26 - Crisis & Disaster

Question 1

Crises that occur as an individual moves from one developmental level to another are called

a. ) reactive crises.
b. ) recurring crises.
c. ) situational crises.
d. ) maturational crises.

Answer 1

d.) maturational crises.

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.

Question 2

When a person becomes unemployed, he is likely to experience a(n)

a. ) reactive crisis.
b. ) situational crisis.
c. ) adventitious crisis.
d. ) substance abuse crisis.

Answer 2

b.) situational crisis.

Situational crises arise from external sources.

Examples are death of a loved one, divorce, marriage, or a change in health status.

Question 3

When a tornado results in the loss of homes, businesses, and life, the town residents are likely to experience a(n)

a. ) maturational crisis.
b. ) situational crisis.
c. ) adventitious crisis.
d. ) endogenous crisis.

Answer 3

c.) adventitious crisis.

An adventitious crisis is unplanned, accidental, and not part of everyday life.

Examples are disasters and crimes of violence.

Question 4

A crisis is so acutely uncomfortable to the individual that it is likely to self-resolve in

a. ) 1 to 10 days.
b. ) 1 to 3 weeks.
c. ) 4 to 6 weeks.
d. ) 3 to 4 months.

Answer 4

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.

Question 5

The expected outcome at the conclusion of crisis intervention therapy is that the client will function

a. ) at a higher level than before the crisis.
b. ) at the precrisis level.
c. ) only marginally below the precrisis level.
d. ) without aid from identified support systems.

Answer 5

b.) at the precrisis level.

The intent of crisis intervention is to return the individual to the precrisis level of functioning.

Question 6

In the event of an adventitious crisis, which age group would be least in need of crisis intervention?

a. ) Children
b. ) Such crises seldom require intervention
c. ) The elderly
d. ) A distinction cannot be made

Answer 6

d.) A distinction cannot be made

The need for psychological first aid (crisis intervention) and debriefing after any crisis situation cannot be overstressed for all age groups (children, adolescents, adults, and the elderly).

Question 7

The nurse caring for a client in crisis shows signs of a problematic nurse-client relationship by

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 permission to call him or her at home when the client “needs to talk.”
d. ) suggesting that the client attend an extra counseling session each month.

Answer 7

c.) giving the client permission to call him or her at home when the client “needs to talk.”

The behavior in option C is a reaction to the nurse’s need to be needed and undermines the client’s sense of self-reliance.

Question 8

When a stressful event occurs and the individual is unable to resolve the situation by using his or her usual coping strategies, the individual

a. ) becomes disorganized and uses trial-and-error problem solving.
b. ) withdraws and acts as though the problem does not exist.
c. ) develops severe personality disorganization.
d. ) resorts to planning suicide.

Answer 8

a.) becomes disorganized and uses trial-and-error problem solving.

This is the second stage of crisis, according to accepted crisis theory.

Question 9

A client is treated in the emergency department for injuries sustained while vacationing hundreds of miles away from home. To best meet the client’s emotional needs, the nurse should

a. ) arrange to hospitalize the client.
b. ) refer the client for traditional psychotherapy for posttraumatic stress disorder.
c. ) provide temporary support by arranging shelter and contacting the client’s friends.
d. ) suggest that contacting a victim support group would be more appropriate than crisis intervention.

Answer 9

c.) provide temporary support by arranging shelter and contacting the client’s friends.

When a client has no support system, the nurse may assume that role for a short time.

Question 10

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.”

Answer 10

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.

Question 11

To assess the client’s perception of the event precipitating a crisis, the nurse would initially ask

a. ) “What was happening just before you began feeling this way?”
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?”

Answer 11

a.) “What was happening just before you began feeling this way?”

Option A 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.

Question 12

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.

Answer 12

a.) The individual is mentally healthy but in a state of disequilibrium.

Only statement A is true.

Question 13

The priority concern of the crisis intervention nurse is

a. ) client safety.
b. ) setting up future contacts.
c. ) brainstorming possible solutions.
d. ) working through termination issues.

Answer 13

a.) client safety.

Client safety is always the priority concern in crisis intervention therapy.

The disequilibrium of crisis predisposes the client to suicidal thinking.

Question 14

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.

Answer 14

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.

Option B indicates a phase 4 response to a crisis; option C would be a phase 3 response.

In option D the client is using inappropriate coping mechanisms, which are not effective to treat depression and anxiety.

Question 15

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.” It is likely the child is

a. ) describing personal identity disorder.
b. ) experiencing a maturational crisis.
c. ) potentially suicidal.
d. ) mildly neurotic.

Answer 15

b.) experiencing a maturational crisis.

The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary.

Question 16

The nurse working with a client in crisis must initially assess for the client’s

a. ) self-report of feeling depressed.
b. ) unrealistic report of a crisis-precipitating event.
c. ) report of a high level of anxiety.
d. ) admission that he or she is abusing drugs.

Answer 16

b.) unrealistic report of a crisis-precipitating event.

A person’s equilibrium may be adversely affected by one or more of the following: an unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms.

These factors must be assessed when a crisis situation is evaluated because data gained from the assessment are used as guides for both the nurse and the client to set realistic and meaningful goals as well as to plan possible solutions to the problem situation.

Question 17

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.”

Answer 17

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.

Question 18

A woman comes to the crisis intervention clinic expressing concern that her 16-year-old is using illegal drugs in their home.The nurse will

a. ) encourage the mother to call the police when her son brings drugs home.
b. ) inform her of the obligation to report this information to the police.
c. ) work with the client to set goals that are mutually acceptable.
d. ) refer the client to the police for consultation.

Answer 18

c.) work with the client to set goals that are mutually acceptable.

Goal setting is a collaborative task. Goals must be acceptable to the client and seen by the nurse as safe and appropriate.

Question 19

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.” Analysis of this interaction reveals that the nurse

a. ) has 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 not followed up on the client’s verbal clues to suicidal thoughts.
d. ) has stepped into the territory of traditional psychotherapy.

Answer 19

c.) has not followed 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.”

Question 20

When the client begins to sob uncontrollably and her speech becomes so incoherent that she is unable to give the nurse any information, the immediate interventions will focus on

a. ) securing hospital admission.
b. ) contacting a family member or close friend.
c. ) lowering her anxiety level from severe to moderate.
d. ) assisting the client to identify new effective coping strategies.

Answer 20

c.) lowering her anxiety level from severe to moderate.

Individuals with severe anxiety are not able to collaborate in problem solving.

The nurse must assist the client to lower anxiety from severe to moderate or lower.

Question 21

Mason and Charlie, both 16 years old, were involved in a bad car accident in which they were both passengers. Mason spoke with a counselor about the incident once and has been able to move forward with little dysfunction. Charlie 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 by:

a. ) perception of the event.
b. ) Mason’s more laid-back personality.
c. ) the possibility that Charlie may have experienced previous trauma from which he did not fully recover.
d. ) the possibility that counseling Charlie received may have been inadequate.

Answer 21

a.) 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 two people respond differently to the same event.

Question 22

Carter, aged 36 years, comes to the crisis clinic for his first visit with complaints of not sleeping, anxiety, and excessive crying. He recently was fired suddenly from his job and 3 days later lost his home to a tornado that devastated the town he lives in. Which of the following statements regarding crisis accurately describes Carter’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 both a situational and an adventitious crisis.
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.

Answer 22

b.) He is experiencing both a situational and an adventitious crisis.

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.

Carter lost his job (situational crisis) and also experienced the devastating effects of a tornado (adventitious crisis).

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 situational crisis, but an adventitious one as well, which makes coping more difficult.

Question 23

Tori is the nurse working with Carter and other members of the community after the tornado. As the weeks go by, she begins to feel anxious and distressed. She speaks to her nurse mentor about her feelings. Which of the following may Tori be experiencing?

a. ) Reactionary grief
b. ) Maturational crisis
c. ) Vicarious traumatization
d. ) Transference

Answer 23

c.) Vicarious traumatization

Even experienced nurses working in disaster situations can become overwhelmed when witnessing catastrophes such as loss of human life or mass destruction of people’s homes and belongings (e.g., floods, fires, tornadoes).

Researchers have found that mental health care providers may experience psychological distress from working with traumatized populations, a phenomenon of secondary traumatic stress or “vicarious traumatization.”

Reactionary grief does not describe secondary stress from working with such populations.

A maturational crisis arises from disruption of a developmental stage.

Transference describes feelings displaced onto the nurse or therapist by the patient.

Question 24

Tori knows that Carter needs assistance with many aspects of getting through the crisis. Tori’s highest priority in Carter’s care is:

a. ) reduction of Carter’s anxiety.
b. ) development of new coping skills.
c. ) prevention of boundary blurring.
d. ) keeping Carter safe.

Answer 24

d.) keeping Carter safe.

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.

Question 25

Carter experiences each of the following during his crisis. Which of the following describes phase IV of Caplan’s phases of crisis?

a. ) Carter experiences increased anxiety and feelings of extreme discomfort the day after the tornado.
b. ) Carter comes to the crisis clinic complaining of depression and expresses that he does not want to go on living.
c. ) Carter experiences a panic attack at his mother’s home in a nearby town where he is staying after the tornado.
d. ) Carter experiences anxiety symptoms the day after he was fired.

Answer 25

b.) Carter comes to the crisis clinic complaining of depression and expresses that he does not want to go on living.

This describes 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.