Chapter 26 - Crisis and Disaster

Question 1

A client comes to the crisis clinic after an unexpected job termination. The client paces, sobs, cringes when approached, and responds to questions with only shrugs or monosyllables. What is the nurse’s best initial comment to this client?

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 feelbetter.”
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

b. “I see you are feeling upset. I’m going to stay and talk with you to help you feelbetter.”

Question 2

A client is seen in the clinic for superficial cuts on both wrists. Initially the client paces and sobs but after a few minutes, the client is calmer. The nurse attempts to determine the client’s perception of the precipitating event by asking which question?

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?”

Answer 2

d. “What was happening when you started feeling this way?”

Question 3

A client 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 client is experiencing what response?

a. Suicidal ideations.
b. Anxiety and fear.
c. Misperceived reality.
d. Potential homicidal thoughts.

Answer 3

b. Anxiety and fear.

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 behavior, but the parents did not believe the adolescent. What type of crisis exists?

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

Answer 4

c. Situational

Question 5

While conducting the initial interview with a client in crisis, the nurse should implement what intervention?

a. speak in short, concise sentences.
b. convey a sense of urgency to the client.
c. be forthright about time limits of the interview.
d. let the client know the nurse controls the interview.

Answer 5

a. speak in short, concise sentences.

Question 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?”

Answer 6

d. “Are you having thoughts of hurting yourself or others?”

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. Mitigation
c. Situational
d. Recurring

Answer 7

c. Situational

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 client’s feelings about the possibility of having a mastectomy
c. Whether the husband is still engaged in an extramarital affair
d. Clarify what the client means by “I can’t take anymore.”

Answer 8

d. Clarify what the client means by “I can’t take anymore.”

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 says tearfully, “What else can happen?” If the woman’s immediate family is unable to provide sufficient support, the nurse should take what initial action?

a. suggest hospitalization for a short period.
b. ask what other relatives or friends are available for support.
c. tell the client, “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

b. ask what other relatives or friends are available for support.

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

d. Coping with the reaction to the daughter’s events

Question 11

A client 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 what time frame?

a. 1 to 2 weeks.
b. 3 to 4 weeks.
c. 4 to 6 weeks.
d. 8 to 12 weeks.

Answer 11

c. 4 to 6 weeks.

Question 12

A student 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 coping related to distress from false accusations

Answer 12

d. Ineffective coping related to distress from false accusations

Question 13

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

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

Answer 13

b. Giving direction

Question 14

Which situation demonstrates use of primary intervention related to crisis?

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

Answer 14

b. Teaching stress-reduction techniques to a first-year college student

Question 15

A victim of intimate partner violence comes to the crisis center seeking help. Which crisis intervention strategies should the nurse focus on?

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

a. supporting emotional security and reestablishing equilibrium.

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. Body image

Answer 16

c. Maturational

Question 17

Which scenario is an example of a situational crisis?

a. The death of a child from sudden infant death syndrome
b. Development of a heroin addiction
c. Retirement of a 55-year-old person
d. A riot at a rock concert

Answer 17

d. A riot at a rock concert

Question 18

Which agency provides coordination in the event of a terrorist attack?

a. Food and Drug Administration (FDA)
b. Environmental Protection Agency (EPA)
c. National Incident Management System (NIMS)
d. Federal Emergency Management Agency (FEMA)

Answer 18

c. National Incident Management System (NIMS)

Question 19

During the initial interview at the crisis center, a client 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

a. “In the past, how have you handled difficult or stressful situations?”

Question 20

An adult has cared for a debilitated parent for 10 years. The health care provider recently recommended transfer of the parent to a skilled nursing facility. 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 adult’s crisis will most closely relate to what issue?

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

Answer 20

a. Resolving the feelings associated with the threat to the person’s self-concept.

Question 21

What principle is most useful to a nurse planning crisis intervention for any client?

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

Answer 21

a. The client is experiencing a state of disequilibrium.

Question 22

A nurse assesses a client in crisis. What is the most appropriate question for the nurse to ask to assess this client’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

b. “Who can be helpful to you during this time?”

Question 23

An adult comes to the crisis clinic after termination from a job of 15 years. The client 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. Interrupted family processes

Answer 23

b. Powerlessness

Question 24

A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next?

a. Ask police to encircle the school campus with yellow tape to prevent parents from entering.
b. Announce over the loudspeakers, “The campus is now secure. Please return to your classrooms.”
c. Require parents to pass through metal detectors and then allow them to look for their children in the school.
d. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.

Answer 24

d. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.

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

Answer 25

c. The nurse is having difficulty terminating the relationship.

Question 26

Emergency response workers arrive in a community after a large-scale natural disaster. What is the workers’ first action?

a. Report to the incident command system (ICS) center.
b. Determine whether the community is safe.
c. Establish teams of workers with varied skills.
d. Evaluate actions completed by local law enforcement.

Answer 26

a. Report to the incident command system (ICS) center.

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

a. Difficulty using a cell phone
d. Rapid speech
e. Trembling

Question 28

A team of nurses report to the community after a category 5 hurricane devastates many homes and businesses. The nurses provide emergency supplies of insulin to persons with diabetes and help transfer clients in skilled nursing facilities to sites that have electrical power. Which aspects of disaster management have these nurses fulfilled? (Select all that apply.)

a. Preparedness
b. Mitigation
c. Response
d. Recovery
e. Evaluation

Answer 28

b. Mitigation
c. Response