Exam 3 Sherpath Questions (NURS 4130 - Crisis 1)

Which factor can adversely affect a person's ability to respond positively to a crisis situation? Select all that apply. 1. A lack of supportive services 2. The actual nature of the crisis 3. An unrealistic perception of the crisis 4. Reliance on ineffective coping mechanisms 5. The age of the individual at the time of the crisis

1. A lack of supportive services 3. An unrealistic perception of the crisis 4. Reliance on ineffective coping mechanisms A person's equilibrium may be affected adversely by one or more of the following: an unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms. Age and nature of the crisis are not considered as impactful.

Successful mourning means a client engages in a complex process of finding a new and durable connection to who he is now and to the person who died. What steps are included in the Four Tasks of Mourning? Select all that apply. 1. Accept the reality of the loss 2. Adjust to a world without the decreased 3. Process the pain of grief while caring for self 4. Practice forgiveness (I forgive you, please forgive me) 5. Find an enduring connection with the deceased in the midst of embarking on a new life

1. Accept the reality of the loss 2. Adjust to a world without the decreased 3. Process the pain of grief while caring for self 5. Find an enduring connection with the deceased in the midst of embarking on a new life The steps included in the Four Tasks of Mourning are accepting the reality of the loss, adjusting to a world without the deceased, processing the pain of grief while caring for self, and finding an enduring connection with the deceased in the midst of embarking on a new life. Forgiveness is not a part of the Four Tasks of Mourning. Forgiveness is a phase of communication in the Four Gifts of resolving relationships.

Which medical complication is possible with the diagnosis of anorexia nervosa? Select all that apply. 1. Acrocyanosis 2. Leukopenia 3. Dysmenorrhea 4. Hematuria 5. Hypokalemic acidosis

1. Acrocyanosis 2. Leukopenia 4. Hematuria Possible medical complications caused by anorexia include acrocyanosis, leukopenia, and hematuria. Patients with anorexia nervosa will more typically experience amenorrhea rather than dysmenorrhea, and hypokalemic alkalosis rather than hypokalemeic acidosis.

Which information is accurate for patients diagnosed with bulimia nervosa? Select all that apply. 1. Are often at or slightly below their idea body weight 2. Have a history is impulsivity and instability 3. Are at low risk for suicidal ideation 4. May or may not exhibit purging behaviors 5. Commonly require surgery for gastric rupture

1. Are often at or slightly below their idea body weight 2. Have a history is impulsivity and instability 4. May or may not exhibit purging behaviors Patients with bulimia nervosa are often at or slightly below their ideal body weight, often have a history of impulsivity and instability, and may or may not exhibit purging behaviors. They are at high risk for suicidal ideation. Gastric rupture is rare.

Which assessment findings support the diagnosis of anorexia nervosa in female patients? Select all that apply. 1. Bradycardia 2. Amenorrhea 3. Hypertension 4. Prolonged QT interval 5. Lethargy related to hypothyroidism

1. Bradycardia 2. Amenorrhea 4. Prolonged QT interval 5. Lethargy related to hypothyroidism Medical complications associated with anorexia nervosa include bradycardia, amenorrhea, prolonged QT interval, and abnormal thyroid functioning resulting in hypothyroidism. Hypertension is not associated with anorexia nervosa.

Which interventions are associated with primary crisis care? Select all that apply. 1. Discussing impact of crisis on the client 2. Administering antidepressant medication as prescribed 3. Planning for discharge, beginning with the admission interview 4. Assisting the client with learning new problem-solving techniques 5. Helping the client to identify environmental changes necessary to reduce stress

1. Discussing impact of crisis on the client 4. Assisting the client with learning new problem-solving techniques 5. Helping the client to identify environmental changes necessary to reduce stress Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. On this level the nurse can work with a client to recognize potential problems by evaluating the client's experience of stressful like events; teaching the client specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills; and assisting the client in evaluating the timing or reduction of like changes to decrease the negative effects of stress as much as possible. This may involve working with a client to plan environmental changes, to make important interpersonal decisions, and to rethink changes in occupational roles. Administering antidepressant medication and planning for discharge are examples of secondary care.

Which clinical manifestation is identified as a symptom of anorexia nervosa? Select all that apply. 1. Emaciation 2. Russell's Sign 3. Dehydration 4. Yellow Skin 5. Hyperkalemia

1. Emaciation 3. Dehydration 4. Yellow Skin Anorexia nervosa is an eating disorder in which the patient has intense fear of weight gain and refuses to maintain optimal weight. Because of malnourishment and starvation, the patient is emaciated and dehydrated. The skin is yellow as a result of elevated carotene levels in the blood. Patients with bulimia nervosa have Russell's sign, or calluses and scars on the hand caused by self-induced vomiting; this is not typically associated with anorexia nervosa. Hypokalemia, as opposed to hyperkalemia, is present in patients with anorexia nervosa because of dehydration.

A mentally ill client committed suicide in the hospital. The nurse plans to conduct a critical stress debriefing for the staff. In which order should the nurse conduct debriefing?

1. Explain the hospital guidelines 2. Discuss the cause of the incident 3. Ask the staff to discuss their thoughts about the incident 4. Discuss the pain the staff are feeling and what they cannot forget 5. Ask the staff to describe the symptoms they are experiencing 6. Involve the staff in stress-management techniques 7. Encourage staff to work effectively Debriefing is done in seven phases. The first phase is the introductory phase, in which the purpose of the meeting and guidelines are explained. The second phase is the fact phase, in which participants discuss the cause of the incident and describe the event from their perspective. The third phase is the thought phase, in which participants discuss their first thoughts about the incident. The fourth phase is the reaction phase, in which participants discuss incidents that were painful and that they cannot forget. The fifth phase is the symptoms phase, in which participants describe the symptoms that they are experiencing. The sixth phase is the teaching phase, in which participants are involved in stress-management techniques. The seventh phase is the reentry phase, in which participants are motived through encouragement, support, and appreciation.

Which signs and symptoms are most commonly associated with the diagnosis of anorexia nervosa? Select all that apply. 1. Fear of gaining weight 2. Chemical dependency 3. Rigorous exercise program 4. Self-induced vomiting 5. Peculiar handling of food

1. Fear of gaining weight 3. Rigorous exercise program 5. Peculiar handling of food A fear of gaining weight, a rigorous exercise program, and peculiar handling of Food are all commonly associated with anorexia nervosa. Chemical dependencies and self-induced vomiting are more typical of bulimia nervosa.

Behaviors have been identified for the various phases of crisis. Place the following behaviors in the order they are likely to be demonstrated.

1. Feelings of anxiety 2. Disorganizational thinking 3. Fight or flight response occurs 4. Demonstration of suicidal behaviors In phase 1, a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. In phase 2, when defense responses fail, individual functioning becomes disorganized. Phase 3 occurs when trial-and-error attempts fail; anxiety can escalate to severe and panic levels, and the person mobilized automatic relief behaviors, such as withdrawal and flight. Phase 4 is characterized by serious personality disorganization, depression, confusion, violence against others, or suicidal behaviors.

A nurse is caring for a patient with bulimia nervosa. Which factors should the nurse discuss when educating the patient about the eating disorder? Select all that apply. 1. Meal planning 2. Effects of purging 3. Effects of starvation 4. Relaxation techniques 5. Eating forbidden foods

1. Meal planning 2. Effects of purging 4. Relaxation techniques Bulimia nervosa is characterized by repeated episodes of binge eating followed by inappropriate behaviors such as induced vomiting or purgation to compensate. Meal planning will help the patient follow a healthy diet and avoid binging and purging. Understanding the effects of purging is important to be able to avoid it and maintain a healthy routine. Following relaxation techniques can help relieve stress by ways other than using food and therefore help in recovery. Understanding the effects of starvation are more important in cases of patients with anorexia nervosa because this disorder involves avoidance of food caused by fear of weight gain. Patients with bulimia nervosa should be encouraged to eat rather than to avoid forbidden foods.

Which medical complications are associated with the diagnosis of bulimia nervosa? Select all that apply. 1. Russell's sign 2. Hyperkalemia 3. Hypocholremia 4. Positive Babinski sign 5. Parotid gland enlargement

1. Russell's sign 3. Hypocholremia 5. Parotid gland enlargement Medical complications of bulimia nervosa include Russell's sign (callus on knuckles from self-induced vomiting), parotid gland enlargement associated with elevated serum amylase levels, and hypochloremia. Hypokalemia, not hyperkalemia, is associated with bulimia nervosa. A positive Babinski sign is not associated with bulimia nervosa.

Which statements are true regarding tertiary crisis care? Select all that apply. 1. The care may be provided on an outpatient basis. 2. A goal is to have the client regain optimum function. 3. A goal is the prevention of further crisis-related emotional disruption. 4. Sheltered workshops are not designed to provide tertiary crisis care. 5. Care focuses on recovery from a disabling mental state resulting from a crisis.

1. The care may be provided on an outpatient basis. 2. A goal is to have the client regain optimum function. 3. A goal is the prevention of further crisis-related emotional disruption. 5. Care focuses on recovery from a disabling mental state resulting from a crisis. Tertiary care provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Social and community facilities that offer tertiary intervention include rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruptions.

A nurse is assessing clients for risk factors that may complicate the successful completion of the mourning process. Which questions will help the nurse identify risk factors? Select all that apply. 1. Was the deceased a child 2. Were there persistent, unresolved conflicts with the deceased? 3. Has the bereaved had difficulty resolving past significant losses? 4. Does the bereaved have a history of cencer, heart disease, or stroke? 5. Does the bereaved have a history of depression or other psychiatric illness?

1. Was the deceased a child 2. Were there persistent, unresolved conflicts with the deceased? 3. Has the bereaved had difficulty resolving past significant losses? 5. Does the bereaved have a history of depression or other psychiatric illness? Obtaining a history from the bereaved can help identify risk factors for complication of the mourning process. The questions that can identify risk factors include the following: Was the deceased a child? Were there persistent, unresolved conflicts with the deceased? Has the bereaved had difficulty resolving past significant losses? Does the bereaved have a history of depression or other psychiatric illness? The question asking about history of cancer, heart disease, or stroke is incorrect because it does not help the nurse identify a risk factor for completion of successful mourning.

One of the most important skills necessary in caring for the dying and their family members is to be "in the moment." How is the nurse demonstrating presence and caring behaviors when caring for a client who is in palliative care with the family at the bedside? Select all that apply. 1. Avoiding discussion of spiritual beliefs 2. Allowing the patient time to express feelings 3. Helping the patient listen to his/her favorite music 4. Assisting in supporting the family in repairing conflicts 5. Making referrals for care when the patient expresses suicidal thoughts

2. Allowing the patient time to express feelings 3. Helping the patient listen to his/her favorite music 4. Assisting in supporting the family in repairing conflicts 5. Making referrals for care when the patient expresses suicidal thoughts A nurse who demonstrates presence and healing behaviors when caring for a patient in palliative care allows the patient time to express feelings; helps the patient make the most of things he/she enjoys, such as favorite music; assists in supporting the family in repairing conflicts; and makes appropriate referrals for care when the patient expresses suicidal thoughts. A nurse is not demonstrating presence and healing behaviors when avoiding discussion of spiritual beliefs. The nurse should assists with spiritual comfort instead.

Which physical finding supports a diagnosis of anorexia nervosa? Select all that apply. 1. Oily skin 2. Facial lanugo 3. Pulse rate of 39 BPM 4. Sensitivity to heat 5. Temperature of 96.7 F

2. Facial lanugo 3. Pulse rate of 39 BPM 5. Temperature of 96.7 F Lanugo (fine body hair) often appears on the face with anorexia nervosa. Decreased body temperature and pulse rate are other common findings in anorexia nervosa. The skin is dry rather than oily. The patient is sensitive to cold because of the loss of insulating body fat.

Which outcome indicates that the individual is demonstrating a commonly observed but negative coping strategy after a crisis event? Select all that apply. 1. Scheduling spiritual counseling sessions three times a week 2. Gaining 10 lbs over a 6-week period of time 3. Losing one's driver's license for driving drunk 4. Offering numerous excuses for not socializing 5. Running 5 miles daily

2. Gaining 10 lbs over a 6-week period of time 3. Losing one's driver's license for driving drunk 4. Offering numerous excuses for not socializing Common coping mechanisms may be overeating, drinking, smoking, withdrawing, yelling or fighting. Counseling and reasonable exercise would not be considered negative coping strategies.

Which diagnostic laboratory test is considered pertinent to the assessment of a patient suspected of having bulimia nervosa? Select all that apply. 1. Liver function 2. Glucose level 3. Thyroid function 4. Electrolyte levels 5. Complete blood count

2. Glucose level 3. Thyroid function 4. Electrolyte levels 5. Complete blood count Medical evaluation usually includes a thorough physical examination, as well as pertinent laboratory testing, including: electrolyte levels, glucose level, thyroid function tests, and complete blood count. Although it may be appropriate in some cases, liver function testing is not considered pertinent to the assessment process.

Which statement accurately describes a developmental crisis? Select all that apply. 1. Such crises occur once adulthood has been reached 2. Physical changes may result in conflict or crisis 3. This form of crisis represents both vulnerability and potential 4. New coping skills must be learned because old ones are ineffective 5. Retirement can result in a maturational crisis for some individuals

2. Physical changes may result in conflict or crisis 3. This form of crisis represents both vulnerability and potential 4. New coping skills must be learned because old ones are ineffective 5. Retirement can result in a maturational crisis for some individuals Developmental crises are associated with maturation, a process that occurs across the life cycle. Each developmental stage represents a time when physical, cognitive, instinctual, and sexual changes prompt an internal conflict or crisis, which results in either psychosocial growth or regression that represents increased vulnerability, and at the same time, heightened potential. When a person arrives at a new stage, formerly used coping styles are no longer effective, and new coping mechanisms have yet to be developed and learned. Examples of events that can precipitate a developmental crisis include leaving home during late adolescence, marriage, birth of a child, retirement, and death of a parent. One does not need to be an adult to experience a developmental crisis.

Which principle related to crisis resolution directs the care provided by a crisis intervention nurse? Select all that apply. 1. The patient employs previously used problem-solving methods to regain pre-crisis functioning 2. The goal of crisis intervention is for the patient to regain pre-crisis level functioning 3. During a crisis, people often are more receptive than usual to outside intervention 4. Early intervention probably increases the chances for effective coping 5. The nurse must be willing to take a passive and nondirective role in the care

2. The goal of crisis intervention is for the patient to regain pre-crisis level functioning 3. During a crisis, people often are more receptive than usual to outside intervention 4. Early intervention probably increases the chances for effective coping The goal of crisis intervention is to return the patient to at least the pre-crisis level of functioning. During a crisis, people often are more receptive than usual to outside intervention. Early intervention probably increases the changes for a favorable prognosis. With intervention, the patient can learn different adaptive means of problem solving to correct in adequate solutions. The nurse must be willing to take an active, even directive, role in intervention.

The nurse is sitting at the table near a patient with bulimia nervosa during lunch. The patient asks the nurse to be excused to go to the bathroom. Which action would the nurse take? Select all that apply. 1. Waiting outside the patient's bathroom 2. Telling the patient to return in 5 minutes 3. Going into the bathroom with the patient 4. Asking the patient to wait until after lunch 5. Having unlicensed assistive personnel go with the patient to the bathroom

3. Going into the bathroom with the patient 5. Having unlicensed assistive personnel go with the patient to the bathroom A patient with bulimia nervosa eats large amounts of food and then purges through self-induced vomiting. When a patient asks to go to the bathroom during mealtime, the nurse or unlicensed assistive personnel should go into the bathroom with the patient. The nurse should not wait outside the patient's bathroom or send the patient off alone and ask him or her to return in 5 minutes as the patient can induce vomiting without being supervised. If the patient truly needs to use the bathroom, it would not be appropriate to ask the patient to wait.

The parents of a 16-year-old patient newly admitted for treatment of an eating disorder voice concern that the hospital is not providing enough food to improve their child's nutrition and weight. Which response would be most appropriate for the nurse to provide? A. "Intake should be increased gradually to prevent cardiac complications" B. "We do not provide a lot of food at first as the patient will waste most of it" C. "As you child begins to feel better, we will increase the amount of food provided" D. "Small, frequent meals are provided until the stomach can handle increased intake"

A. "Intake should be increased gradually to prevent cardiac complications" Refeeding syndrome can occur when an emaciated person attempts to eat too much at one time. The body switches from a catabolic state to an anabolic state. If this happens too fast, fluid and electrolytes can shift, leading to cardiac problems including heart failure and dysrhythmias. The nurse should not tell the parents that food is not provided because of the waste. Increased intake is not based on how the patient feels, but on laboratory tests and cardiac status. Small, frequent meals would be provided until fluid and electrolyte status improves, not because of stomach size.

When an individual in the second stage of crisis is unable to resolve the situation by using his or her usual coping strategies, the individual is likely to implement which coping strategy? A. Becomes disorganized and uses trial-and-error problem solving. B. Withdraws and acts as though the problem does not exist. C. Develops severe personality disorganization. D. Resorts to planning suicide.

A. Becomes disorganized and uses trial-and-error problem solving. Becoming disorganized and using trial-and-error problem solving is characteristic of the second stage of crisis, according to accepted crisis theory. Withdrawing and acting as though the problem does not exist, developing severe personality disorganization, and planning suicide are not associated with the second stage of crisis.

A patient states, "If I get back to a body mass index (BMI) of 20, I will never be able to have the life I want." Which cognitive distortion is this patient displaying? A. Catastrophizing B. Personalization C. Overgeneralization D. Emotional reasoning

A. Catastrophizing Catastrophizing involves magnifying the consequences of an event to unrealistic proportions. Personalization involves overinterpreting events as having personal significance. Overgeneralization involves believing that a single event affects unrelated situations. Emotional reasoning involves the belief that subjective emotions determine reality.

What is the priority concern for the crisis intervention nurse? A. Client safety B. Setting up future contacts C. Brainstorming possible solutions D. Working through termination issues

A. Client safety Client safety is always the priority concern in crisis intervention therapy. The disequilibrium of crisis predisposes the client to suicidal thinking. Setting up contacts, brainstorming solutions, and working through termination issues are all concerns of crisis intervention, but they are secondary to safety.

Which therapy is most helpful to patients diagnosed with eating disorders to address problems associated with emotional dysregulation? A. Dialectical Behavioral Therapy B. Family Therapy C. Group Therapy D. Psychodynamic Therapy

A. Dialectical Behavioral Therapy Dialectical behavioral therapy is a form of cognitive behavioral therapy adapted to address problems associated with emotional dysregulation. Family therapy is especially efficacious in early-onset and short-duration anorexia. It supports parent refeeding of children and identifies family dynamics that may be contributing to the problem. Group therapy offers support to patients who feel isolated while offering an arena in which to explore the eating disorder. Psychodynamic therapy explores the underpinnings of the disorder.

Which coping mechanism is commonly adopted during a crisis? A. Engaging in other physical activity B. Setting realistic goals C. Avoiding talking with others D. Avoiding eating

A. Engaging in other physical activity During a crisis, patients use different coping techniques to cope with the situation. Some patients may get involved in physical activity such as walking to relieve restlessness. Because the patient has had a crisis, he/she may not be psychologically stable and may not be able to set realistic goals. Some patients may try to cope with the stress by talking to others. Some patients tend to overeat to cope with stress.

Which pharmaceutical treatment is considered the "gold standard" for bulimia nervosa? A. Fluoxetine B. Olanzapine C. Benzodiazepine D. Anticonvulsant

A. Fluoxetine Fluoxetine has been approved by the Food and Drug Administration (FDA) for the treatment of bulimia nervosa and has been regarded as the "gold standard" in the treatment of this disorder. Olanzapine, a second-generation antipsychotic, is increasingly being reported in the literature to positively affect weight gain and improve cognition and body image for anorexia nervosa. Benzodiazepine and anticonvulsant therapies are not specifically indicated for eating disorders.

patient has been hospitalized with anorexia nervosa. The patient's weight is 65% of normal. Which outcome for this patient is realistic for the end of the first week of hospitalization? A. Gain 3 pounds and improve electrolyte balance B. Develop a pattern of normal eating behavior C. Discuss fears and feelings about gaining weight D. Verbalize awareness of the sensation of hunger

A. Gain 3 pounds and improve electrolyte balance The critical outcome during hospitalization for anorexia nervosa is weight gain and addressing acute complications, such as electrolyte imbalance. Developing a pattern of normal eating behavior, discussing fears and feelings, and verbalizing awareness of hunger are longer-term goals to be set after the patient has achieved basic physiological stability.

Which situation identifies how assessment findings differ for a patient diagnosed with bulimia compared to a patient diagnosed with anorexia nervosa? A. Maintaining a normal weight B. Purging to keep weight down C. Holding a distorted body image D. Performing more rigorous exercising

A. Maintaining a normal weight Many patients diagnosed with bulimia are at or near normal weight, whereas those diagnosed with anorexia nervosa are underweight. Patients with either disorder may engage in purging, distorted body image, or excessive exercise.

Which focus is appropriate for the acute phase of treatment for a patient diagnosed with anorexia nervosa? A. Restoring weight B. Improving interpersonal skills C. Learning effective coping methods D. Changing family interaction patterns

A. Restoring weight Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is threatened seriously by an acutely underweight status. Interpersonal skills, coping, and family interactions are important areas to be explored after the patient's physical health has been stabilized.

An adult has a family history of colon cancer, so this adult has screening colonoscopies every 5 years. At age 55, the colonoscopy reveals a malignant tumor in the ascending colon. The nurse should assess this adult for which type of crisis? A. Situational B. Adventitious C. Maturational D. Developmental

A. Situational A situational crisis may occur after the loss or change of a job, the death of a loved one, an abortion, a change in financial status, divorce, or severe illness. In this scenario, a situational crisis may occur despite the adult's predisposition to colon cancer. An adventitious crisis results from events that are unplanned and may be accidental, caused by nature, or human-made (natural disaster, a national disaster, or a crime of violence). A maturational crisis may be associated with leaving home during late adolescence, marriage, birth of a child, retirement, or death of a parent. Each developmental stage represented a maturational crisis that is a critical period of increased vulnerability and, at the same time, heightened potential.

Which assumption serves as a foundation for the use of crisis intervention? A. The individual is mentally healthy but in a state of disequilibrium B. Long-term dysfunctional adjustment can be addressed by crisis intervention C. An anxious person is unlikely to be willing to try new problem-solving strategies D. Crisis intervention nurses need to remain passive as the patient deals with the crisis

A. The individual is mentally healthy but in a state of disequilibrium The individual is mentally healthy but in a state of disequilibrium is the only true statement. Crisis intervention cannot address long-term dysfunctional adjustment. An anxious person is not likely to try new strategies. Crisis intervention nurses take an active role in working with the patient.

Postvention for the family and friends who are survivors of a suicide is most successful when initiated within which time frame? A. 4 to 8 hours B. 24 to 72 hours C. After 72 hours D. Within 24 hours

B. 24 to 72 hours Intervention for family and friends of a person who has completed suicide is called postvention and should be initiated within 24 to 72 hours after the death. Survivors may still be in shock within the first 4 to 8 hours. Unfortunately, few friends or family members of a person who has completed suicide seek counseling, therefore waiting until after 72 hours should decrease the success of postvention. Natural feelings of denial and avoidance predominate during the first 24 hours.

Which assessment findings most accurately describe a client experiencing uncomplicated grief? A. A caregiver at the bedside of a patient who is terminally ill in hospice care B. A young male complaining of insomnia after losing his mother 2 weeks ago 3. A young female who has thoughts of harming herself after losing her father 3 months ago 4. A fan mourning the death of a country music singer who passed away suddenly in a car accident

B. A young male complaining of insomnia after losing his mother 2 weeks ago The young male who lost his mother 2 weeks ago is correct because insomnia is a normal reaction in uncomplicated grief. The caregiver at the bedside is experiencing anticipatory grief. The young female experiencing suicidal thoughts has complicated grief. The fan mourning the death of a country music singer is experiencing disenfranchised grief.

The expected outcome at the conclusion of crisis intervention therapy is that the client will function: A. At a higher level than before the crisis. B. At the pre-crisis level. C. Only marginally below the pre-crisis level. D. Without aid from identified support systems.

B. At the pre-crisis level. The intent of crisis intervention is to return the individual to the pre-crisis level of functioning. A crisis would not provide the necessary teaching factors to result in the functioning at a higher level. The goal is not to lose function. Not all crises require help from a support system.

In the United States, which agency has overall responsibility to coordinate responses to disasters? A. World Health Organization (WHO) B. Department of Homeland Security (DHS) C. Federal Emergency Management Agency (FEMA) D. National Incident Management System (NIMS)

B. Department of Homeland Security (DHS) The DHS has ultimate government responsibility for the safety of United States citizens and territories while assuring adequate preparedness, response, and recovery protocols are immediately available. WHO serves the global community. DHS oversees operations of FEMA. NIMS helps first responders from different disciplines and areas to work together effectively when a community has exhausted its available resources in addressing a large-scale occurrence.

A patient who experienced a sexual assault 2 weeks ago continues to feel threatened, will not leave the apartment, and has increased anxiety of feeling unsafe. Which crisis phase is the patient experiencing? A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4

B. Phase 2 The patient is experiencing signs of being in phase 2 of the crisis response because the patient refuses to leave the apartment and has increased anxiety. Phase 1 would be after the initial sexual assault when determining to seek medical care. Phase 3 would be if the patient tries to leave the apartment and suffers panic attacks. Phase 4 would be evident if the patient were developing depression, confusion, and suicidal behavior.

Which pathology do biological theorists suggest is a cause of eating disorders? A. Dopamine excess B. Serotonin imbalance C. Normal weight phobia D. Body image disturbance

B. Serotonin imbalance Serotonin pathways are abnormal in both anorexia nervosa and bulimia nervosa. Brain scans of patients with these disorders reveal altered serotonin receptors and transporters. Dopamine excess is not associated with eating disorders. Normal weight phobia and body image disturbance may be involved, but they are not biological factors.

The nurse must initially assess a client in crisis for which equilibrium-focused behavior? A. Self-report of feeling depressed B. Unrealistic report of a crisis-precipitating event C. Report of a high level of anxiety D. Admission that he or she is abusing drugs

B. Unrealistic report of a crisis-precipitating event A person's equilibrium may be affected adversely by one or more of the following: an unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms. These factors must be assessed when a crisis situation is evaluated because data gained from the assessment are used as guides for both the nurse and the client to set realistic and meaningful goals, as well as to plan possible solutions to the problem situation. Feelings of depression or anxiety and admission of drug use are important to the crisis management process, but they are secondary to assessing the client's report of the event.

Which period reflects how much time it usually takes for a crisis to self-resolve? A. 1 to 10 days B. 1 to 3 weeks C. 4 to 6 weeks D. 3 to 4 months

C. 4 to 6 weeks At 4 to 6 weeks, the individual is making accommodations and adjustments to relieve anxiety, and the crisis is no longer a crisis. These adjustments usually cannot be made in less time, but taking 3 to 4 months would not be tolerable.

Which sign or symptom would be assessed in a patient in phase 2 of a crisis? A. Suicidal intentions B. Intention to harm others C. Feelings of extreme discomfort D. Severe panic

C. Feelings of extreme discomfort Crisis is categorized into 4 distinct phases based on the behavior of the patient. A patient in phase 2 crisis has feelings of extreme discomfort, threat, and anxiety. Patients in phase 4 have suicidal ideation and/or intention to harm others. Patients who exhibit severe panic and withdrawal are included in phase 3.

The nurse is reviewing the health record of a patient with anorexia nervosa before entering the room. Which finding would the nurse expect during the assessment? A. Dental caries B. Russell's sign C. Irregular heart rate D. Palpable parotid gland

C. Irregular heart rate Patients with anorexia nervosa would develop an irregular heart rate and/or rhythm caused by electrolyte imbalances from nutritional deficits. Dental caries occur from purging, and Russell's sign is a callus on the knuckles; these both occur with bulimia nervosa. Patients with bulimia nervosa can develop an enlarged parotid gland, which can be easily palpated; this is a result of increased serum amylase levels.

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A. γ-Aminobutyric acid B. Dopamine C. Serotonin D. Acetylcholine

C. Serotonin Low serotonin levels have been noted among individuals who have committed suicide. While γ-Aminobutyric acid, dopamine, and acetylcholine are neurotransmitters, they are not believed to be associated with suicidal ideation.

Which stage of critical incident stress debriefing includes acknowledgement of expressed symptoms? A. Thought phase B. Reaction phase C. Teaching phase D. Symptom phase

C. Teaching phase Critical incident stress debriefing is a form of tertiary intervention for crisis and disaster management. It is a type of group therapy that consists of seven phases in which the patients share their thoughts, feelings, and ideas. In the teaching phase the patients acknowledge the normality of their symptoms. They are also taught about the symptoms of stress that they may anticipate in the future. The thought phase includes the sharing of ideas and thoughts between the patients of the group. In the reaction phase the participants talk about the painful events associated with the crisis incident. In the symptom phase participants describe their cognitive, physical, emotional, or behavioral experiences of the incident.

A patient diagnosed with bulimia nervosa frequently uses enemas and laxatives to purge. Which imbalance might be present with this patient? A. Elevated serum sodium level B. Elevated serum potassium level C. Increase in the red blood cell count D. Disruption of fluid and electrolyte balance

D. Disruption of fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. Serum sodium levels, potassium levels, and red blood cell count may be affected by purging, but the nurse can gain information about any of these imbalances by monitoring fluid and electrolyte balance overall.

Which event can lead to the development of a situational crisis in clients? A. Physical assault B. Natural disaster C. Birth of a child D. Loss of a job

D. Loss of a job A situational crisis arises from external events such as loss of a job or an abortion. An adventitious crisis results from accidental events that are unplanned, which may be human-made or caused by nature. This crisis arises from situations such as physical assaults and natural disasters like floods and earthquakes. A maturational crisis arises from developmental changes in a person's life such as the birth of a child or death of parents.

Which classic characteristic is common among patients diagnosed with bulimia nervosa? A. Male B. Obese C. Involved in sports D. Onset in late adolescence

D. Onset in late adolescence Anorexia nervosa has an average age of onset in early to middle adolescence whereas bulimia nervosa more typically appears in late adolescence. Eating disorders of all kinds are more prevalent in females than males. The DSM-5 states that only approximately one third of binge eaters are obese. Being involved in sports is not considered a characteristic.

During which crisis phase does a client exhibit serious personality disorganization, depression, and confusion? A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4

D. Phase 4 Caplan was the first person who conducted an extensive study on individual behavior. He proposed Your stages based on the emotional status of a client during a crisis. Patients with high personality disorganization, depression, and confusion are categorized under phase 4. These clients also exhibit suicidal thoughts. Increased level of anxiety caused by external stimuli is experienced by a client during phase 1. lithe anxiety level grows to a level of extreme discomfort, the client has reached the phase 2 level of crisis. Phase 3 is characterized by an increased level of panic due to grief and loss.