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 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 a. suicidal. b. anxious and fearful. c. misperceiving reality. d. 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 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 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: 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 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?‖