Chapter 13: Crisis Intervention

Question 1

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:
   a. an anxiety reaction.
   b. a situational crisis.
   c. a maturational crisis.
   d. an adjustment disorder.

Answer 1

ANS: B
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.

Question 2

2. A jet plane carrying 140 passengers crashes in a nearby community. One can reliably predict that the survivors, families, and community will initially experience:
   a. a situational crisis.
   b. problem resolution.
   c. adjustment disorders.
   d. psychological equilibrium.

Answer 2

ANS: A

A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium.

Question 3

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:
   a. a situational crisis.
   b. a maturational crisis.
   c. psychological equilibrium.
   d. a pseudopsychological crisis.

Answer 3

ANS: B

Maturational crises are developmental events requiring role change.

Question 4

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 a _____ crisis.
   a. situational
   b. maturational
   c. developmental
   d. pseudopsychological

Answer 4

ANS: A

A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium.

Question 5

5. A patient who undergoes 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:
   a. “No one can really say.”
   b. “It usually takes about 6 weeks.”
   c. “My best guess would be 6 months.”
   d. “The experience usually results in permanent changes.”

Answer 5

ANS: B

Successful crisis intervention therapy is usually limited to 6 weeks’ duration.

Question 6

6. A teenaged new mother reports she has felt apathetic, fatigued, and helpless since giving birth. She states, “I don’t know what’s expected of me.” The nurse believes the patient will benefit from:
   a. crisis intervention.
   b. short hospitalization.
   c. neuroleptic medication.
   d. antidepressant medication.

Answer 6

ANS: A
The patient is probably experiencing a maturational crisis related to the role changes required by the birth of the baby. Crisis intervention is appropriate.

Question 7

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:
   a. experience reduced anxiety.
   b. undergo personality change.
   c. identify the need for a support system.
   d. return to the precrisis level of functioning.

Answer 7

ANS: D

A return to the precrisis level of functioning is the expected outcome for crisis intervention.

Question 8

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 a problem with:
   a. dependency.
   b. role mastery.
   c. biological functioning.
   d. unmet financial responsibility.

Answer 8

ANS: B
Self-esteem is threatened when role mastery is not attained. Role mastery is achieved when the person attains work, sexual, and family role successes.

Question 9

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:
   a. situational support.
   b. problem resolution.
   c. coping mechanisms.
   d. perception of the event.

Answer 9

ANS: A
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.

Question 10

10. To understand the effects of a precipitating event such as the loss of one’s job, a nurse must assess the:
    a. patient’s appraisal of the event.
    b. perception of the support group.
    c. patient’s awareness or lack of awareness of options.
    d. patient’s own feelings about his or her response to the situation.

Answer 10

ANS: D
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.

Question 11

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?
    a. General support
    b. Generic approach
    c. Individual approach
    d. Environmental manipulation

Answer 11

ANS: B

The generic approach is designed to reach high-risk individuals and large groups as quickly as possible.

Question 12

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?
    a. Catharsis
    b. Manipulation
    c. Raising self-esteem
    d. Reinforcement of behavior

Answer 12

ANS: A
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.

Question 13

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:
    a. reducing dependency.
    b. environmental manipulation.
    c. reducing the children’s stressors.
    d. increasing contact with the extended family.

Answer 13

ANS: B
Environmental manipulation includes interventions that directly change the patient’s physical or interpersonal situation. These interventions provide situational support or remove stress.

Question 14

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 approach will be most appropriate for this patient?
    a. Environmental manipulation
    b. Individual approach
    c. Generic approach
    d. General support

Answer 14

ANS: B
This type of crisis intervention can be effective with all types of crises. It is particularly useful in combined situational and maturational crises.

Question 15

15. A nurse working with a patient in individual crisis intervention would characterize the approaches used as:
    a. open-ended.
    b. passive and indirect.
    c. active, focused, and explorative.
    d. psychoanalytic-based techniques.

Answer 15

ANS: C
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.

Question 16

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:
    a. clarification.
    b. support of defenses.
    c. reinforcement of behavior.
    d. raising the patient’s self-esteem.

Answer 16

ANS: A
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.

Question 17

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:
    a. clarification.
    b. support of defenses.
    c. raising self-esteem.
    d. reinforcement of behavior.

Answer 17

ANS: B

Support of defenses encourages the use of adaptive defenses and discourages maladaptive and unhealthy coping strategies.

Question 18

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?
    a. Clarification
    b. Support of defenses
    c. Raising self-esteem
    d. Exploration of solutions

Answer 18

ANS: C
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.

Question 19

19. 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:
    a. suicidal risk.
    b. physical condition.
    c. recent drug dependency.
    d. current alcohol consumption.

Answer 19

ANS: A

Whenever a patient alludes to the possibility of suicide the nurse should actively explore the topic.

Question 20

20. When a patient in crisis intervention therapy alludes to the possibility of self-harm, the nurse should:
    a. arrange for someone to check in on the patient.
    b. take all steps necessary to ensure the patient’s safety.
    c. advise the patient that such thoughts are common in crisis.
    d. tell the patient that he or she is too intelligent to consider that as a solution.

Answer 20

ANS: B

All suicidal thoughts are serious, and a nurse’s first priority is keeping the patient safe.

Question 21

21. When evaluating care of a crisis patient, a psychiatric nurse must remember that one of the primary goals of crisis intervention is to:
    a. support the patient through the process.
    b. help the patient return to the precrisis state.
    c. give the patient new, healthy coping mechanisms.
    d. listen to the patient to help reduce the stress levels.

Answer 21

ANS: B
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 to explore is whether the patient has returned to the precrisis level of functioning.

Question 22

22. Which statement made by a person in a crisis state indicates the presence of a balancing factor?
    a. “I’ve been drinking more than usual.”
    b. “I’ve always been a loner. I don’t need other people.”
    c. “I pray when things get tough. It’s always helped me survive trouble.”
    d. “My spouse just went to the store. I don’t believe it when they tell me my spouse is dead.”

Answer 22

ANS: C

Praying represents a coping mechanism previously and successfully used by the patient.

Question 23

23. A variety of crisis intervention modalities are available in contemporary society depending on the needs of patients. Some of them are:
    a. in mobile crisis programs.
    b. available only during non-daytime hours.
    c. in primary care provider (PCP) office settings.
    d. available only to members of certain patient populations.

Answer 23

ANS: A
Mobile crisis teams provide front-line interdisciplinary crisis intervention to individuals, families, and communities. It is not true that crisis intervention is only available during non-daytime hours, is usually available in PCP office settings, or is only available to members of certain patient populations.

Question 24

MULTIPLE RESPONSE

1. A patient who was held hostage for 12 hours by a carjacker now repeatedly states, “I can’t believe it happened to me!” while admitting to feeling anxious and being afraid of strangers and of ever driving again. The nurse’s interventions should target: (Select all that apply.)
   a. denial.
   b. anxiety.
   c. confusion.
   d. self-efficacy.
   e. suicide potential.

Answer 24

ANS: A, B, D
The patient is using denial, admits to anxiety, and has self-doubts. These would be appropriate targets for intervention.