testbanks_and_xanax - Halter: Varcarolis’ Foundations of Psychiatri...

testbanks_and_xanax

Chapter 26: Crisis and Disaster

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE

• 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.

• ―Everything is going to be all right. You are here at the clinic and the staff will keep you

safe.‖

• ―I see you are feeling upset. I‘m going to stay and talk with you to help you feel better.‖
• ―You need to try to stop crying and pacing so we can talk about your problems.‖
• ―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

testbanks_and_xanax

• 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.‖

• ―How did your wrists get injured?‖
• ―How can I help you feel more comfortable?‖
• ―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

• 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.

• anxious and fearful.
• misperceiving reality.
• potentially homicidal.

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

• 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

• Tertiary
• Situational
• 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

testbanks_and_xanax

MSC: Client Needs: Psychosocial Integrity

• While conducting the initial interview with a patient in crisis, the nurse should
• speak in short, concise sentences.
• convey a sense of urgency to the patient.
• be forthright about time limits of the interview.
• 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: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 26-15, 19, 42 (Table 26-3), 45 (Box 26-2) | Page 26-24 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

• 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?

• ―Would you like to talk to a psychiatrist about some medication to help you cope during

the trial?‖

• ―What resources do you need to help you cope with this situation?‖
• ―Do you have enough support from your family and friends?‖
• ―Are you having thoughts of hurting yourself or others?‖

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

• 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

• Mitigation
• Situational
• 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

testbanks_and_xanax

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

• 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?

• Identify measures useful to help improve the couple‘s communication.
• The patient‘s feelings about the possibility of having a mastectomy
• Whether the husband is still engaged in an extramarital affair
• 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

• 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.

• ask what other relatives or friends are available for support.
• tell the patient, ―You are a strong person. You can get through this crisis.‖
• 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

• 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