Crisis and Suicide

​Case Study: Alex Rivera – Acute Agitation and Crisis

Background: Alex Rivera, a 22-year-old college student, is brought to the behavioral health unit after an argument with a family member. A bystander reports Alex shouted, “No one cares if I live or die,” punched the door, and threatened to “make everyone leave me alone.” Alex has a history of major depressive disorder and intermittent explosive disorder. According to his mother, the past month has involved insomnia, missed classes, and alcohol binges on weekends. On arrival, Alex paces rapidly, clenches fists, and speaks in loud, pressured bursts. Skin is diaphoretic; pulse 118/min; respirations 26/min; pupils dilated. The nurse notes restlessness, difficulty concentrating, and limited ability to follow directions.

Multiple Select

Select all findings that elevate Alex’s risk for self‑harm based on case data.

Select all that apply.

• Recent alcohol binges.

• Supportive family engagement.

• Insomnia for the past month.

• Loud, pressured speech and pacing.

• History of intermittent explosive disorder.

Multiple Choice

Based on the assessment, Alex is most likely in which anxiety level?

• Mild

• Moderate

• Severe

• Panic

Multiple Choice

The nurse first approaches Alex using which priority intervention?

• Speak in a calm voice and validate feelings while maintaining safe distance.

• Obtain a restraint order and prepare four-point restraints.

• Confront the threatening statements and demand immediate cooperation.

• Ask the family to enter and help calm Alex.

Multiple Choice

Which environmental modification best supports de‑escalation for Alex?

• Stand directly in front of the exit to ensure control.

• Request group therapy to process anger immediately.

• Increase lighting and invite unit visitors for distraction.

• Move to a quieter room with reduced stimuli and provide short, simple directions.

Multiple Choice

Priority nursing action when Alex continues pacing loudly and clenching fists despite verbal de‑escalation attempts:

• Ignore the behavior to avoid reinforcing attention-seeking.

• Ensure safety by removing hazards and calling additional trained staff for assistance.

• Begin lengthy education on stress physiology to improve insight.

• Threaten to call law enforcement to ensure compliance.

Multiple Choice

Legal/ethical criterion required before applying restraints:

• Patient refusal to take scheduled medication.

• Imminent danger to self or others after lesser measures fail.

• Family request to control behavior.

• Short staffing on the unit.

Multiple Choice

Which assessment statement requires the most immediate follow‑up for suicide risk?

• “No one cares if I live or die.”

• “I cannot sleep lately.”

• “I skipped classes this week.”

• “I am angry with my family.”

Multiple Select

Select all actions that are consistent with least-restrictive intervention principles during a crisis. Select all that apply

• Offer PRN oral anxiolytic if prescribed.

• Use seclusion first to prevent stimuli exposure.

• Employ guided breathing and grounding cues.

• Attempt mechanical restraints prior to verbal techniques.

• Engage a trained staff member to continue verbal de‑escalation.

Multiple Choice

Which statement reflects correct use of PRN medication in crisis?

• Offer ordered oral PRN anxiolytic after verbal techniques fail and agitation persists.

• Begin with IM sedatives before attempting verbal strategies.

• Use PRN solely to enforce staff control.

• Administer PRN without consent because admission was involuntary.