INI-CET EXAM -2026
Mental Health Nursing
Medium
A 45-year-old recently divorced alcoholic expresses suicidal ideation. What is the next best step?
Appeared in: INI-CET EXAM -2026
Explanation
- The foremost priority in managing a patient with active suicidal ideation is ensuring their safety.
- Hospitalization provides a secure, controlled environment for continuous monitoring and prevents access to means of self-harm.
- This immediate intervention allows for stabilization and the initiation of comprehensive psychiatric evaluation and treatment.
- According to psychiatric principles, a patient with severe suicidal ideation requires inpatient hospitalization until the ideation resolves (SRC_1583).
Why Other Options Were Wrong
- Option A: Cognitive Behavioral Therapy (CBT) and weekly outpatient visits are long-term management strategies and are not sufficient to manage an acute suicidal crisis where the risk of self-harm is immediate.
- Option B: Antidepressants are not the immediate priority. They take several weeks to reach therapeutic levels and can paradoxically increase the risk of suicide in the initial phase of treatment. Safety must be established first.
- Option D: Monitoring for recurrence is a component of long-term management and follow-up care, not the initial action for a patient in an acute suicidal crisis.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Acute Suicidal Ideation as background academic context rather than a clinical decision trigger.
- Nurses play a critical role in suicide risk assessment, using standardized tools and clinical judgment to determine the level of risk.
- Implementing suicide precautions (e.g., one-to-one observation, removing dangerous items, ensuring a safe environment) is a key nursing responsibility in an inpatient setting.
- What if? If the patient denied suicidal ideation but the nurse observed concerning behaviors like giving away possessions or writing a suicide note, the nurse must still escalate care and initiate safety protocols immediately, as actions can indicate intent even with verbal denial.
How to Approach the Question
- First, identify the core clinical problem: The patient is expressing active suicidal ideation.
- Recognize this as a psychiatric emergency. In any emergency, the principle of 'safety first' applies.
- Evaluate the options based on the immediate need for safety. Ask yourself: 'Which option provides the most immediate and comprehensive safety for this patient?'
- Option A (outpatient therapy) and D (monitoring for recurrence) are clearly not immediate safety measures.
- Option B (antidepressants) is a treatment, but it's not immediate and doesn't guarantee safety.
- Option C (hospitalization) directly addresses the safety risk by placing the patient in a secure, monitored environment. This is the most appropriate 'next best step'.
Concept Tested & Keywords
- Concept Tested: Management of Acute Suicidal Ideation
- Stem keywords: 45-year-old, alcoholic, divorced, suicidal ideation
- Lead-in keywords: next best step
- Clinical cues: The combination of active suicidal ideation with multiple psychosocial stressors (divorce, alcoholism) indicates a high-risk situation requiring immediate intervention.
Question ID
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Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 904-906
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 8807-8809
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 308-310
Practise the full INI-CET EXAM -2026
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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