Varcarolis Chapter 25: Suicide and
Non-Suicidal Self-Injury
A patient tells the nurse that he or she believes his or her situation is intolerable. The nurse
assesses that the patient is isolating socially. A nursing diagnosis that should be considered is
1. Hopelessness
2. Deficient knowledge
3. Chronic low self-esteem
4. Compromised family coping - ANS1
Which neurotransmitter has been implicated as playing a part in the decision to commit suicide?
1. γ-Aminobutyric acid
2. Dopamine
3. Serotonin
4. Acetylcholine - ANS3
Which change in neurotransmission is associated with suicidal thinking?
1. Increased gamma-aminobutyric acid (GABA) activity in the hypothalamus.
2. Increased norepinephrine reserves in the thalamus and pons.
3. Decreased serotonin activity in the brainstem and prefrontal cortex.
4. Decreased numbers of dopamine and glutamate receptors in the temporal lobes. - ANS3
Low serotonin levels are related to depressed mood and depression is commonly associated
with suicide. Postmortem examinations of individuals who complete suicide also reveal a low
level of serotonin in the brainstem or the frontal cortex. GABA is associated with anxiety.
Increased norepinephrine is associated with stimulation of the sympathetic nervous system.
A patient admitted to the hospital for radiation therapy for lung cancer wants to end his life.
What would be the most appropriate response of the nurse?
1. Inform the health care provider.
2. Inform the hospital security staff.
3. Ignore the patient and continue with the assessment.
4. Ask if the patient has any plans to commit suicide. - ANS4
A man tells the nurse that his life became a mess after he married his wife a few months earlier
and he has no reason to continue living. What should the nurse ask him first?
1. "Do you have any plans to end your life right now?"
2. "Life has ups and downs, but we need to face it bravely."
3. "Do you have any relatives to look after you when you are sick?"
4. "Can you please tell me the exact duration of your married life?" - ANS1
,A young adult is informed of a positive laboratory test for human immunodeficiency virus (HIV).
The patient tells the nurse, "Well, I know what I need to do now." What is the nurse's next
action?
1. Give information on local support groups.
2. Assess the patient's risk for suicide.
3. Discuss results of the newest medication research.
4. Arrange a consultation with the social worker. - ANS2
A patient who has come for flu treatment is found to have agranulocytosis and myocarditis on
assessment. He has taken acetaminophen (Tylenol) and cetirizine (Zyrtec) for flu. The patient is
also a known diabetic and has schizophrenia. He is taking metformin (Glucophage) for diabetes
and clozapine (Clozaril) for schizophrenia. Which of these drugs could have caused
agranulocytosis and myocarditis?
1. Metformin (Glucophage)
2. Clozapine (Clozaril)
3. Cetirizine (Zyrtec)
4. Acetaminophen (Tylenol) - ANS2
Clozapine decreases the risk of suicide in patients with schizophrenia. However, these patients
should be regularly monitored for severe side effects of clozapine, like agranulocytosis,
myocarditis, and altered glucose metabolism. A common side effect of metformin is
gastrointestinal disturbance; cetirizine can cause drowsiness; and paracetamol in large amounts
can lead to liver toxicity.
If a suicidal patient is to be treated outside the hospital, which intervention would be of highest
priority?
1. Have the patient identify three people to call if the patient is overwhelmed by hopelessness.
2. Make sure the patient has food enough to last for two to three days.
3. Arrange for a police visit every 24 hours.
4. Provide a one-week supply of antidepressant medication. - ANS1
the nurse is caring for a patient who has been admitted for being at a risk of suicide. The patient
is very angry about the meals that are provided. How should the nurse respond to the patient's
behavior?
1. Remain neutral and do not react angrily to the patient.
2. Restrain the patient to the bed as there is risk of injury to others.
3. Call the security staff immediately to control the patient.
4. Ask the patient to cooperate as all the patients get the same meals. - ANS1
The nurse is giving information about different theories of suicide. When does a person usually
commit copycat suicide?
1. After a person loses his or her job
2. After a person loses his or her self-esteem
3.After losing freedom due to imminent incarceration
4. After a highly publicized suicide of a public figure - ANS4
, The nurse is concerned that a depressed male patient may be displaying a nonverbal suicidal
threat when he presents another patient with his favorite shirt as a "gift." What is the nurse's
initial intervention?
1. Place the patient on suicide precautions, including 15-minute checks.
2. Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself.
3. Support the patient by telling him that he will need the shirt when he's discharged.
4. Document that the patient has shown behaviors that are likely subtle suicide threats. - ANS2
A nurse is taking caring of a patient who has attempted suicide. What appropriate intervention
should the nurse follow for effective treatment?
1. Encourage nonverbal communication in the patient.
2. Believe that the patient doesn't plan to commit suicide in the future.
3. Emotionally connect with the patient's situation.
4. Identify the problems experienced by the patient. - ANS4
A child dies after being struck by a car. The health care provider tells the parents, "Your child's
injuries were so severe that there was nothing we could do." What is the initial nursing
intervention?
1. Bring the parents to a room to be alone.
2. Explain all the medical interventions attempted.
3. Stay with the parents until a support person arrives.
4. Give the parents a referral for a grief-counseling group. - ANS3
A 70-year-old male patient lost a spouse 3 months ago, has no children, and lives alone. The
patient had depression at the age of 25, started drinking alcohol then, and has been treated with
antidepressants. The patient reports disturbed sleep and decreased appetite. On assessment
the nurse finds that the patient has dementia and is unable to think rationally. What would be the
most appropriate intervention for the nurse according to the SAD PERSONS scale?
1. Hospitalize the patient.
2. Refer the patient to a psychiatrist.
3. Follow up the next day.
4. Follow up after a few days - ANS1
The nurse should evaluate the patient for the risk of suicide according to the SAD PERSONS
scale. According to this scale, the patient's total score is 7, with 1 point each for age (1), gender
(1), lack of spouse (1), lack of social support (1), use of alcohol (1), episode of depression (1),
and loss of ability to think rationally (1). Therefore, the nurse should immediately hospitalize the
patient as there is high risk for suicide. The psychiatrist can be contacted once the patient is
hospitalized. The patient should not be sent home and asked to come for follow-up because the
patient is at high risk of suicide.
An adult attempted suicide after termination from employment. This patient was hospitalized
and has taken antidepressant medication for two weeks. The nurse observes the patient is now
brighter and more sociable. What is the nurse's highest priority intervention?
Non-Suicidal Self-Injury
A patient tells the nurse that he or she believes his or her situation is intolerable. The nurse
assesses that the patient is isolating socially. A nursing diagnosis that should be considered is
1. Hopelessness
2. Deficient knowledge
3. Chronic low self-esteem
4. Compromised family coping - ANS1
Which neurotransmitter has been implicated as playing a part in the decision to commit suicide?
1. γ-Aminobutyric acid
2. Dopamine
3. Serotonin
4. Acetylcholine - ANS3
Which change in neurotransmission is associated with suicidal thinking?
1. Increased gamma-aminobutyric acid (GABA) activity in the hypothalamus.
2. Increased norepinephrine reserves in the thalamus and pons.
3. Decreased serotonin activity in the brainstem and prefrontal cortex.
4. Decreased numbers of dopamine and glutamate receptors in the temporal lobes. - ANS3
Low serotonin levels are related to depressed mood and depression is commonly associated
with suicide. Postmortem examinations of individuals who complete suicide also reveal a low
level of serotonin in the brainstem or the frontal cortex. GABA is associated with anxiety.
Increased norepinephrine is associated with stimulation of the sympathetic nervous system.
A patient admitted to the hospital for radiation therapy for lung cancer wants to end his life.
What would be the most appropriate response of the nurse?
1. Inform the health care provider.
2. Inform the hospital security staff.
3. Ignore the patient and continue with the assessment.
4. Ask if the patient has any plans to commit suicide. - ANS4
A man tells the nurse that his life became a mess after he married his wife a few months earlier
and he has no reason to continue living. What should the nurse ask him first?
1. "Do you have any plans to end your life right now?"
2. "Life has ups and downs, but we need to face it bravely."
3. "Do you have any relatives to look after you when you are sick?"
4. "Can you please tell me the exact duration of your married life?" - ANS1
,A young adult is informed of a positive laboratory test for human immunodeficiency virus (HIV).
The patient tells the nurse, "Well, I know what I need to do now." What is the nurse's next
action?
1. Give information on local support groups.
2. Assess the patient's risk for suicide.
3. Discuss results of the newest medication research.
4. Arrange a consultation with the social worker. - ANS2
A patient who has come for flu treatment is found to have agranulocytosis and myocarditis on
assessment. He has taken acetaminophen (Tylenol) and cetirizine (Zyrtec) for flu. The patient is
also a known diabetic and has schizophrenia. He is taking metformin (Glucophage) for diabetes
and clozapine (Clozaril) for schizophrenia. Which of these drugs could have caused
agranulocytosis and myocarditis?
1. Metformin (Glucophage)
2. Clozapine (Clozaril)
3. Cetirizine (Zyrtec)
4. Acetaminophen (Tylenol) - ANS2
Clozapine decreases the risk of suicide in patients with schizophrenia. However, these patients
should be regularly monitored for severe side effects of clozapine, like agranulocytosis,
myocarditis, and altered glucose metabolism. A common side effect of metformin is
gastrointestinal disturbance; cetirizine can cause drowsiness; and paracetamol in large amounts
can lead to liver toxicity.
If a suicidal patient is to be treated outside the hospital, which intervention would be of highest
priority?
1. Have the patient identify three people to call if the patient is overwhelmed by hopelessness.
2. Make sure the patient has food enough to last for two to three days.
3. Arrange for a police visit every 24 hours.
4. Provide a one-week supply of antidepressant medication. - ANS1
the nurse is caring for a patient who has been admitted for being at a risk of suicide. The patient
is very angry about the meals that are provided. How should the nurse respond to the patient's
behavior?
1. Remain neutral and do not react angrily to the patient.
2. Restrain the patient to the bed as there is risk of injury to others.
3. Call the security staff immediately to control the patient.
4. Ask the patient to cooperate as all the patients get the same meals. - ANS1
The nurse is giving information about different theories of suicide. When does a person usually
commit copycat suicide?
1. After a person loses his or her job
2. After a person loses his or her self-esteem
3.After losing freedom due to imminent incarceration
4. After a highly publicized suicide of a public figure - ANS4
, The nurse is concerned that a depressed male patient may be displaying a nonverbal suicidal
threat when he presents another patient with his favorite shirt as a "gift." What is the nurse's
initial intervention?
1. Place the patient on suicide precautions, including 15-minute checks.
2. Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself.
3. Support the patient by telling him that he will need the shirt when he's discharged.
4. Document that the patient has shown behaviors that are likely subtle suicide threats. - ANS2
A nurse is taking caring of a patient who has attempted suicide. What appropriate intervention
should the nurse follow for effective treatment?
1. Encourage nonverbal communication in the patient.
2. Believe that the patient doesn't plan to commit suicide in the future.
3. Emotionally connect with the patient's situation.
4. Identify the problems experienced by the patient. - ANS4
A child dies after being struck by a car. The health care provider tells the parents, "Your child's
injuries were so severe that there was nothing we could do." What is the initial nursing
intervention?
1. Bring the parents to a room to be alone.
2. Explain all the medical interventions attempted.
3. Stay with the parents until a support person arrives.
4. Give the parents a referral for a grief-counseling group. - ANS3
A 70-year-old male patient lost a spouse 3 months ago, has no children, and lives alone. The
patient had depression at the age of 25, started drinking alcohol then, and has been treated with
antidepressants. The patient reports disturbed sleep and decreased appetite. On assessment
the nurse finds that the patient has dementia and is unable to think rationally. What would be the
most appropriate intervention for the nurse according to the SAD PERSONS scale?
1. Hospitalize the patient.
2. Refer the patient to a psychiatrist.
3. Follow up the next day.
4. Follow up after a few days - ANS1
The nurse should evaluate the patient for the risk of suicide according to the SAD PERSONS
scale. According to this scale, the patient's total score is 7, with 1 point each for age (1), gender
(1), lack of spouse (1), lack of social support (1), use of alcohol (1), episode of depression (1),
and loss of ability to think rationally (1). Therefore, the nurse should immediately hospitalize the
patient as there is high risk for suicide. The psychiatrist can be contacted once the patient is
hospitalized. The patient should not be sent home and asked to come for follow-up because the
patient is at high risk of suicide.
An adult attempted suicide after termination from employment. This patient was hospitalized
and has taken antidepressant medication for two weeks. The nurse observes the patient is now
brighter and more sociable. What is the nurse's highest priority intervention?
