Ch 21: Crisis, Loss, Grief, Response, Bereavement, and Disaster Management
a) Situational Pg. 315 A situational crisis is a response to a sudden and unavoidable traumatic event that largely affects a person's identity and roles. When a stressful event threatens a person's physical, emotional, or social integrity, crisis is likely.
1. Losing one's job is an example of which type of crisis? a) Situational b) Unexpected c) Adventitious d) Maturational
a) Sister: "It is all my fault; I wanted him to die" Pg. 319 The death of a child is a devastating experience for the family. The family may express feelings of guilt by wondering if they were responsible, and a sibling may have guilt feelings for having wished the ill child dead.
10. A nurse who provides bereavement counseling is working with the family of a child who recently died from cancer. Which of the following statements may be a common expression of grief and guilt a by family member? a) Sister: "It is all my fault; I wanted him to die" b) Uncle: "It was for the best" c) Parents: "We did everything we could and we are at peace" d) 65-year-old grandparent: "It helped me prepare for my death"
c) "Your wife's death is a terrible loss for you" Pg. 319 An open-ended statement that validates the bereaved person's loss is most helpful. It signifies understanding. The other options are clichés, closed, and do not elicit therapeutic communication.
11. After the death of a client's spouse, the client tells the nurse, "I can never live without my spouse. They were my whole life." Which is the most therapeutic response from the nurse? a) "Your friends will help you cope with this" b) "Remember, your wife is no longer suffering" c) "Your wife's death is a terrible loss for you" d) "Each day will get a little better"
d) Hostility is a common behavioral response to grief Pg. 321 Irritability and hostility toward others reveal anger and frustration in the grief process. These responses are expected as the person moves through the stages of grief. Empathy can be demonstrated by nurses at all stages of grief and it does depend on the nurse sharing the same life experiences as the client. In most cases, the client's anger is not the result of the nurse's actions but it related directly to the loss. Grief is highly individualized, but hostility following a loss does not necessarily indicate a latent personality trait.
12. The nurse is working with a client who lost the client's youngest child 2 months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases a response to the client on the understanding of what? a) Personality traits such as aggressiveness are exaggerated during the grief process b) The nurse may have nonverbally indicated a judgmental attitude toward the client c) It is too soon after the loss to empathize with the client d) Hostility is a common behavioral response to grief
a) "If you wish you would die, do you have a plan for this?" Pg. 315 The nurse needs to assess a client's risk of suicide when a client makes this statement based on a crisis that has occurred due to a traumatic event. Assessing for a plan for this is an important part of determining suicide risk. Asking about upsetting the family effectively dismisses the client's concern. While it is true that is important that the client made it out of the fire and likely does have a place to live, these do not address the client's statement about wanting to die.
13. A client is admitted with smoke inhalation after a fire has destroyed their home. The client states, "I wish I would have died in the fire." What is the nurse's best response? a) "If you wish you would die, do you have a plan for this?" b) "You don't want to upset your family by saying this, do you?" c) "Don't worry, you will be able to have a place to live" d) "I am just glad you made it out of the house in time"
d) Complicated grief Pg. 320-321 Prolonged grieving and suffering from clinical depression may be considered outside the norm of the grieving process. The client suffering from complicated grief may suffer from these symptoms or may experience a void of emotion or suffer grief disproportionate to the event. Disenfranchised grief is the grief over the loss that cannot be expressed openly. Anger is the step in the grieving process where the client is developing awareness of the loss and expresses anger towards God, caregivers, or the health care providers. Outcry is also a phase of grief that accompanies outward expression of grief such as sobbing tearfully and crying loudly. The client starts developing awareness about the grief in this phase.
14. The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which term correctly describes the client's response to the loss? a) Anger b) Disenfranchised grief c) Outcry d) Complicated grief
a) Degree of preventability c) Extent of violence e) Suddenness Pg. 320 The external circumstances of death include (1) suddenness and lack of anticipation; (2) violence, mutilation and destruction; (3) degree of preventability or randomness of the death; (4) multiple deaths (bereavement overload); and (5) the mourner's personal encounter with death involving significant threat to personal survival or a massive and shocking confrontation with the deaths (or mutilation) of others.
15. In traumatic grieving, external factors influence reactions and potential long-term outcomes. Which characteristic would a nurse identify as an external factor? Select all that apply. a) Degree of preventability b) Anticipation of the death c) Extent of violence d) Single death experience e) Suddenness
d) Insomnia Pg. 314 Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms. Hair loss usually has an exclusively physiologic cause. Compulsions are usually related to a mental health disorder rather than the grieving process. Indigestion and various gastrointestinal symptoms may accompany grief, but vomiting would be atypical.
16. The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which physical symptom of grief would the nurse most likely expect to detect in the history? a) Hair loss b) Compulsive behaviors c) Vomiting d) Insomnia
c) Resolving immediate problems perceived as most threatening to the client Pg. 315-316 During crisis intervention, the nurse assists clients to resolve immediate problems that they perceive as overwhelming.
17. Effective interventions while providing care during a crisis include... a) Educating the client about his or her mental illness b) Confronting and exploring unresolved past issues c) Resolving immediate problems perceived as most threatening to the client d) Exploring the unhealthy aspects of the person's functioning
b) Past history of mental health care Pg. 315-316 The nurse first determines the client's perception of the stressful event. After determining the client's perception of the event, the nurse focuses on who is available to support the client, and encourages the client to describe specific coping methods, determining whether the coping mechanisms are adaptive or maladaptive. Past history is not an immediate priority when assessing a person's current state of crisis.
18. Which of the following would not be essential to assess when working with a person in crisis? a) Perception of the event b) Past history of mental health care c) Coping skills d) Support systems
b) "I just can't believe that my spouse is gone" Pg. 319 The dual process model (DPM) offers a non-linear explanation of how grieving persons and families come to terms with their loss over time. According to the DPM, the person adjusts to the loss by oscillating between loss-oriented coping (preoccupation with the deceased) and restoration-oriented coping (preoccupation with stressful events as a result of the death including financial issues, new identity as a widow[er]). Oscillation is the process of confronting (loss-oriented coping) and avoiding (restoration-oriented coping) the stresses associated with bereavement. At times, the bereaved person is confronted with the loss and memories, and at other times, the persons will be distracted and the thoughts and memories will be avoided. The bereaved experiences relief from the intense emotion associated with the loss by focusing on other things. The statement about the spouse being gone reflects loss-oriented coping. The statements about paying bills, making meals, and making an appointment reflect restoration-oriented coping.
19. A nurse is assessing a person who has suffered a loss and is grieving. When applying the dual process model, the nurse would most likely interpret which client statement as reflecting loss-oriented coping? a) "I need to get some groceries to make my meals" b) "I just can't believe that my spouse is gone" c) "I have to make an appointment with my doctor" d) "I have to get a handle on what bills need to be paid"
b) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living d) The survivor begins to gain independence and confidence e) The survivor develops new ways of managing life and new relationships Pg. 315-316 Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge and new relationships form. The person's life is reorganized and seems "normal" again, although different than that before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings.
2. The bereaved client has worked through many processes of grief with the nurse. Which are eventual outcomes of the emotional dimension of grieving? Select all that apply. a) The survivor forgets about the loss b) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living c) The survivor's life returns to the same state as it was before the loss d) The survivor begins to gain independence and confidence e) The survivor develops new ways of managing life and new relationships
b) Plan funeral arrangements for the child Pg. 322 Funerals are often the beginning outward sign of mourning and help begin the grieving process. This couple will need to talk about the child's death repeatedly as the couple begins to grieve. It will not likely be possible for the couple to accept that they could do nothing to prevent this death within this time period, but they must begin to hear this. They should not delay the grieving process.
20. A couple came to the emergency department with their 5-month-old child. The child was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to do what? a) Minimize discussion of the death with others b) Plan funeral arrangements for the child c) Delay the grieving process until the couple is ready to cope d) Postpone notification to the extended family
b) The nurse who has worked with the client before and after the amputation Pg. 317 In this case, the charge nurse's best option for nursing assignment to this client is to assign the nurse who has worked with the client before and after the amputation. At present the client's ability to relate to others may be impaired. Limiting the number of new contacts initially will promote familiarity and trust and decrease the client's feelings of being overwhelmed.
21. A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? a) A nurse who is just returning to work from a one-week vacation b) The nurse who has worked with the client before and after the amputation c) A nurse who often has been assigned to the client 3 previous night shifts d) A nurse with previous experience working with clients who have amputations
a) Occurs when an individual is at a breaking point Pg. 314 A crisis occurs when the individual is at a breaking point. It generally lasts no longer than 4 to 6 weeks. People who live in constant turmoil are not in crisis but in chaos. Feelings of fear, desperation, and being out of control are common during a crisis, but the precipitating event and circumstances are unusual or rare, perceived as a threat, and specific to the individual.
22. What is accurate regarding a crisis? a) Occurs when an individual is at a breaking point b) Occurs from a common precipitating event c) Defined as being in constant turmoil d) Lasts longer than 6 weeks
c) "Do I have the strength to be present and to facilitate the client who is grieving?" Pg. 316 Ongoing self-examination is an effective method of keeping the therapeutic relationship goal-directed and acutely attentive to the client's needs. Honestly answering if a nurse is still effective in the care he or she gives grieving clients is the most effective way to determine overall therapeutic approach. The remaining options are more nurse than client focused.
23. What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? a) "How long can I continue working with grieving clients?" b) "How do I personally react when I am working through the grieving process?" c) "Do I have the strength to be present and to facilitate the client who is grieving?" d) "Do I still get personal satisfaction from my work with the grieving client?"
c) What the mastectomy means to the client Pg. 313-314 Assessment begins with exploration of the client's perception of the loss. A client who is scheduled for a mastectomy would possibly be having anticipatory loss of a physiologic nature. It would not be appropriate to discuss the client's plans for reconstructive surgery as this is not likely what is causing the client to be quiet and show little emotion. It is important to ascertain whether the client truly understands the surgery when witnessing the client's signature of the operative consent, but there is no indication that this is what is being addressed at this time. It would not be appropriate to assume that the client is depressed or not. It would be better to explore the client's perception of the loss.
24. A client is scheduled for a mastectomy for breast cancer. The client is quiet, shows little emotion, and states that she has no questions. What topic would the nurse's assessment need to focus on? a) The client's plans for reconstructive surgery b) Why the client seems depressed c) What the mastectomy means to the client d) Whether the client truly understands the surgery
a) A woman newly diagnosed with lung cancer laments the fact that she has never made a sincere effort to quit smoking Pg. 321 Identifying a link between past smoking habits and present lung cancer shows a realistic understanding of the causation of a crisis. Severe anxiety without tangible cause, resignation, and fatalism are defense and coping mechanisms that are associated with an unrealistic understanding of a crisis.
25. Which of the following clients exhibits the most realistic perception of his or her present crisis? a) A woman newly diagnosed with lung cancer laments the fact that she has never made a sincere effort to quit smoking b) A woman whose daughter will soon graduate from high school experiences chronic insomnia due to worrying about her daughter's future c) A woman with uncontrolled diabetes states that it is a waste of time to monitor her blood sugar levels because "whatever happens was supposed to happen" d) A man believes that his business would have failed no matter what action he had taken to operate it differently
a) Giving clear communication Pg. 322 The client who is confused is in the C part of ABCS with cognition and needs clear communication to be able to understand what is occurring and what the client needs to do to be safe. Providing consolation would be most important in the A of ABCS with arousal; administering an antianxiety medication is not indicated at this time as the client doesn't have noted anxiety and this may cause further alteration in the CNS. Prioritizing resources would be more appropriate as a later intervention and would be dependent on the client's cognition at that time.
26. The nurse is providing psychological first aid for a client after a hurricane who is exhibiting confusion. Which intervention is most appropriate for the client? a) Giving clear communication b) Providing consolation c) Assisting with prioritization of resources d) Administering an antianxiety medication
c) Behavioral Pg. 321 The nurse can explain to the client that this is a behavioral response to grief. Drug and alcohol abuse indicate the client has developed a maladaptive response to the spiritual and emotional despair related to the death of the mother. Emotional responses to grief are characterized by the expression of a range of emotions over the course of the grieving process. Alcohol abuse is not an emotional response in grief, however, it is a behavior that is used to attempt to manage the emotional pain associated with the loss. Spiritual responses to grief are related to an individual's personal values regarding the spiritual dimension of the human experience. Although alcohol abuse is not a spiritual response to grief, it can be a behavioral response to the spiritual discord the client may be experiencing as he processes the mother's death. Physiologic responses to grief refer to the natural body responses that emerge for the body to adapt to loss. Although the client may use alcohol to try to treat a physiologic response to grief---for example, to promote sleep or calm anxiety---it remains a behavioral response.
27. A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate explanation for the client's grief response? a) Emotional b) Physiologic c) Behavioral d) Spiritual
c) "How is this affecting you right now?" Pg. 322 The nurse should elicit more information and demonstrate empathy by asking an open-ended question about the client's subjective experience. There is no obvious need to know if the husband has done this before. Stating "You have to face reality" is a heavy-handed and non-therapeutic response. Focusing on the client's finances does not address the client's apparent denial.
28. A client has just been served divorce papers from a spouse. The client has no financial resources and little social support. The client states, "My spouse is not really leaving. My spouse will be back." The most appropriate response by the nurse would be what? a) "I'll call social services and get you signed up for financial assistance" b) "You have to face reality. Here are the papers" c) "How is this affecting you right now?" d) "Has your spouse done this before?"
c) Loss of safety Pg. 320 Safety loss is the loss of a safe environment. That feeling of safety is shattered when public violence occurs. Examples of physiologic loss include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. A loss of self-esteem includes any change in how a person is valued at work or in relationships. Loss related to self-actualization includes an external or internal crisis that blocks or inhibits strivings toward fulfillment that may threaten personal goals and individual potential.
29. A child who has witnessed the murder of a classmate while at school would experience which kind of loss? a) Loss related to self-actualization b) Physiologic loss c) Loss of safety d) Loss of self-esteem
a) Traumatic Pg. 315 The client is undergoing a traumatic crisis, which is an unexpected and unusual event that can cause injury, trauma, destruction, or sacrifice. A developmental crisis is a significant maturational event such as graduation from high school or leaving home for the first time. The client experiencing a situational crisis would experience an internal or external event that challenges biopsychosocial integrity, requiring adaptation, but is not violent; examples include moving to another city or accepting a job promotion. The familial crisis is not a specific type of crisis; a crisis involving the family could be any of the three types mentioned.
3. A client is crying uncontrollably after having experienced an assault by a family member. The nurse is aware that the client is experiencing which type of crisis? a) Traumatic b) Situational c) Familial d) Developmental
a) "Who do you want to share information about your prognosis with?" Pg. Purposeful assessment of support systems provides the grieving client with an awareness of those who can meet his or her emotional and spiritual needs for security and love. The nurse can help the client to identify his or her support systems and reach out and accept what they can offer. The remaining options provide attempts at support that the client may not be ready or able to accept at this time.
30. Which statement, made by the nurse, focuses on the purposeful assessment of a client coping with a terminal diagnosis? a) "Who do you want to share information about your prognosis with?" b) "Getting such news has to be upsetting; can we talk about your feelings?" c) "How can I help you right now?" d) "Social services will help make the arrangements for your hospice care"
c) The result of an external source of severe stress the individual is not prepared to cope with effectively Pg. 315 A situational crisis refers to the result of an external source of severe stress the individual is not prepared to cope with effectively. A situational crisis does not refer to any of the following: a stress-induced response that relates to an individual's exposure to the various developmental stages; the extreme physiological response to events such as menopause and retirement; or a term used to describe any severe stress reaction with a known origin of cause.
31. A situational crisis refers to... a) A term used to describe any severe stress reaction with a known origin of cause b) A stress-induced response that relates to an individual's exposure to the various developmental stages c) The result of an external source of severe stress the individual is not prepared to cope with effectively d) The extreme physiological response to events such as menopause and retirement
c) Emotional Pg. 319 Feelings of anger are common when death has resulted from extreme circumstances such as suicide. In addition to despair and anger, some people may also experience feelings of loss of control in their lives. The statement made by this client is reflective of an emotional response to grief. A spiritual response to grief, a person would more likely feel or verbalize anger towards God or other religious figures. This type of response is deeply embedded in personal values related to an individual's spirituality. A behavioral response to grief is characterized by what others can observe in the grieving person for example, becoming heavily engrossed in distracting work, often sobbing uncontrollably or avoiding places that are associated with the deceased. A physiologic response to grief is characterized by physical or health problems resulting from adapting to the loss. Commonly, people report insomnia, changes in appetite, weight loss, palpitations and gastrointestinal problems.
32. A nurse is facilitating a support group for family members of people who have committed suicide. One client states,"My kids and I are just not the same. It was so selfish of my husband to do this." The nurse can accurately identify this as which type of response to grief? a) Behavioral b) Spiritual c) Emotional d) Physiologic
d) The client has experienced a number of previous losses Pg. 320-321 The following factors have negative effects on the mourning process: high dependency on the deceased, ambivalence toward the deceased, a poor or absent support system, a high number of past losses or other recent losses, poor physical or mental health, and young age of the deceased. The other options do not support difficult bereavement.
33. A nurse is caring for a client who is grieving the loss of a loved one. Which factor would the nurse identify as contributing to the possibility of complicated bereavement? a) The client had few unresolved conflicts in the relationship with the deceased b) The client has a good support system with meaningful relationships evident c) The client was relatively independent of the deceased d) The client has experienced a number of previous losses
a) Traumatic Pg. 314 A traumatic crisis is initiated by unexpected, unusual events that can affect an individual or a multitude of people. In such situations, people face overwhelmingly hazardous events that entail injury, trauma, destruction, or sacrifice. Examples of events include national disasters (e.g., racial persecutions, riots, war), violent crimes (e.g., rape, murder, kidnappings, and assault and battery), and environmental disasters (e.g., earthquakes, floods, forest fires, hurricanes). Maturational crises are a normal part of growth and development and successfully resolving a crisis at one stage allows one to move to the next. The concept of developmental crisis continues to be used today to describe significant maturational events, such as leaving home for the first time, completing school, and accepting the responsibility of adulthood. A situational crisis occurs whenever a specific stressful event threatens a person's physical and psychosocial integrity and results in some degree of psychological disequilibrium. The event can be an internal one, such as a disease process, or any number of external threats.
34. A nurse is providing care to a family whose house was destroyed in a tornado. The nurse interprets this as which type of crisis? a) Traumatic b) Maturational c) Developmental d) Situational
b) Death by suicide c) Sudden, unexpected death d) Death of a child Pg. Risk factors for vulnerability include the death of a child, that the death was unexpected (the client was not aware her son was experiencing depression) and that the death was by suicide. The client would be considered at risk for complicated grief. Within the information provided in the question, there is no indication that the client has low self-esteem or low trust in others. These are, however, factors that, if present, can complicate grief.
35. The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) a) Low self-esteem b) Death by suicide c) Sudden, unexpected death d) Death of a child e) Low trust in others
d) Complicated Pg. 320-321 The client is experiencing complicated grief, which tends to last longer than 6 months and may be accompanied by feelings of life being meaningless without the deceased person. Traumatic grief is associated with external factors that influence reactions and has potential long-term outcomes- there is no evidence of this type of situation with the parent' s death. Simple or normal grief can be painful and disruptive but usually shows signs of improving with a decline of yearning, depression and disbelief within the first 6 months, although these can last through the first two years. There are signs of gradual improvement however.
36. The nurse is counseling a client who lost a parent one year ago. The client states "I wish I could die too." The nurse is aware that the client is experiencing which type of grief? a) Simple b) Normal c) Traumatic d) Complicated
a) The patient will resume the precrisis level of functioning Pg. 315 Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in one of three ways. In the first two, the person either returns to his or her precrisis level of functioning or begins to function at a higher level; both are positive outcomes for the individual. The third resolution is that the person's functioning stabilizes at a level lower than precrisis functioning, which is a negative outcome for the individual. Assisting the person to use existing supports or helping the individual find new sources of support can decrease the feelings of being alone or overwhelmed. The patient may develop guilt if he or she examines possible causes for the crisis. Expression of anger at 4 to 6 weeks indicates a less than favorable outcome of crisis intervention.
37. The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome? a) The patient will resume the precrisis level of functioning b) The patient will express anger regarding the crisis event c) The patient will discover a new sense of self-sufficiency in coping d) The patient will identify possible causes for the crisis
a) "I am still so angry about my grandmother's death even after a year" Pg. 320-321 The client who is experiencing complicated grief can have continued bitterness and anger even after a prolonged period. The client experiencing traumatic grief has external factors that influence the reactions and potential long-term outcomes; these factors can include suddenness of death, as well as violence or destruction- these can be involved with a car accident or suicide. With uncomplicated grief, the client would still be mourning a loved one's loss for some time such as with the mother, but this would be considered normal.
38. Which statement by a client would alert the nurse that the client is experiencing complicated grief? a) "I am still so angry about my grandmother's death even after a year" b) "It's been a week, but it still seems unreal that my mother has died" c) "I blame myself for my brother having committed suicide" d) "I keep imagining the scene of my spouse's accident that caused death"
a) "The loss of your spouse must be very painful for you" Pg. 319 The nurse makes an empathetic response, acknowledging the client's loss. "At least you and your spouse enjoyed life right until the end," is judgmental. "It's better to go quickly like your spouse did instead of suffering," does not address the client's grief. "You'll feel better after you get over the shock of your spouse's death," is false reassurance.
39. A client comes to the health care provider's office for an annual checkup. During the interview, the nurse learns that the client's spouse died unexpectedly of a heart attack 2 months ago. Which would be the most appropriate response by the nurse? a) "The loss of your spouse must be very painful for you" b) "You'll feel better after you get over the shock of your spouse's death" c) "It's better to go quickly like your spouse did instead of suffering" d) "At least you and your spouse enjoyed life right until the end"
c) Places trust in people who are familiar to him or her Pg. 320-321 People who are vulnerable to complicated grieving include those with low self-esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts, or absent or unhelpful family members.
4. The nurse visits with a client who was recently in a motor vehicle accident. Which is most likely to prevent the client from experiencing complicated grief? a) Dependent on others to meet needs b) Tendency to suppress emotions c) Places trust in people who are familiar to him or her d) History of depression
b) Yearning Pg. 319 This client is expressing emotion related to yearning for the lost loved one and protesting the permanence of the loss. The client is experiencing the phase of yearning in accordance with Bowlby's stages of grieving. Shock, numbness, and protest refers to the phase in which people experience numbness and deny the loss. Disorganization and despair is the phase in which people experience cognitive disorganization and emotional despair with difficulty functioning in the everyday world, such as with work or parenting. The reorganization phase refers to the reintegrating of self to pull their life back together.
40. A female client tells the nurse she has had low appetite and motivation since the recent breakup of a long-term relationship. The client states, "I just can't stand not having her around. I need her back." The client is experiencing which of Bowlby's phases of grieving? a) Shock, numbness and protest b) Yearning c) Disorganization and despair d) Reorganization
a) Interpretation of the crisis as overwhelming or irresolvable Pg. 316 While numerous negative consequences exist when an individual lacks situational support in a crisis, one of the most common is the tendency to interpret a crisis as overwhelming or irresolvable.
41. A 19-year-old college student sought care at the campus medical clinic with complaints of unusual vaginal discharge and was subsequently diagnosed with gonorrhea. The student's friends and family all live in her home state, and she has not yet formed close relationships with her classmates and roommates. What risk does the student's lack of situational support most clearly pose? a) Interpretation of the crisis as overwhelming or irresolvable b) Use of simplistic or ineffective coping mechanisms c) Deficient knowledge of the options available d) Failure to identify the severity of the crisis
a) "I am trying to work through this but have had to cut myself a few times" Pg. 316 The client who is using self-mutilation such as cutting is in need of further mental health counseling and potentially admission to a psychiatric unit. This is evidence of having difficulty coping and the client needs a more in-depth assessment of potential support measures. Having a hard time going to work or sleeping are normal grief reactions. The client who is angry is also working through a stage of grief but there is no evidence with any of these other situations that the client is not coping with this crisis.
42. The nurse is working with a client who is experiencing a crisis due to a divorce. Which statement would alert the nurse to the client's need for referral for further mental health counseling? a) "I am trying to work through this but have had to cut myself a few times" b) "I am really angry with my spouse for divorcing me" c) "I am having a hard time going to work every day as if nothing is happening" d) "I have been having a hard time going to sleep at night"
c) Perception of the precipitating event Pg. 316 Factors that influence the outcome of a crisis include previous problem-solving experience, perception or view of the problem, amount of help or hindrance from significant others, number and types of past crises, time elapsed since the last crisis, membership in a vulnerable population, sense of mastery, and resilience.
43. A nurse is conducting a class for a group of colleagues about crisis. Which information would the nurse most likely include as being most influential on the outcome for a person experiencing a crisis? a) Past coping skills b) Financial resources c) Perception of the precipitating event d) Membership in a vulnerable population
d) Gradual and observable Pg. Cognitive declines are typically gradual in progression and the effects are readily observable to others. Such a loss would likely be unexpected and anticipatory, but it would not be perceived (i.e., invisible to others) nor temporary.
44. An 81-year-old woman has been experiencing episodes of increasing forgetfulness in recent months, a problem that prompted her to seek care from her primary care physician. After tests and referrals, she has just received a diagnosis of early-stage Alzheimer's disease. What type of loss is this woman most likely to experience? a) Anticipatory and perceived b) Temporary and unexpected c) Sudden and perceived d) Gradual and observable
d) Cultural influences Pg. 317 Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a how a person expresses their of grief.
45. Which factor is likely to have the greatest impact on how a client responds to grief? a) Cause of death b) Religious influences c) Socioeconomic factors d) Cultural influences
a) Debriefing has not been validated by research as a useful treatment after traumatic incidents Pg. 326 Debriefing (the reconstruction of the traumatic events by the victim) may be helpful for some. Long a common practice, debriefing was believed to be necessary in order for the person to develop a healthy perspective of the event and ultimately prevent PTSD. However, research does not support debriefing as a useful treatment for the prevention of PTSD after traumatic incidents. Additionally, different cultural groups respond differently to traumatic events, and many non-Western ethnic groups present symptoms somatically rather than psychologically. Therefore, compulsory debriefing is not recommended
46. A psychiatric-mental health nurse is conducting a teaching session for a group of community personnel who are members of a the local disaster response team. One of the responders asks the nurse, "Isn't debriefing important to helping those involved cope with the disaster?" Which information would be important for the nurse to include in the response? a) Debriefing has not been validated by research as a useful treatment after traumatic incidents b) Debriefing is essential to preventing post-traumatic stress disorder c) Debriefing has been shown to help those involved to develop a healthy perspective of the event d) Compulsory debriefing is critical for individuals of non-Western ethnic groups
b) An increase in anxiety levels develops due to the spouse's death and the client uses standard problem-solving techniques to decrease the anxiety level a) The problem-solving techniques are ineffective and anxiety levels increase. The client uses trial-and-error methods to help decrease anxiety levels c) Anxiety escalates due to failure of trial-and-error methods and automatic relief measures are used to cope with the anxiety d) Anxiety leads to serious personality disorganization and it is recognized that a client is in crisis Pg. 314 The client's anxiety begins with encounter of a problem, which was the death of a spouse and grief experience. Usual problem-solving methods would be used to help decrease the anxiety from this. When these are not working, the client would then have an increase in anxiety and begin trial-and-error methods. When trial-and-error methods fail, anxiety level increases and automatic relief measures are used. Once this occurs, the client develops a serious personality disorganization and a crisis is then recognized
47. A client experiences a crisis after the death of a spouse. Place the phases of crisis development in order. All options must be used. a) The problem-solving techniques are ineffective and anxiety levels increase. The client uses trial-and-error methods to help decrease anxiety levels b) An increase in anxiety levels develops due to the spouse's death and the client uses standard problem-solving techniques to decrease the anxiety level c) Anxiety escalates due to failure of trial-and-error methods and automatic relief measures are used to cope with the anxiety d) Anxiety leads to serious personality disorganization and it is recognized that a client is in crisis
a) Return the client to his pre-crisis level of function Pg. 315 The fundamental goal of crisis interventions is to return the client to his pre-crisis level of function. Protecting the client from additional stress, helping the client identify the cause of stress, and minimizing the length of the current hospitalization are not the fundamental goals of a crisis intervention.
5. When establishing long-term treatment outcomes for a client experiencing a psychiatric crisis, the nurse references the fundamental goal of crisis interventions, which is to... a) Return the client to his pre-crisis level of function b) Minimize the length of the current hospitalization c) Protect the client from additional stress d) Help the client identify the cause of his crisis
b) Has a realistic view of the situation Pg. 314-315 The timely and successful resolution of a crisis is more likely if an individual has a realistic view of the situation, adequate supports available, and effective coping mechanisms.
6. Successful resolution of a crisis an individual is experiencing is more likely to occur if the individual... a) Increases their own pressures to quickly resolve the situation effectively b) Has a realistic view of the situation c) Seeks help from a professional d) Has experienced a prior stressor with greater magnitude
c) The client will develop a plan for coping with the loss Pg. 319 The development of a specific plan for dealing with loss is a desirable outcome for a grieving client. Self-reliance is an unrealistic goal and the resulting isolation can cause complicated grieving. Denying the significance of the loss and suppressing emotions are similarly "warning signs" for complicated grieving and are not desirable outcomes.
7. The nurse is establishing outcomes for a grieving client. Which is an appropriate outcome? a) The client will verbalize that loss will not adversely affect the quality of life b) The client will demonstrate self-reliance during the grief process c) The client will develop a plan for coping with the loss d) The client will suppress emotions related to the loss
c) "You look very sad. What is happening?" Pg. 316 The nurse needs to encourage the person to express any and all feelings without trying to calm or placate him or her. Acknowledging the client's behavior and asking an open-ended question is likely to promote communication and demonstrate empathy. The nurse should not presume that the client is sad, but should instead state that the client appears to be sad and ask for the client's input. Saying "It will get better" is a non-therapeutic platitude. Asking, "What is bothering you?" may inadvertently suggest that the nurse does not see any need for the client to be upset.
8. The nurse approaches a client who looks very sad and is sitting alone crying. Which is the best response by the nurse in this situation? a) "I'm sorry you are sad. Is there anything I can do to help you feel better?" b) "What is bothering you?" c) "You look very sad. What is happening?" d) "Please don't cry. It will get better."
d) Situational Pg. 315 The client is experiencing the loss of a significant person. Situational crises, such as death of a significant other, loss of a job, or other loss, affect self-confidence. A maturational crisis occurs in developmental stages or passages. Adventitious crises are disasters, crimes of violence, and national disasters.
9. A 15-year-old client comes to the clinic in a state of crisis because her boyfriend has ended their relationship. Which type of crisis would the nurse describe this as? a) Maturational b) Developmental c) Adventitious d) Situational
