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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 26: Crisis and Disaster Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition MULTIPLE CHOICE 1. 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.” ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-18, 19, 45 (Box 26-2) | Page 26-24 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity NURSINGTB.COM

2. 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?” ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-10, 11 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. 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 suicidal. anxious and fearful. misperceiving reality. potentially homicidal.

a. b. c. d.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: B

Individuals in crisis are universally anxious. They are often frightened and may be mildly confused. Perceptions are often narrowed with anxiety. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-15, 42 (Table 26-3) TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity 4. 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 ANS: 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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-7, 8 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. While conducting the initial interview with a patient in crisis, the nurse should NURSINGTB.COM 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. ANS: 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. PTS: REF: Plan) MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 26-15, 19, 42 (Table 26-3), 45 (Box 26-2) | Page 26-24 (Case Study and Nursing Care TOP: Nursing Process: Implementation Client Needs: Psychosocial Integrity

6. 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?”

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: 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. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 26-10, 42 (Table 26-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. 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 ANS: 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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-7, 8 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity NURSINGTB.COM 8. 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.” ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-10, 42 (Table 26-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

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. ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-11, 12, 42 (Table 26-3), 45 (Box 26-2) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 10. 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 ANS: 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. NURSINGTB.COM

PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-10, 11, 14, 44 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 11. 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. ANS: 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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 26-44 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 12. 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?

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

Ineffective denial related to threats to professional identity Deficient knowledge related to sexual harassment protocols Impaired social interaction related to loss of teaching abilities Ineffective coping related to distress from false accusations

ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-14, 15, 39 (Table 26-2) TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity 13. Which communication technique will the nurse use more in crisis intervention than traditional

counseling? Role modeling Giving direction Information giving Empathic listening

a. b. c. d.

ANS: 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 NURSINGTB.COM intervention and traditional counseling roles. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 26-44 (Box 26-1) | Page 26-42 (Table 26-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 14. 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 ANS: B

Primary care-related crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary interventions. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 26-14 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 15. 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

c. promoting growth of the individual. d. providing legal assistance. ANS: 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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-16, 17, 44 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 16. 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 ANS: 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. NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-6, 7 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17. 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 ANS: D

The rock concert riot is unplanned, accidental, violent, and not a part of everyday life. The incorrect options are examples of maturational crises. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-6, 7 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 18. 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) ANS: C

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-22, 23 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 19. 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?” ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-12, 13, 42 (Table 26-3), 45 (Box 26-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. 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.” NURSINGTB.COM 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. ANS: 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-8, 44 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 21. 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

d. has high potential for self-injury. ANS: 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. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 26-4, 5, 44 (Box 26-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 22. 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?” ANS: B

Only the answer focuses on situational support. The incorrect options focus on the patient’s ...