Question Of The Day: Foundations of Psychiatric Nursing

Q. A nurse makes a home visit to a client who was discharged from a psychiatric hospital. The client is irritable and walks about her room slowly and morosely. After 10 minutes, the nurse prepares to leave, but the client plucks at the nurse's sleeve and quickly asks for help rearranging her belongings. She also anxiously makes inconsequential remarks to keep the nurse with her. In view of the fact that the client has previously made a suicidal gesture, which of the following interventions by the nurse should be a priority at this time?

A. Ask the client frankly if she has thoughts of or plans for committing suicide.
B. Avoid bringing up the subject of suicide to prevent giving the client ideas of self-harm.
C. Outline some alternative measures to suicide for the client to use during periods of sadness.
D. To draw out the client, mention others the nurse has known who have felt like the client and attempted suicide.

Correct Answer: A

Explanation: Investigating the presence of suicidal thoughts and plans by overtly asking the client if she is thinking of or planning to commit suicide is a priority nursing action in this situation. Direct questioning about thoughts or plans related to self-harm does not give a person the idea to harm herself. Self-harm is an individual decision. Avoiding the subject when a client appears suicidal is unwise; the safest procedure is to investigate. It would be premature in this situation to outline alternative measures to suicide. Describing other clients who have attempted suicide is too indirect to be helpful and minimizes the client's feelings.