Week 3 (Crisis Intervention)

Upon assessment after a motor vehicle crash, an uninjured patient is without suicidal or homicidal ideation. The patient's thoughts are well organized, and the patient's mood is within normal limits. What should be done next?

A. Provide information about normal stress response, self-care, and community resources and document nursing actions. Rationale: Because the patient is not demonstrating signs of a severe crisis response, the expectation is that he or she will soon recover normal function. Furthermore, encouraging self-help increases the patient's feeling of control and decreases anxiety. The patient should not be cautioned to avoid discussing the event; rehearsing events and ventilating feelings may increase feelings of control. Not all individuals requiring crisis intervention need ongoing services in a group or individual setting.

Which statement is true regarding crisis intervention?

B. Allowing time for the patient and family to place events in sequence and verbalize feelings is important. Rationale: Allowing time for the patient and family to place events in sequence and verbalize feelings results in improved mastery of the stressor and decreases the likelihood of long-term sequelae. A direct approach is desirable because it helps the confused, scared, or overwhelmed patient focus. Posttraumatic stress disorder occurs among individuals of all ages, and older adult patients may be a source of strength to younger people. Involving family members is desirable because it provides emotional support, enhances a feeling of normalcy, and provides additional assessment data.

An elderly person has experienced the sudden death of her spouse. Which response can be anticipated?

B. An exacerbation of her hypertension Rationale: Crisis response in elderly patients may involve an exacerbation of previous medical conditions, such as hypertension. The response would not involve an improvement in medical conditions or cognitive functioning. Although no changes may be obvious, additional cognitive and behavioral assessments may be required because crises can precipitate an increase in confusion and dementia in the elderly.

Which consequence would not result from poor crisis management?

B. Heightened functioning Rationale: Poor crisis management can lead depression, suicidal thoughts, poor concentration, and cognitive issues. Heightened functioning would be a result of effective crisis management.

A patient who was recently injured in a shooting has had a history of crises. How can previous experiences affect the patient?

C. Coping skills developed in the past can assist the patient in the current crisis. Rationale: The skills developed in past crises can help the patient to deal with the current crisis. Past events have an impact on the patient and the use of coping skills should be explored to assist the patient in managing the current situation. Successfully coping with past crises can help the patient deal with the current crisis.

A young woman presents with a facial laceration and multiple contusions. She states she has been assaulted, but becomes increasingly tearful as she tries to tell her story. What should the primary intervention be?

D. Assess the patient for head and body injury. Rationale: The primary action should be to assess the patient for injury. Although the patient may require antianxiety medication, an assessment should be performed first. Asking the patient to recount the events of the attack can increase her anxiety. A quiet place should be found to assess the patient to decrease his or her potential for distraction and anxiety; the nurses' station is not an appropriate area for this.

Effective crisis intervention may lead to which of these outcomes?

D. Avoidance of chronic stress disorders Rationale: Effective crisis intervention cannot prevent future crises, nor can it prevent feelings of insecurity or the need for aftercare services. It can, however, help a patient avoid chronic stress disorder following the experience of a crisis.

Crisis intervention has which of these goals?

D. Easing acute distress and returning to autonomous functioning Rationale: Crisis intervention focuses on the immediate crisis, easing acute distress, and helping the patient achieve autonomy. It is not meant to help patient with all areas of problem solving or all functional issues. Nor is the goal to remove the patient's autonomy even though at times during a crisis a patient may need to be directed. Helping a patient avoid future crises is not possible.

The risk of posttraumatic stress disorder may be decreased by which action?

D. Providing prompt intervention Rationale: Immediacy is one of the cornerstones of crisis intervention. Not all older adult patients experience dementia or confusion as a result of crisis, so an extensive cognitive assessment is not necessary. Inpatient admission is not necessary for all patients who have experienced a crisis; crisis interventionists provide services with the expectation that the individual will rapidly return to normal function and that encouraging self-help may prevent sequelae. Providing a sedative may be required, but sedatives do not decrease the risk of posttraumatic stress disorder.

A family of two parents and three children present for assessment at the emergency department after a house fire. The home requires only minor repairs and is habitable. After meeting the children's physical needs, what should the parent be advised to do?

D. Return the children to their usual chore, mealtime, and bedtime schedules. Rationale: Returning to usual routines decreases anxiety and increases feelings of mastery. Keeping the children out of school and distracting the children does not address the children's needs. Verbalizing feelings or expressing them with drawings or creative play helps children to recover from crisis. Children and adolescents respond to parental stress levels, and most do not require psychiatric care.