# Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincial hospital two months after losing his job. He lives alone and has had depressed mood for 6 weeks. He is medically stable. He says, "Sometimes I think it would be easier to just end it." When the nurse asks directly, he admits that he is thinking of killing himself. All of the questions below belong in his assessment. Which question should the nurse ask NEXT?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629990  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincial hospital two months after losing his job. He lives alone and has had depressed mood for 6 weeks. He is medically stable.

He says, "Sometimes I think it would be easier to just end it." When the nurse asks directly, he admits that he is thinking of killing himself. All of the questions below belong in his assessment. Which question should the nurse ask NEXT?

## 보기

1. "Do you intend to act on these thoughts soon?"
2. "Have you ever tried to end your life before?"
3. "What method have you thought of using?" **✔ 정답**
4. "Do you have pills or a weapon at home right now?"

**정답: 3**

## 해설

Direct suicide assessment follows an order: confirm ideation, then ask about the plan and how specific it is (the method), then access to that means, then intent and timing, then lethality, past attempts, and protective factors. Once ideation is confirmed, the method question comes next because the questions on means and intent build on the method he names.

## 심화 해설

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.

## 임상 시나리오

Suicide Risk Assessment SequenceWhat to ask after ideation is confirmed
Confirm ideation, then ask about the method to judge how specific the plan is.

Next ask about access to means for that method, then intent and timing, then lethality, past attempts, and protective factors.

Ask directly and calmly. Asking about suicide does not plant the idea; it opens the conversation.

CautionRecent job loss, living alone, male sex, and weeks of depressed mood raise his risk; a specific plan with available means calls for urgent action.

## 핵심 개념

- **Suicidal ideation** — Thoughts of ending one's own life, ranging from passive wishes to active plans.
- **Suicide plan** — The specific method, means, and timing a person has thought of for ending his life.
- **Access to means** — Whether the person can obtain the method he plans to use, such as pesticide or pills.
- **Protective factors** — Supports, reasons for living, and coping resources that lower suicide risk.

## 같은 주제 문제

- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629986)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629987)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629988)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629989)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629991)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629992)
- [Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive d…](https://mymerci.kr/pages/nclex_q.php?qn_id=629993)
- [Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive d…](https://mymerci.kr/pages/nclex_q.php?qn_id=629994)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._