Which of the following would indicate an increased suicidal risk? (Select all that apply)

Choice A reason: The belief that clients who talk about suicide are less likely to attempt it is a myth. Verbalizing suicidal ideation often reflects severe distress and heightened risk, as it may indicate prefrontal cortex dysfunction and impaired impulse control. This misconception underestimates the neurobiological basis of suicidal behavior, requiring vigilant assessment.

Choice B reason: Assuming clients who fail a suicide attempt will not try again is incorrect. Previous attempts increase future risk, as suicidal behavior is linked to persistent psychological distress and serotonin dysregulation. This assumption ignores the chronicity of underlying conditions like depression, necessitating ongoing monitoring and intervention to prevent recurrence.

Choice C reason: Claiming failed suicide attempts indicate a lack of intent to die is false. Many attempts fail due to external factors, not lack of intent. Suicidal behavior reflects complex neurobiological factors, including serotonin imbalance and prefrontal cortex deficits, requiring serious intervention regardless of outcome, as intent persists in high-risk individuals.

Choice D reason: A specific suicide plan indicates high risk, as it reflects advanced ideation and intent, often linked to prefrontal cortex dysfunction and reduced impulse control. Detailed planning suggests the client has visualized the act, increasing likelihood of completion. This principle guides nursing care to prioritize safety and immediate psychiatric intervention.

Choice A reason: Redirecting to an activity uses distraction to reduce agitation in Alzheimer’s, where hippocampal and cortical degeneration causes disorientation and memory loss. Engaging in familiar activities leverages preserved procedural memory, calming the client without confronting their delusion, which aligns with neurobiological strategies to manage confusion and distress.

Choice B reason: Stating the mother died confronts the client’s delusion, likely increasing agitation due to impaired reality testing from Alzheimer’s-related cortical damage. This approach disregards the client’s cognitive limitations, as memory deficits prevent processing such corrections, potentially worsening emotional distress and behavioral symptoms.

Choice C reason: Asking why the client seeks her mother probes a delusion rooted in Alzheimer’s-related memory loss and hippocampal dysfunction. This may confuse or frustrate the client, as they cannot articulate reasons due to cognitive impairment. Redirection is more effective than exploring motives in advanced dementia.

Choice D reason: Assuming upset and addressing emotional distress may escalate agitation, as Alzheimer’s impairs emotional regulation due to amygdala and prefrontal cortex damage. While empathetic, this response risks focusing on the delusion, which the client cannot process, making redirection to an activity a more effective, neurobiologically informed approach.