Varcarolis Ch 26: Crisis and Disaster - all

5. The highest-priority goal of crisis intervention is: a. Patient safety. b. Anxiety reduction. c. Identification of situational supports. d. Teaching specific coping skills that are lacking.

A

When does a patient have symptoms of self-hatred and depression? 1. When the patient has chronic low self-esteem 2. When the patient has posttrauma syndrome 3. When the patient has impaired social interaction 4. When the patient has acute confusion

1 Patients experiencing crisis have chronic low self-esteem, posttrauma syndrome, impaired social interaction, and acute confusion. The symptoms of chronic low self-esteem are self-hatred and depression. The symptoms of posttrauma syndrome are denial, hypervigilance, and panic. Symptoms of impaired social interaction include feelings of isolation and little or no social support. Symptoms of acute confusion include feelings of numbness, confusion, and incoherence.

A nurse working in a trauma center has been accused of getting overly attached to some patients. The nurse has even called some patients after they are discharged and tries to give advice about general health issues. What is the best course of action for this nurse? 1. share personal feelings with trained professionals 2. employ the appropriate nursing intervention to treat new health issues 3. contact patient only for issues related to original trauma. 4. write a note to the patient in order to gain closure.

1 A nurse giving crisis intervention to a patient may have difficulty in terminating the relationship and may be tempted to work on other problems of the patient to prolong contact. This is not an acceptable behavior so the nurse should share his or her feelings of abandonment or termination with experienced professionals so that letting the patient go is easier. The nurse should refer the patient to the primary health care provider for treating routine health care concerns rather than trying to treat the patient directly. The nurse should not contact the patient after discharge, by letter or otherwise, to discuss the original trauma or new health issues.

The nurse interacts with a patient at a crisis center. The patient speaks of distressing events and makes dismissive comments. What diagnosis should the nurse make from the patient's symptoms? 1. Acute confusion 2. Ineffective denial 3. Impaired social interaction 4. Disturbed personal identity

2. Ineffective denial

Which situation has the potential for early crisis intervention to occur? 1. Mrs. R tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist. 2. Ms. T is hospitalized after an unsuccessful suicide attempt that she states, "was a mistake." 3. Mr. W asks for reassurance that he will be welcome at the day hospital after his hospital discharge. 4. Mr. G enters the emergency department with a strong smell of alcohol on his person, stating he is anxious and depressed.

1 Phase I intervention is when a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety. An unsuccessful suicide attempt deemed a mistake indicates a phase 4 response to a crisis; reassurance would be a phase 3 response. Mr. G is using inappropriate coping mechanisms, which are not effective to treat depression and anxiety.

The expected outcome at the conclusion of crisis intervention therapy is that the patient will function in which of the following ways? 1. At the pre-crisis level 2. At a higher level than before the crisis 3. Only marginally below the pre-crisis level 4. Without aid from identified support systems

1. At the pre-crisis level

After the bomb explosions at the Boston Marathon in 2013, members of the community donned t-shirts that said, "Boston Strong." Which phase of the disaster management continuum is evident by this behavior? 1. Recovery 2. Mitigation 3. Evaluation 4. Preparedness

1. Recovery

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? 1. Situational 2. Adventitious 3. Maturational 4. Developmental

1. Situational

Which type of crisis arises from events that are extraordinary, external rather than internal, and often unanticipated? 1. Situational 2. Maturational 3. Adventitious 4. Posttraumatic stress

1. Situational

A family's home and possessions are lost when a massive forest fire burns out of control. What type of crisis has occurred? 1. situational 2. adventitious 3. maturational 4. developmental

2

When a person becomes unemployed, he or she is likely to experience a(n) 1. Reactive crisis 2. Situational crisis 3. Adventitious crisis 4. Substance abuse crisis

2

The nurse interacts with a patient at a crisis center. The patient speaks of distressing events and makes dismissive comments. What diagnosis should the nurse make from the patient's symptoms? 1. acute confusion 2. ineffective denial 3. impaired social interaction 4. disturbed personality disorder

2 Patients with ineffective denial talk about distressing events and make dismissive comments. They also display inappropriate affect and delay seeking care. Patients with acute confusion have confusion and incoherence, and may have problems with substance abuse. Impaired social interaction is characterized by difficult interpersonal relationships, isolation, and few or no social supports. Disturbed personal identity is identified by self-hatred and feelings of being overwhelmed and ineffectual.

Whose model does a nurse follow while conducting crisis intervention for a patient with acute stress disorder? 1. Gerald Caplan's 2. Albert R. Roberts 3. Erich Lindemann's 4. Donna Aguilera and Janice Mesnick's

2 Several theories have been proposed for treating individuals diagnosed with acute stress disorder. Roberts's model of crisis interventions is especially useful for patients who have suffered from an acute situational crisis and those who are diagnosed with acute stress disorder. It is a seven-step process that includes planning, establishing relations, identifying cause, active listening, searching for alternatives, formulating, and implementation. Caplan's advanced crisis theory provides an outline of the knowledge of crisis and disaster management. Lindemann was the first person to propose the concept of crisis theory. He conducted a study of relatives of the 492 victims of the Cocoanut Grove nightclub fire accident. Aguilera and Mesnick's theory explains the framework of planning strategies for effective crisis management. Unlike Roberts's model of crisis interventions, these other models do not specifically focus on interventions for acute stress disorder.

A 12-year-old female finds herself feeling anxious and overwhelmed and seeks out the school nurse to report that "Everything is changing...my body, the way the boys who were my friends are treating me, everything is so different." It is likely the child is 1. Describing personal identity disorder 2. Experiencing a maturational crisis 3. Potentially suicidal 4. Mildly neurotic

2 The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary.

Which outcome indicates the individual is demonstrating a commonly observed but negative coping strategy after a crisis event? Select all that apply. 1. scheduling spiritual counseling sessions 3 times a week 2. gaining 10 pounds over 6 week period of time 3. losing one's driver license for driving drunk 4. offering numerous excuses for not socializing 5. running 5 miles dialy

2, 3, 4

A family's home and possessions are lost when a massive forest fire burns out of control. What type of crisis has occurred? 1. Situational 2. Adventitious 3. Maturational 4. Developmental

2. Adventitious

Whose model does a nurse follow while conducting crisis intervention for a patient with acute stress disorder? 1. Gerald Caplan 2. Albert R. Roberts 3. Erich Lindemann 4. Donna Aguilera and Janice Mesnic

2. Albert R. Roberts

Which government entity is charged with coordinating responses to American disasters, particularly in situations in which local and state resources are inadequate to the presenting challenge? 1. Department of Defense (DOD) 2. Department of Homeland Security (DHS) 3. Department of Health and Human Services (DHHS) 4. Department of Housing and Urban Development (HUD)

2. Department of Homeland Security (DHS)

What is the best description of a psychiatric advance directive plan? 1. Outpatient care with the goal of preventing hospitalization 2. Proactive method of addressing a crisis situation before it occurs 3. Legal, written statement regarding a person's wishes regarding medical treatment 4. Continuous 24-hour observation and supervision for those not requiring inpatient services

2. Proactive method of addressing a crisis situation before it occurs

A nurse is conducting crisis intervention for a patient who is a victim of physical assault and learns that the patient is confused and overwhelmed. Which strategy does the nurse implement while interacting with the patient to make the patient feel comfortable? 1. The nurse avoids making eye contact with the patient. 2. The nurse summarizes the information given by the patient. 3. The nurse advises the patient to have regular follow-up visits. 4. The nurse refrains from giving frequent feedback to the patient.

2. The nurse summarizes the information given by the patient.

An adult recently diagnosed with multiple sclerosis says, "I'm worried I won't be able to support my family or send my children to college." This person begins drinking alcohol heavily and omitting prescribed medications. What is the likely cause of the patient's behavior? 1. The patient is in a state of equilibrium.An adult recently diagnosed with multiple sclerosis says, "I'm worried I won't be able to support my family or send my children to college." This person begins drinking alcohol heavily and omitting prescribed medications. What is the likely cause of the patient's behavior? 1. The patient is in a state of equilibrium. 2. The patient is in a state of situational crisis. 3. The patient is reflecting on the situational event. 4. The patient is perceiving the event in a distorted way.

2. The patient is in a state of situational crisis.

A major hurricane destroyed a community. Afterward, which comment best predicts that a victim will be able to maintain or promptly return to a state of equilibrium? 1. "I think we will be fine. There are emergency agencies that will take care of us." 2. "It seems that trouble always finds me. Like in the past, I will do my best to cope with this disaster." 3. "We had had big storms before. If we pull together, we can help each other and rebuild our community." 4. "This storm wasn't so bad. It could have killed more people or destroyed the underground power lines."

3

A nurse is depressed after being unsuccessful in managing a patient in crisis. While reviewing the nurse's care plan, a nurse manager finds that the nurse had set unrealistic goals for the patient. What suggestion does the nurse manager give to the nurse? 1. "You should not have any expectations from the patient." 2. "Patients who have experienced a crisis cannot make decisions." 3. "You should stop setting goals and encourage the patient to set self goals." 4. "Patients who have experienced a crisis cannot follow your instructions."

3

Following an assessment, the nurse concludes that the patient is in phase 2 crisis. What signs and symptoms does the nurse find in the patient? 1. suicidal intentions 2. intention to harm others 3. feelings of extreme discomfort 4. severe panic

3 Crisis is categorized into four 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.

A woman comes to the crisis intervention clinic expressing concern that her 16-year-old is using illegal drugs in their home. The nurse will 1. encourage mother to call the police when her song brings drugs home 2. inform her of the obligation to report this information to the police. 3. work w. the patient to set goals that are mutually acceptable 4. refer patient to police for consultation

3 Goal setting is a collaborative task. Goals must be acceptable to the patient and seen by the nurse as safe and appropriate.

Which best describes the principle of crisis intervention? 1. Support that includes all people who are available that can be depended upon during the time of crisis 2. An action that promotes mental health and reduces mental illness to decrease the incidence of crisis 3. A directive, time-limited, and goal-directed strategy designed to assist individuals who are experiencing crisis 4. A technique in which those affected by a crisis or disaster come together to share thoughts, feelings, and experiences

3. A directive, time-limited, and goal-directed strategy designed to assist individuals who are experiencing crisis

When a tornado results in the loss of homes, businesses, and life, the town residents are likely to experience what type of crisis? 1. Situational crisis 2. Maturational crisis 3. Adventitious crisis 4. Endogenous crisis

3. Adventitious crisis

The nurse is caring for a depressed patient who was rescued from an earthquake. As part of the counseling and treatment, the nurse wants to assess the patient's family and the patient's stressors. What appropriate action will the nurse take? 1. Interact with the patient's family. 2. Check the patient's medical history. 3. Ask the patient to describe his or her feelings. 4. Ask the patient what makes him or her feel better.

3. Ask the patient to describe his or her feelings.

What is the primary factor that makes an event a crisis? 1. Type of loss that the event causes. 2. Nature of the stress caused by the event. 3. Ineffectiveness of one's usual coping strategies. 4. Preexistence of a stress-related mental illness.

3. Ineffectiveness of one's usual coping strategies.

The nurse is caring for a patient with rape-trauma syndrome. What outcome shown by the patient after 8 weeks indicates effective crisis intervention? 1. The patient maintains good hygiene. 2. The patient sleeps for a short span of time. 3. The patient concentrates on the given task. 4. The patient uses nonverbal communication.

3. The patient concentrates on the given task.

Which event leads to the development of a situational crisis in patients? 1. Physical assault 2. Natural disaster 3. Birth of a child 4. Loss of a job

4

During which crisis phase does a patient exhibit serious personality disorganization, depression, and confusion? 1. phase 1 2. phase 2 3. phase 3 4. phase 4

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

The nurse is counseling a patient at a crisis center. After assessing the patient's situation, the nurse identifies that the patient is suffering from adventitious crisis. Which patient response supports the nurse's findings? 1. "I have nothing to do and feel worthless." 2. "I love my parents. Why did they leave me alone?" 3. "My husband assaults me every day; I want to put an end to my life." 4. "Terrorists brutally killed all the passengers; I somehow managed to escape."

4. "Terrorists brutally killed all the passengers; I somehow managed to escape."

The nurse is performing crisis intervention for a sexually assaulted patient. What appropriate action should the nurse take to help the patient cope with the crisis? Select all that apply. 1. Guide the patient about maintaining support systems. 2. Convince the patient to file a complaint against the attacker. 3. Encourage the patient to make conclusions about their suffering. 4. Encourage the patient to express feelings in a nondestructive manner. 5. Frequently restate the statements made by the patient during interview.

4. Encourage the patient to express feelings in a nondestructive manner. 5. Frequently restate the statements made by the patient during interview. 1. Guide the patient about maintaining support systems.

Following an assessment, the nurse concludes that the patient is in phase 2 crisis. What signs and symptoms does the nurse find in the patient? 1. Severe panic 2. Suicidal intentions 3. Intention to harm others 4. Feelings of extreme discomfort

4. Feelings of extreme discomfort

Which of the following is an example of a maturational crisis? 1. Experiencing an unplanned pregnancy 2. Losing one's job within months of retiring 3. Working at a bank that recently was robbed 4. Having one's only child leave home to attend college

4. Having one's only child leave home to attend college

A man is having difficulty adjusting to becoming a father. He has not bonded with his newborn and frequently stays out at night drinking with friends. Which type of crisis is evident? 1. External 2. Situational 3. Adventitious 4. Maturational

4. Maturational

What are the two initial goals for crisis interventions? 1. Anxiety reduction and coping 2. Crisis resolution and planning 3. Assessment and nursing diagnosis 4. Patient safety and anxiety reduction

4. Patient safety and anxiety reduction

1. Which statement about crisis theory will provide a basis for nursing intervention? a. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable. b. A person in crisis has always had adjustment problems and has coped inadequately in his or her usual life situations. c. Crisis is precipitated by an event that enhances a person's self-concept and self-esteem. d. Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis.

A

3. When responding to the patient in question 2, the intervention that takes priority is to: a. Reduce anxiety. b. Arrange shelter. c. Contact out-of-area family. D. Hospitalize and place the patient on suicide precautions

A

4. Which belief would be least helpful for a nurse working in crisis intervention? a. A person in crisis is incapable of making decisions. b. The crisis counseling relationship is one between partners. c. Crisis counseling helps the patient refocus to gain new perspectives on the situation. d. Anxiety-reduction techniques are used so the patient's inner resources can be accessed.

A

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 client deals with the crisis.

A Only statement A is true.

To assess the client's perception of the event precipitating a crisis, the nurse would initially ask A. "What was happening just before you began feeling this way?" B. "During difficult times in the past, what has helped you?" C. "Can you give me the name of someone you trust?" D. "Who is available to help you?"

A Option A is the only query that is directed at the client's perception of the precipitating event. The other options ask important questions but are not related to perception of the precipitating event.

Mason and Charlie, both 16 years old, were involved in a bad car accident in which they were both passengers. Mason spoke with a counselor about the incident once and has been able to move forward with little dysfunction. Charlie has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained by: A. perception of the event. B. Mason's more laid-back personality. C. the possibility that Charlie may have experienced previous trauma from which he did not fully recover. D. the possibility that counseling Charlie received may have been inadequate.

A People vary in the way they absorb, process, and use information from the environment. Some people may respond to a minor event as if it were life-threatening. Conversely, others may experience a major event and look at it in a calmer fashion. The other options may be true but are not the primary reason two people respond differently to the same event.

When a stressful event occurs and the individual is unable to resolve the situation by using his or her usual coping strategies, the individual 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 This is the second stage of crisis, according to accepted crisis theory.

The principle most useful to a nurse planning crisis intervention for any patient is that the patient: a. is experiencing a state of disequilibrium. b. is experiencing a type of mental illness. c. poses a threat of violence to others. d. has high potential for self-injury.

ANS: A Disequilibrium is the only answer universally true for all patients in crisis. A crisis represents a struggle for equilibrium when problems seem unsolvable. Crisis does not reflect mental illness. Potential for self-violence or other-directed violence may or may not be a factor in crisis. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 498-499 | Page 501 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

While conducting the initial interview with a patient in crisis, the nurse should: a. speak in short, concise sentences. b. convey a sense of urgency to the patient. c. be forthright about time limits of the interview. d. let the patient know the nurse controls the interview.

ANS: A Severe anxiety narrows perceptions and concentration. By speaking in short concise sentences, the nurse enables the patient to grasp what is being said. Conveying urgency will increase the patient's anxiety. Letting the patient know who controls the interview or stating that time is limited is non-therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 506 (Table 26-3) | Page 507 (Box 26-2) | Page 510-512 (Nursing Care Plan 26-1) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

A victim of spousal violence comes to the crisis center seeking help. Crisis intervention strategies the nurse uses will focus on: a. supporting emotional security and reestablishing equilibrium. b. long-term resolution of issues precipitating the crisis. c. promoting growth of the individual. d. providing legal assistance.

ANS: A Strategies of crisis intervention address the immediate cause of the crisis and restoration of emotional security and equilibrium. The goal is to return the individual to the pre-crisis level of function. Crisis intervention is, by definition, short term. The correct response is the most global answer. Promoting growth is a focus of long-term therapy. Providing legal assistance might or might not be applicable. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 498-499 | Page 501 (Box 26-1) | Page 506 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

During the initial interview at the crisis center, a patient says, "I've been served with divorce papers. I'm so upset and anxious that I can't think clearly." Which comment should the nurse use to assess personal coping skills? a. "In the past, how have you handled difficult or stressful situations?" b. "What would you like us to do to help you feel more relaxed?" c. "Tell me more about how it feels to be anxious and upset." d. "Can you describe your role in the marital relationship?"

ANS: A The correct answer is the only option that assesses coping skills. The incorrect options are concerned with self-esteem, ask the patient to decide on treatment at a time when he or she "cannot think clearly," and seek to explore issues tangential to the crisis. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 502 | Page 504 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

An adult has cared for a debilitated parent for 10 years. The parent's condition recently declined, and the health care provider recommended placement in a skilled nursing facility. The adult says, "I've always been able to care for my parents. Nursing home placement goes against everything I believe." Successful resolution of this person's crisis will most closely relate to: a. resolving the feelings associated with the threat to the person's self-concept. b. ability of the person to identify situational supports in the community. c. reliance on assistance from role models within the person's culture. d. mobilization of automatic relief behaviors by the person.

ANS: A The patient's crisis clearly relates to a loss of (or threatened change in) self-concept. Her capacity to care for her parents, regardless of the deteriorating condition, has been challenged. Crisis resolution will involve coming to terms with the feelings associated with this loss. Identifying situational supports is relevant, but less so than coming to terms with the threat to self-concept. Reliance on lessons from role models can be helpful but not the primary factor associated with resolution in this case. Automatic relief behaviors will not be helpful. Automatic relief behaviors are part of the fourth phase of crisis. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 498-499 | Page 501 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

A nurse driving home after work comes upon a serious automobile accident. The driver gets out of the car with no apparent physical injuries. Which assessment findings would the nurse expect from the driver immediately after this event? Select all that apply. a. Difficulty using a cell phone b. Long-term memory losses c. Fecal incontinence d. Rapid speech e. Trembling

ANS: A, D, E Immediate responses to crisis commonly include shock, numbness, denial, confusion, disorganization, difficulty with decision making, and physical symptoms such as nausea, vomiting, tremors, profuse sweating, and dizziness associated with anxiety. Incontinence and long-term memory losses would not be expected.

A patient comes to the crisis center saying, "I'm in a terrible situation. I don't know what to do." The triage nurse can initially assume that the patient is: a. suicidal. b. anxious and fearful. c. misperceiving reality. d. potentially homicidal.

ANS: B Individuals in crisis are universally anxious. They are often frightened and may be mildly confused. Perceptions are often narrowed with anxiety. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 499 | Page 502 | Page 505-506 (Table 26-2) TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity

A patient comes to the crisis clinic after an unexpected job termination. The patient paces around the room sobbing, cringes when approached, and responds to questions with only shrugs or monosyllables. Choose the nurse's best initial comment to this patient. a. "Everything is going to be all right. You are here at the clinic, and the staff will keep you safe." b. "I see you are feeling upset. I'm going to stay and talk with you to help you feel better." c. "You need to try to stop crying and pacing so we can talk about your problems." d. "Let's set some guidelines and goals for your visit here."

ANS: B A crisis exists for this patient. The two primary thrusts of crisis intervention are to provide for the safety of the individual and use anxiety-reduction techniques to facilitate use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient's safety, and interpersonal reassurance. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 505-507 (Table 26-4) and (Box 26-2) | Page 510-512 (Nursing Care Plan 26-1) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle's behavior, but the parents did not believe the adolescent. What type of crisis exists? a. Maturational b. Adventitious c. Situational d. Organic

ANS: B An adventitious crisis is a crisis of disaster that is not a part of everyday life. It is unplanned or accidental. Adventitious crises include natural disasters, national disasters, and crimes of violence. Sexual molestation falls within this classification. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. Situational crisis arises from an external source such as a job loss, divorce, or other loss affecting self-concept or self-esteem. "Organic" is not a type of crisis. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 500-502 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A nurse assesses a patient in crisis. Select the most appropriate question for the nurse to ask to assess this patient's situational support. a. "Has anything upsetting occurred in the past few days?" b. "Who can be helpful to you during this time?" c. "How does this problem affect your life?" d. "What led you to seek help at this time?"

ANS: B Only the answer focuses on situational support. The incorrect options focus on the patient's perception of the precipitating event. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 499 | Page 502-503 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which situation demonstrates use of primary care related to crisis intervention? a. Implementation of suicide precautions for a depressed patient b. Teaching stress reduction techniques to a first-year college student c. Assessing coping strategies used by a patient who attempted suicide d. Referring a patient with schizophrenia to a partial hospitalization program

ANS: B Primary care-related crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary care. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 506-507 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman tearfully, "What else can happen?" If the woman's immediate family is unable to provide sufficient support, the nurse should: a. suggest hospitalization for a short period. b. ask what other relatives or friends are available for support. c. tell the patient, "You are a strong person. You can get through this crisis." d. foster insight by relating the present situation to earlier situations involving loss.

ANS: B The assessment of situational supports should continue. Even though the patient's nuclear family may not be supportive, other situational supports may be available. If they are adequate, admission to an inpatient unit will be unnecessary. Psychotherapy is not appropriate for crisis intervention. Advice is usually non-therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501-503 | Page 506 (Table 26-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Which communication technique will the nurse use more in crisis intervention than traditional counseling? a. Role modeling b. Giving direction c. Information giving d. Empathic listening

ANS: B The nurse working in crisis intervention must be creative and flexible in looking at the patient's situation and suggesting possible solutions to the patient. Giving direction is part of the active role a crisis intervention therapist takes. The other options are used equally in crisis intervention and traditional counseling roles. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501 (Box 26-1) | Page 506 (Table 26-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

An adult comes to the crisis clinic after termination from a job of 15 years. The patient says, "I don't know what to do. How can I get another job? Who will pay the bills? How will I feed my family?" Which nursing diagnosis applies? a. Hopelessness b. Powerlessness c. Chronic low self-esteem d. Disturbed thought processes

ANS: B The patient describes feelings of lack of control over life events. No direct mention is made of hopelessness or chronic low self-esteem. The patient's thought processes are not altered at this point. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 504-506 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity

A team of nurses report to the community after a category 5 hurricane devastates many homes and businesses. The nurses provide emergency supplies of insulin to persons with diabetes and help transfer patients in skilled nursing facilities to sites that have electrical power. Which aspects of disaster management have these nurses fulfilled? Select all that apply. a. Preparedness b. Mitigation c. Response d. Recovery e. Evaluation

ANS: B, C This community has experienced a catastrophic event. There are five phases of the disaster management continuum. The nurses' activities applied to mitigation (attempts to limit a disaster's impact on human health and community function) and response (actual implementation of a disaster plan). Preparedness occurs before an event. Recovery actions focus on stabilizing the community and returning it to its previous status. Evaluation of the response efforts apply to the future. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 508-509 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman tearfully says to the nurse, "What else can happen?" What type of crisis is this person experiencing? a. Maturational b. Adventitious c. Situational d. Recurring

ANS: C A situational crisis arises from an external source and involves a loss of self-concept or self-esteem. An adventitious crisis is a crisis of disaster, such as a natural disaster or crime of violence. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. No classification of recurring crisis exists. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 500-502 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred? a. Reactive b. Situational c. Maturational d. Adventitious

ANS: C Maturational crises occur when a person arrives at a new stage of development and finds that old coping styles are ineffective but has not yet developed new strategies. Situational crises arise from sources external to the individual, such as divorce and job loss. There is no classification called reactive. Adventitious crises occur when disasters, such as natural disasters (e.g., floods, hurricanes), war, or violent crimes, disrupt coping. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 500-502 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which agency provides coordination in the event of a terrorist attack? a. Food and Drug Administration (FDA) b. Environmental Protection Agency (EPA) c. National Incident Management System (NIMS) d. Federal Emergency Management Agency (FEMA)

ANS: C The National Incident Management System (NIMS) provides a systematic approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector during disaster situations. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 508-509 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment

A patient who is visiting the crisis clinic for the first time asks, "How long will I be coming here?" The nurse's reply should consider that the usual duration of crisis intervention is: a. 1 to 2 weeks. b. 3 to 4 weeks. c. 4 to 8 weeks. d. 8 to 12 weeks.

ANS: C The disorganization associated with crisis is so distressing that it usually cannot be tolerated for more than 4 to 8 weeks. If it is not resolved by that time, the individual usually adopts dysfunctional behaviors that reduce anxiety without solving the problem. Crisis intervention can shorten the duration. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 505 | Page 507-508 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

At the last contracted visit in the crisis intervention clinic, an adult says, "I've emerged from this a stronger person. You helped me get my life back in balance." The nurse responds, "I think we should have two more sessions to explore why your reactions were so intense." Which analysis applies? a. The patient is experiencing transference. b. The patient demonstrates need for continuing support. c. The nurse is having difficulty terminating the relationship. d. The nurse is empathizing with the patient's feelings of dependency.

ANS: C The nurse's remark is clearly an invitation to work on other problems and prolong contact with the patient. The focus of crisis intervention is the problem that precipitated the crisis, not other issues. The scenario does not describe transference. The patient shows no need for continuing support. The scenario does not describe dependency needs. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 503 (Table 26-1) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

A patient being seen in the clinic for superficial cuts on both wrists is pacing and sobbing. After a few minutes, the patient is calmer. The nurse attempts to determine the patient's perception of the precipitating event by asking: a. "Tell me why you were crying." b. "How did your wrists get injured?" c. "How can I help you feel more comfortable?" d. "What was happening just before you started to feel this way?"

ANS: D A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events permits assessment of the precipitating event. "Why" questions are non-therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501-502 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which health care worker should be referred for critical incident stress debriefing? a. A nurse who works at an oncology clinic where patients receive chemotherapy b. A case manager whose patients have serious mental illness and are cared for at home c. A health care employee who worked 12 hours at the information desk of a critical care unit d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall

ANS: D Although each of the individuals mentioned experiencing job-related stress on a daily basis, the person most in need of critical incident stress debriefing is the EMT, who experienced an adventitious crisis event by responding to a bombing and provided care to trauma victims. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 507-509 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

A troubled adolescent pulled out a gun in a school cafeteria, fatally shooting three people and injuring many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next? a. Ask police to encircle the school campus with yellow tape to prevent parents from entering. b. Announce over the loudspeakers, "The campus is now secure. Please return to your classrooms." c. Require parents to pass through metal detectors and then allow them to look for their children in the school. d. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.

ANS: D Chaos is likely among students and desperate parents. A directive approach is best. Once the scene is secure, creative solutions are needed. Creating zones by letters of the alphabet will assist anxious parents and their children to unite. Preventing parents from uniting with their children will further incite the situation. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501 (Box 26-1) | Page 506 (Table 26-3) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

A woman said, "I can't take anymore! Last year my husband had an affair, and now we don't communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college." What is the nurse's priority assessment? a. Identify measures useful to help improve the couple's communication. b. The patient's feelings about the possibility of having a mastectomy c. Whether the husband is still engaged in an extramarital affair d. Clarify what the patient means by "I can't take anymore."

ANS: D During crisis intervention, the priority concern is patient safety. This question helps assess personal coping skills. The other options are incorrect because the focus of crisis intervention is on the event that occurred immediately before the patient sought help. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501-502 | Page 505 (Table 26-2) | Page 506 (Table 26-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A woman says, "I can't take anymore. Last year my husband had an affair, and now we do not communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college and moving in with her boyfriend." Which issue should the nurse focus on during crisis intervention? a. The possible mastectomy b. The disordered family communication c. The effects of the husband's extramarital affair d. Coping with the reaction to the daughter's events

ANS: D The focus of crisis intervention is on the most recent problem: "the straw that broke the camel's back." The patient had coped with the breast lesion, the husband's infidelity, and the disordered communication. Disequilibrium occurred only with the introduction of the daughter leaving college and moving. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 501-504 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

An adult seeks counseling after the spouse was murdered. The adult angrily says, "I hate the beast that did this. It has ruined my life. During the trial, I don't know what I'll do if the jury doesn't return a guilty verdict." What is the nurse's highest priority response? a. "Would you like to talk to a psychiatrist about some medication to help you cope during the trial?" b. "What resources do you need to help you cope with this situation?" c. "Do you have enough support from your family and friends?" d. "Are you having thoughts of hurting yourself or others?"

ANS: D The highest nursing priority is safety. The nurse should assess suicidal and homicidal potential. The distracters are options, but the highest priority is safety. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 501-502 | Page 505 (Table 26-2) | Page 506 (Table 26-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which scenario is an example of an adventitious crisis? a. The death of a child from sudden infant death syndrome b. Being fired from a job because of company downsizing c. Retirement of a 55-year-old person d. A riot at a rock concert

ANS: D The rock concert riot is unplanned, accidental, violent, and not a part of everyday life. The incorrect options are examples of situational or maturational crises. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 500-502 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, "I cannot teach nor do any research. My mind is totally preoccupied with these false accusations." What is the priority nursing diagnosis? a. Ineffective denial related to threats to professional identity b. Deficient knowledge related to sexual harassment protocols c. Impaired social interaction related to loss of teaching abilities d. Ineffective role performance related to distress from false accusations

ANS: D This nursing diagnosis is the priority because it reflects the consequences of the precipitating event associated with the professor's crisis. There is no evidence of denial. Deficient knowledge may apply, but it is not the priority. Data are not present to diagnose impaired social interaction. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 504-506 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity

2 Lilly, a single mother of four, comes to the crisis center 24 hours after an apartment fire in which all the family's household goods and clothing were lost. Lilly has no other family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. You assess the situation as: a. A maturational crisis. b. A situational crisis. c. An adventitious crisis. d. An existential crisis.

B

The nurse working with a client in crisis must initially assess for the client's 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 A person's equilibrium may be adversely affected 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.

Carter, aged 36 years, comes to the crisis clinic for his first visit with complaints of not sleeping, anxiety, and excessive crying. He recently was fired suddenly from his job and 3 days later lost his home to a tornado that devastated the town he lives in. Which of the following statements regarding crisis accurately describes Carter's situation? A. He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home. B. He is experiencing both a situational and an adventitious crisis. C. He is experiencing ineffective coping and should be hospitalized for intensive therapy. D. He is experiencing a situational crisis with the added stress of financial burden.

B It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. Carter lost his job (situational crisis) and also experienced the devastating effects of a tornado (adventitious crisis). The first option may be true but doesn't accurately describe the crisis criteria. There is nothing in the scenario suggesting he needs acute hospitalization at this time. He is experiencing not only a situational crisis, but an adventitious one as well, which makes coping more difficult.

When a person becomes unemployed, he is likely to experience a(n) A. reactive crisis. B. situational crisis. C. adventitious crisis. D. substance abuse crisis.

B Situational crises arise from external sources. Examples are death of a loved one, divorce, marriage, or a change in health status.

A 12-year-old finds herself feeling anxious and overwhelmed and seeks out the school nurse to report that "Everything is changing . . . my body, the way the boys who were my friends are treating me, everything is so different." It is likely the child is A. describing personal identity disorder. B. experiencing a maturational crisis. C. potentially suicidal. D. mildly neurotic.

B The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary.

Carter experiences each of the following during his crisis. Which of the following describes phase IV of Caplan's phases of crisis? A. Carter experiences increased anxiety and feelings of extreme discomfort the day after the tornado. B. Carter comes to the crisis clinic complaining of depression and expresses that he does not want to go on living. C. Carter experiences a panic attack at his mother's home in a nearby town where he is staying after the tornado. D. Carter experiences anxiety symptoms the day after he was fired.

B This describes phase IV, which, if coping is ineffective, may lead to depression, confusion, violence, or suicidality. The other options describe phase II, phase III, and phase I in Caplan's phases of crisis.

Which statement would suggest to the crisis intervention nurse the need to arrange for hospitalization of a client? A. "I'm feeling overwhelmed by all that has happened, and I need help sorting it out." B. "I see no solution for this situation if nothing changes by tomorrow." C. "There are three possibilities that might help, but I can't decide what to do." D. "I feel a little calmer than yesterday at this time, but things are still very difficult."

B Whenever the client presents a danger to himself or herself or others, hospitalization must be considered.

A crisis is so acutely uncomfortable to the individual that it is likely to self-resolve in A. 1 to 10 days. B. 1 to 3 weeks. C. 4 to 6 weeks. D. 3 to 4 months

C At 4 to 6 weeks, the individual is making accommodations and adjustments to relieve anxiety, and the crisis is no longer a crisis.

Tori is the nurse working with Carter and other members of the community after the tornado. As the weeks go by, she begins to feel anxious and distressed. She speaks to her nurse mentor about her feelings. Which of the following may Tori be experiencing? A. Reactionary grief B. Maturational crisis C. Vicarious traumatization D. Transference

C Even experienced nurses working in disaster situations can become overwhelmed when witnessing catastrophes such as loss of human life or mass destruction of people's homes and belongings (e.g., floods, fires, tornadoes). Researchers have found that mental health care providers may experience psychological distress from working with traumatized populations, a phenomenon of secondary traumatic stress or "vicarious traumatization." Reactionary grief does not describe secondary stress from working with such populations. A maturational crisis arises from disruption of a developmental stage. Transference describes feelings displaced onto the nurse or therapist by the patient.

A woman comes to the crisis intervention clinic expressing concern that her 16-year-old is using illegal drugs in their home.The nurse will A. encourage the mother to call the police when her son brings drugs home. B. inform her of the obligation to report this information to the police. C. work with the client to set goals that are mutually acceptable. D. refer the client to the police for consultation.

C Goal setting is a collaborative task. Goals must be acceptable to the client and seen by the nurse as safe and appropriate.

A client comes to the crisis intervention clinic and tearfully tells the nurse, "It is so painful! I have thought about it, and I cannot see how I can go on without my partner." The nurse states, "You have resilience and will look back on this as a crisis you were able to manage." Analysis of this interaction reveals that the nurse A. has a good understanding of the effect of time on perception of a crisis. B. is offering a statement of positive outcome based on client coping ability. C. has not followed up on the client's verbal clues to suicidal thoughts. D. has stepped into the territory of traditional psychotherapy.

C Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client's clues. This client clearly was open to discussing her suicidal thoughts, or she would not have said, "I cannot see how I can go on."

The nurse caring for a client in crisis shows signs of a problematic nurse-client relationship by A. offering to change the time of the counseling session for the second time in 3 weeks. B. experiencing frustration about the decisions the client is making. C. giving the client permission to call him or her at home when the client "needs to talk." D. suggesting that the client attend an extra counseling session each month.

C The behavior in option C is a reaction to the nurse's need to be needed and undermines the client's sense of self-reliance.

A client is treated in the emergency department for injuries sustained while vacationing hundreds of miles away from home. To best meet the client's emotional needs, the nurse should A. arrange to hospitalize the client. B. refer the client for traditional psychotherapy for posttraumatic stress disorder. C. provide temporary support by arranging shelter and contacting the client's friends. D. suggest that contacting a victim support group would be more appropriate than crisis intervention

C When a client has no support system, the nurse may assume that role for a short time.

When a tornado results in the loss of homes, businesses, and life, the town residents are likely to experience a(n) A. maturational crisis. B. situational crisis. C. adventitious crisis. D. endogenous crisis.

C An adventitious crisis is unplanned, accidental, and not part of everyday life. Examples are disasters and crimes of violence.

When the client begins to sob uncontrollably and her speech becomes so incoherent that she is unable to give the nurse any information, the immediate interventions will focus on A. securing hospital admission. B. contacting a family member or close friend. C. lowering her anxiety level from severe to moderate. D. assisting the client to identify new effective coping strategies.

C Individuals with severe anxiety are not able to collaborate in problem solving. The nurse must assist the client to lower anxiety from severe to moderate or lower.

Crises that occur as an individual moves from one developmental level to another are called A. reactive crises. B. recurring crises. C. situational crises. D. maturational crises.

D Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective.

Tori knows that Carter needs assistance with many aspects of getting through the crisis. Tori's highest priority in Carter's care is: A. reduction of Carter's anxiety. B. development of new coping skills. C. prevention of boundary blurring. D. keeping Carter safe.

D The nurse's initial task is to promote safety by assessing the patient's potential for suicide or homicide. The other options are all important components of the care plan, but safety of the patient takes the highest priority.

In the event of an adventitious crisis, which age group would be least in need of crisis intervention? A. Children B. Such crises seldom require intervention C. The elderly D. A distinction cannot be made

D The need for psychological first aid (crisis intervention) and debriefing after any crisis situation cannot be overstressed for all age groups (children, adolescents, adults, and the elderly).