Psych Exam 5
To assess the client's perception of the event precipitating a crisis, the nurse would initially ask which question? "How does this situation affect your life?" "During difficult times in the past, what has helped you?" "Can you give me the name of someone you trust?" "Who is available to help you?"
"How does this situation affect your life?"
Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." "Our son is really a good little boy, but he needs to be disciplined both at home and in school." "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." "We have become active in the support group but still find the suggestions extremely difficult to put into practice."
"My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."
When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? "It makes sense that rape is a crime of violence, not a crime of sex." "Who would have guessed that most rape victims know the rapist?" "So if you dress conservatively, your risk of being raped is small." "I always thought rapes happened at night, but now I know that isn't true."
"So if you dress conservatively, your risk of being raped is small."
A sexual assault survivor tells the nurse, "I should have tried to fight him off! But I was so terrified that I could not move. I should have tried harder." Which response should the nurse make to reassure the client? "Try not to think about it. Put it out of your mind." "We each behave in characteristic ways in a crisis. That was your way." "Do you think others will think badly of you for not trying to fight?" "The way you behaved was the right thing to do at the time."
"The way you behaved was the right thing to do at the time."
A woman comes to the crisis intervention clinic and reports that her 16-year-old son uses drugs in the home and often assaults her. The nurse tells the client: "This is not an uncommon problem. Don't worry." "Together we will be able to work on this problem." "Now that you are asking for help, everything will be all right." "I have friends in law enforcement who can help us choose a solution."
"Together we will be able to work on this problem."
During the immediate post-rape period what verbal nursing intervention would best lower client anxiety and increase feelings of well-being? "You are safe here. I will stay with you while you have your examination." "I know you feel confused. We will make all the necessary decisions for you." "Please tell me as much about the details of the rape as you can remember." "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."
"You are safe here. I will stay with you while you have your examination."
Assessment guidelines for anger and aggression
*interventions of violence is single best predictor of future violence* Pts are delusional, hyperactive, or impulsive Aggression occurs most often in the context of "Limit setting"
Rohypnol (flunitrazepam)
-priority is to monitor for respiratory depression
A crisis is so acutely uncomfortable to the individual that it is likely to self-resolve in what time frame? 1 to 10 days. 1 to 3 weeks. 4 to 6 weeks. 3 to 4 months.
4 to 6 weeks.
Which child is at lowest risk for abuse? A 3-month-old who has colic and teenaged parents A 4-year-old who has cerebral palsy and cognitively challenged parents A 2-year-old who has leukemia and two working parents A 5-year-old who has ADHD and a father who was abused as a child
A 2-year-old who has leukemia and two working parents
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." What term is used to describe what this child is experiencing? A personal identity disorder A maturational crisis Suicidal ideations Mild neurosis
A maturational crisis
How is anger best defined? An unhealthy way of releasing anxiety Doing intentional harm to others An expression of conflict with others A normal response to a perceived threat
A normal response to a perceived threat
Which assessment finding is the best predictor of violence in a newly admitted client? A recent assault on a drinking companion A family history of bipolar disorder The nurse's subjective feeling that the client is uncooperative A childhood history of being bullied at school
A recent assault on a drinking companion
Which event is most likely to contribute to a client's escalating anger? Watching violence on television Another client's depressed mood A staff member challenging them A staff member asking them to help another client
A staff member challenging them
Which statement about crisis theory will provide a basis for nursing intervention? A. A crisis is an acute time-limiting 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 the usual life situations C. Crisis is precipitated by an event that enhances a person's self-concept and self-esteem D. Nursing intervention is crisis situations rarely has the effect of stopping the crisis
A. A crisis is an acute time-limiting phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable
Which statement concerning a crisis experience is true and should be used as a guideline for crisis management care? SATA A. A crisis is self-limiting and usually resolves in 4 to 6 days B. The earlier the interventions are implemented, the better the expected prognosis C. The nurse should maintain a nondirective role D. The pt in crisis is assumed to be mentally unhealthy and in an extreme state of disequilibrium E. The goal of crisis management is to return that pt to at least the precrisis level of functioning
A. A crisis is self-limiting and usually resolves in 4 to 6 days B. The earlier the interventions are implemented, the better the expected prognosis E. The goal of crisis management is to return that pt to at least the precrisis level of functioning
What is the typical response when a stressful event occurs and the individual is unable to resolve the situation by using their usual coping strategies? A. A state of emotional disorder results in trial-and-error problem solving. B. They will withdraw and act as though the problem does not exist. C. They develop severe personality disorganization. D. Their distress often causes them to resort to planning suicide
A. A state of emotional disorder results in trial-and-error problem solving.
Which individuals are most at risk for displaying aggressive behavior? (SATA) A. An adolescent embarrassed in front of friends B. a young male who feels rejected by the social group C. A young adult depressed after the death of a friend D. A middle-aged adult who feels that concerns are going unheard E. A pt who was discovered telling a lie
A. An adolescent embarrassed in front of friends B. a young male who feels rejected by the social group D. A middle-aged adult who feels that concerns are going unheard E. A pt who was discovered telling a lie
Which intervention should the nurse implement when helping a pt express anger in an inappropriate manner? (SATA) A. Approach the pt in a calm, reassuring manner B. Provide suggestions regarding acceptable ways of communicating anger C. Warn the pt that being angry is not a healthy emotional state D. Set limits on the angry behavior that will be tolerated E. Allow any expression of anger as long as no one is hurt
A. Approach the pt in a calm, reassuring manner B. Provide suggestions regarding acceptable ways of communicating anger D. Set limits on the angry behavior that will be tolerated
The use of a pt centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the pt and: A. Establish trust and rapport B. Ask lots of questions C. Interrupt the pt story to allow for decompression D. Utilize close ended questions
A. Establish trust and rapport
Which patient statement indicates the helpfulness of the nurse-patient relationship? A. I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem B. I really need to talk with you. You always give me good advice about how to address my anger issues C. If it wasn't for you and the hours we've spent talking, I don't think I would be on my way to getting my anxiety under control. D. You always showed me sympathy when I was at my lowest point after the sexual assault. Knowing you had been there too was such a help
A. I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem
You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response? A. I'm here to listen, and we can talk about your feelings B. You don't need to go to the hospital if you don't want to C. If you don't go to the hospital, we can't collect evidence to help convict your rapist D. Why are you afraid to seek medical attention?
A. I'm here to listen, and we can talk about your feelings
Which guidelines should direct nursing care when deescalating an angry pt? (SATA) A. Intervene as quickly as possible B. Identify trigger for the anger C. Behave calmly and respectfully D. Recognize the pts need for increased personal space E. Demands are agreed to as long as they won't result in harm to anyone
A. Intervene as quickly as possible B. Identify trigger for the anger C. Behave calmly and respectfully D. Recognize the pts need for increased personal space
Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime? A. Multiracial B. American Indian C. Black non-Hispanic D. Caucasian
A. Multiracial
Which signs and symptoms are associated with acute stress disorder and often observed in patients who have been sexually assaulted? (SATA) A. Outbursts of anger B. Depression C. Auditory hallucinations D. Flashbacks E. Amnesia for the event
A. Outbursts of anger B. Depression D. Flashbacks E. Amnesia for the event
Which problem is observed in children who regularly witness acts of violence in their family? (SATA) A. Phobias B. Low self esteem C. Major depressive disorder D. Narcissistic personality disorder E. Posttraumatic stress disorder
A. Phobias B. Low self esteem C. Major depressive disorder E. Posttraumatic stress disorder
The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the pt? (SATA) A. The police dept. B. An abuse hotline C. A responsible friend or family member D. A domestic violence shelter E. The hospital emergency dept.
A. The police dept. B. An abuse hotline C. A responsible friend or family member D. A domestic violence shelter
Twenty-four-hour observation is a good choice for restraint in which of the following pts? A. an inmate with suicidal ideation on hospice care B. a sex offender in the psychiatric intensive care unit C. An aggressive female with antisocial personality disorder D. An inmate diagnosed with paranoid schizophrenia
A. an inmate with suicidal ideation on hospice care
Acute battering stage of violence
Abuser physically assaults the victim Violence cycle does not include a stabilization stage
`Aggression
Action or behavior that results in verbal of physical attack May occur in self defense Signs: Abrupt pacing, clenched fists, staring at staff
posttraumatic stress disorder (PTSD)
Acute stress can lead to ptsd if symptoms last longer than 1 month
Which nursing intervention is best directed at the psychological needs of a physically abused client? Encourage the client to immediately leave the abuser. Affirm that the client did not deserve or cause the abuse. Provide a referral to social services for economic problems. Facilitate contact with law enforcement to take legal action.
Affirm that the client did not deserve or cause the abuse.
How is the act of rape is best described? An act of violence using sex as the weapon Assault by a stranger on an unsuspecting victim Sexual desire satisfied inappropriately An act prompted by early childhood neglect
An act of violence using sex as the weapon
Perpetrator
Any family member who is violent towards another
Restraints
Any manual method, physical or mechanical device, material or equipment that restricts freedom of movement
Sexual abuse
Any type of form of sexual contact or exposure without consent, or in circumstances in which the victim is incapable of giving consent
When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, what should the priority nursing intervention be? Advising her to enter counseling at the mental health center Assisting her in developing a plan to go to a shelter in case of a crisis Suggesting that she leave the abuser immediately and go to a trusted friend's home Teaching her to counter verbal abuse with assertive replies
Assisting her in developing a plan to go to a shelter in case of a crisis
Six Safety considerations for staff
Avoid wearing dangling jewelry Ensure that ther is enough staff for backup Always know the layout of the area Do not stand directly in front of the pt or infront of the doorway. Have a way out! If a pts behavior begins to escalate provide feedback "You seem to be very upset" Avoid confrontation with the pt, either through verbal means of through a show of force with security gaurds
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. "I see no solution for this situation if nothing changes by tomorrow."
Which statement made by a new mother should be explored further by the nurse? A. "I have three children, that's enough" B. "I think the baby cries just to make me angry" C. "I wish my husband could help more with the baby" D. "Babies are a blessing, but they are a lot of work"
B. "I think the baby cries just to make me angry"
A newly admitted male pt has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint? A. "If his behavior warrants restraints, someone will stay with him the entire time he is restrained" B. "I'll call the primary provider and get a PRN seclusion/restraint order." C. "If he is restrained, be sure he is offered food and fluids regularly." D. "Remember that physical restraints are our last resort."
B. "I'll call the primary provider and get a PRN seclusion/restraint order."
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. An adventitious crisis C. A crisis of confidence D. An existential crisis
B. An adventitious crisis
A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression? A. I need to be aware of pts who are withdrawn and sitting alone B. An obvious change in behavior is a risk factor for aggression C. Pts who seek constant attention are more likely to be violent D. Pts who talk to themselves are the most dangerous.
B. An obvious change in behavior is a risk factor for aggression
Secondary effects of abuse often manifest as arrested development in children due to the fact that: A. Coping is easier than emotional growth B. Energy for development is diverted to coping C. Children cannot differentiate love from abuse D. Abuse fosters a sense of belonging, even if dysfunctional
B. Energy for development is diverted to coping
Considering client function, what is the expected outcome at the conclusion of crisis intervention therapy? A. Function is higher level than before the crisis. B. Function is at the precrisis level. C. Function is only marginally below the precrisis level. D. Function is occurring without aid from identified support systems.
B. Function is at the precrisis level.
Which statement is an accurate depiction of sexual assault? A. Rape is a sexual act B. Most rapes occur in the home C. Rape is usually an impulsive act D. Women are usually raped by strangers
B. Most rapes occur in the home
What type of crisis is a newly unemployed person most likely to experience? A. Reactive B. Situational C. Maturational D. Unexpected
B. Situational
Which statement made by a sexually assaulted patient strongly suggests the drug gamma-hydroxybutyrate acid (GHB) was involved? A. I remember everything that happened, but felt too tired to fight back B. The drink I was given had a salty taste to it C. They tell me I was unconscious for 24 hrs D. I heard that I was fighting the nursing staff and saying that they were trying to kill me
B. The drink I was given had a salty taste to it
An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: A. Decrease in family interaction so that there are fewer opportunities for abuse to occur B. The perpetrator will recognize destructive patterns of behavior and learn alternative responses C. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy D. A triad of treatment modalities, including medication, counseling, and role-playing opportunities
B. The perpetrator will recognize destructive patterns of behavior and learn alternative responses
The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and elderly due to: A. The love they have for parents and children B. Their limited options C. The need to feel safe at home D. Other relatives do not want them
B. Their limited options
What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? A. the caregiver is a single male relative B. the caregiver was neglected as a child C. The caregiver is under the age of 50 D. The caregiver has little experience with the elderly
B. the caregiver was neglected as a child
To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control his/her anger, what is the most appropriate short-term goal for the parent? Demonstrating understanding of the impact of violence on the child within 2 days Beginning attending anger management training sessions within 2 weeks Stating a willingness to attend a support group for physical abusers within 1 week Showing remorse for their anger management issues within 2 days
Beginning attending anger management training sessions within 2 weeks
The nurse is engaged in crisis intervention with a patient reporting, "I have no reason to keep on living." What is the nurse's intervention? A. Advise the pt about services available to help them B. Ask the pt "Have you ever been this depressed before" C. Ask the pt "Do you have any plan to hurt yourself or anyone else" D. Assure the pt that he or she is in a safe place and will be cared for
C. Ask the pt "Do you have any plan to hurt yourself or anyone else"
A young woman named Carly was raped behind the restaurant where she works after closing shift. Six months have passed and Carly has not been able to return to work, refuses to go out to eat, and feels that she has less value as a woman now that she has been raped. Carly's clinical presentation suggests: A. Re-experiencing B. Hyperarousal C. Avoidance D. Physical effects
C. Avoidance
An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through: A. A casual authoritative demeanor B. Keeping pts busy C. Brief, frequent, nonthreatening encounters D. Threats of seclusion or punishment
C. Brief, frequent, nonthreatening encounters
A female nurse had been sexually assaulted as a teenager. She finds it difficult to work with pts who have undergone the same trauma. Which is the most helpful response? A. Discussing these feelings with the nurse supervisor B. Requesting that these pts not be a part of her pt assignment C. Discussing these feelings with a mental health professional D. Accepting her role in providing unbiased, respectful, and professional care to all pts.
C. Discussing these feelings with a mental health professional
Perpetrators of sexual assault are often incarcerated but frequently do not undergo therapy. Samuel, convicted of rape and sentenced to 15 years in prison, has requested to see a therapist. The psychiatric nurse practitioner is surprised to learn of the request as many perpetrators: A. Boast of their assault history B. Feel regret and remorse C. Do not acknowledge the need for change D. Are unable to recognize rape as a crime
C. Do not acknowledge the need for change
John Patrick is a widower with four daughters. He has enjoyed a healthy relationship with all of them until they reached puberty. As each girl began to mature physically, he acted in an aggressive manner, beating her without provocation. John Patrick is most likely acting on: A. Self-protective measures B. Stress of raising 4 daughters C. Frustration of unhealthy desires D. Motivating his daughters to be chaste
C. Frustration of unhealthy desires
Which nursing action directed toward a client in crisis demonstrates signs of a problematic nurse-client relationship? 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 a personal number to call when they "need to talk" D. Suggesting that the client attend an extra counseling session each month
C. Giving the client a personal number to call when they "need to talk"
A pt whose history includes experiences with abusive partners is being treated for major depressive disorder. The pts care plan includes rape-trauma syndrome among nursing diagnoses. What goal is directly associated with this diagnosis? A. Remains free from self-harm B. Wears appropriate clothing C. Reports feeling stronger and having a sense of hopefulness D. Demonstrates appropriate affect for both positive and negative emotions
C. Reports feeling stronger and having a sense of hopefulness
Ron is a victim of assault and has revealed to his family and friends the fact that he was raped. The family reacts with horror and disgust, and the nurse caring for Ron recognizes: A. Ron's family is being judgmental B. Ron's family should leave the hospital C. Ron's family will also need support D. Dysfunctional family dynamics
C. Ron's family will also need support
Avoidance
Changing routines, avoiding places, events or objects that remind them of event
Tension-building stage of violence
Characterized by abusive verbalization, pushing or threatening
Honeymoon stage of violence
Characterized by kind, loving behaviors, toward the victim when the perpetrator acts remorseful The victim believes the promises and drops the plan to seek legal help or leave
Crisis Phase 1
Conflict or problem Self-concept threatened Increased anxiety Use of problem-solving techniques and defense mechanisms Resolve conflict or problem Reduce anxiety
Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship presents the greatest personal risk? Relying on alcohol to escape the emotional pain of abuse Adapting an aggressive attitude toward her abuser Considering ways to commit suicide Threatening to call the police if she is abused again
Considering ways to commit suicide
Economic abuse
Controlling a person's access to their economic resources as a means of keeping them dependent or for their own personal gain
The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction to trauma, resulting in: A. Posttraumatic stress disorder B. Anxiety C. Depression D. All of the above
D. All of the above
Which comorbid condition would result in cautious use of a selective serotonin reuptake inhibitors for a patient with chronic aggression? A. Asthma B. Anxiety disorder C. Glaucoma D. Bipolar disorder
D. Bipolar disorder
Chronic obstructive pulmonary disease, spinal cord injury, seizure disorder, and pregnancy are conditions that: A. frequently result in out of control behavior B. respond well to therapeutic holding C. necessitate the use of only 2-point restraint D. Contraindicate restraint or seclusion
D. Contraindicate restraint or seclusion
Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority? A. Do you want the police to be called? B. Did you recognize the person who assaulted you? C. Do you have someone you trust that you can stay with? D. Do you have any thoughts about harming yourself?
D. Do you have any thoughts about harming yourself?
What type of crises occur as an individual moves from one developmental level to another? A. Reactive B. Recurring C. Situational D. Maturational
D. Maturational
The highest-priority goal of crisis intervention is: A. Anxiety reduction B. Identification of situational reports C. Teaching specific coping skills that are lacking D. Patient Safety
D. Patient Safety
What safety-related responsibility does the nurse have in any situation of suspected of abuse? A. protect the pt from future abuse B. Inform the suspected abuser that the authorities have been notified C. Arrange for counseling for all involved parties but especially the patient D. Report suspected abuse to the proper authorities
D. Report suspected abuse to the proper authorities
Crisis Phase 2
Defense mechanisms fail Threat persists Anxiety increases Feelings of extreme discomfort Functioning disorganized Trial-and-error attempt to solve problem and restore normal balance
Depersonalization
Detaches from mental process
What medications reduce incidence of EPS symptoms when given with an anti-psychotic?
Diphenhydramine (Benadryl) Benztropine (Cogentin)
When interviewing an adult victim of abuse, what is the nurse's best approach when asking relevant questions? Confrontational and assertive Gentle but direct Direct and professional Sympathetic but detached
Direct and professional
A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of which form of abuse? Neglect Physical Emotional Tough love
Emotional
Anger
Emotional response to frustration of desires, threat to one's needs, or a challenge
An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, what is the most appropriate nursing diagnosis? Hopelessness Fear Post-trauma syndrome Risk for self-directed violence
Fear
The emergency department nurse planning care for a rape survivor must realize that the emotional reaction displayed by many rape victims during the initial assessment and treatment is which emotion? Fear Eagerness Aggression Disinterest
Fear
An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses as the client may be at risk for what form of abuse? Neglect Physical violence Psychological Financial maltreatment
Financial maltreatment
When there is reason to suspect that a child is being abused, the nurse must initially implement which intervention? Call the local police to report it. Follow agency policy for reporting. Confront the parent or parents. Question the child to obtain proof.
Follow agency policy for reporting.
Ketamine
Hallucinogenic with anesthetic Airway maintenance Confusion Paranoid
Which characteristic places the client at highest risk for violence directed at others? Has a history of recurrent severe depression Is in an alcohol rehabilitation program Has delusions of persecution Is experiencing somatic symptoms for which no organic basis is found
Has delusions of persecution
The nurse performing the assessment of a wheelchair-bound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should implement which assessment intervention? Confront the wife with the suspicion that her husband's injuries are the result of abuse. Have the wife wait in the waiting room so her husband can be interviewed in private. Report the husband's injuries to the police and ask for a confidential investigation. Document the suspicion and follow a policy of "wait and see" whether he returns again.
Have the wife wait in the waiting room so her husband can be interviewed in private.
An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse recognizes that the client is describing which stage of the cycle of violence? Tension building Acute battering Honeymoon Escalation
Honeymoon
B52
IM Haldol, benadryl, and ativan
A client has a history of demonstrating aggression physically. What short-term goal will best help the client manage this anger? Strike objects rather than people. Limit aggression to verbal outbursts. Isolate in lieu of striking people. Identify situations that precipitate hostility.
Identify situations that precipitate hostility.
Which statement would be an appropriate long-term outcome for a rape client? Integrate of the rape event and resumption of an optimal level of functioning. Identify and develop coping skills necessary to reduce level of anxiety. Appropriately blame the rapist rather than blaming herself for the situation. Repress feelings of shame, embarrassment, and self-blame.
Integrate of the rape event and resumption of an optimal level of functioning
Anticipatory teaching for a rape victim should include information addressing what common survivor problem? Denial of the event Headaches and fatigue Shock and numbness Intrusive thoughts
Intrusive thoughts
Seclusion
Involuntary confinement alone in a room that the patient is physically prevented from leaving
An adolescent male is swearing and shouting at his physician who refused to give him a pass to leave the unit. What is the primary importance of this behavior? It is acceptable if directed at staff but not when directed at other clients. It may reduce tension and prevent the client from physically acting out. It is a major indicator that the client may become physically aggressive. It can be attributed to lack of parental controls applied at an early age.
It is a major indicator that the client may become physically aggressive.
Which neurotransmitter imbalance has been shown to be related to impulsive aggression? Low levels of ã-aminobutyric acid Low levels of serotonin High levels of norepinephrine High levels of acetylcholine
Low levels of serotonin
Which statement reflects a truth about rape? Some women want to be raped. Rapists are oversexed. Most rapes are planned. Most women are raped by strangers.
Most rapes are planned.
A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by implementing which intervention? Continuing to manage the situation personally. Telling the client, "It isn't safe for me to leave the room." Moving outside of the client's personal space. Apologizing for upsetting the client.
Moving outside of the client's personal space.
Which situation has the potential for early crisis intervention to occur? Mrs. R tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist. Ms. T is hospitalized after an unsuccessful suicide attempt that she states, "was a mistake." Mr. W asks for reassurance that he will be welcome at the day hospital after his hospital discharge. Ms. G enters the emergency department with a strong smell of alcohol on his person, stating he is anxious and depressed.
Mrs. R tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist.
Neglect
Needs are not provided for Physical, emotional, educational, and medical
What distinction can be made between abuse and neglect? Neglect occurs in the psychological domain; abuse occurs in the physical domain. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. Neglect is perpetrated against children; abuse victims can be children or adults. Neglect is a failure to provide; abuse is a failure to control aggression.
Neglect is a failure to provide; abuse is a failure to control aggression.
Rape
Nonconsensual activity Any penetration of the vagina or anus with any object or body part, or the oral penetration by a sex organ of another person
Outcomes of crisis depend on
Perception of the event and other personal factors Adequate situational supports Adequate coping mechanisms Adequate interventions
Characteristics of vulnerable older adults
Poor mental or physical health such as Alzheimer's disease Dependent on perpetrator Female, older than 75 years, white, living with a relative Elderly father cared for by a daughter he abused as a child Elderly woman cared for by a husband who has abused her in the past
Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which psychiatric disorder? Posttraumatic stress disorder (PTSD) A maturational crisis A dissociative disorder Obsessive compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Characteristics of vulnerable women
Pregnancy may trigger or increase violence Violence may escalate when wife makes a more toward independence (get a job, make new friends) Greatest risk for violence when the woman attempts to leave the relationship
Crisis phase 4
Problem is unsolved and coping skills are ineffective Overwhelming anxiety Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior
A client has been placed in seclusion to control aggressive behavior. Nursing care while the client is in mechanical restraints should include which intervention? Observation every 30 minutes Releasing the client every 8 hours Increasing sensory stimulation Providing regularly scheduled nutrition and hydration
Providing regularly scheduled nutrition and hydration
A client is treated in the emergency department for injuries sustained while vacationing hundreds of miles away from home. How should the nurse best meet the client's emotional needs in order to minimize the risk of crisis? Arranging to hospitalize the client so all needs will be met. Referring the client for traditional psychotherapy for the expected development of posttraumatic stress disorder. Providing temporary support by arranging shelter for the client and contacting family or traveling companions. Suggesting that contacting a victim support group would be more appropriate than crisis intervention.
Providing temporary support by arranging shelter for the client and contacting family or traveling companions.
Acute stress disorder
Psychological reaction to a serious trauma: shock, numbness emotionally, confusion, restlessness, disbelief 3 days to 1 month
A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. What action the nurse should take? Refer the woman for social services counseling. Report and document the request. Ask the supervising nurse to reassign the client. Ask the client to reevaluate her request after 24 hours.
Report and document the request.
Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression? Social isolation Risk for other-directed violence Ineffective coping: overwhelmed Ineffective coping: maladaptive
Risk for other-directed violence
GHB (gamma-hydroxybutyric acid)
Salty water
When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving which form of treatment? Primary prevention Secondary prevention Tertiary prevention Stop-gap therapy
Secondary prevention
To provide discharge treatment and support, the nurse should realize that the most common outcome of acquaintance rape is which psychosocial dysfunction? Sexual distress Fear of men Depression Anxiety
Sexual distress
What is the priority concern of the crisis intervention nurse regarding the client? The client's physical safety Setting up support contacts Helping the client brainstorm possible solutions Assisting the client to work through termination issues associated with therapy
The client's physical safety
Which assumption serves as a foundation for the use of crisis intervention? The individual is mentally healthy but in a state of disequilibrium. Long-term dysfunctional adjustment can be addressed by crisis intervention. An anxious person is unlikely to be willing to try new problem-solving strategies. Crisis intervention nurses need to remain passive as the client deals with the crisis.
The individual is mentally healthy but in a state of disequilibrium.
When should the nurse expect the abuse of a victim to worsen? The perpetrator feels he is in complete control. The perpetrator is feeling remorseful for being abusive. The victim moves toward independence from the abuser. The victim submits to the domination of the perpetrator.
The victim moves toward independence from the abuser.
The risk of elder abuse in a home is best determined by conducting which assessment? The vulnerability of the elder and the stress of the caregiver The amount of disruption the elder causes in the home How much actual physical assistance the elder needs on a daily basis The financial contribution of the elder and the caregiver's early life experience with abuse
The vulnerability of the elder and the stress of the caregiver
Central nervous depressant associated with rape
Use of alcohol w this increase risk for respiratory depression
Which statement reflects a fact about family violence? Ninety-five percent of abuse victims are women. The victim's behavior is often the cause of the violence. Violence occurs in families of all backgrounds. Alcohol and stress are the major causes of abuse.
Violence occurs in families of all backgrounds
Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of which personal characteristic? Isolation Confidence Hopelessness Vulnerability
Vulnerability
An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior that focuses on behavior therapy concepts? Telling him they will not change his dressing if he is going to abuse them. When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control. Assuring him they will complete the dressing change as quickly as possible. Explaining that they are professionals and unused to being shouted at by people they are trying to help.
When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control.
Characteristics of vulnerable children
Younger than 3 years Perceived as different (Different temperament, congenital abnormalities, chronic disease) Remind parents of someone they do not like Product of an unwanted pregnancy Interference with emotional bonding between parent and child (Premature or sick infant)
crisis intervention
a short term therapeutic process that focuses on the fast resolution of the crisis or emergency using available resources such as friends, family, healthcare professionals, etc.
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. A person in crisis is incapable of making decisions.
Perpetrators of domestic violence tend to: Select all that apply. a. have relatively poor social skills and to have grown up with poor role models b. believe they, if male, should be dominant and in charge in relationships c. force their mates to work and expect them to handle financial decisions d. be controlling and willing to use force to maintain their power in relationships e. prevent their mates from having relationships and activities outside the family
a. have relatively poor social skills and to have grown up with poor role models b. believe they, if male, should be dominant and in charge in relationships d. be controlling and willing to use force to maintain their power in relationships e. prevent their mates from having relationships and activities outside the family
situational crisis
events are external and extraordinary (Fired, divorce, illness)
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." What is the evaluation of the nurse's response after analysis of this nurse-client interaction? demonstrates a good understanding of the effect of time on perception of a crisis. is offering a statement of positive outcome based on client coping ability. has failed to follow up on the client's verbal clues to suicidal thoughts. has introduced a concept associated with traditional psychotherapy.
has failed to follow up on the client's verbal clues to suicidal thoughts.
Adventitious crisis
natural disaster, national disaster, crime of violence (Fire, flood, war, assaults, murders)
Crisis
profound disruption of normal psychological homeostasis
Derealization
surroundings unreal
Emotional abuse
the infliction of mental anguish -threatening, humiliating, intimidating, isolating
Physical abuse
the infliction of physical pain or bodily harm
Crisis Phase 3
trial-and-error methods of resolution fail anxiety escalates to severe or panic levels flight or withdrawal behaviors may occur Resolution may be devised (compromising one's needs or redefining the situation)
maturational crisis
with new developmental stage (Going to college, retirement, parent death) Need new coping skills