Psychiatric Mental Health Nurse Practitioner Track

A 60 year old caucasian male presents to the assessment office of your
psychiatric facility. You are asked to evaluate him. He has a chief complaint of “I just
can’t take this anymore! I’m gonna END her and then ME!!! I’m tired of this!” Patient
reports over the past few several weeks feeling more irritable and frustrated with the
pending divorce with his wife of 20 years. The patient admits to frequent crying spells,
getting easily distracted, having poor sleep initiation with frequent awakening throughout
the night, and having difficulty making work decisions. He says that in the past couple
of days he just “flies off the handle” at work and got sent home yesterday. He does not
report any history of auditory or visual hallucinations. He also tells you that since the
separation from his wife he can drink only diet sodas or beer. So he says that he drinks
a six pack of beer alone between Friday evening and Sunday evening. He denies any
illicit drug use. He hasn’t smoked cigarettes in over ten years.
He is staying at a family cabin 30 miles from town due to the pending divorce.
The couple’s only son lives three states away. The patient told your assessment
coordinator that he keeps a loaded gun “under his pillow” because there are “bad
people in this world.” Patient has never had any psychiatric treatment and is on
medication for diabetes, COPD, and hypertension. He has no surgical history and no
allergies. He has no history of legal problems, military service, or trauma. He has no
history of violence. He is from Mississippi and has been married 20 years. He reports no
other significant relationships. Both parents are deceased, and he was an only child.
By the end of the assessment, the patient has calmed considerably. He denies
any thoughts of harming himself or anyone else (including his wife). “Oh…I was just
pissed off…” He reports he just wanted to vent his frustration and insists he does not
need hospitalization.

  1. With the limited information available, what is the number one priority symptom
    that requires your intervention? Most importantly, write 1-3 paragraphs that
    defend your choice with a clinical rationale (30 points).
  2. Discuss how you would perform a suicide risk assessment for this patient (for
    example, would you use only your clinical interview skills? 30 points)
  3. Consider the Tarasoff (1976) ruling. Does a duty to warn apply in this case? What
    resources, if any, would you identify to assist with resolving this case (30
    points) ?

Sample Solution