RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018
Mental Health Nursing
Medium
Which of the following comments, if made by a patient who has major depression would indication increased risk of suicide?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018
Explanation
- The statement "I won't be a problem much longer" is a classic indirect (covert) verbal cue for suicide.
- It implies the patient is contemplating ending their life as a way to stop being a 'problem' to others.
- Such statements signal a sense of finality and hopelessness, which are strongly associated with increased suicide risk.
- Recognizing these veiled communications is a critical nursing skill for timely intervention.
Why Other Options Were Wrong
- Option A: This is a direct denial of suicidal intent. While a patient may not be truthful, the statement itself, taken at face value, is a rejection of suicidal planning, not an indicator of it.
- Option B: This statement indicates social withdrawal and an unwillingness to seek help, which are significant risk factors for depression and suicide. However, it is not a statement of suicidal intent itself.
- Option D: This expresses a feeling of being a burden, which is a key component of the 'IS PATH WARM' mnemonic for suicide risk (T for Trapped/Burdensomeness). While a serious risk factor, it is a statement about a feeling, not a statement implying an action or plan like the correct answer.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Assessment of suicide risk through verbal cues in patients with major depression to guide bedside assessment, documentation, and the next nursing action.
- A nurse's primary responsibility when caring for a depressed patient is to ensure safety. Recognizing indirect cues is a critical skill for suicide prevention, as many patients do not state their intentions directly.
- Any statement hinting at suicide, whether direct or indirect, must be taken seriously and requires immediate follow-up with a direct question, such as, 'That sounds serious. Are you thinking of harming yourself?'.
- What if? If the patient had said, 'I've been saving up my medications,' this would be an even more alarming statement. It indicates not just ideation but also a specific plan and access to means, requiring immediate crisis intervention and removal of the means.
How to Approach the Question
- First, identify the core task of the question: you must find the statement that most strongly indicates an increased risk of suicide.
- Analyze each patient comment. Categorize them mentally: Is this a direct statement about suicide? An indirect hint? A feeling associated with depression? A denial?
- Recall the different ways suicidal intent is communicated. Patients may not always be direct. Indirect cues, like talking about being a burden 'no longer' or giving away possessions, are serious red flags.
- Evaluate the options based on this framework. The statement 'I won't be a problem much longer' implies a resolution through disappearance or death, making it a significant indirect cue.
- Compare this to the other options. While feeling like a burden or being withdrawn are risk factors, the chosen statement has a stronger and more immediate implication of impending self-harm.
Concept Tested & Keywords
- Concept Tested: Assessment of suicide risk through verbal cues in patients with major depression.
- Stem keywords: major depression, increased risk of suicide, patient comment
- Lead-in keywords: Which
- Negative lead-in flag: false
Question ID
QaLUqO9HfmtBjFDXhP5HAM
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 5507-5509
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2553-2555
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