Ch. 26 Crisis and Disaster

What is the fourth phase of a crisis?

The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociate symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self.

What is the third phase of a crisis?

Trial-and-error methods of resolution fail, and the client's anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors.

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.

What is the second phase of a crisis?

anxiety continues escalating as defense responses fail, functioning becomes disorganized and the client resorts to trial-and-error attempts to resolve anxiety.

The highest-priority goal of crisis intervention is: A. anxiety reduction B. Identification of situational supports C. Teaching specific coping skills that are lacking D. Patient safety

D. Patient safety

Emergency response workers arrive in a community after a large-scale natural disaster. What is the workers' first action? a. Report to the incident command system (ICS) center. b. Determine whether the community is safe. c. Establish teams of workers with varied skills. d. Evaluate actions completed by local law enforcement.

A An ICS provides a common organizational structure facilitating an immediate response. It establishes a clear chain of command that supports the coordination of personnel and equipment at an event site. The incorrect responses describe actions that may or may not be taken by the ICS.

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

A Disequilibrium is the only answer universally true for all patients in crisis. A crisis represents a struggle for equilibrium when problems seem unsolvable. Crisis does not reflect mental illness. Potential for self-violence or other-directed violence may or may not be a factor in crisis.

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

A Severe anxiety narrows perceptions and concentration. By speaking in short concise sentences, the nurse enables the patient to grasp what is being said. Conveying urgency will increase the patient's anxiety. Letting the patient know who controls the interview or stating that time is limited is nontherapeutic.

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

A Strategies of crisis intervention address the immediate cause of the crisis and restoration of emotional security and equilibrium. The goal is to return the individual to the precrisis level of function. Crisis intervention is, by definition, short term. The correct response is the most global answer. Promoting growth is a focus of long-term therapy. Providing legal assistance might or might not be applicable.

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

A The adult's crisis clearly relates to a loss of (or threatened change in) self-concept. Her capacity to care for her parents, regardless of the parent's condition, has been challenged. Crisis resolution will involve coming to terms with the feelings associated with this loss. Identifying situational supports is relevant, but less so than coming to terms with the threat to self-concept. Reliance on lessons from role models can be helpful but not the primary factor associated with resolution in this case. Automatic relief behaviors include withdrawal or flight and will not be helpful. Automatic relief behaviors are part of the third phase of crisis.

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

A The correct answer is the only option that assesses coping skills. The incorrect options are concerned with self-esteem, ask the patient to decide on treatment at a time when he or she "cannot think clearly," and seek to explore issues tangential to the crisis.

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 state of emotional disorder results in trial-and-error problem solving.

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

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

To assess the client's perception of the event precipitating a crisis, the nurse would initially ask which question? A. "How does this situation affect your life?" B. "During difficult times in the past, what has helped you?" C. "Can you give me the name of someone you trust?" D. "Who is available to help you?"

A. "How does this situation affect your life?" Individuals process information differently. An event may be minor to some while being extremely serious to others. The correct option is the only query that is directed at the client's perception of the precipitating event. The other options ask important questions but are not related to perception of the precipitating event.

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 wasnt for you and the hours we've spent talking, I dont 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."

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

A. A crisis is an acute time-limited 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? (Select all that apply). A. A crisis is self-limiting and usually resolves within 4-6 weeks B. The earlier interventions are implemented, the better the expected prognosis C. The nurse should maintain a nondirective role D. The patient in crisis is assumed to be mentally unhealthy and in an extreme state of disequilibrium E. The goal of crisis management is to return the patient to at least the precise level of functioning

A. A crisis is self-limiting and usually resolves within 4-6 weeks B. The earlier interventions are implemented, the better the expected prognosis E. The goal of crisis management is to return the patient to at least the precise level of functioning

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

A. Mrs. R tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist. Phase I intervention is when a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety. Alcohol represents an ineffective coping mechanism while the other options demonstrate the existence of a crisis.

Two 16-year-old students were both involved in serious car accident. Both students have spoken with a counselor about the incident. One student has been able to move forward with little dysfunction as a result of the accident while the other has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained primarily by what factor? A. Personal perception of the event. B. Individual personality. C. Existence of previous, unresolved emotion trauma. D. One student received ineffective counseling.

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

When responding to Lilly (a single mother of four, who 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.), the intervention that takes priority is to: A. Reduce anxiety B. arrange shelter C. contact out-of-area family D. hospitalize and place the patient on suicide precautions

A. Reduce anxiety

A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (select all that apply) A. Lithium carbonate B. Paroxetine C. Risperidone D. Haloperidol E. Lorazepam

B. Paroxetine E. Lorazepam

What is the priority concern of the crisis intervention nurse regarding the client? A. The client's physical safety B. Setting up support contacts C. Helping the client brainstorm possible solutions D. Assisting the client to work through termination issues associated with therapy

A. The client's physical safety Client safety is always the priority concern in crisis intervention therapy. The disequilibrium of crisis predisposes the client to suicidal thinking. None of the other options have priority over client safety.

What is the expected outcome for an individual who has successful resolved all the maturational crises they have been presented with? Select all that apply. A. The development of basic human qualities B. The elimination of future maturational crises C. The development of new, effective coping mechanisms D. The elimination to specific barriers to psychosocial growth E. The ability to pass through subsequent developmental stages

A. The development of basic human qualities C. The development of new, effective coping mechanisms E. The ability to pass through subsequent developmental stages Successful resolution of these maturational tasks leads to development of basic human qualities. Erikson believed that the way these crises are resolved at one stage affects the person's ability to pass through subsequent stages. Each crisis provides the starting point for movement toward the next stage with the opportunity to learn new coping mechanisms and experience personal psychosocial growth. Each new stage of development results in a maturational crisis.

Which assumption serves as a foundation for the use of crisis intervention? A. The individual is mentally healthy but in a state of disequilibrium. B. Long-term dysfunctional adjustment can be addressed by crisis intervention. C. An anxious person is unlikely to be willing to try new problem-solving strategies. D. Crisis intervention nurses need to remain passive as the client deals with the crisis.

A. The individual is mentally healthy but in a state of disequilibrium. The patient in a crisis situation is assumed to be mentally healthy, to have functioned well in the past, and to be presently in a state of disequilibrium. None of the other options present correction foundational statements for crisis intervention

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

B A crisis exists for this patient. The two primary thrusts of crisis intervention are to provide for the safety of the individual and use anxiety-reduction techniques to facilitate use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient's safety, and interpersonal reassurance

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

B Individuals in crisis are universally anxious. They are often frightened and may be mildly confused. Perceptions are often narrowed with anxiety.

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

B Only the answer focuses on situational support. The incorrect options focus on the patient's perception of the precipitating event.

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

B Primary care-related crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary interventions.

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

B The assessment of situational supports should continue. Even though the patient's nuclear family may not be supportive, other situational supports may be available. If they are adequate, admission to an inpatient unit will be unnecessary. Psychotherapy is not appropriate for crisis intervention. Advice is usually nontherapeutic.

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

B The nurse working in crisis intervention must be creative and flexible in looking at the patient's situation and suggesting possible solutions to the patient. Giving direction is part of the active role a crisis intervention therapist takes. The other options are used equally in crisis intervention and traditional counseling roles.

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

B The patient describes feelings of lack of control over life events. No direct mention is made of hopelessness or chronic low self-esteem. The patient's family processes are not interrupted at this point.

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

B, C This community has experienced a catastrophic event. There are five phases of the disaster management continuum. The nurses' activities applied to mitigation (attempts to limit a disaster's impact on human health and community function) and response (actual implementation of a disaster plan). Preparedness occurs before an event. Recovery actions focus on stabilizing the community and returning it to its previous status. Evaluation of the response efforts apply to the future.

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." Whenever the client presents a danger to himself or herself or others, hospitalization must be considered. Such a danger may exist if the client expresses hopelessness as in the correct option. None of the other options express hopelessness.

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: A. "This is not an uncommon problem. Don't worry." B. "Together we will be able to work on this problem." C. "Now that you are asking for help, everything will be all right." D. "I have friends in law enforcement who can help us choose a solution."

B. "Together we will be able to work on this problem." The nurse takes an active collaborative role in problem resolution beginning with telling the client that a solution will be found. None of the other options offers support but rather unrealistic reassurance or minimization of the problem.

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. A personal identity disorder B. A maturational crisis C. Suicidal ideations D. Mild neurosis

B. A maturational crisis The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary. The child's statements provide no support for any of the other options.

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 A. A crisis of confidence D. An existential crisis

B. An adventitious crisis

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. The intent of crisis intervention is to return the individual to the precrisis level of functioning. While this goal is not always attainable, it remains the expected outcome of crisis intervention therapy.

A 36 year old comes to the crisis clinic with reports of not sleeping, anxiety, and excessive crying. After a tornado devastated his hometown, the client was suddenly unemployed and homeless. Which of the following statements regarding crisis accurately describes the client's situation? A. He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home. B. He is experiencing a situational crisis that is associated with both a natural disaster and a personal event. C. He is experiencing ineffective coping and should be hospitalized for intensive therapy. D. He is experiencing a situational crisis with the added stress of financial burden.

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

What type of crisis is a newly unemployed person most likely to experience? A. Reactive B. Situational C. Maturational D. Unexpected

B. Situational Situational crises arise from external sources. Examples are death of a loved one, divorce, marriage, or a change in health status. Unemployment is not generally associated with any of the other options.

Which assessment data describes a client in phase IV of Caplan's phases of crisis? A. The client reports experiencing increased anxiety and feelings of extreme discomfort the day after the tornado. B. The client comes to the crisis clinic reporting depression and expresses that he does not want to go on living. C. The client reports experiencing a panic attack. D. The client reports experiencing anxiety symptoms the day after being fired.

B. The client comes to the crisis clinic reporting depression and expresses that he does not want to go on living. This describes that phase IV, which, if coping is ineffective, may lead to depression, confusion, violence, or suicidality. The other options describe phase II, phase III, and phase I in Caplan's phases of crisis.

A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss

B. marriage

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

C A situational crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. Sexual molestation falls within this classification. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. "Organic" and "Tertiary" are not types of crisis.

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

C Maturational crises occur when a person arrives at a new stage of development and finds that old coping styles are ineffective but has not yet developed new strategies. Situational crises arise from sources external to the individual. "Reactive" and "body image" are not types of crisis.

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

C Severe physical or mental illness is a potential cause of a situational crisis. The potential loss of a loved one also serves as a potential cause of a situational crisis. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. No classification of recurring crisis exists. Mitigation refers to attempts to limit a disaster's impact on human health and community function.

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

C Termination is indicated; however, the nurse's remark is clearly an invitation to work on other problems and prolong contact with the patient. The focus of crisis intervention is the problem that precipitated the crisis, not other issues. The scenario does not describe transference. The patient shows no need for continuing support. The scenario does not describe dependency needs.

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

C The NIMS provides a systematic approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector during disaster situations.

A patient who is visiting the crisis clinic for the first time asks, "How long will I be coming here?" The nurse's reply should consider that the usual duration of crisis intervention is a. 1 to 2 weeks. b. 3 to 4 weeks. c. 4 to 6 weeks. d. 8 to 12 weeks.

C The disorganization associated with crisis is so distressing that it usually cannot be tolerated for more than 4 to 6 weeks. If it is not resolved by that time, the individual usually adopts dysfunctional behaviors that reduce anxiety without solving the problem. Crisis intervention can shorten the duration.

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

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

The nurse is engaged in crisis intervention with a patient reporting, "I have no reason to keep on living." What is the nurse's initial intervention? A. Advise the patient about the services available to help them B. Ask the patient, "Have you ever been this depressed before?" C. Ask the patient, "Do you have any plan to hurt yourself or anyone else?" D. Assure the patient that he or she is in a safe place and will be well cared for

C. Ask the patient, "Do you have any plan to hurt yourself or anyone else?"

A female nurse had been sexually assaulted as a teenager. She finds it difficult to work with patients who have undergone the same trauma. What is the most helpful response? A. Discussing these feelings with the nurse supervisor. B. Requesting that these patients not be a part of her patient assignment C. Discussing these feelings with a mental health professional D. Accepting her role in providing unbiased, respectful, and professional care to all patients

C. Discussing these feelings with a mental health professional

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" Giving a client one's personal telephone number is a reaction to the nurse's need to be needed and undermines the client's sense of self-reliance. None of the other behaviors demonstrate a breakdown in the nurse-client behavior but rather reactions to commonly experienced issues within that relationship.

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? A. Arranging to hospitalize the client so all needs will be met. B. Referring the client for traditional psychotherapy for the expected development of post-traumatic stress disorder. C. Providing temporary support by arranging shelter for the client and contacting family or traveling companions. D. Suggesting that contacting a victim support group would be more appropriate than crisis intervention.

C. Providing temporary support by arranging shelter for the client and contacting family or traveling companions. When a client has no support system, the nurse may assume that role for a short time. In this situation, temporary shelter and contact with family/friends would be supportive. The other options are appropriate when a crisis occurs.

A patient whose history includes experiences with abusive partners is being treated for major depressive disorder. The patient's care plan includes rape-trauma syndrome among its nursing diagnosis. 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

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? A. demonstrates a good understanding of the effect of time on perception of a crisis. B. is offering a statement of positive outcome based on client coping ability. C. has failed to follow up on the client's verbal clues to suicidal thoughts. D. has introduced a concept associated with traditional psychotherapy.

C. has failed to follow up on the client's verbal clues to suicidal thoughts. Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client's clues. This client clearly was open to discussing her suicidal thoughts, or she would not have said, "I cannot see how I can go on." The nurse's statement is not associated with the evaluation presented by any of the other options

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

D A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events facilitates assessment of the precipitating event. The patient is unlikely to be able to articulate what interventions will increase feelings of comfort. "Why" questions are nontherapeutic.

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

D Chaos is likely among students and desperate parents. A directive approach is best. Once the scene is secure, creative solutions are needed. Creating zones by letters of the alphabet will assist anxious parents and their children to unite. Preventing parents from uniting with their children will further incite the situation.

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

D During crisis intervention, the priority concern is patient safety. This question helps assess personal coping skills. The other options are incorrect because the focus of crisis intervention is on the event that occurred immediately before the patient sought help.

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

D Ineffective coping may be evidenced by inability to meet basic needs, inability to meet role expectations. This nursing diagnosis is the priority because it reflects the consequences of the precipitating event associated with the professor's crisis. There is no evidence of denial. Deficient knowledge may apply, but it is not the priority. Data are not present to diagnose impaired social interaction.

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

D The focus of crisis intervention is on the most recent problem: "the straw that broke the camel's back." The patient had coped with the breast lesion, the husband's infidelity, and the disordered communication. Disequilibrium occurred only with the introduction of the daughter leaving college and moving.

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

D The highest nursing priority is safety. The nurse should assess suicidal and homicidal potential. The distracters are options, but the highest priority is safety.

Which scenario is an example of a situational crisis? a. The death of a child from sudden infant death syndrome b. Development of a heroin addiction c. Retirement of a 55-year-old person d. A riot at a rock concert

D The rock concert riot is unplanned, accidental, violent, and not a part of everyday life. The incorrect options are examples of maturational crises.

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 Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective. This challenge is not specifically associated with any of the other options.

What is the highest nursing priority for a client experiencing a situational crisis? A. Reduction of expressed anxiety. B. Development of new coping skills. C. Prevention of boundary blurring. D. Promoting client safety.

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

What is the first phase of a crisis?

escalating anxiety from a threat activates increased defense responses