A nurse working in a psychiatric hospital is performing a suicide ...

[jhjkgdfhk]

A nurse working in a psychiatric hospital is performing a suicide assessment on a client diagnosed with major depressive disorder (MDD). Which actions by the nurse are appropriate when conducting a suicide assessment?
 
  Select all that apply.
  A) Assess all clients for suicide risk by using indirect questioning.
  B) Ask if the client has any thought of suicide.
  C) Asking about suicide will plant the idea in the client's mind.
  D) Assess the lethality of the suicide plan, if one exists.
  E) If the client has suicidal thoughts, assess whether or not the client would act on them.

Question 2

The nurse is evaluating the success of wellness care provided to a new family in the community. Which observations indicate that care has been successful?
 
  Select all that apply.
  A) The children are observed eating donuts for breakfast.
  B) All family members have up-to-date immunizations.
  C) The family spends every Saturday afternoon participating in physical activities.
  D) The youngest child squints when reading school work.
  E) The oldest child does not wash his hands before eating.

[scottmt]

Answer to Question 1

Answer: B, D, E

When performing a suicide assessment, the nurse should always use direct, not indirect, questioning. The nurse should ask if the client has any thought of suicide and assess the lethality of the suicide plan, if one exists, and whether or not the client will act on these thoughts. Asking about suicide will not plant the idea in the client's mind.

Answer to Question 2

Answer: B, C

Evaluation of care is based on the family's progress toward goals and outcomes mutually determined by the family and nurse. Examples of achieved outcomes include the following: family members demonstrate more frequent engagement in activities that involve the entire family unit, each family member is up to date with all vaccinations, and individual family members report a decrease in or cessation of behaviors associated with adverse health conditions and disease. Eating donuts for breakfast could indicate poor nutrition. Squinting when reading indicates the need for a vision assessment. And not washing hands before eating could lead to the ingestion of a microorganism that could cause disease.

[jhjkgdfhk]

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