The nurse should frequently assess a client with a depressive disorder for lethality risk related to suicidal ideation. Which questions should the nurse include? (Select all that apply.)
"Where do you keep your gun?"
"Are you thinking about hurting yourself or someone else?"
"Have you thought about how you would hurt yourself?"
"Can you tell me your feelings about dying?"
"Have you told your psychiatrist you feel like dying?"
Correct Answer : A,B,C,D
Choice A reason: While it’s important to assess access to lethal means, this question is too specific and assumes the client owns a gun. A more appropriate question might be, “Do you have access to any means to harm yourself?”
Choice B reason: Inquiring about thoughts of self-harm or harming others is a direct question that assesses suicidal ideation and intent, which is essential for determining immediate risk.
Choice C reason: Understanding if the client has specific plans for self-harm can help gauge the immediacy and seriousness of the suicide risk.
Choice D reason: Discussing feelings about dying can provide insight into the client's emotional state and potential risk for suicide.
Choice E reason: This question is important but it should not replace direct questions about the client’s current thoughts and feelings. It’s possible for a client to deny feelings of suicidality to their psychiatrist while still experiencing them.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: Coping patterns can influence an individual's ability to handle stress and may contribute to suicide risk if they are maladaptive.
Choice B reason: Alcohol use can increase impulsivity and lower inhibitions, potentially increasing the risk of suicide.
Choice C reason: Socioeconomic status can impact access to resources and support, which may affect an individual's suicide risk.
Choice D reason: Support systems can provide emotional support and connection, which are protective factors against suicide.
Choice E reason: Identifying suicide risk is essential in assessing the immediate danger and the need for interventions.
Correct Answer is ["A","B"]
Explanation
Choice A reason: Elevated prolactin levels can lead to galactorrhea, which is the production of breast milk in individuals who are not breastfeeding.
Choice B reason: Gynecomastia, the enlargement of breast tissue in males, can also be a symptom associated with high prolactin levels.
Choice C reason: Social withdrawal is a symptom of Schizophrenia but is not directly related to elevated prolactin levels.
Choice D reason: Apathy can be a symptom of Schizophrenia but is not directly related to elevated prolactin levels.
Choice E reason: Anhedonia is a symptom of Schizophrenia but is not directly related to elevated prolactin levels.
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