A charge nurse on a mental health unit is describing assessments for suicide risks to a group of newly licensed nurses. Which of the following tests should the nurse include? (Select All that Apply.)
Harvard Implicit Association Test (IAT)
PHQ-9
Altman Self-Rating Mania Scale
SAD PERSONS
SAFE-T
Correct Answer : B,D,E
Rationale:
A. The Harvard Implicit Association Test (IAT) measures implicit biases and is not used specifically for assessing suicide risk.
B. The PHQ-9 (Patient Health Questionnaire-9) is a validated tool for screening, diagnosing, monitoring, and measuring the severity of depression, which is closely related to suicide risk.
C. The Altman Self-Rating Mania Scale is used to assess the severity of manic symptoms in clients with bipolar disorder, not for suicide risk assessment.
D. The SAD PERSONS scale is a tool specifically designed to assess suicide risk based on key risk factors.
E. The SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) is a comprehensive framework for assessing suicide risk, making it an appropriate tool to include in suicide risk assessments.
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View Related questions
Correct Answer is C, A, D, E, B
Explanation
Rationale:
Murophobia: Client A's extreme fear of mice indicates a specific phobia. In this case, it is specifically referred to as murophobia.
Separation anxiety: Client B's distress over their partner's absence aligns with separation anxiety.
Mutism: Client C's continued silence in group sessions suggests mutism, a form of non-verbal behavior often associated with anxiety or trauma.
Body dysmorphism: Client D's behavior of wearing boots due to negative feelings about their feet reflects body dysmorphic disorder, where a person has a distorted view of their body.
Trichotillomania: Client E’s behavior of pulling out their hair after twisting it indicates trichotillomania, a disorder characterized by compulsive hair pulling.
Correct Answer is C
Explanation
Rationale:
A. Somatic symptom disorder involves physical symptoms without a clear medical cause, but the client's intention to be the center of attention is more characteristic of factitious disorder.
B. Functional neurological symptom disorder involves neurological symptoms with no identifiable neurological basis, which does not align with the client’s motivations.
C. Factitious disorder involves the intentional production of symptoms to assume the sick role and gain attention, which aligns with the client's desire to be the center of a dramatic medical situation.
D. Illness anxiety disorder involves preoccupation with having a serious illness despite a lack of symptoms but does not involve intentionally causing harm.