Chapter 27: Inward-Focused Emotions: Suicide Nursing School Test Banks

Chapter 27: Inward-Focused Emotions: Suicide
Test Bank

MULTIPLE CHOICE

1. Self-protective responses are seen in behaviors that meet basic:
a. Goals
b. Needs
c. Wants
d. Demands
ANS: B
People behave in many ways to secure basic safety and security needs.

DIF: Cognitive Level: Knowledge REF: p. 311 OBJ: 1
TOP: Continuum of Behavioral Responses
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

2. Bob drives fast everywhere he goes, especially when he is drinking. Last night, he was arrested for gambling and loud behavior. Bob is engaging in ____ behavior.
a. Adaptive
b. Suicidal
c. Direct self-destructive
d. Indirect self-destructive
ANS: D
Indirect self-destructive behaviors are behaviors that may result in harm or death to the individual who has no intention of ending his or her life. Suicide and direct self-destructive behavior are behaviors that convey an active wish to die. The behavior in this situation is maladaptive, not adaptive.

DIF: Cognitive Level: Application REF: p. 311 OBJ: 1
TOP: Continuum of Behavioral Responses
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

3. Suicide in the United States is:
a. Not a problem
b. The tenth leading cause of death
c. Most prevalent among the middle-aged
d. Controlled by the use of antidepressants
ANS: B
Suicide is the tenth leading cause of death in the United States.

DIF: Cognitive Level: Knowledge REF: p. 312 OBJ: 2
TOP: Impact of Suicide on Society KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. The theory that suicide rates are affected by group support, social changes, regulations, religion, legal sanctions or limitations, and philosophical beliefs is known as the ____ theory.
a. Biological
b. Sociological
c. Interpersonal
d. Psychoanalytical
ANS: B
Sociological theory considers the relationship between the number of suicides and the social conditions in an area. Biological theory refers to anxiety and depression caused by irregularities in neurotransmitters, leading to suicide; interpersonal theory views suicide as the result of an inability to resolve interpersonal conflicts; and psychoanalytical theory considers suicide as anger turned inward.

DIF: Cognitive Level: Knowledge REF: p. 315 OBJ: 6
TOP: Theories about Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. Children are at greater risk for committing suicide if they have ____ problems.
a. Family
b. Social
c. Mental health
d. Acute physical
ANS: C
Children with existing mental health problems are at greater risk for committing suicide than are other children because they often do not have effective coping skills.

DIF: Cognitive Level: Knowledge REF: p. 316 OBJ: 7
TOP: Suicide and Children KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

6. Suicide is attempted three times more frequently by ____ but is more often successfully completed by ____.
a. Adult men, women
b. Adult women, men
c. Adult fathers, mothers
d. Adolescent mothers, fathers
ANS: B
Women attempt suicide three times more frequently than men, but men are more often successful at completing the act.

DIF: Cognitive Level: Knowledge REF: p. 317 OBJ: 2 | 7
TOP: Suicide and Adults KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. The caregiver works with suicidal clients to establish therapeutic rapport. The focused communications and concerned actions encourage suicidal persons to:
a. Feel in control
b. Feel self-worth
c. Talk about themselves
d. Feel foolish for thinking about suicide
ANS: B
The focused communications and concerned actions of caregivers help suicidal individuals to feel self-worth, which directly affects the treatment goals of the individual.

DIF: Cognitive Level: Application REF: p. 320 OBJ: 9
TOP: Therapeutic Interventions for Suicidal Clients
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

8. Suicide attempts by ____ are more successful because one out of every two attempts results in death.
a. Adolescents
b. Older adults
c. Young adults
d. Middle-aged adults
ANS: B
The incidence of successful suicides increases with age because of the fact that older adults are less likely than persons of all other age-groups to communicate their intentions to others.

DIF: Cognitive Level: Knowledge REF: p. 317 OBJ: 7
TOP: Suicide and Older Adults KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. When the environment lacks security or presents dangers, the perception that life will be short or will end in violence is most compelling for:
a. Children
b. Adolescents
c. Young adults
d. Middle-aged adults
ANS: B
This age-group tends to feel this way more than other age-groups do, and if this is the feeling of an adolescent, he or she sees no promise for the future.

DIF: Cognitive Level: Comprehension REF: p. 317 OBJ: 7
TOP: Suicide and Adolescents KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. All people who commit suicide are depressed or psychotic. This statement is a(n):
a. Fact
b. Myth
c. Opinion
d. Attitude
ANS: B
Many false ideas about suicide still exist. It is important for the nurse to become familiar with these myths if he is to be skilled in educating others about suicide.

DIF: Cognitive Level: Comprehension REF: p. 312 OBJ: 2
TOP: Myths about Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

11. The nurse is caring for a male client with a major depressive disorder who has not responded well to various treatments in the past. The latest treatment method has resulted in slight improvement in the clients symptoms. On this particular day, the client has a very positive affect and says he feels amazingly better. The nurse should:
a. Congratulate him on his recovery.
b. Document the clients improvement.
c. Ask him what he feels has helped him feel better so suddenly.
d. Assess the client for signs and symptoms of suicidal thoughts.
ANS: D
This behavior is frequently seen when a depressed individual has made the decision to commit suicide. The other options ignore this important sign.

DIF: Cognitive Level: Application REF: p. 312 OBJ: 2
TOP: Myths about Suicide KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

12. An adult female whose fianc recently called off the wedding attempts suicide by taking an overdose of sleeping medication. Immediately after taking the medication, she calls friends and family to tell them what she has done. Her friends and family activate the emergency response system, and she is taken to the emergency room and is admitted to a mental health facility for monitoring. She is exhibiting signs and symptoms most evident of which suicidal motivational category?
a. Crying for help
b. Relieving distress
c. Preoccupation with suicide
d. Refusal to accept a diminished style of life
ANS: A
This behavior is characteristic of a cry for help. Calling others after her attempt shows that she was not intent on committing suicide. Relieving distress refers to individuals who face situations that threaten their own intactness as a person, such as terminal illness; preoccupation with suicide indicates the only form of control for ones own life; and refusal to accept a diminished style of life refers to considering all options, then rationally deciding that suicide is the best option.

DIF: Cognitive Level: Application REF: p. 314 OBJ: 4
TOP: Categories of Motivation KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

13. A terminally ill female client chooses the time and place of her own death. This is an example of:
a. Suicide
b. Self-injury
c. Rational suicide
d. Planned suicide
ANS: C
In this situation, the person knows that she is going to die, so the decision of where to die is made freely and with sound mind. Suicide and planned suicide simply refer to intentionally taking ones own life. Self-injury is an active attempt to injure oneself.

DIF: Cognitive Level: Comprehension REF: p. 313 OBJ: 3
TOP: Social Factors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. An elderly male clients wife of 50 years recently died from cancer. He suffers from a chronic debilitating illness and has been refusing to eat, drink, or take his medications. This client is displaying behavior characteristic of:
a. Suicidal threats
b. Suicidal attempts
c. Suicidal ideation
d. Passive suicide
ANS: D
Passive suicide is seen most frequently in older adults as a result of depression and loneliness. Suicidal threats refer to written or verbal threats of suicide; suicidal attempts are self-directed actions to harm oneself; and suicidal ideation is a preoccupation with the idea of suicide.

DIF: Cognitive Level: Application REF: p. 317 OBJ: 7
TOP: Suicide and Older Adults KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. In the ______ dimension, an individual who is considering suicide experiences distorted thinking and self-defeating thoughts.
a. Emotional
b. Social
c. Intellectual
d. Spiritual
ANS: C
This dimension is characterized by self-defeating thoughts rather than attempts to problem-solve. The emotional dimension refers to feelings such as ambivalence, anger, guilt, and hopelessness; the social dimension refers to feelings of inferiority; and the spiritual dimension encompasses an individuals ethics, religion, and societal beliefs.

DIF: Cognitive Level: Comprehension REF: p. 314 OBJ: 4
TOP: Characteristics of Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. Methods of suicide differ by gender. What is a preferred method of female suicide victims?
a. Firearm use
b. Hanging
c. Overdose
d. Drowning
ANS: C
Women who commit suicide use a method such as overdose or inhalation of carbon monoxide. Men generally utilize more violent methods such as firearm use, hanging, or drowning.

DIF: Cognitive Level: Comprehension REF: p. 314 OBJ: 2
TOP: Characteristics of Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. Biological studies of suicide victims show an imbalance of which neurotransmitter system?
a. Serotonin
b. Epinephrine
c. Norepinephrine
d. Dopamine
ANS: A
Researchers have demonstrated that when certain chemicals in the brain (neurotransmitters) are not in balance, people have difficulty regulating their moods. Irregularities in a certain neurotransmitter pattern, called the serotonin system, have been found in depressed and suicidal persons

DIF: Cognitive Level: Comprehension REF: p. 316 OBJ: 6
TOP: Theories about Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. In assessing a client for suicide, which finding presents the greatest risk for the client?
a. If I had AIDS or cancer and died, then my family would be sorry.
b. I just dont see any other way out of this situation.
c. I tried to kill myself 6 months ago, but my friend stopped me. The next time, no one will know.
d. I have thought about planning it, but I havent done it.
ANS: C
In assessing a client for risk of suicide, all of these factors (suicide ideation, present suicide plan, level of despair) indicate a risk. However, a client with previous attempts presents the highest risk.

DIF: Cognitive Level: Comprehension REF: p. 318 OBJ: 8
TOP: Suicide Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

19. After establishing a no-harm contract with the client, the nurse should:
a. Begin to assess client risk factors.
b. Continue to maintain close observation.
c. Decrease observation activity to allow client autonomy.
d. Begin treatment with antidepressants.
ANS: B
After the client agrees to a no-harm contract, the health care provider must still maintain close observation while continuing to work on underlying issues of self-worth and despair. The assessment process should have been started prior to this. Antidepressants are prescribed based on physician order. Decreasing observation may increase client risk at this time.

DIF: Cognitive Level: Comprehension REF: p. 320 OBJ: 9
TOP: Therapeutic Interventions for Suicidal Clients
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

20. Which of the following are included in the continuum of self-protective responses? (Select all that apply.)
a. Suicide
b. Self-injury
c. Depression
d. Goal setting
e. Self-enhancement
f. Growth promoting risk taking
g. Supportive communications
ANS: A, B, E, F
Suicide, self-injury, positive (growth promoting) risk taking, and self-enhancement are behaviors in the continuum of self-protective responses.

DIF: Cognitive Level: Knowledge REF: p. 311 OBJ: 1
TOP: Continuum of Behavioral Responses
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

21. Which are facts about suicide? (Select all that apply.)
a. Suicide occurs most often in lower socioeconomic classes.
b. Depression is a high risk factor for attempting suicide.
c. Giving away important possessions is a sign of suicidal thoughts.
d. It is harmful to discuss the subject of suicide with clients.
e. Suicidal threats are serious only if the client conveys the planned method.
ANS: B, C
These are only two of the facts about suicide. The other options are myths regarding suicide. It is important for the nurse to be familiar with both the facts and the myths regarding suicide.

DIF: Cognitive Level: Comprehension REF: p. 312 OBJ: 2
TOP: Myths about Suicide KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Which social factors impact the incidence of suicide? (Select all that apply.)
a. Social isolation
b. Legal status of gun ownership
c. Poverty and homelessness
d. Veterans of combat
e. Availability of Internet resources
ANS: A, B, C, D
Social isolation suffered as resulting from people are being more mobile and therefore being separated from family and support systems can be a factor in suicide. The legal availability of firearms increases the suicide rate. Circumstances where people cannot care for their basic needs because of homelessness and poverty increase the incidence of suicide. Persons who have suffered some type of PTSD, either as survivors of natural disasters or veterans of combat, suffer higher suicide rates. Access to Internet resources does not impact the incidence of suicide.

DIF: Cognitive Level: Comprehension REF: p. 313 OBJ: 3
TOP: Social Factors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. Standard interventions implemented in a mental health facility to prevent a client from attempting suicide are called __________.

ANS:
suicide precautions
Clients with strong suicidal intent require these precautions, which are standard in all mental health facilities.

DIF: Cognitive Level: Knowledge REF: p. 319 OBJ: 9
TOP: Therapeutic Interventions for Suicidal Clients
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

24. __________ is a term that is used to describe a form of active suicidal behavior, such as gestures, threats, or attempts to end ones own life.

ANS:
Direct self-destructive behavior
These behaviors convey an active wish to die, even though the individual may be indecisive about wanting to live and wanting to die.

DIF: Cognitive Level: Knowledge REF: p. 311 OBJ: 1
TOP: Continuum of Behavioral Responses
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

25. __________ is when a client thinks or fantasizes about death with no definite intent to commit suicide.

ANS:
Suicidal ideation
This is a risk factor for attempting suicide and should be investigated further.

DIF: Cognitive Level: Knowledge REF: p. 318 OBJ: 8
TOP: Assessment of Suicidal Potential KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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