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Chapter 26: Crisis and Disaster
Terms in this set (28)
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."
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 asking:
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?"
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:
b. anxious and fearful.
c. misperceiving reality.
d. potentially homicidal.
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?
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.
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?"
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 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."
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, "What else can happen?" If the woman's immediate family is unable to provide sufficient 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 are a strong person. You can get through this crisis."
d. foster insight by relating the present situation to earlier situations involving loss.
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
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:
a. 1 to 2 weeks.
b. 3 to 4 weeks.
c. 4 to 8 weeks.
d. 8 to 12 weeks.
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
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
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
A victim of spousal violence comes to the crisis center seeking help. Crisis intervention strategies the nurse uses will 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.
After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred?
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
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)
During the initial interview at the crisis center, 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?"
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 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 person's crisis will most closely relate to:
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 behaviors by the person.
The principle most useful to a nurse planning crisis intervention for any patient is that the patient:
a. is experiencing a state of disequilibrium.
b. is experiencing a type of mental illness.
c. poses a threat of violence to others.
d. has high potential for self-injury.
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?"
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?
c. Chronic low self-esteem
d. Disturbed thought processes
A troubled adolescent pulled out a gun in a school cafeteria, fatally shooting three people and injuring 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.
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.
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
A, D, E
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
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 patients in skilled nursing facilities to sites that have electrical power. Which aspects of disaster management have these nurses fulfilled? Select all that apply.
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