Ch. 20 Flashcards
A patient comes to the clinic with superficial cuts on the left wrist. The patient paces around the room sobbing but cringes when approached and responds to questions with only shrugs or monosyllables. Select the nurse’s best initial statement 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 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 the use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient’s safety, and interpersonal reassurance.
DIF: Cognitive Level: Application REF: Page: 391|Page: 394
A patient comes to the clinic with superficial cuts on the left wrist. The patient is pacing and sobbing. After a few minutes with the nurse, the patient is calmer. What should the nurse ask to determine the patient’s perception of the precipitating event?
a.
“Tell me why you were crying.”
b.
“How did your wrist get injured?”
c.
“How can I help you feel more comfortable?”
d.
“What was happening just before you started to feel this way?”
ANS: D
A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events permits the assessment of the precipitating event. Asking “why” questions is a poor communication technique.
DIF: Cognitive Level: Application REF: Page: 327
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.
DIF: Cognitive Level: Analysis REF: Pages: 390-393
An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The patient told the parents about the uncle’s behavior, but the parents did not believe the adolescent. What type of crisis exists?
a.
Maturational
b.
Adventitious
c.
Situational
d.
Organic
ANS: B
An adventitious crisis is a crisis of disaster that is not a part of everyday life; it is unplanned or accidental. Adventitious crises include natural disasters, national disasters, and crimes of violence. 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. Situational crisis arises from an external source such as a job loss, divorce, or other loss affecting self-concept or self-esteem. Organic is not a type of crisis.
DIF: Cognitive Level: Application REF: Pages: 326
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.
DIF: Cognitive Level: Application REF: Pages: 388-391
An adult seeks counseling after the spouse is 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?”
ANS: D
The highest nursing priority is safety. The nurse should assess suicidal and homicidal potentials. The incorrect options are important but not the highest priority.
DIF: Cognitive Level: Application REF: Pages: 392-394
A woman says, “I can’t take it 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 type of crisis is this person experiencing?
a.
Maturational
b.
Adventitious
c.
Situational
d.
Recurring
ANS: C
A situational crisis arises from an external source and involves a loss of self-concept or self-esteem. An adventitious crisis is a crisis of disaster, such as a natural disaster or crime of violence. 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.
DIF: Cognitive Level: Application REF: Page: 389
A woman says, “I can’t take it 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.
Identifying measures useful to help improve the couple’s communication
b.
Discussing the patient’s feelings about the possibility of having a mastectomy
c.
Determining whether the husband is still engaged in an extramarital affair
d.
Clarifying what the patient means by, “I can’t take it 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.
DIF: Cognitive Level: Application REF: Pages: 392-394
A woman says, “I can’t take it 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.” If this person’s immediate family is unable to provide sufficient situational support, the nurse should:
a.
suggest hospitalization for a short period.
b.
ask what other relatives or friends are available for support.
c.
tell the patient, “You must be strong. Don’t let this crisis overwhelm you.”
d.
foster insight by relating the present situation to earlier situations involving loss.
ANS: B
The assessment of situational supports should continue. Although 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.
DIF: Cognitive Level: Application REF: Pages: 391-392
A woman says, “I can’t take it 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 and moving in with her boyfriend.” Which issue should be the focus for crisis intervention?
a.
Possible mastectomy
b.
Disordered family communication
c.
Effects of the husband’s infidelity
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 has coped with the breast lesion, the husband’s infidelity, and the disordered communication. Disequilibrium occurs only with the introduction of the daughter leaving college and moving.
DIF: Cognitive Level: Application REF: Page: 388
A patient 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 _____________ weeks.
a.
1 to 2
b.
3 to 4
c.
4 to 6
d.
6 to 12
ANS: C
The disorganization associated with crisis is so distressing that it usually cannot be tolerated for more than 4 to 6 weeks. If the crisis 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.
DIF: Cognitive Level: Comprehension REF: Page: 388
An adult tells the nurse, “I can’t take it 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 told me she’s quitting college and moving in with her boyfriend.” What is the priority nursing diagnosis?
a.
Fear, related to impending surgery
b.
Deficient knowledge, related to breast lesion
c.
Ineffective coping, related to perceived loss of daughter
d.
Impaired verbal communication, related to spousal estrangement
ANS: C
This nursing diagnosis is the priority because it reflects the precipitating event associated with the patient’s crisis. Data are not present to make the other diagnoses of Deficient knowledge, Fear, or Impaired verbal communication.
DIF: Cognitive Level: Analysis REF: Pages: 392-393
Which communication technique is used more in crisis intervention than traditional counseling?
a.
Role modeling
b.
Giving direction
c.
Information giving
d.
Empathic listening
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 intervention and traditional counseling roles.
DIF: Cognitive Level: Comprehension REF: Pages: 396-398
Which situation demonstrates the use of primary care related to crisis intervention?
a.
Implementing suicide precautions for a patient with depression.
b.
Teaching stress reduction techniques to a beginning student nurse.
c.
Assessing coping strategies used by a patient who has attempted suicide.
d.
Referring a patient with schizophrenia to a partial hospitalization program.
ANS: B
Primary crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary intervention.
DIF: Cognitive Level: Application REF: Pages: 392-395
A victim of spousal violence comes to the crisis center seeking help. The nurse uses crisis intervention strategies that focus on:
a.
supporting emotional security and reestablishing equilibrium
b.
offering a long-term resolution of issues precipitating the crisis
c.
promoting growth of the individual
d.
providing legal assistance
ANS: A
Strategies of crisis intervention are directed toward the immediate cause of the crisis and are aimed at bolstering the emotional security and reestablishing equilibrium, rather than focusing on underlying issues and long-term resolutions. The goal is to return the individual to the pre-crisis level of function. Crisis intervention is, by definition, short term. Promoting growth is a focus of long-term therapy. Providing legal assistance might be applicable.
DIF: Cognitive Level: Application REF: Page: 388|Page: 394
