The nurse is caring for a client who is hospitalized for major depressive disorder. Which findings should the nurse recognize as warning signs that require an immediate suicide risk assessment? Select all that apply.
- AThe client gives a favorite watch to a roommate.
- BThe client asks to attend the unit's morning exercise group.
- CThe client, who had been withdrawn and tearful, suddenly appears calm and cheerful.
- DThe client says, "Soon none of this will matter anymore."
- EThe client asks what time visiting hours start so a sister can visit.
- FSeveral of the client's tablets are found hidden in a sock in the bedside drawer.
Show answer and explanations
Answer
A, C, D, F
A: Giving away a valued possession can be a warning sign. B: Interest in exercise alone is not a recognized suicide warning sign. C: Sudden calm after severe distress can warrant renewed risk assessment. D: A statement of finality can suggest suicidal thinking. E: Planning a supportive visit alone is not a recognized warning sign. F: Hoarded tablets can provide means for self-harm.
A
Giving away a valued possession can be a warning sign.
B
Interest in exercise alone is not a recognized suicide warning sign.
C
Sudden calm after severe distress can warrant renewed risk assessment.
D
A statement of finality can suggest suicidal thinking.
E
Planning a supportive visit alone is not a recognized warning sign.
F
Hoarded tablets can provide means for self-harm.
