behaviors, risk and protective factors, and context to form a
clinical judgment
D. Replaces the need for safety planning
Correct Answer: C. Explores ideation, plans, intent, behaviors, risk and protective factors,
and context to form a clinical judgment
Rationale: Screening identifies who needs further evaluation, while assessment gathers detailed
information to estimate risk and plan care. It leads directly into safety planning. It is performed by trained
clinicians, not family.
6. A clinician feels anxious and wants to end the interview quickly after a patient discloses
suicidal thoughts. This reaction:
A. Means the patient is not at risk
B. Is common and should be recognized so it does not interfere with a thorough assessment
C. Should lead to immediate discharge
D. Is a reason to avoid future assessments
Correct Answer: B. Is common and should be recognized so it does not interfere with a
thorough assessment
Rationale: Strong clinician emotions, including anxiety, frustration or avoidance, can lead to incomplete
assessment or reactive decisions. Supervision and consultation help clinicians manage them. These
feelings do not indicate patient risk level.
,7. When deciding on level of care, clinicians should consider the patient's:
A. Risk level, protective factors, supports, willingness to engage, and access to means
B. Insurance alone
C. Diagnosis alone
D. Age alone
Correct Answer: A. Risk level, protective factors, supports, willingness to engage, and access
to means
Rationale: Disposition depends on the overall formulation, including whether supports can provide
monitoring and whether means can be secured. A single factor such as insurance or diagnosis is
insufficient.
8. A patient at high risk who agrees to admission should generally be offered:
A. Involuntary admission regardless of willingness
B. Discharge home
C. Voluntary admission, which preserves autonomy and engagement
D. No treatment
Correct Answer: C. Voluntary admission, which preserves autonomy and engagement
Rationale: Voluntary admission is preferred when the person has capacity and agrees, supporting
collaboration. Involuntary status is used when the person refuses and meets legal criteria. Discharging a
high-risk patient without a safe plan is unsafe.
9. The Crisis Response Plan developed by Bryan and Rudd differs from a standard safety plan in
that it:
A. Is often written on an index card and emphasizes a narrative of the suicidal crisis to identify
warning signs
B. Is a legal contract
C. Excludes coping strategies
D. Is only used in hospitals
Correct Answer: A. Is often written on an index card and emphasizes a narrative of the
suicidal crisis to identify warning signs
Rationale: The CRP is a brief intervention shown to reduce suicide attempts among military personnel,
using a card format with warning signs, coping strategies, reasons for living and crisis resources. It is not
a contract.
, 10. Medication safety counseling for a person at risk includes:
A. Stockpiling extra supplies
B. Keeping all medications in one easily accessible place
C. Avoiding pharmacist involvement
D. Limiting quantities at home, using a lockbox, and disposing of unused medications
Correct Answer: D. Limiting quantities at home, using a lockbox, and disposing of unused
medications
Rationale: Reducing the amount of medication available limits the harm of an impulsive overdose; family
can hold and dispense medications. Pharmacists can provide blister packs and smaller supplies.
Stockpiling increases risk.
11. Youth suicide prevention gatekeepers in schools include:
A. Only psychiatrists
B. Only parents
C. No school staff
D. Teachers, coaches, counselors, nurses, and other staff trained to recognize warning signs
Correct Answer: D. Teachers, coaches, counselors, nurses, and other staff trained to
recognize warning signs
Rationale: Training school staff increases recognition and referral of at-risk students. School nurses often
see students with somatic complaints that mask distress. Prevention involves the whole school
community.
12. Research has shown rising suicide rates among Black youth in recent years, and
contributing factors may include:
A. Lack of any stressors
B. Higher access to mental health services than other groups
C. Genetic inferiority
D. Racism, discrimination, community violence, and reduced access to culturally responsive care
Correct Answer: D. Racism, discrimination, community violence, and reduced access to
culturally responsive care
Rationale: Black youth, including young children, have shown concerning increases in suicide deaths,
and structural racism and barriers to care contribute. Culturally responsive services and anti-racist
approaches are needed. Genetic explanations are unfounded and harmful.
