Crisis Questions copy - exam help practice PDF

Preview

Summary

exam help practice...

Description

Stuart: Principles and Practice of Psychiatric Nursing, 9th Edition Chapter 13: Crisis Intervention 1. A patient comes to the mental health clinic with insomnia, irritability, increased tension, and headaches. The symptoms began 1 week ago after the patient was laid off from work. The patient expresses concern that this will result in a relocation that will be hard on the entire family. The patient is most likely experiencing: 2. a situational crisis. ANS: 2 A situational crisis occurs when a life event upsets an individual’s psychological equilibrium. Loss of a job can give rise to a situational crisis. 2. A jet plane carrying 140 passengers crashes in a nearby community. One can reliably predict that the survivors, families, and community will experience: 1. a situational crisis. ANS: 1 A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium. 3. A patient comes to the mental health center and relates feeling very anxious since graduating from high school 1 week ago. The patient is having difficulty concentrating and feels shaky. This typifies: 2. a maturational crisis. ANS: 2 Maturational crises are developmental events requiring role change. 4. A patient comes to the mental health center after being held hostage during a bank robbery 2 days ago. The patient relates a number of symptoms, including intrusive thoughts, nightmares, and feelings of helplessness. The nurse should consider the possibility that the patient is experiencing: 1. a situational crisis. ANS: 1 A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium. 5. A patient who experiences intrusive thoughts, nightmares, and feelings of helplessness after a hostage experience begins crisis intervention therapy. The patient asks, “How long before I will feel like myself again?” The reply that shows the best understanding of the parameters of crisis intervention therapy would be: 1. “It usually takes about 6 weeks.”

ANS: 1 Crisis intervention therapy is usually limited to 6 weeks’ duration. 6. A patient, age 19 years, recently gave birth. Since bringing the baby home, she says she has felt apathetic, fatigued, and helpless. She cares adequately for the baby but states, “I don’t know what’s expected of me.” No cognitive impairment or thought disorder is noted. The nurse should consider the possibility that the patient may benefit from: 4. antidepressant medication. ANS: 1 The patient is probably experiencing a maturational crisis related to the role changes required by the birth of the baby. Crisis intervention is appropriate. 7. The outcome of crisis intervention therapy that should be identified for a patient who has been apathetic, fatigued, and feeling helpless since the recent birth of her baby is that she will: 4. return to the precrisis level of functioning. ANS: 4 A return to the precrisis level of functioning is the expected outcome for crisis intervention. 8. A patient is being seen for crisis intervention as a result of receiving a poor job evaluation. The self-esteem need that nursing assessment will most likely reveal will be related to: 2. role mastery. ANS: 2 Self-esteem is threatened when role mastery is not attained. Role mastery is achieved when the person attains work, sexual, and family role successes. 9. When a crisis clinic nurse asks a patient, “Who takes care of you when you are sick?” the nurse is exploring the balancing factors of: 1. situational support. ANS: 1 Balancing factors are important in the development and resolution of a crisis and include the precipitating stressor, the patient's perception of the stressor, the nature and strength of a patient’s support systems and coping resources, and previous strengths and coping mechanisms. Family, friends, religious leaders, and co-workers are considered part of the patient’s support system. 10. To understand the effects of a precipitating event such as the loss of one’s job, a nurse must assess the: 1. patient’s appraisal of the event. ANS: 1

The patient’s perception is a key factor. What may be trivial to one may seem overwhelming to another and vice versa. If the patient does not perceive the event as problematical, a crisis may be averted. 11. Survivors of a hurricane are grieving the loss of loved ones and homes. Which level of crisis intervention would be most appropriate for a nurse to use? 2. Generic approach ANS: 2 The generic approach is designed to reach high-risk individuals and large groups as quickly as possible. 12. A critically ill postsurgical patient tells a nurse about recent emergency surgery and the expected long-term postoperative course. As the patient speaks, the nurse notices that the speech lacks affect. Which technique of crisis intervention would be most therapeutic to use initially? 1. Catharsis ANS: 1 Catharsis is the release of feelings that takes place as the patient talks about the event. The nurse solicits the patient’s feelings about the situation by asking open-ended, explorative questions and focusing on feelings. 13. A nurse working with a parent in crisis suggests that the parent send both children to stay with their grandparents temporarily. This is an example of: 2. environmental manipulation. ANS: 2 Environmental manipulation includes interventions that directly change the patient’s physical or interpersonal situation. These interventions provide situational support or remove stress. 14. A patient comes to the clinic and states, “I’ve just lost my job, and I’m afraid that I’m at an age where I’ll no longer be able to find work in my career field.” Which level of approach will be most appropriate for this patient? 3. Individual approach ANS: 3 This type of crisis intervention can be effective with all types of crises. It is particularly useful in combined situational and maturational crises. 15. A nurse working with a patient in individual crisis intervention would characterize the approaches used as: 3. active, focused, and explorative. ANS: 3

Because of time constraints, nurses performing crisis intervention use techniques that are active, focused, and explorative to carry out the interventions. Interventions must be aimed at achieving quick resolution. Nurses must be creative, flexible, and competent in the use of many techniques. *16. While working with a patient in crisis, a nurse attempts to help the patient identify the relationship between the event precipitating the crisis and the patient’s subsequent feelings and behaviors. This is an example of: 1. clarification. ANS: 1 Clarification is used when a nurse helps the patient identify the relationship among events, behavior, and feelings. For example, clarification can mean helping a patient see that the patient only felt too sick to go to work after being passed over for a promotion. 17. A nurse notes that a patient is using alcohol each evening as a means of coping with the loneliness associated with a recent divorce. Pointing this out and encouraging the patient to join an exercise club or try jogging in lieu of drinking are examples of an approach called: 2. support of defenses. ANS: 2 Support of defenses encourages the use of adaptive defenses and discourages maladaptive and unhealthy coping strategies. 18. A crisis intervention clinic nurse responds to a patient who has many concerns about marriage by saying, “You seem to be very committed to the success of your marriage. I think you have the ability to work through these issues and end up with a stronger relationship.” This is an example of which technique? 3. Raising self-esteem ANS: 3 Raising self-esteem helps a patient regain feelings of self-worth by communicating confidence that the patient has strengths and can find solutions to problems. 19. A patient was the driver of a car that was car-jacked. The patient was held hostage for 12 hours before being released and now repeatedly states, “I can’t believe it happened to me!” while admitting to feeling anxious and being afraid of strangers. The patient expresses concern about ever being able to drive again. The nurse’s interventions should target: 3. denial, anxiety, and self-efficacy. ANS: 3 The patient is using denial, admits to anxiety, and has self-doubts. These would be appropriate targets for intervention.

20. A patient was the driver of a car that struck and killed a child. The patient tells a nurse, “I killed a child! I’m haunted by the sight of the body being thrown into the air. If I hadn’t been drinking I might have been able to stop. I don’t know how I can go on living with myself!” The crisis nurse should give priority to assessing the patient’s: 1. suicidal risk. ANS: 1 Whenever a patient alludes to the possibility of suicide the nurse should actively explore the topic. 21. When a patient in crisis intervention therapy alludes to the possibility of self-harm, the nurse should: 2. take all steps necessary to ensure the patient’s safety. ANS: 2 All suicidal thoughts are serious, and a nurse’s first priority is keeping the patient safe. 22. When evaluating care of a crisis patient, a psychiatric nurse must remember that one of the primary goals of crisis intervention is to: 2. help the patient return to the precrisis state. ANS: 2 The last phase of crisis intervention is evaluation, when the nurse and patient evaluate whether the intervention resulted in a positive resolution of the crisis. One area is to explore whether the patient has returned to the precrisis level of functioning. 23. Which statement made by a person in a crisis state indicates the presence of a balancing factor (coping mechanism)? 3. “I pray when things get tough. It’s always helped me survive trouble.” ANS: 3 Praying represents a coping mechanism previously and successfully used by the patient. 24. A variety of crisis intervention modalities are available in contemporary society depending on the needs of patients. Some of them are: 1. in mobile crisis programs. ANS: 1 Mobile crisis teams provide front-line interdisciplinary crisis intervention to individuals, families, and communities. Crisis intervention usually is not available only during nondaytime hours nor is it usually available in primary care providers’ offices nor do caregivers usually discriminate or treat certain groups of individuals. Fortinash: Psychiatric Mental Health Nursing, 4th Edition Chapter 20: Crisis: Theory and Intervention

1. Following the Coconut Grove fire in Boston in 1942, which finding by Eric Lindemann and his colleagues had implications for nursing? 2. Early help with mourning can prevent later psychologic difficulties.

ANS: 2 Lindemann’s work suggested that early intervention could prevent later problems. He further proposed that grief might be normal or morbid, depending on the preexisting vulnerabilities of the person. 1. His suggestion was for brief counseling, but he did not specify individual or generic therapy. 3. This was not one of his premises. 4. He did not draw this conclusion. 2. Which event has the potential for causing a situational crisis? 2. Losing a job after 10 years ANS: 2 A situational crisis occurs when a specific, external event, such as job loss, disturbs one’s psychologic equilibrium. The other options would be considered internal (subjective) crises. 3. A client’s wife walked out on the family. The client became angry, breaking china and destroying potted plants. A neighbor convinced him to seek help at the local crisis center. Which question would the crisis nurse ask to determine the client’s immediate problem? 3. "What brings you here today?" ANS: 3 This question gives the nurse an understanding of the client’s chief complaint. 1. This question places the blame on the client, without knowing the circumstances. 2. This question will not help determine the client’s chief complaint, but it might be used later. 4. This question does not help determine the client’s chief complaint. 4. A 16-year-old girl comes to the crisis clinic because of anxiety associated with having to change schools during the middle of the school year when her father changed jobs. She has used the coping methods listed below for anxiety relief. Which method would be considered adaptive? 1. Talking to a friend ANS: 1 The only coping method that would be considered adaptive is talking to a friend. Ventilating will relieve stress and help the client to deal with feelings. 2. Occasional crying will relieve stress, but crying for hours is not adaptive. 3. Sleeping is a way of avoiding dealing with the situation. 4. Screaming at another person uses displacement. 5. A client, admitted to the hospital after an attempted suicide following the sudden death of her husband, reported she and her husband were together most of the time and did not socialize with others. Now she is experiencing extreme loneliness and lack of companionship. Which nursing diagnosis would address the loneliness she mentions?

3. Social isolation related to absence of supportive others ANS: 3 Social isolation is aloneness experienced by the individual and perceived as imposed by others. In this case the aloneness was imposed by the death of her husband. Options 1 and 4 do not address the issue of loneliness. Option 2 is incorrect because the data do not support a diagnosis of post trauma syndrome. 6. During the initial interview with a client in crisis, the nurse would estimate, based on experience and crisis theory that crisis intervention therapy will be completed in: 3. 4 to 6 weeks ANS: 3 Crisis intervention is usually achieved in 4 to 6 weeks. The other intervals are either too short or too long. 7. An appropriate intervention for the nurse to use with clients at the initial interview is to: 2. Assist the client to expect positive outcomes ANS: 2 Goals of therapy include instilling a sense of hope and the expectation that the therapy will produce positive outcomes and also assisting with practical coping strategies. 1. The client will have a sense of urgency. The nurse should remain calm. 3. Medication may or may not be necessary. 4. Clients are too disorganized to be told they are in charge. The nurse should be an active participant. 8. Several school-age children injured in a school bus accident were brought to the ED. Family members and friends paced back and forth in the waiting room. Members of the crisis team were called in for the primary purpose of: 4. Facilitating understanding and providing support ANS: 4 A crisis team is able to provide immediate emotional support to friends and families who are distressed over the event and the state of victims, and they are able to facilitate understanding of the event by teaching. 1. This is not a function of the crisis team. 2. This is not the primary purpose of the crisis team. 3. The crisis team will do more than simply wait with families. 9. The crisis nurse is interviewing a client who has come to the center in a state of severe anxiety. Which intervention would the nurse initiate first? ANS: 1 The precipitating event and its meaning to the client are of primary importance in assessment. Little can be accomplished without this information. Options 2 and 3 would not be considered the first interventions. Option 4 would not be possible until the event and its meaning are identified.

10. A worker has recently been involved in assisting with the cleanup from a flood that washed away many homes in his area and caused loss of life. Which intervention would assist the worker in dealing with the traumatic experience? 1. Providing him the opportunity to talk about the experience ANS: 1 The worker needs to be able to express his feelings and deal with the pain associated with the crisis event. Nurses can help facilitate understanding of the event by listening and teaching. Option 2 would be inappropriate. Option 3 may not be necessary. Option 4 is incorrect because no data are given regarding whether or not the worker has a minister. 11. A client who survived a tornado is without shelter and food, has lost his car, and has learned that several friends sustained injuries. To tailor intervention to the client’s needs, the nurse would make it a priority to: 1. Arrange for an agency to provide shelter and food ANS: 1 Maslow’s hierarchy of need theory suggests that survival needs should be met first. Thus arranging for food and shelter takes precedence over other concerns. 12. A new nurse mentions, “I can understand a situational crisis upsetting a person’s equilibrium, but I don’t understand how something positive, like getting married or having a baby, can precipitate a crisis.” To explain, the mentor should answer, “You need to think of a crisis as a(n): 1. threat to the familiar.” ANS: 1 By viewing a crisis as a threat to the norm, it is possible to understand why even positive events, such as winning the lottery, may provoke a crisis. Option 2 indicates how the nurse currently views a crisis. Option 3 does not address the nurse’s question. Option 4 is incorrect because crises are not considered discrete psychiatric disorders. *13. At the crisis center a staff nurse tells the nurse clinician, “The client is dealing with an internal crisis situation.” Which situation would qualify as a trigger for that designation? 4. Loss of religious faith ANS: 4 Internal (subjective) crises are threats to a person’s well-being that are not so obvious to the outside observer. Some are associated with phase-of-life events. Loss of faith in a supreme being would exemplify an internal crisis. The other options are considered external (situational) crises. 14. The nurse assesses a client as presenting with the clinical picture of posttraumatic stress syndrome. The priority information the nurse will need to obtain will refer to: 2. The antecedent crisis

ANS: 2 A situational (external) crisis event always precedes posttraumatic stress disorder. The nurse must obtain information about this triggering event to plan effective interventions. 1. Assessing child development is not a priority. 3. Assessing cognitive distortions is not the priority, but it will be a later consideration. 4. While important, this is not the priority information. 15. Which clinical picture can the nurse expect to see most frequently among clients who have been in a bus-train collision and derailment? 3. Shock, numbness, confusion, disorganization ANS: 3 Common immediate responses to a traumatic event include shock, numbness, denial, dissociative behavior, confusion, disorganization, indecisiveness, and suggestibility. The other options contain behaviors that may be observed, but they are far less common than the behaviors given in option 3. 16. To plan effectively for an individual who is in crisis, the nurse must have an understanding of: 3. The meaning of the crisis event to the individual ANS: 3 Knowing the meaning to the individual is crucial, since the mitigating circumstances and supports a client has may reduce the impact of the crisis event. For example, a property loss is likely to be of greater concern to someone with few financial resources than to someone who is wealthy or fully insured. 1. Establishing rapport should occur prior to the planning stage. 2. An understanding of family counseling techniques is not necessary. 4. Crisis intervention may not depend on information about posttraumatic stress disorder. 17. A client who was mugged attends his third crisis intervention therapy session and reports that he has lost 10 pounds, cannot sleep, and feels very low. He ruminates about the possibility of being at fault for the mugging. The priority action the nurse should take is: 2. Refer for assessment for antidepressant therapy ANS: 2 Crisis intervention therapists are very active in therapy, making referrals and suggestions for coping strategies. In this case the nurse would recognize the client’s symptoms as suggesting depression. Antidepressant medication is used in crisis therapy when symptoms suggest it is necessary; thus the nurse would refer the client to a physician or nurse practitioner with prescriptive privileges for evaluation for medication therapy. 1. Hospitalization is not necessary unless suicidal ideation is present. 3. The topic should be discussed, but if the ruminations are due to depression, simple discussion may not change his thinking. 4. This is appropriate, ...