Chapter 24: Crisis and Disaster

Question 1

A patient comes to the crisis clinic after an unexpected job termination. The patient paces around the room sobbing, 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.”

Answer 1

ANS: B
This patient is experiencing a crisis. The two primary thrusts of crisis intervention are to provide for the safety of the individual and to 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.

DIF: Cognitive Level: Apply (Application) REF: Page 499
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Question 2

A patient being seen in the clinic for superficial cuts on both wrists is pacing and sobbing. After a few minutes, the patient is calmer. The nurse attempts to determine the patient’s perception of the precipitating event by saying which of the following?

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 just before you started to feel this way?”

Answer 2

ANS: D
A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events permits assessment of the precipitating event. “Why” questions are nontherapeutic.

Question 3

A patient comes to the crisis centre saying, “I’m in a terrible situation. I don’t know what to do.” The triage nurse can initially assume that the patient is which of the following?

a. Suicidal
b. Anxious and fearful
c. Misperceiving reality
d. Potentially homicidal

Answer 3

ANS: B
Individuals in crisis are universally anxious. They are often frightened and may be mildly confused. Perceptions are often narrowed with anxiety.

Question 4

An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle’s behaviour, but the parents did not believe the adolescent. What type of crisis exists?

a. Maturational
b. Adventitious
c. Situational
d. Organic

Answer 4

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 crises 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.

Question 5

While conducting the initial interview with a patient in crisis, the nurse should do which of the following?

a. Listen carefully and summarize often
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

Answer 5

ANS: A
Severe anxiety narrows perceptions and concentration. The nurse should listen carefully and summarize what the patient is saying to ensure correct meaning. Conveying urgency will increase the patient’s anxiety. Letting the patient know who controls the interview or stating that time is limited is nontherapeutic.

Question 6

An adult seeks counselling 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?”

Answer 6

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.

Question 7

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
b. Adventitious
c. Situational
d. Recurring

Answer 7

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.

Question 8

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?

a. Identify measures useful to help improve the couple’s communication.
b. The patient’s feelings about the possibility of having a mastectomy
c. Whether the husband is still engaged in an extramarital affair
d. Clarify what the patient means by “I can’t take anymore.”

Answer 8

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.

Question 9

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, “What else can happen?” If the woman’s immediate family is unable to provide sufficient support, which of the following should the nurse do?

a. Suggest hospitalization for a short period
b. Ask what other relatives or friends are available for support
c. Tell the patient, “You are a strong person. You can get through this crisis”
d. Foster insight by relating the present situation to earlier situations involving loss

Answer 9

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.

Question 10

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 quitting college and moving in with her boyfriend.” Which issue should the nurse focus on during crisis intervention?

a. The possible mastectomy
b. The disordered family communication
c. The effects of the husband’s extramarital affair
d. Coping with the reaction to the daughter’s events

Answer 10

ANS: D
The focus of crisis intervention is on the most recent problem: “the straw that broke the camel’s back.” The patient had coped with the breast lesion, the husband’s infidelity, and the disordered communication. Disequilibrium occurred only with the introduction of the daughter leaving college and moving.

Question 11

A patient who is 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 how long?

a. 1 to 2 weeks
b. 3 to 4 weeks
c. 4 to 6 weeks
d. 6 to 8 weeks

Answer 11

ANS: C
The disorganization associated with crisis is so distressing that it usually cannot be tolerated for more than 4 to 6 weeks. If it is not resolved by that time, the individual usually adopts dysfunctional behaviours that reduce anxiety without solving the problem. Crisis intervention can shorten the duration

Question 12

A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, “I cannot teach nor do any research. My mind is totally preoccupied with these false accusations.” What is the priority nursing diagnosis?

a. Ineffective denial related to threats to professional identity
b. Deficient knowledge related to sexual harassment protocols
c. Impaired social interaction related to loss of teaching abilities
d. Ineffective role performance related to distress from false accusations

Answer 12

ANS: D
This nursing diagnosis is the priority because it reflects the consequences of the precipitating event associated with the professor’s crisis. There is no evidence of denial. Deficient knowledge may apply, but it is not the priority. Data are not present to diagnose impaired social interaction

Question 13

Which communication technique will the nurse use more in crisis intervention than in traditional counselling?

a. Role modeling
b. Giving direction
c. Information giving
d. Empathic listening

Answer 13

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 counselling roles.

Question 14

Which situation demonstrates use of primary care related to crisis intervention?

a. Implementation of suicide precautions for a depressed patient
b. Teaching stress reduction techniques to a first-year college student
c. Assessing coping strategies used by a patient who attempted suicide
d. Referring a patient with schizophrenia to a partial hospitalization program

Answer 14

ANS: B
Primary care-related crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary care.

Question 15

A victim of spousal violence comes to the crisis centre seeking help. Which of the following crisis intervention strategy will be the nurse’s focus?

a. Supporting emotional security and reestablishing equilibrium
b. Long-term resolution of issues precipitating the crisis
c. Promoting growth of the individual
d. Providing legal assistance

Answer 15

ANS: A
Strategies of crisis intervention address the immediate cause of the crisis and restoration of emotional security and equilibrium. The goal is to return the individual to the pre-crisis level of function. Crisis intervention is, by definition, short term. The correct response is the most global answer. Promoting growth is a focus of long-term therapy. Providing legal assistance might or might not be applicable.

Question 16

After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred?

a. Reactive
b. Situational
c. Maturational
d. Adventitious

Answer 16

ANS: C
Maturational crises occur when a person arrives at a new stage of development and finds that old coping styles are ineffective but has not yet developed new strategies. Situational crises arise from sources external to the individual, such as divorce and job loss. There is no classification called reactive. Adventitious crises occur when disasters, such as natural disasters (e.g., floods, hurricanes), war, or violent crimes, disrupt coping.

Question 17

Which scenario is an example of an adventitious crisis?

a. The death of a child from sudden infant death syndrome
b. Being fired from a job because of company downsizing
c. Retirement of a 55-year-old person
d. A riot at a rock concert

Answer 17

ANS: D
The rock concert riot is unplanned, accidental, violent, and not a part of everyday life. The incorrect options are examples of situational or maturational crises.

Question 18

Which agency plays a major role in mass disaster planning and prevention?

a. Health Canada
b. Provincial or territorial disaster management agencies
c. National Incident Management System
d. Federal Emergency Management Agency

Answer 18

ANS: C

Health Canada plays a major role in mass disaster planning and prevention.

Question 19

During the initial interview at the crisis centre, a patient says, “I’ve been served with divorce papers. I’m so upset and anxious that I can’t think clearly.” Which comment should the nurse use to assess personal coping skills?

a. “In the past, how have you handled difficult or stressful situations?”
b. “What would you like us to do to help you feel more relaxed?”
c. “Tell me more about how it feels to be anxious and upset.”
d. “Can you describe your role in the marital relationship?”

Answer 19

ANS: A
The correct answer is the only option that assesses coping skills. The incorrect options are concerned with self-esteem, ask the patient to decide on treatment at a time when he or she cannot think clearly, and seek to explore issues tangential to the crisis.

Question 20

An adult has cared for a debilitated parent for 10 years. The parent’s condition recently declined, and the health care provider recommended placement in a nursing home. The adult says, “I’ve always been able to care for my parents. Nursing home placement goes against everything I believe.” Successful resolution of this person’s crisis will most closely relate to which of the following?

a. Resolving the feelings associated with the threat to the person’s self-concept
b. Ability of the person to identify situational supports in the community
c. Reliance on assistance from role models within the person’s culture
d. Mobilization of automatic relief behaviours by the person

Answer 20

ANS: A
The patient’s crisis clearly relates to a loss of (or threatened change in) self-concept. Her capacity to care for her parents, regardless of the deteriorating condition, has been challenged. Crisis resolution will involve coming to terms with the feelings associated with this loss. As in all crises, the stressful event involves loss or change that threatens the person’s self-concept, self-esteem, and sense of security. Identifying situational supports is relevant, but less so than coming to terms with the threat to self-concept. Reliance on lessons from role models can be helpful but is not the primary factor associated with resolution in this case. Automatic relief behaviours will not be helpful; these are part of the fourth phase of crisis.

Question 21

The principle most useful to a nurse planning crisis intervention for any patient is which of the following?

a. That the patient is experiencing a state of disequilibrium
b. That the patient is experiencing a type of mental illness
c. That the patient poses a threat of violence to others
d. That the patient has high potential for self-injury

Answer 21

ANS: A
Disequilibrium is the only universally true answer for all patients in crisis. A crisis represents a struggle for equilibrium when problems seem unsolvable. Crisis does not reflect mental illness. Potential for self-violence or other-directed violence may or may not be a factor in crisis.

Question 22

A nurse assesses a patient in crisis. Select the most appropriate question for the nurse to ask to assess this patient’s situational support.

a. “Has anything upsetting occurred in the past few days?”
b. “Who can be helpful to you during this time?”
c. “How does this problem affect your life?”
d. “What led you to seek help at this time?”

Answer 22

ANS: B
Only the correct answer focuses on situational support. The incorrect options focus on the patient’s perception of the precipitating event.

Question 23

An adult comes to the crisis clinic after termination from a job of 15 years. The patient says, “I don’t know what to do. How can I get another job? Who will pay the bills? How will I feed my family?” Which nursing diagnosis applies?

a. Hopelessness
b. Powerlessness
c. Chronic low self-esteem
d. Disturbed thought processes

Answer 23

ANS: B
The patient describes feelings of lack of control over life events. No direct mention is made of hopelessness or chronic low self-esteem. The patient’s thought processes are not altered at this point.

Question 24

A patient that has recently survived a plane crash has returned to work and reports being able to sleep well at night. The nurse meets with the patient once a month to provide ongoing support and encouragement. Which type of crisis intervention is the nurse performing?

a. Primary
b. Secondary
c. Tertiary
d. Critical incident stress debriefing

Answer 24

ANS: C
Tertiary care provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruptions

Question 25

At the last contracted visit in the crisis intervention clinic, an adult says, “I’ve emerged from this a stronger person. You helped me get my life back in balance.” The nurse responds, “I think we should have two more sessions to explore why your reactions were so intense.” Which analysis applies?

a. The patient is experiencing transference.
b. The patient demonstrates need for continuing support.
c. The nurse is having difficulty terminating the relationship.
d. The nurse is empathizing with the patient’s feelings of dependency.

Answer 25

ANS: C
The nurse’s remark is clearly an invitation to work on other problems and prolong contact with the patient. The focus of crisis intervention is the problem that precipitated the crisis, not other issues. The scenario does not describe transference. The patient shows no need for continuing support. The scenario does not describe dependency needs.

Question 26

Which health care worker should be referred for critical incident stress debriefing?

a. A nurse who works at an oncology clinic where patients receive chemotherapy
b. A case manager whose patients have serious mental illness and are cared for at home
c. A health care employee who worked 12 hours at the information desk of a critical care unit
d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall

Answer 26

ANS: D
Although each of the individuals mentioned experiencing job-related stress on a daily basis, the person most in need of critical incident stress debriefing is the EMT, who experienced an adventitious crisis event by responding to a bombing and provided care to trauma victims.

Question 27

A nurse driving home after work comes upon a serious automobile accident. The driver gets out of the car with no apparent physical injuries. Which assessment findings would the nurse expect from the driver immediately after this event? Select all that apply.

a. Difficulty using a cell phone
b. Long-term memory losses
c. Fecal incontinence
d. Rapid speech
e. Trembling

Answer 27

ANS: A, D, E
Signs and symptoms may include denial, exaggerated startle response, flashbacks, horror, hypervigilance, intrusive thoughts and dreams, panic attacks, feeling numb, substance abuse, confusion, and incoherence. Immediate responses to crisis commonly include shock, and the person may have difficulty using a cell phone, be talking fast and incoherently, and be shaking or trembling. Incontinence and long-term memory losses would not be expected.

Question 28

Which are characteristics of a mental health emergency? Select all that apply.

a. Self-care limitations
b. Depression
c. Effective coping strategies
d. Behavioural disturbances
e. Collective self-efficacy

Answer 28

ANS: A, B, D
A mental health emergency is a state of overwhelming anxiety that can lead to serious personality disorganization, depression, confusion, and behavioural disturbances. In a mental health emergency, there are urgent issues of safety, potentially because of risk for self-care limitations (e.g., lack of nutrition, exposure to physical risks), self-harm behaviour (e.g., substance abuse, risk of suicide), or violence against others.