Module 6: Chapter 12 - Crisis Intervention

The nurse is a volunteer for the American Red Cross and has visited victims of a tornado that occurred a month ago. Many of the area's adult residents' responses have included sadness and an increase in alcohol use, while the children have separation anxiety to the point of sleeping with their parents. Which is the correctly written priority nursing diagnosis for this population? 1. Ineffective community coping related to (R/T) natural disaster 2. Anxiety R/T fear of another disaster as evidenced by (AEB) inability to proceed with cleanup 3. Risk for injury R/T hopelessness 4. Risk for low self-esteem R/T loss events

ANS: 1 1. This is correct. The priority nursing diagnosis is ineffective community coping, The AEB factors of increased alcohol use and separation anxiety show that the community has not been able to cope with the loss. 2. This is incorrect. Although the community may have anxiety, it does not appear to be fear of another disaster (no verbalization of the community members); this is not a priority nursing diagnosis. 3. This is incorrect. Although there may be a risk for injury this is not a priority at this time. The clients do not verbalize hopelessness or injury potential. 4. This is incorrect. Nurses should prioritize diagnoses and outcomes based on the potential safety risk to the client and/or others. A correctly written nursing diagnosis includes actual evidence if the problem is current and does not have evidence if the situation is potential.

Which of the following are most appropriate when performing a nursing assessment with an individual in crisis? Select all that apply. 1. "Tell me, in your own words, what happened." 2. "What coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

ANS: 1, 2, 3 1. This is correct. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis. 2. This is correct. Assessing the client's prior successful coping mechanisms may help with the progression of the nursing care plan. 3. This is correct. This assessment would provide an opportunity to help the client find a possible goal. 4. This is incorrect. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis. This is a nursing intervention. This would negate any opportunity to discuss any prior coping mechanisms. 5. This is incorrect. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis. This is a nursing intervention. This would not be a nursing assessment but rather the development of a plan and goal.

Which of the following interventions should the nurse utilize when caring for an inpatient client who is expressing anger inappropriately? Select all that apply. 1. Maintain a calm demeanor. 2. Clearly delineate the consequences of the behavior. 3. Use therapeutic touch to convey empathy. 4. Set firm limits on the behavior. 5. Teach the client to avoid "I" statements related to expression of feelings.

ANS: 1, 2, 4 1. This is correct. Maintaining a calm demeanor reduces the client's anxiety and encourages a sense of safety. 2. This is correct. Delineating consequences of behavior increases the client's awareness of the impact of actions and encourages the client to take responsibility for feelings. 3. This is incorrect. The use of therapeutic touch may not be appropriate and could escalate the client's anger. 4. This is correct. Setting firm limits communicates which behaviors are acceptable and those that are not. 5. This is incorrect. "I" messages encourage the client to express feelings and take responsibility for them.

A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? 1. Maturational/developmental crisis 2. Psychiatric emergency crisis 3. Anticipated life-transition crisis 4. Traumatic stress crisis

ANS: 2 1. This is incorrect. A maturational/developmental crisis occurs in response to failed attempts to master developmental tasks associated with transitions in the life cycle. 2. This is correct. The husband is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume personal responsibility. 3. This is incorrect. Anticipated life-transition crises are expected, even events over which the individual may feel a lack of control. 4. This is incorrect. Crises resulting from traumatic stress are precipitated by an unexpected external stressor over which the individual has little or no control, and because of which he or she feels emotionally overwhelmed and defeated.

An inpatient client with a known history of violence suddenly begins to pace. Which client behavior alerts the nurse to the client's escalating anger and aggression? 1. The client requests their prn medications. 2. The client has a tense facial expression and body language. 3. The client refuses to eat all three meals for the day. 4. The client sits in group therapy with back to peers.

ANS: 2 1. This is incorrect. The client is acknowledging the need for a prn medication to cope with the anxiety/crisis. 2. This is correct. Tense facial expressions and body language may indicate that a client's anger is escalating. The nurse should conduct a thorough assessment of the client's past and current violent behaviors and develop interventions to deescalate the client's anger. 3. This is incorrect The client's refusal to eat meals is not a sign of pending violence; rather, it is a behavioral issue or response to a crisis. 4. This is incorrect. This is a nonaggressive behavior and not a sign of a pending violent outburst.

A despondent client who recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing reply is most appropriate? 1. "I'm confident you know what's best for you." 2. "This may not be the best time for you to make such an important decision." 3. "Your children will be terribly disappointed to lose their childhood home." 4. "Tell me why you want to make this change."

ANS: 2 1. This is incorrect. This does not provide guidance for problem-solving with the client. This may be an impulsive decision due to a crisis. 2. This is correct. The nurse should guide the client through the problem-solving process. The nurse should help the individual confront the source of the problem, encourage exploration of feelings about aspects of the crisis that cannot be changed, and encourage the client to discuss changes he or she would like to make. The nurse should also assist the client in determining whether changes are realistic and if the timing of those changes is appropriate. This encourages the client to think through whether the decision is impulsive. 3. This is incorrect. This does not address the client's needs nor does it provide guidance toward a decision. 4. This is incorrect. Although this uses a therapeutic response, it does not address the need for guidance toward a less-impulsive decision.

Which is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken down" after a violent outburst? 1. To reinforce unit rules with the client population 2. To create protocols for the future release of tensions associated with anger 3. To process feelings and concerns related to the witnessed intervention 4. To discuss the client problems that led to inappropriate expressions of anger

ANS: 3 1. This is incorrect. This is a nontherapeutic communication and would potentiate loss of communication within the client population. 2. This is incorrect. The protocols should be in place prior to a takedown incident and developed by staff, not by the clients. 3. This is correct. The nursing rationale for facilitating a debriefing session with clients and staff after clients have witnessed a peer being "taken down" after a violent outburst is to process feelings and concerns related to the witnessed intervention. 4. This is incorrect. This statement would present a confidentiality issue and possibly prohibit further discussion with the witnesses.

The nurse is providing care to a client who has become emotionally labile with paranoia after losing their career and home due to a motor vehicle accident. The nurse recognizes that the client is at what phase of crisis development? 1. Phase 1 2. Phase 2 3. Phase 3 4. Phase 4

ANS: 4 1. This incorrect. In phase 1, the individual is exposed to a precipitating crisis. Symptoms include increased anxiety and the use of previously employed problem-solving techniques. 2. This is incorrect. In phase 2, previous problem-solving techniques do not relieve the stressor, which further increases anxiety. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not successful. 3. This is incorrect. In phase 3, all possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. New problem-solving techniques may be used, and, if effectual, resolutions may occur at this phase, with the client returning to a higher level, lower level, or the previous level of precrisis functioning. 4. This is correct. In phase 4, if the resolution does not occur in previous phases, Caplan states that the "tension mounts beyond a further threshold or its burden increases over time to a breaking point. Major disorganization of the individual with drastic results often occurs" (p. 41). Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking.

The rape crisis nurse has completed several counseling sessions with a client who was nearly raped while jogging. Which client statement made at the final session most clearly suggests that the goals of crisis intervention have been met? 1. "You've really been helpful. Can I count on you for continued support?" 2. "I use the indoor track on campus and avoid going outside." 3. "I'm really glad I didn't go home. It would have been hard to come back." 4. "I carry mace when I jog. It makes me feel safe and secure."

ANS: 4 1. This is incorrect. During the termination phase of counseling, the client would not rely upon a return to the therapist. 2. This is incorrect. This does not address the issue of the risk for another assault attempt. 3. This is incorrect. Although this may be a statement that would provide insight on how the client feels, it is an insight, not an intervention. 4. This is correct. The client is describing a plan of action to deal with a potential crisis similar to the one that precipitated this crisis. This statement indicates that the client has developed adaptive coping strategies and has achieved the goals of crisis intervention.

An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which is the nurse's priority intervention? 1. Initiate forced-medication protocol. 2. Help the client to explore the source of anger. 3. Avoid reinforcement of the behavior. 4. Set firm limits on the behavior.

ANS: 4 1. This is incorrect. The priority nursing intervention is to set firm limits on the client's behavior. The client's behavior does not warrant forced medication because pushing food onto the floor is not a direct safety concern. 2. This is incorrect. The priority nursing intervention is to set firm limits on the client's behavior. Exploring the source of anger may be appropriate after the client has gained emotional control. 3. This is incorrect. The priority nursing intervention is to set firm limits on the client's behavior. Ignoring the behavior may further upset the client and does not reinforce appropriate behavior. 4. This is correct. The priority nursing intervention is to set firm limits on the client's behavior.

A parent is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? 1. This type of crisis is precipitated by unexpected external stressors. 2. This type of crisis is precipitated by preexisting psychopathology. 3. This type of crisis is precipitated by an acute response to an external stressor. 4. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

ANS: 4 1. This is incorrect. The type of crisis precipitated by an unexpected external stressor over which the individual has little or no control is known as a crisis resulting from traumatic stress. 2. This is incorrect. Preexisting pathology can also precipitate a crisis. 3. This is incorrect. Dispositional crises reflect an acute response to a situational stressor. 4. This is correct. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.

A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. Which long-term outcome is realistic to address the client's crisis? 1. The client will develop adaptive behaviors by week 1. 2. The client will list five positive self-attributes by week 2. 3. The client will examine how childhood events led to this behavior by week 3. 4. The client will return to previous adaptive levels of functioning by week 6.

ANS: 4 1. This is incorrect. This is neither a long-term nor measurable goal. 2. This is incorrect. Although this is client-centered, and measurable, this is not a long-term goal. 3. This is incorrect. This may prove difficult to achieve in the short term of three weeks. 4. This is correct. A realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes related to the client's current situation. A correctly written outcome is client centered, specific, measurable, and realistic and contains a time frame.