Assessment follows a logical order
Once a client admits to thoughts of killing himself, the nurse continues a direct, structured suicide risk assessment. The sequence is: confirm ideation, then ask about the plan and how specific it is, beginning with the method, then access to means, then intent and timing, and then lethality, past attempts, and protective factors. Ideation has just been confirmed, so the next question is about the method he has thought of using. The questions about means and intent build on the method he names.
Why the method comes before means and intent
Knowing the method tells the nurse how specific and how lethal the plan is, and it makes the next question precise. If he names pesticide, the nurse asks whether he has pesticide at home; if he names a rope or pills, the questions change accordingly. Asking generally whether he has pills or a weapon before knowing his method may miss the means he actually has in mind. Intent and timing are then assessed in relation to that specific plan.
| Step | Question focus | Example |
|---|
| 1. Ideation | Thoughts of suicide | "Are you thinking of killing yourself?" |
| 2. Plan: method | How specific the plan is | "What method have you thought of using?" |
| 3. Access to means | Whether the method is available | "Do you have that at home now?" |
| 4. Intent and timing | How soon he may act | "Do you intend to act on these thoughts soon?" |
| 5. History and protective factors | Past attempts, supports, reasons for living | "Have you tried before?" |
Why the other questions come later
All four questions belong in his assessment, as the stem says, so the issue is order. Past attempts are an important risk factor, but they are history; the current plan weighs most in judging how imminent the danger is. Access to means is asked once the method is known. Intent and timing are explored after the plan and means have been clarified. Asking directly about suicide does not plant the idea; it opens the conversation and is the standard of care.
Watch out! This man has several risk factors: male sex, middle age, recent job loss, living alone, and 6 weeks of depressed mood. The more specific his plan and the more available the means, the more urgent the response.
Exam takeaway
Key point! After ideation is confirmed, ask about the method first, then access to that means, then intent and timing. Use clear, direct words such as "killing yourself" and stay calm and nonjudgmental throughout.