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EAQ - Ch26: Crisis and Disaster
Terms in this set (15)
The nurse interacts with a patient at a crisis center. The patient speaks of distressing events and makes dismissive comments. What diagnosis should the nurse make from the patient's symptoms?
a. Acute confusion
b. Ineffective denial
c. Impaired social interaction
d. Disturbed personal identity
Patients with ineffective denial talk about distressing events and make dismissive comments. They also display inappropriate affect and delay seeking care. Patients with acute confusion have confusion and incoherence, and may have problems with substance abuse. Impaired social interaction is characterized by difficult interpersonal relationships, isolation, and few or no social supports. Disturbed personal identity is identified by self-hatred and feelings of being overwhelmed and ineffectual.
p. 496, Table 26.1
A patient comes to the crisis intervention clinic and tearfully tells the nurse, "It is so painful! I have thought about it, and I cannot see how I can go on without my partner." The nurse states, "You have resilience and will look back on this as a crisis you were able to manage." Analysis of this interaction reveals what about the nurse?
a. The nurse has stepped into the territory of traditional psychotherapy.
b. The nurse has not followed up on the patient's verbal clues to suicidal thoughts.
c. The nurse has a good understanding of the effect of time on perception of a crisis.
d. The nurse is offering a statement of positive outcome based on patient coping ability.
Nurses who are uncomfortable with the idea of suicide may fail to pick up on a patient's clues. This patient clearly was open to discussing suicidal thoughts, or the patient would not have said, "I cannot see how I can go on."
p. 497, Table 26.2
Which of the following is an example of a maturational crisis?
a. Experiencing an unplanned pregnancy
b. Losing one's job within months of retiring
c. Working at a bank that recently was robbed
d. Having one's only child leave home to attend college
Maturational crises are related to traditional periods of life where roles are changing, such as experiencing midlife empty nesting. An unplanned pregnancy can result in a situational crisis if the individual's equilibrium is upset enough. The loss of a job at any time can result in a situational crisis. Being victimized, such as in a robbery, can result in a situational crisis if the individual's equilibrium is upset enough.
Which event leads to the development of a situational crisis in patients?
a. Loss of a job
b. Birth of a child
c. Natural disaster
d. Physical assault
A situational crisis arises from external events such as loss of a job or an abortion. An adventitious crisis results from accidental events that are unplanned, which may be human-made or caused by nature. This crisis precipitates from situations such as physical assaults and natural disasters like floods and earthquakes. A maturational crisis arises from developmental changes in a person's life such as the birth of a child or death of parents.
A nurse is planning crisis intervention for a patient who has acute stress and panic episodes. Which nursing intervention does the nurse implement while giving primary care to the patient?
a. The nurse assesses coping styles of the patient.
b. The nurse teaches relaxation techniques to the patient.
c. The nurse assesses the support systems of the patient.
d. The nurse suggests the patient join a rehabilitation center.
Crisis interventions consist of three levels of care, including primary care, secondary care, and tertiary care. Primary care is intended to reduce stress and promote the mental health of the patient. At this level the nurse teaches relaxation techniques to the patient to reduce the stress. Secondary care is established during an acute crisis to prevent prolonged anxiety in the patient. The nurse plans the crisis interventions based on the coping styles and support systems of the patient. Tertiary care is provided to those patients who have experienced a severe crisis and are now recovering from a disabling mental state. At this level the nurse learns more about the patients' support systems and may suggest other support options that are available. The nurse should suggest such patients join a rehabilitation center, for instance.
The nurse is caring for a patient in the emergency room who was in a serious motor vehicle accident in which a child died. Which assessment question takes priority?
a. "How does this situation affect your life?"
b. "Have you thought about hurting yourself?"
c. "How do you see this event affecting your future?"
d. "Is there anyone, family or friends, you would like involved in your care?
The priority assessment following a crisis is to ascertain if the patient is suicidal by asking "Have you thought about hurting yourself?" Next, the nurse can assess the patient's perception of the problem by asking, "How does this situation affect your life?" or "How do you see this event affecting your future?" Asking if he or she would like particular people involved in the care plan helps the nurse to assess the patient's situational supports.
Which of the following is a common coping mechanism a patient adopts during a crisis?
a. Avoiding eating
b. Setting realistic goals
c. Avoiding talking with others
d. Engaging in other physical activity
During a crisis, patients use different coping techniques to cope with the situation. Some patients may get involved in physical activity such as walking to relieve restlessness. As the patient has had a crisis, the patient may not be psychologically stable, and might not be able to set realistic goals. Some patients may try to cope with the stress by talking to others. Some patients tend to overeat in order to cope with stress.
A man is having difficulty adjusting to becoming a father. He has not bonded with his newborn and frequently stays out at night drinking with friends. Which type of crisis is evident?
Each developmental stage represents a maturational crisis that is a critical period of increased vulnerability and, at the same time, heightened potential. A maturational crisis may occur associated with leaving home during late adolescence, marriage, birth of a child, retirement, or death of a parent. A situational crisis may occur after the loss or change of a job, the death of a loved one, an abortion, change in financial status, divorce, or severe illness. An adventitious crisis results from events that are unplanned and may be accidental, caused by nature, or human-made (natural disaster, a national disaster, or a crime of violence). "External" is not a type of crisis.
The nurse is caring for a patient who recently escaped a relationship marked by repeated domestic violence. The nurse observes that the patient is unable to make decisions and is dependent on the nurse. What appropriate action should the nurse take?
a. Be around the patient to help.
b. Set realistic goals for the patient.
c. Have another nurse assigned to the patient.
d. Encourage the patient to seek help in decision making.
The nurse should prevent the patient from becoming emotionally dependent on the nurse. The nurse should set realistic goals for the patient and encourage problem solving. The nurse should not have another nurse assigned as it can interrupt the treatment plan of the patient. The patient may feel nervous and anxious due to the change. It must not be suggested to the patient to seek help to make decisions. The nurse should encourage the patient to be independent and should give the patient space to make independent decisions. This would help in preventing the patient from becoming dependent on the nurse.
The nurse is performing crisis intervention for a sexually assaulted patient. What appropriate action should the nurse take to help the patient cope with the crisis? SATA
a. Guide the patient about maintaining support systems.
b. Convince the patient to file a complaint against the attacker.
c. Encourage the patient to make conclusions about their suffering.
d. Encourage the patient to express feelings in a nondestructive manner.
e. Frequently restate the statements made by the patient during interview.
The nurse can verify the situation by giving frequent feedback to the patients and restating their statements. It assures the patient that the nurse is listening attentively. The nurse should encourage the patient to express feeling in a nondestructive manner. It helps to reduce the potential harm to the patient and others. The nurse should give guidance to the patient about maintaining support systems. It helps the patient to develop social skills and not feel isolated. The nurse should not insist the patient file a complaint. The decision should be the patient's to make. The nurse should not encourage the patient to become judgmental and make conclusions about their suffering. The nurse should help the patient cope effectively with the situation.
p. 497, Table 26.2
The nurse is caring for a depressed patient who was rescued from an earthquake. As part of the counseling and treatment, the nurse wants to assess the patient's family and the patient's stressors. What appropriate action will the nurse take?
a. Interact with the patient's family.
b. Check the patient's medical history.
c. Ask the patient to describe his or her feelings.
d. Ask the patient what makes him or her feel better.
By assessing the patient's family and stressors, the nurse can learn the patient's perception of the situation. The nurse should ask the patient to describe his or her feelings. This will help the nurse to understand the patient's problems. Interacting with the patient's family will not help the nurse to understand the perception of the patient toward the situation. Checking the patient's medical record will give information about the patient's previous health conditions, but not the patient's perception. Coping skills of the patient can be assessed by asking what makes him or her feel better.
A parent seeks counseling after the rape and murder of a child. The parent tearfully says, "I hate the person who did this. At the trial, I don't know what I will do if he's not found guilty." What is the nurse's highest priority response?
a. "Do you have enough support from your family and friends?"
b. "What resources do you need to help you cope with this situation?"
c. "Have you talked to a psychiatrist about taking some medication to help you cope?"
d. "Are you thinking of killing yourself or others like the person who killed your child?"
Safety is the nurse's highest priority. The nurse should clarify and assess the patient's intentions and then initiate necessary precautions to safeguard the patient or others at risk for physical harm. Asking about support, resources for coping, or medication represent later actions the nurse may consider.
p. 497, Box 26.2
When a tornado results in the loss of homes, businesses, and life, the town residents are likely to experience what type of crisis?
a. Situational crisis
b. Maturational crisis
c. Adventitious crisis
d. Endogenous crisis
An adventitious crisis is unplanned, accidental, and not part of everyday life. Examples are disasters and crimes of violence. Maturational, situational, and endogenous crises generally do not have the factors associated with an adventitious crisis.
Which outcome indicates the individual is demonstrating a commonly observed but negative coping strategy after a crisis event? SATA
a. Running 5 miles daily
b. Gaining 10 pounds over a 6-week period
c. Losing one's driver's license for driving drunk
d. Offering numerous excuses for not socializing
e. Scheduling spiritual counseling sessions three times a week
Common coping mechanisms may be overeating, drinking, smoking, withdrawing, yelling, or fighting. Counseling and reasonable exercise would not be considered negative coping strategies.
The student nurse is providing examples of adventitious crisis to a peer. Which examples of adventitious crisis listed by the student nurse requires correction? SATA
a. The birth of a child
b. Death of a loved one
c. Murder of a coworker
d. An unexpected tornado
e. A change in financial status
f. Leaving home for the first time
The death of a loved one is a situational crisis, and the birth of a child is a maturational crisis. A change in financial status is also situational, while leaving home for the first time is maturational. Adventitious crises are caused by events that are unplanned and may be accidental, caused by nature, or human-made. Examples of adventitious crises are natural disasters and a crimes of violence.
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