Post RN BSN Advance Concepts in Nursing-III – Unit IV (A) Therapeutic Interventions, Anger, Coping, Suicide and Crisis Solved Answers

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Post RN BSN Advance Concepts in Nursing-III – Unit IV (A) Therapeutic Interventions, Anger, Coping, Suicide and Crisis Solved Answers

Posted by POST RN BSN Resources · Original syllabus post: May 4, 2017 · Category: Post RN BSN Nursing Course Syllabus

Post RN BSN Nursing – Advance Concepts in Nursing-III (Psychiatric and Mental Health Nursing), Course No. 715 – Part 5 of 8. Expanded exam-style model answers for the first half of Unit IV: cognitive and behavioural therapies, therapeutic interventions, occupational therapy, impaired verbal communication, anger management, ineffective coping, crisis intervention and suicide. Use them as a study guide and write in your own words in the exam hall.

Please note: The syllabus lists topics only. These are exam-style questions and model answers prepared from those topics; they are not an official LUMHS paper or answer key. Case examples are made up for learning. Drug names are given for study only, without doses; always follow the current prescription, hospital policy and a drug reference.

📚 Course syllabus: Advance Concepts in Nursing-III (Course No. 715), LUMHS Post RN BSN – read the full course syllabus here.

In this article

1. Unit IV (A) – Therapeutic Interventions, Anger, Coping, Suicide and Crisis

CBT, Anger Management, Crisis, Suicide Care Solved | Post RN BSN Use as a revision guide and verify with your course notes.

Unit IV (A): Therapeutic Interventions, Anger, Coping, Suicide and Crisis

Course syllabus · Model exam answers

B.Sc NURSING (POST-RN), SECOND YEAR, SEMESTER-III

ADVANCE CONCEPTS IN NURSING-III – COURSE NO. 715

UNIT IV (A): THERAPEUTIC INTERVENTIONS, ANGER, COPING, SUICIDE AND CRISIS

Credit hours: 6 (Theory 3, Clinical 3)Source: course syllabus

Evaluation: Assignment 10%, Internal 10%, Final 80%

Syllabus topics: Cognitive and behavioural therapies; therapeutic interventions in general; occupational therapy; impaired verbal communication; anger management; crisis intervention; ineffective individual coping; suicide.

Note: Unit IV has 12 topics, so it is split into two parts. This part covers therapies, communication, anger, coping, crisis and suicide; Part 6 covers ethical and legal issues, community mental health, promotion and prevention. Suicide is answered in a care-focused way without describing methods. If you or someone you know is in immediate danger, contact local emergency services or a crisis line in your country.

Q-1. What are therapeutic interventions in psychiatric nursing? Classify them.

Therapeutic interventions are planned treatments and nursing actions used to relieve symptoms, change harmful behaviour, restore function and promote recovery.

Group	Examples
Biological (somatic)	Psychotropic drugs, electroconvulsive therapy (ECT), light therapy
Psychological (psychotherapy)	Supportive, cognitive, behavioural, interpersonal, psychodynamic, family and group therapy
Social / environmental	Milieu therapy, social skills training, rehabilitation, community support
Activity-based	Occupational, recreational, art, music and exercise therapy
Educational	Psychoeducation, health education, relaxation and stress management
Crisis and emergency	Crisis intervention, de-escalation, safety measures

The nurse may act as direct therapist (counselling, groups, education), co-therapist, coordinator of the team, and advocate, within her training and scope.

Q-2. What is psychotherapy? Describe the common types.

Psychotherapy is the treatment of mental and emotional problems by talking and structured psychological methods between a trained therapist and a client or group.

Type	Main idea
Supportive	Reassurance, encouragement, support during crisis; strengthens coping
Psychodynamic / psychoanalytic	Explores unconscious conflicts and early experiences (Freud)
Behavioural	Changes learned behaviour using learning principles
Cognitive	Changes negative patterns of thinking (Beck)
Interpersonal	Improves relationships and role transitions; used in depression
Group	Learning from sharing among members
Family	Treats the family as the unit (see Part 3)
Motivational interviewing	Resolves ambivalence to change, e.g. in substance use

Q-3. Define behaviour therapy. Explain its principles and techniques.

Behaviour therapy is based on the idea that most behaviours, including symptoms, are learned and can be unlearned or replaced using learning principles: classical conditioning (Pavlov), operant conditioning (Skinner; behaviour is shaped by its consequences) and social learning (Bandura; learning by observing).

Technique	Description	Use
Systematic desensitization (Wolpe)	Learn relaxation, then be gradually exposed to a hierarchy of feared situations	Phobias, anxiety
Exposure and response prevention	Facing the feared object without performing the ritual	OCD
Flooding	Prolonged exposure to the most feared situation (specialist use only)	Severe phobias
Modelling	Learning by watching others do the behaviour	Social skills, phobias
Positive reinforcement	Rewarding desired behaviour so that it increases	Self-care, cooperation
Token economy	Tokens earned for target behaviour and exchanged for rewards	Chronic psychiatric clients, children
Shaping	Reward small steps towards the final goal	Speech and activity in withdrawn clients
Extinction and time-out	Withdraw reward or attention for unwanted behaviour; brief removal from the setting	Tantrums, disruptive behaviour
Assertiveness and social skills training	Role play and rehearsal of direct, respectful communication	Anxiety, anger, low self-esteem
Relaxation and biofeedback	Control of body tension and breathing	Anxiety, pain, hypertension
Contingency contract	Written agreement of rewards and responsibilities	Adherence, substance use

Aversion therapy (pairing a behaviour with an unpleasant stimulus) is controversial and seldom used because of ethical concerns.

Q-4. Define cognitive therapy. Describe Beck’s cognitive model and common cognitive distortions.

Cognitive therapy (Aaron Beck) holds that emotions and behaviours are influenced by the way a person interprets events. In depression, thinking is dominated by the cognitive triad: negative views of self, the world and the future. Albert Ellis’s ABC model (REBT) is similar: Activating event → Belief → Consequence (feelings and behaviour).

The cognitive behavioural model.

Cognitive distortion	Example
All-or-nothing thinking	“If I am not perfect, I am a failure.”
Overgeneralization	“I failed once, so I always fail.”
Catastrophizing	“This headache must be a brain tumour.”
Mind reading	“They all think I am stupid.”
Personalization	“The patient got worse because of me.”
Emotional reasoning	“I feel guilty, so I must have done wrong.”
“Should” statements	“I should never make a mistake.”
Selective attention (filtering)	Seeing only the negative comment from the evaluation

Q-5. What is cognitive behavioural therapy (CBT)? Describe its process, techniques, indications and the nurse’s role.

CBT combines cognitive and behavioural methods. It is structured, time-limited (often 6–20 sessions), goal-oriented, and collaborative; the client is taught to be his or her own therapist.

Process

1. Assessment and a shared problem list; set goals.
2. Teach the CBT model (thoughts, feelings, behaviour).
3. Identify automatic negative thoughts (using a thought diary).
4. Test them with evidence (Socratic questioning) and replace them with balanced thoughts (cognitive restructuring).
5. Behavioural experiments, activity scheduling, graded exposure, relaxation and problem solving.
6. Homework between sessions; review; relapse-prevention plan.

Sample thought record (made up)

Situation	Automatic thought	Feeling (0–100)	Evidence against	Balanced thought
Colleague did not greet me	“She dislikes me.”	Sad 70	She was busy and greeted others late; we had a friendly talk yesterday	“She was probably busy; I will greet her tomorrow.” (Sad 30)

Indications

Depression, anxiety disorders, panic, phobias, OCD, PTSD, eating disorders, substance use, psychosis (adjunct), insomnia and chronic pain.

Nurse’s role

• Use basic CBT skills: help clients notice thoughts and feelings, and keep a diary.
• Encourage homework and activity scheduling; reinforce progress.
• Support clients attending therapy; communicate with the therapist.
• Specialist CBT needs additional training.

Q-6. Write short notes on group therapy and milieu therapy.

Group therapy

A small group (usually 6–10 members) meets with a trained leader. Yalom described therapeutic factors such as hope, universality (“I am not alone”), sharing information, altruism, group cohesion, imitation of positive behaviour and catharsis.

• Types: psychoeducational, support, skills-training, task and activity groups.
• Nurse’s role: leader or co-leader; set group rules (confidentiality, respect, one person speaks at a time); encourage participation; manage dominating or withdrawn members; evaluate.
• Phases: orientation, working, termination.

Milieu therapy (therapeutic community)

The whole hospital environment, including staff, other clients, routine and rules, is arranged to be therapeutic. Maxwell Jones described the therapeutic community.

• Goals: safety, structure, normalization, respect, social learning and participation in decisions.
• Features: community meetings, daily schedule, group activities, shared responsibility, clear and consistent rules, staff as role models.
• Nurse’s role: maintain a safe, calm, welcoming environment; consistent limits; involve clients in planning.

Q-7. Define occupational therapy. Describe its goals, types of activities and the nurse’s role.

Occupational therapy (OT) uses purposeful activity (work, self-care, leisure) to help people with mental or physical problems to recover function, independence and meaning in life.

Goals

• Restore daily living and work skills; build concentration and routine.
• Reduce symptoms by occupying the mind, and improve mood and self-esteem.
• Develop social skills and teamwork.
• Prepare for return to family, school or work (rehabilitation).
• Provide healthy use of time and creative expression.

Activity	Examples	Benefits
Daily living skills	Cooking, cleaning, personal care, money management	Independence
Work or vocational	Carpentry, tailoring, gardening, weaving, computer skills	Employment skills, self-worth
Creative	Drawing, painting, craft, music, writing	Expression of feelings; calming
Recreational and physical	Games, sports, walking, yoga	Mood, energy, socialization
Social and educational	Group projects, literacy, problem solving	Communication, cognition

Principles and nurse’s role

• Activity is chosen according to the client’s interest, ability and stage of illness (simple, short tasks for acutely ill clients).
• Safety: check tools and sharp objects, supervise, count items.
• Nurse encourages attendance, observes behaviour and progress, records, and links OT with the nursing care plan; works with the occupational therapist.

Q-8. What is impaired verbal communication? Describe its causes and nursing management.

Impaired verbal communication (NANDA-I nursing diagnosis) is a decreased, delayed or absent ability to receive, process, transmit and use a system of symbols (language).

Causes (related to)	Signs (defining characteristics)
Psychosis (disorganized thought), severe anxiety or depression, mutism, catatonia, dementia, delirium, stroke (aphasia), intellectual disability, brain injury, hearing or speech problems, language and cultural barriers, intubation	Cannot or will not speak; slow or absent speech; word salad, disorganized, incoherent or very rapid speech; difficulty finding words; inappropriate verbalization; speaks in a foreign language; difficulty understanding; non-verbal clues instead of speech

Nursing management

• Assess the cause: speech, understanding, hearing and sight, language, orientation, symptoms, and urgent needs (pain, safety).
• Establish trust; speak calmly, slowly and clearly in short, simple sentences; one idea at a time; use the client’s name.
• Reduce noise and distraction; face the client at the same level; allow plenty of time for answers.
• Use yes/no questions and offer choices when the client cannot speak freely.
• Use non-verbal methods: gestures, pictures, cards, writing board, pen and paper; observe body language.
• Do not shout, rush, finish sentences or talk about the client in front of him; do not pretend to understand.
• For mute or withdrawn clients, sit quietly and offer presence; accept silence.
• For disorganized speech, do not argue; focus on feelings and key words: “You seem worried. Let us talk about one thing at a time.”
• Use an interpreter when language is different; involve the family to learn familiar words.
• Refer to a speech therapist, doctor or audiologist; treat the underlying condition.
• Anticipate needs (food, toilet, pain) until communication improves; document and evaluate.

Q-9. Define anger, hostility, aggression and violence. Describe the causes and the cycle of aggression.

Term	Meaning
Anger	A normal emotion of displeasure in response to a threat or frustration
Hostility	Persistent resentment and negative attitude towards others
Aggression	Behaviour intended to harm or dominate, verbal or physical
Violence	Aggression causing physical injury or damage

Causes

• Psychiatric: psychosis (command hallucinations, paranoid delusions), mania, personality disorders, substance intoxication or withdrawal, delirium and dementia.
• Psychological: frustration, learned aggression, low self-esteem, previous trauma.
• Environmental: overcrowding, noise, long waiting, rigid rules, perceived loss of control or privacy, provocation by staff.
• Biological: head injury, epilepsy, hormonal and neurochemical factors, pain.

The cycle of aggression: early intervention in the escalation phase prevents crisis.

Phase	Features	Nursing action
Calm / baseline	Normal behaviour	Build rapport; identify triggers and warning signs
Trigger	Event causes frustration or fear	Remove or reduce trigger
Escalation	Pacing, clenched fists, raised voice, threats, tense face, restlessness	Early de-escalation
Crisis	Physical aggression or violence	Safety of all; team response; medication or restraint as last resort
Recovery	Calming, exhaustion	Observe; allow calm; avoid blame
Post-crisis	Remorse, depression, shame	Debrief client and staff; review plan

Q-10. Describe the assessment and the nursing management of an aggressive client, including de-escalation, seclusion and restraint.

Assessment

• History of violence, substance use, current symptoms (paranoia, command hallucinations), recent stress, and triggers.
• Warning signs: pacing, clenched fists, tense posture, staring, loud or threatening speech, restlessness, agitation.
• Environment and availability of items that could be used as weapons.

De-escalation steps

• Stay calm; use a low, slow, firm voice; keep your hands visible and open; stand at an angle (not face-to-face), at a safe distance, near an exit; do not turn your back.
• Only one staff member speaks to the client; keep others nearby but out of sight if possible; call for help early.
• Use short, simple sentences; acknowledge feelings: “You look upset. Tell me what happened.”
• Listen without arguing; avoid threats, sarcasm, and challenging looks; do not touch without warning.
• Offer choices and a quiet place; reduce noise and crowd; offer water, a walk or “time out”.
• Set clear, simple limits: “I want to help you; I cannot let anyone be hurt.”
• Offer medication (oral first) as ordered.

Seclusion and physical restraint (last resort)

• Used only when less restrictive methods fail and there is immediate danger; by a trained team and with a written medical order as required by policy and law.
• Maintain dignity and safety; check airway, breathing and circulation; one team leader; do not restrain in a position that restricts breathing (e.g. prone).
• Observe continuously or at the intervals set by policy; offer food, fluids, toilet; check limbs and skin; remove as soon as safe.
• Document reason, time, response, and checks; debrief the client and the team afterwards.

Nursing diagnoses: Risk for other-directed violence; Risk for self-directed violence; Ineffective coping.

Q-11. What is anger management? Describe the steps and techniques taught to clients.

Anger management is a set of skills for recognizing anger early and expressing it safely and effectively rather than suppressing or acting out violently.

• Recognize triggers and early warning signs: fast heartbeat, tense muscles, hot face, clenched jaw, rising voice; keep an anger diary.
• Time-out: leave the situation calmly, agree in advance on a signal, and return when calm.
• Relaxation: slow breathing, muscle relaxation, counting, a short walk.
• Cognitive restructuring: replace thoughts such as “He did it on purpose” with “Maybe he did not mean it.”
• Assertive communication: use “I” statements. Example: “I feel upset when my work is criticized in front of others; I would like to talk privately.”
• Problem solving and compromise; avoid blame.
• Physical activity and good sleep; avoid alcohol and drugs.
• Role play and practice with feedback; group programmes; medicines for underlying disorder as prescribed.

Nurse’s role: model calm behaviour; teach and rehearse the skills; praise efforts; involve the family; refer for counselling if needed. Hitting objects or “venting” through aggression is not recommended because it tends to increase anger.

Q-12. Define coping. Describe the types of coping and the common defence mechanisms.

Coping is the set of thoughts and behaviours a person uses to manage stress and demands that seem to exceed his or her resources (Lazarus and Folkman: stress depends on how an event is appraised and on available coping resources).

Type	Meaning	Examples
Problem-focused	Deals with the problem itself	Planning, seeking information, asking for help, solving problems
Emotion-focused	Manages the feelings caused by the problem	Relaxation, prayer, talking to friends, acceptance
Adaptive (healthy)	Reduces stress without harm	Exercise, social support, humour, problem solving
Maladaptive	Gives short relief but causes harm	Substance use, withdrawal, aggression, self-harm, excessive sleeping or eating

Defence mechanisms (ego defences)

Mechanism	Example
Denial	Refusing to accept a diagnosis of cancer
Repression	Forgetting a painful event unconsciously
Projection	“The manager hates me” (when I dislike the manager)
Displacement	Shouting at family after being scolded at work
Rationalization	“I failed because the paper was unfair.”
Regression	Adult client behaves like a child when ill
Reaction formation	Being over-polite to someone one dislikes
Sublimation	Turning aggression into sport or art (healthy)
Intellectualization	Discussing a loss in technical terms without feeling
Compensation	Excelling in studies to make up for a physical weakness

Q-13. Describe ineffective individual coping (nursing diagnosis) and the nursing management.

Ineffective coping is the inability to form a valid appraisal of the stressors, inadequate choices of responses, or inability to use available resources.

Defining characteristics	Related factors
Poor concentration, fatigue, sleep problems, substance use, withdrawal, inability to meet roles or basic needs, frequent illness, worry, destructive behaviour, verbalizes inability to cope	Overwhelming or repeated stress, loss, illness, poor support, inadequate coping skills, low self-esteem, crisis

Nursing interventions

• Assess stressors, current coping, strengths, supports, risk of harm.
• Establish a trusting relationship; listen and accept feelings.
• Help the client identify and name the problem and the effect of old coping methods.
• Teach stress management: relaxation, exercise, time management, problem-solving steps, assertiveness.
• Encourage adaptive methods and use of social support, spiritual resources and community services.
• Reduce stress where possible (rest, environment, information); set small achievable goals.
• Praise successes; evaluate; involve the family.

Problem-solving steps: define the problem → list options → weigh pros and cons → choose → act → review.

Q-14. Define crisis. Describe its types, phases and characteristics.

A crisis is a temporary state of upset and disorganization in which the person’s usual coping methods fail when faced with a hazardous event or a threat perceived as overwhelming (Gerald Caplan). It is usually time-limited (about 4–6 weeks) and an opportunity for growth as well as a danger.

Type	Meaning	Examples
Maturational (developmental)	Predictable life transitions	Adolescence, marriage, first child, retirement
Situational	Sudden, unexpected life event	Job loss, divorce, serious illness, death of a loved one
Adventitious (social)	Disaster or violence	Earthquake, flood, war, assault, accident

Caplan’s phase	Features
1	Initial rise in tension; usual problem solving is tried
2	Tension increases because solutions fail; disorganization
3	Further increase in tension; emergency and new resources are tried (including seeking help)
4	Unresolved problem: major disorganization or breakdown, e.g. depression, suicide risk

Characteristics: arises from an event, is a normal response, lasts a limited time, is not a mental illness, can lead to growth or breakdown, and the person is open to help.

Q-15. Describe crisis intervention: its goals, steps and the role of the nurse.

Crisis intervention is short-term, immediate, problem-focused help to restore the person to his pre-crisis level of functioning and to prevent harm.

Principles and goals

• Act quickly; focus on the present problem, not on personality change.
• Ensure safety of the client and others.
• Restore balance, and help the client develop better coping skills.
• Short duration (usually up to six weeks).

Aguilera’s problem-solving approach: balancing factors

Balancing factor	Question to ask
Perception of the event	Is it realistic? Help to see the event clearly
Situational supports	Who is available (family, friends, neighbours, community)?
Coping mechanisms	What has helped before? What new methods can be learned?

Steps (nursing process)

1. Assess: the event, the client’s reaction, risk of suicide or violence, and resources.
2. Plan: set short-term goals, choose interventions with the client.
3. Intervene: listen and encourage ventilation of feelings, give accurate information, help to examine alternatives, mobilize supports, teach coping, link to services; avoid taking over.
4. Evaluate and follow up: check goals, plan for further problems, refer if needed.

Nurse’s roles: first-line responder, counsellor, coordinator, teacher and advocate in hospitals, communities and disasters. Psychological first aid (be calm, ensure safety, listen, meet basic needs, connect to help) is the basic skill.

Example (made up): a man loses his job and says he cannot cope. The nurse assesses safety, listens, helps him identify supports (brother, friends, community job centre), plans two small steps for this week and follows up in 3 days.

Q-16. Define suicide and related terms. Discuss the magnitude, risk factors, protective factors and warning signs.

Term	Meaning
Suicidal ideation	Thoughts of ending one’s own life
Suicide attempt	A non-fatal self-injury with intent to die
Suicide	Death caused by self-directed injury with intent to die
Non-suicidal self-injury (NSSI)	Self-harm without intent to die, often to cope with distress; still a risk factor for later suicide

Magnitude: suicide is a major public health problem; the World Health Organization reports that hundreds of thousands of people die by suicide worldwide every year and that it is one of the leading causes of death among young people. Many more attempt it. It is preventable.

Risk factors	Protective factors
Previous attempt (strongest predictor); mental disorders (depression, bipolar, schizophrenia, substance use, personality disorders); hopelessness; recent loss, humiliation or financial or legal trouble; chronic painful illness; family history; abuse; isolation; impulsivity; access to means; recent discharge from hospital; male sex (higher death rates) and young or old age	Social support and connectedness; reasons for living (children, faith); good coping and problem solving; access to care; restricted access to means; cultural and religious beliefs against suicide; regular treatment

Warning signs

• Talking about wanting to die, being a burden, or having no reason to live; hopelessness.
• Giving away possessions, saying goodbye, sudden calm after depression.
• Withdrawal, severe mood change, rage, reckless behaviour, increased alcohol or drug use.
• Searching for ways to end life or making a plan.

Any statement about suicide must be taken seriously.

Q-17. Write the myths and facts about suicide.

Myth	Fact
People who talk about suicide will not do it.	Most people who die by suicide gave some warning; take every statement seriously.
Asking about suicide puts the idea into a person’s head.	Asking calmly and directly does not increase risk; it can bring relief and open the way to help.
Suicide happens without warning.	Warning signs are often present.
Only mentally ill people die by suicide.	Most are linked to a mental disorder, but not all; crises can affect anyone.
Improvement means the risk has gone.	Risk may be high when energy returns, or after discharge.
Suicide cannot be prevented.	Support, treatment, safety measures and follow-up save lives.

Q-18. How should the nurse assess a client at risk of suicide?

• Create privacy and a calm setting; listen without judging; do not promise secrecy that you cannot keep.
• Ask directly: “Are you thinking of ending your life?” Then ask about frequency, plan, intent, preparation, and previous attempts. (Structured tools such as the Columbia Suicide Severity Rating Scale or local protocols help; scoring tools should never replace judgement.)
• Assess risk factors, protective factors, current symptoms (hopelessness, psychosis, command hallucinations, agitation), alcohol or drug use, stressors, supports and reasons for living.
• Assess access to dangerous means and ask the family to restrict them where appropriate.
• Judge the level of risk (low, moderate, high) with the team, and act accordingly.
• Reassess regularly; document the assessment, the client’s own words, and actions taken.

Do not rely on a verbal “no-harm contract” as a protection; it does not replace observation and treatment.

Q-19. Describe the nursing management of a client with suicidal risk. Prepare a care plan.

Immediate care (high risk)

• Do not leave the client alone; stay with the client and call for help.
• Remove dangerous objects; provide a safe environment (as per hospital policy); observe at the level ordered (e.g. constant, or at set intervals).
• Inform the doctor and the team; admit if necessary; follow the law and hospital policy.
• Be calm, kind and non-judgemental; show that you take the client seriously and want to help.

Nursing diagnosis	Goal	Interventions
Risk for suicide	Client remains safe and says he or she will tell staff when thoughts return	Observation; safe environment; ask about thoughts at each shift; check that medicine is swallowed; restrict means; involve family
Hopelessness	Expresses reasons for living and hope	Listen; accept feelings; identify strengths and past coping; set small goals; help to see temporary nature of crisis
Ineffective coping	Names two safe coping actions	Teach problem solving, relaxation, grounding; plan activities
Social isolation	Joins group activity or contacts a supporter	Encourage contact with family and friends; groups
Risk of non-adherence	Attends follow-up and takes treatment	Teach; arrange appointment; contact after discharge

Safety plan (written with the client)

1. My warning signs and triggers.
2. Things I can do on my own to feel safer.
3. People and places that help distract me.
4. People I can ask for help (names and phone numbers).
5. Professionals and emergency numbers I can contact.
6. Making my environment safe.

Other care

• Treat the underlying disorder (medicines, ECT, psychotherapy).
• Careful follow-up after discharge; this is a high-risk period.
• Involve family; educate about warning signs and means restriction.
• Support the nurse: seek supervision and support after a client attempts or dies by suicide.
• Postvention: support for family, other clients and staff after a suicide.
• Prevention at community level: awareness, reducing stigma, gatekeeper training, responsible media reporting that avoids describing methods.

Q-20. Solve these short cases (made up).

Case 1. A client says quietly: “I cannot go on; everyone would be better without me.” What should the nurse do?

Answer: Stay with the client; thank him for telling you; ask directly about thoughts of suicide, plan and means; do not leave him alone if the risk is high; remove hazards; inform the doctor and team; document and continue observation.

Case 2. A client shouts and paces, clenching his fists, after a visit from relatives. What is the best first response?

Answer: Early de-escalation: calm, low voice, safe distance, offer a quiet place, listen, avoid arguing, call for help, offer medicine as ordered; restraint only as a last resort.

Case 3. A woman believes “If I make one mistake at work, everyone will despise me.” Which cognitive distortion is this, and how can the nurse help?

Answer: All-or-nothing thinking with catastrophizing and mind reading. Help her record the thought, look for evidence for and against, and create a balanced thought.

Case 4. A teenager who lost his father last week cannot sleep or concentrate, but denies suicidal thoughts. What approach is used?

Answer: Crisis intervention: assess safety, encourage expression of grief, identify supports, teach coping, arrange follow-up, and watch for signs of depression.

Q-21. Write the importance of this unit for a Post RN BSN nurse.

• The nurse is often the first person to meet a client in crisis, anger or suicidal distress.
• Basic CBT, behavioural and communication skills can be used in everyday nursing care.
• Safe de-escalation and suicide assessment protect clients, families and staff.
• Teaching coping skills and anger management prevents relapse and harm.

Conclusion: Therapeutic interventions combine evidence-based therapies with calm communication, safety and hope; the nurse’s timely response in anger, crisis and suicide risk can save lives.

Suggested references (the syllabus page lists topics only): Videbeck, S. L. Psychiatric-Mental Health Nursing (latest edition). Lippincott Williams & Wilkins.
Townsend, M. C. Essentials of Psychiatric Mental Health Nursing (latest edition). F. A. Davis.
World Health Organization. Mental health fact sheets and the ICD-11 classification (current versions).
American Psychiatric Association. DSM-5-TR (2022).

Source syllabus: LUMHS Post RN BSN Advance Concepts in Nursing-III (course syllabus) (original post dated May 4, 2017).

Series (Advance Concepts in Nursing-III, Course No. 715): Part 1: Unit I – Mental Health and Mental Illness. Part 2: Unit II (A) – Communication, Self and Anxiety-Related Disorders. Part 3: Unit II (B) – Mood Disorders and Family Therapy. Part 4: Unit III – Schizophrenia and Personality Disorders. Part 5: Unit IV (A) – Therapeutic Interventions, Suicide and Crisis. Part 6: Unit IV (B) – Ethical, Legal and Community Mental Health. Part 7: Clinical Objectives. Part 8: Learning Psychiatric Nursing – facts, skills, uses, benefits and hurdles.

Independent educational resource: POST RN BSN Nursing Resources is not affiliated with, endorsed by or an official publication of LUMHS or PNMC. Model answers are study aids; verify against your course notes and textbooks.

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