GMCH Chandigarh - 2019
Mental Health Nursing
Medium
A nurse is caring for a client who expresses active suicidal ideation. Which of the following should be the nurse's action?
Appeared in: GMCH Chandigarh - 2019
Explanation
- Engaging the client in a conversation about their suicidal thoughts is the most therapeutic and essential first step.
- This direct approach allows the nurse to assess the immediate risk, including the presence of a plan, the lethality of the method, and the client's intent.
- Openly discussing suicide helps to build a therapeutic alliance, reduces the client's feelings of isolation, and is the foundation for developing a safety plan.
- Contrary to a common myth, asking directly about suicide does not 'plant the idea' but rather provides an opportunity for intervention and shows the client that the nurse is taking their distress seriously.
Why Other Options Were Wrong
- Option A: Engaging the client in activities to distract them from talking about suicide is a form of avoidance. It is non-therapeutic, dismisses the client's distress, and prevents the nurse from assessing the immediate risk.
- Option B: Administering antidepressants is not the immediate priority. It requires a physician's order, and these medications take several weeks to become effective. Furthermore, some antidepressants can temporarily increase suicide risk in the initial phase of treatment.
- Option C: Teaching relaxation exercises like Jacobson's Progressive Muscle Relaxation (JPMR) is not appropriate for managing an acute suicidal crisis. The priority is immediate safety and risk assessment, not long-term coping skills.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Immediate nursing management of a client with active suicidal ideation to guide bedside assessment, documentation, and the next nursing action.
- A nurse has an ethical and legal responsibility to take any mention of suicide seriously and to act to ensure the client's safety.
- The principle of 'patient safety first' always supersedes other interventions. For a client with active suicidal ideation, this means direct observation and creating a safe environment.
- What if? If a client who previously denied suicidal thoughts suddenly becomes calm and happy after a period of deep depression, this can be a red flag. This change may indicate they have made a decision to die and feel at peace with it, requiring an immediate increase in observation and reassessment.
How to Approach the Question
- First, identify the critical information in the question: the client has 'active suicidal ideation'. This immediately signals a psychiatric emergency.
- Recognize that patient safety is the absolute highest priority in this situation.
- Evaluate each option based on its ability to address the immediate safety risk.
- Option A (distraction) and Option C (relaxation) avoid the core problem and are therefore incorrect as a first step.
- Option B (medication) is not an independent nursing action and is not an immediate solution.
- Option D (direct interaction) is the only choice that directly addresses the crisis by allowing for assessment, building rapport, and initiating safety planning. This makes it the correct priority action.
Concept Tested & Keywords
- Concept Tested: Immediate nursing management of a client with active suicidal ideation.
- Stem keywords: nurse, caring, client, active suicidal ideation, nurse's action
- Lead-in keywords: should be
- Clinical cues: The client's expression of 'active suicidal ideation' is the most critical cue, signaling an immediate and serious safety risk that requires a direct and therapeutic response.
Question ID
QreJIM5QKxbQbs-zp5ec8A
Reference Book
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 217-219
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 5516-5518
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 108-110
Practise the full GMCH Chandigarh - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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