NURSfb1210fbCh21fbExamfb2
Afbstudentfbtellsfbthefbschoolfbnurse,fb"Myfbfriendfbthreatenedfbtofbtakefbanfbove
rdosefboffbpills."fbThefbnursefbtalksfbtofbthefbfriendfbwhofbverbalizedfbthefbsuicid
alfbthreat.fbWhatfbisfbthefbmostfbcriticalfbquestionfbforfbthefbnursefbtofbask?
a.fb"Whyfbdofbyoufbwantfbtofbkillfbyourself?"
b.fb"Dofbyoufbhavefbaccessfbtofbmedications?"
c.fb"Havefbyoufbbeenfbtakingfbdrugsfbandfbalcohol?"
d.fb"Didfbsomethingfbhappenfbwithfbyourfbparents?"fb-fbcorrectfbanswer✔ ✔
B
Thefbnursefbmustfbassessfbthefbpatient'sfbaccessfbtofbafbmeansfbtofbcarryfboutfbthef
bplanfband,fbiffbtherefbisfbaccess,fbalertfbthefbparentsfbtofbremovefbthefb medicatio
nsfbfromfbthefbhome.fbThefbinformationfbinfbthefbotherfbquestionsfbisfbimportant
fbtofbask,fbbutfbitfbisfbnotfbthefb mostfbcritical.
Afbtearfulfbpatientfbatfbthefbmentalfbhealthfbcenterfbsays,fb"Ifbshouldfbbefbdead."fb
Whatfbisfbthefbmostfbimportantfbfirstfbtaskfbforfbthefbnursefbinfbassessingfbthisfbp
atient?
a.fbAscertainfbthefblethalityfboffbthefbsuicidefbplan.
b.fbEstablishfbafbrapportfbwithfbthefbpatient.
c.fbDeterminefbthefbriskfbfactorsfbforfbsuicide.
d.fbEncouragefbexpressionfboffbfeelings.fb-fbcorrectfbanswer✔ ✔ B
,Establishingfbrapportfbwillfballowfbthefbnursefbtofbobtainfbrelevantfbassessment
fbdatafbsuchfbasfbthefbpresencefboffbafbsuicidefbplan,fblethalityfboffbplan,fbandfbpre
sencefboffbriskfbfactorsfbforfbsuicide.
Afbpatientfbbeingfbtreatedfbatfbthefbmentalfbhealthfbcenterfbsays,fb"Ifbamfbhavingf
bthoughtsfbaboutfbsuicide."fbWhatfbisfbthefbnurse'sfb mostfbtherapeuticfbrespons
e?
a.fb"Thankfbyoufbforfbtellingfbme,fbbutfbthere'sfbnothingfbtofbworryfbabout.fbWefb
willfbhandlefbitfbtogether."
b.fb"Tellingfbmefbaboutfbthesefbfeelingsfbisfbafbveryfbpositivefbactionfbonfbyourfb
part."
c.fb"It'sfbimportantfbforfbyoufbtofbbefbhospitalizedfbasfbsoonfbasfbpossible."
d.fb"Let'sfbtalkfbaboutfbthefbthingsfbyoufbhavefbtofblivefbfor."fb-fbcorrectfbanswer
✔ ✔ B
Thisfbresponsefbgivesfbthefbpatientfbreinforcementfbandfbvalidationfbforfbmaki
ngfbafbpositivefbresponsefbratherfbthanfbactingfboutfbafbsuicidalfbimpulse.fbItfbgiv
esfbneitherfbadvicefbnorfbfalsefbreassurance,fbandfbitfbdoesfbnotfbimplyfbstereoty
pesfbsuchfbasfb"Youfbhavefbafblotfbtofblivefbfor."fbItfbusesfbthefbpatient'sfbambivale
ncefbandfbsetsfbthefbstagefbforfbmorefbrealisticfbproblem-solving.
Selectfbthefbmostfbappropriatefbcommentfbbyfbthefbnursefbwhenfbafbdepressedfb
patientfbsays,fb"What'sfbthefbusefbinfbgoingfbon?"
, a.fb"Arefbyoufbthinkingfbaboutfbsuicide?"
b.fb"IfbamfbnotfbsurefbIfbunderstandfbwhatfbyoufbarefbsaying."
c.fb"Keepfbyourfbhopefbalive.fbIt'sfbalwaysfbdarkestfbjustfbbeforefblight."
d.fb"Tellfbmefbmorefbaboutfbyourfbactivitiesfbbeforefbyoufbgotfbdepressed."fb-
fbcorrectfbanswer✔ ✔ A
Thefbpossibilityfboffbsuicidefbmustfbbefbopenlyfbaddressed.fbThefbpatientfboften
fbfeelsfbrelievedfbtofbbefbablefbtofbtalkfbaboutfbsuicidalfbideation.fbThefbsubjectfb
mustfbbefbaddressedfbdirectly.
Afbnursefbcounselsfbafbpatientfbwhofbmadefbafbsuicidefbattemptfb3fbdaysfbago.fb
Whatfbisfbthefbnurse'sfbmostfbtherapeuticfbresponse?
a.fb"I'mfbgladfbyoufbvoluntarilyfbadmittedfbyourselffbtofbthefbhospital.fbWefbcanf
bhelpfbyoufbhere."
b.fb"Whenfbyoufbhavefbbadfbfeelings,fbtryfbtofbrememberfbthefbgoodfbthingsfbabo
utfbyourfblife."
c.fb"Youfbmustfbtakefbcontrolfboffbyourfbproblemsfbandfbtryfbtofbfindfbsolutions."
d.fb"Let'sfbdiscussfbsomefbwaysfbtofbsolvefbyourfbmostfbimportantfbproblem."fb-
fbcorrectfbanswer✔ ✔ D
Thefbnursefbhelpsfbthefbpatientfbtofbdevelopfbeffectivefbcopingfbskills.fbAssistfbt
hefbpatientfbtofbreducefbthefboverwhelmingfbeffectsfboffbproblemsfbbyfbgenerati
ngfbandfbtestingfbwaysfbtofbsolvefbthem.fbThefbdistractersfbpresentfboverwhelm
ingfbapproachesfbtofbproblem-solving.
Afbstudentfbtellsfbthefbschoolfbnurse,fb"Myfbfriendfbthreatenedfbtofbtakefbanfbove
rdosefboffbpills."fbThefbnursefbtalksfbtofbthefbfriendfbwhofbverbalizedfbthefbsuicid
alfbthreat.fbWhatfbisfbthefbmostfbcriticalfbquestionfbforfbthefbnursefbtofbask?
a.fb"Whyfbdofbyoufbwantfbtofbkillfbyourself?"
b.fb"Dofbyoufbhavefbaccessfbtofbmedications?"
c.fb"Havefbyoufbbeenfbtakingfbdrugsfbandfbalcohol?"
d.fb"Didfbsomethingfbhappenfbwithfbyourfbparents?"fb-fbcorrectfbanswer✔ ✔
B
Thefbnursefbmustfbassessfbthefbpatient'sfbaccessfbtofbafbmeansfbtofbcarryfboutfbthef
bplanfband,fbiffbtherefbisfbaccess,fbalertfbthefbparentsfbtofbremovefbthefb medicatio
nsfbfromfbthefbhome.fbThefbinformationfbinfbthefbotherfbquestionsfbisfbimportant
fbtofbask,fbbutfbitfbisfbnotfbthefb mostfbcritical.
Afbtearfulfbpatientfbatfbthefbmentalfbhealthfbcenterfbsays,fb"Ifbshouldfbbefbdead."fb
Whatfbisfbthefbmostfbimportantfbfirstfbtaskfbforfbthefbnursefbinfbassessingfbthisfbp
atient?
a.fbAscertainfbthefblethalityfboffbthefbsuicidefbplan.
b.fbEstablishfbafbrapportfbwithfbthefbpatient.
c.fbDeterminefbthefbriskfbfactorsfbforfbsuicide.
d.fbEncouragefbexpressionfboffbfeelings.fb-fbcorrectfbanswer✔ ✔ B
,Establishingfbrapportfbwillfballowfbthefbnursefbtofbobtainfbrelevantfbassessment
fbdatafbsuchfbasfbthefbpresencefboffbafbsuicidefbplan,fblethalityfboffbplan,fbandfbpre
sencefboffbriskfbfactorsfbforfbsuicide.
Afbpatientfbbeingfbtreatedfbatfbthefbmentalfbhealthfbcenterfbsays,fb"Ifbamfbhavingf
bthoughtsfbaboutfbsuicide."fbWhatfbisfbthefbnurse'sfb mostfbtherapeuticfbrespons
e?
a.fb"Thankfbyoufbforfbtellingfbme,fbbutfbthere'sfbnothingfbtofbworryfbabout.fbWefb
willfbhandlefbitfbtogether."
b.fb"Tellingfbmefbaboutfbthesefbfeelingsfbisfbafbveryfbpositivefbactionfbonfbyourfb
part."
c.fb"It'sfbimportantfbforfbyoufbtofbbefbhospitalizedfbasfbsoonfbasfbpossible."
d.fb"Let'sfbtalkfbaboutfbthefbthingsfbyoufbhavefbtofblivefbfor."fb-fbcorrectfbanswer
✔ ✔ B
Thisfbresponsefbgivesfbthefbpatientfbreinforcementfbandfbvalidationfbforfbmaki
ngfbafbpositivefbresponsefbratherfbthanfbactingfboutfbafbsuicidalfbimpulse.fbItfbgiv
esfbneitherfbadvicefbnorfbfalsefbreassurance,fbandfbitfbdoesfbnotfbimplyfbstereoty
pesfbsuchfbasfb"Youfbhavefbafblotfbtofblivefbfor."fbItfbusesfbthefbpatient'sfbambivale
ncefbandfbsetsfbthefbstagefbforfbmorefbrealisticfbproblem-solving.
Selectfbthefbmostfbappropriatefbcommentfbbyfbthefbnursefbwhenfbafbdepressedfb
patientfbsays,fb"What'sfbthefbusefbinfbgoingfbon?"
, a.fb"Arefbyoufbthinkingfbaboutfbsuicide?"
b.fb"IfbamfbnotfbsurefbIfbunderstandfbwhatfbyoufbarefbsaying."
c.fb"Keepfbyourfbhopefbalive.fbIt'sfbalwaysfbdarkestfbjustfbbeforefblight."
d.fb"Tellfbmefbmorefbaboutfbyourfbactivitiesfbbeforefbyoufbgotfbdepressed."fb-
fbcorrectfbanswer✔ ✔ A
Thefbpossibilityfboffbsuicidefbmustfbbefbopenlyfbaddressed.fbThefbpatientfboften
fbfeelsfbrelievedfbtofbbefbablefbtofbtalkfbaboutfbsuicidalfbideation.fbThefbsubjectfb
mustfbbefbaddressedfbdirectly.
Afbnursefbcounselsfbafbpatientfbwhofbmadefbafbsuicidefbattemptfb3fbdaysfbago.fb
Whatfbisfbthefbnurse'sfbmostfbtherapeuticfbresponse?
a.fb"I'mfbgladfbyoufbvoluntarilyfbadmittedfbyourselffbtofbthefbhospital.fbWefbcanf
bhelpfbyoufbhere."
b.fb"Whenfbyoufbhavefbbadfbfeelings,fbtryfbtofbrememberfbthefbgoodfbthingsfbabo
utfbyourfblife."
c.fb"Youfbmustfbtakefbcontrolfboffbyourfbproblemsfbandfbtryfbtofbfindfbsolutions."
d.fb"Let'sfbdiscussfbsomefbwaysfbtofbsolvefbyourfbmostfbimportantfbproblem."fb-
fbcorrectfbanswer✔ ✔ D
Thefbnursefbhelpsfbthefbpatientfbtofbdevelopfbeffectivefbcopingfbskills.fbAssistfbt
hefbpatientfbtofbreducefbthefboverwhelmingfbeffectsfboffbproblemsfbbyfbgenerati
ngfbandfbtestingfbwaysfbtofbsolvefbthem.fbThefbdistractersfbpresentfboverwhelm
ingfbapproachesfbtofbproblem-solving.
