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Exam 2 Practice Questions and Flashcards (Crisis/Stress, Grief & Loss, Spirituality)

Terms in this set (66)

Which patient statement indicates the helpfulness of the nurse-patient relationship?

a. "I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem."

b. "I really need to talk with you. You always give me good advice about how to address my anger issues."

c. "If it wasn't for you and the hours we've spent talking, I don't think I would be on my way to getting my anxiety under control."

d. "You always showed me sympathy when I was at my lowest point after the sexual assault. Knowing you had been there too was such a help."
a. "I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem."
A female nurse had been sexually assaulted as a teenager. She finds it difficult to work with patients who have undergone the same trauma. What is the most helpful response?

a. Discussing these feelings with the nurse supervisor.

b. Requesting that these patients not be a part of her patient assignment.

c. Discussing these feelings with a mental health professional.

d. Accepting her role in providing unbiased, respectful, and professional care to all patients.
c. Discussing these feelings with a mental health professional.
A patient whose history includes experiences with abusive partners is being treated for major depressive disorder. The patient's care plan includes rape-trauma syndrome among its nursing diagnoses. What goal is directly associated with this diagnosis?

a. Remains free from self-harm

b. Wears appropriate clothing

c. Reports feeling stronger and having a sense of hopefulness

d. Demonstrates appropriate affect for both positive and negative emotions
c. Reports feeling stronger and having a sense of hopefulness
The nurse is engaged in crisis intervention with a patient reporting, "I have no reason to keep on living." What is the nurse's initial intervention?

a. Advise the patient about the services available to help them.

b. Ask the patient, "Have you ever been this depressed before?"

c. Ask the patient, "Do you have any plan to hurt yourself or anyone else?"

d. Assure the patient that he or she is in a safe place and will be well cared for.
c. Ask the patient, "Do you have any plan to hurt yourself or anyone else?"
Which statement concerning a crisis experience is true and should be used as a guideline for crisis management care? Select all that apply.

a. A crisis is self-limiting and usually resolves within 4 to 6 weeks.

b. The earlier interventions are implemented, the better the expected prognosis.

c. The nurse should maintain a nondirective role.

d. The patient in crisis is assumed to be mentally unhealthy and in an extreme state of disequilibrium.

e. The goal of crisis management is to return the patient to at least the precrisis level of functioning.
a, b, e

a. A crisis is self-limiting and usually resolves within 4 to 6 weeks.

b. The earlier interventions are implemented, the better the expected prognosis.

e. The goal of crisis management is to return the patient to at least the precrisis level of functioning.
Which statement about crisis theory will provide a basis for nursing intervention?

a. A crisis is an acute time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable.

b. A person in crisis has always had adjustment problems and has coped inadequately in the usual life situations.

c. Crisis is precipitated by an event that enhances a person's self-concept and self-esteem.

d. Nursing intervention in crisis situations rarely has the effect of stopping the crisis.
a. A crisis is an acute time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable.
Lilly, a single mother of four, comes to the crisis center 24 hours after a fire in which all the houses within a one-block area were wiped out. All of Lilly's household goods and clothing were lost. Lilly has no other family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. You assess the situation as:

a. A maturational crisis.

b. An adventitious crisis.

c. A crisis of confidence.

d. An existential crisis.
b. An adventitious crisis.
Lilly, a single mother of four, comes to the crisis center 24 hours after a fire in which all the houses within a one-block area were wiped out. All of Lilly's household goods and clothing were lost. Lilly has no other family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. The intervention that takes priority is to:

a. Reduce anxiety.

b. Arrange shelter.

c. Contact out-of-area family.

d. Hospitalize and place the patient on suicide precautions.
a. Reduce anxiety.
Which belief would be least helpful for a nurse working in crisis intervention?

a. A person in crisis is incapable of responding to instruction.

b. The crisis counseling relationship is one between partners.

c. Crisis counseling helps the patient refocus to gain new perspectives on the situation.

d. Anxiety-reduction techniques are used so the patient's inner resources can be accessed.
a. A person in crisis is incapable of responding to instruction.
The highest-priority goal of crisis intervention is:

a. Anxiety reduction.

b. Identification of situational supports.

c. Teaching specific coping skills that are lacking.

d. Patient safety.
d. Patient safety.
An 80-year-old female patient is receiving palliative care for heart failure. The primary purpose(s) of her receiving palliative care is (are) to (select all that apply)

a. improve her quality of life.

b. assess her coping ability with disease.

c. have time to teach patient and family about disease.

d. focus on reducing the severity of disease symptoms.

e. provide care that the family is unwilling or unable to give.
a, d

a. improve her quality of life.

d. focus on reducing the severity of disease symptoms.
The primary purpose of hospice is to

a. allow patients to die at home.

b. provide better quality of care than the family can.

c. coordinate care for dying patients and their families.

d. provide comfort and support for dying patients and their families.
d. provide comfort and support for dying patients and their families.
A 67-year-old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating?

a. Peacefulness

b. Decreased socialization

c. Decreased decision making

d. Anxiety about unfinished business
b. Decreased socialization
For the past 5 years Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing?

a. Adaptive grief

b. Disruptive grief

c. Anticipatory grief

d. Prolonged grief disorder
d. Prolonged grief disorder
The home health nurse visits a 40-year-old patient with metastatic breast cancer who is receiving palliative care. The patient is experiencing pain at a level of 7 (0-10 point scale). In prioritizing activities for the visit, what should the nurse do first?

a. Auscultate for breath sounds.

b. Administer PRN pain medication.

c. Check pressure points for skin breakdown.

d. Ask family about patient's food and fluid intake.
b. Administer PRN pain medication.
While caring for his dying wife, the husband states that his wife is a devout Roman Catholic but he is a Baptist. Who is considered the most reliable source for spiritual preferences concerning EOL care for the dying wife?

a. A priest

b. Dying wife

c. Hospice staff

d. Husband of dying wife
b. Dying wife
A tearful patient tells the nurse that her brother (who is in prison) just received a diagnosis of terminal metastatic lung cancer. She is worried that her brother will die in pain and alone. What is the nurse's best response?

a. "It's too bad that they don't have hospice services in prison."

b. "I'm sure the prison will let him out if they know he is dying."

c. "Maybe if he had not committed a crime, he wouldn't be in this situation."

d. "Many prisons offer health care services, including hospice and palliative care."
d. "Many prisons offer health care services, including hospice and palliative care."
The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serious stroke. Who is responsible for making the decision about EOL measures when the patient cannot communicate his or her specific wishes?

a. Notary and attorney

b. Physician and family

c. Wife and adult children

d. Physician and nursing staff
c. Wife and adult children
The children caregivers of an older patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicate the potential for an abnormal grief reaction to occur (select all that apply)?

a. Family cannot express their feelings to one another.

b. Dying patient is becoming more restless and agitated.

c. A family member is going through a difficult divorce.

d. Family talks with and reassures the patient at frequent intervals.

e. Siblings who were estranged from each other have now reunited.
a, c

a. Family cannot express their feelings to one another.

c. A family member is going through a difficult divorce.
A nurse has been working full time with terminally ill patients for 3 years. He has been experiencing irritability and mixed emotions when expressing sadness since four of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own

a. full-time work schedule.

b. past feelings toward death.

c. patterns for dealing with grief.

d. demands for involvement in patient care.
c. patterns for dealing with grief.
What is the difference between primary appraisal and secondary appraisal in effective coping?
Primary = initial assessment, determines meaning & impact of stressor(s)

Secondary = evaluate resources available
What is the definition of crisis? What does it result from?
A time limited event that triggers adaptive or non-adaptive responses to maturational, situational, or traumatic experiences.

Crisis results from stressful events for which coping mechanisms FAIL to provide adequate adaptive skill to address perceived challenge or threat.
What is a developmental or maturational crisis?
Normal part of growth and development (e.g. puberty, pregnancy, aging).
What is a situational crisis?
A disruptive, unexpected event that occurs (e.g. fired from job, breakup, divorce).
What is an adventitious/traumatic crisis?
A very unexpected or unusual event(s) that involves one or many persons (e.g. earthquakes, tornados, terrorism atttacks).
What are the phases in the development of crisis?
1. Stressor occurs, tension rises, usual coping mechanisms used.
2. Coping mechanisms ineffective, tension increases.
3. Emergency coping strategies ineffective.
4. If no resolution, tension increases & major disorganization occurs.
What is the goal of cognitive behavior therapy (CBT)?
For the person to identify the cognitive distortion arising from the thought and replace the thought.
What is the focus of dialectical behavior therapy (DBT)? What are the 5 aspects?
Acceptance and mindfulness as a means of altering behaviors.

1. Emotional regulation
2. Mindfulness
3. Distress tolerance
4. Interpersonal effectiveness
5. Walking the middle path
Which is strongly supported by evidence-based practice: CBT or DBT?
CBT
What is pharmacogenetics?
Study of how genetic variations can affect individual responses to drugs.
What are the requirements to allow a voluntary psychiatric admission to leave (even if AMA)?
Need orders for discharge, must not be a danger to themselves or others, must have a ride to leave & a place to go afterward.
Which 2 conditions must be met regarding restraints?
1. Written order of physician
2. Confined to specific, time-limited periods (e.g. 2 hr)
What is the goal of crisis intervention?
Return the person to pre-crisis level of functioning.
What are the top 4 priorities in crisis intervention?
1. ABCs
2. Pain
3. Education
4. Feelings
What are some biologic/psychological/social assessment findings in crisis?
Tachycardia, tachypnea, increased perspiration, N/V, dilated pupils, shakiness, loss of control, disregard for safety, injury risk, screaming, aggression, disorientation, depression, crying.
What are 2 immediate interventions for crisis?
1. Treat acute symptoms
2. Provide safety.
Which medications are fast-acting and useful in crisis for anxiety?
Benzodiazepines (work in 15-30 min)

e.g. lorazepam, clonazepam, alprazolam
What are the ABCs of crisis interventions?
A = arousal (calm them)
B = behavior (assist in coping)
C = cognition (assess reality testing, educate)
Does debriefing work? Why or why not?
Yes - but only if it is wanted, not if it is forced.
What is the difference between loss and grief?
Loss = what actually happened (absence of object, position, ability, or attribute)

Grief = reaction to loss
What is bereavement?
Provides dispensation from usual activities for a variable period of time.
What is mourning?
An adjustment process which involves integrating the loss into everyday life.
What are patients' basic needs at the end of life?
Control physical symptoms, shelter, assistance with elimination/hygiene, nourishment, companionship, recognition of their continued existence.
What is anticipatory grief?
Grief experienced prior to a loss.
What is acute grief?
Natural grief after a loss has occurred.
What is normal grief?
Emotional pain, suffering, impairment for a while; this is universal.

Shock/disbelief --> depression, intense emotions --> hopeful, renewed sense of well-being
What are the two goals of grief work?
1. Healing oneself
2. Recovering from the loss
What is complicated grief?
Grieving that is unusually long, incapacitating, exhibits disorganized or depressed behaviors
What is absent grief?
Person is unmoved & psychologically detached as they discuss loss.
What is delayed grief?
Grief is postponed for days, months, or years. Often a trigger when grief is finally felt.
What is chronic grief?
Grieving that is exaggerated and does not or cannot resolve.
What is distorted grief?
Emotional upheaval that does not allow the person to effectively live - extremely high guilt & anger.
What is converted grief?
Somatization disorder - preoccupation with physical or psychological symptoms that the person does not see as coming from their loss.
What is disenfranchised grief?
Grief that is experienced when a loss cannot be openly acknowledged, publicly mourned, or supported.

(e.g. friends of the deceased who are alienated from participation in end of life & funeral)
What are the "transitions of fading away"?
1. Redefining
2. Burdening
3. Struggling with paradox
4. Contending with change
5. Searching for meaning
6. Living day to day
7. Preparing for death
What is the difference between palliative care and hospice?
Palliative care = treats symptoms

Hospice = no longer receiving treatment, focused on comfort
What are some physical considerations with end of life?
Fever, bowel changes, incontinence, decreased intake
What are the 4 most common symptoms in the final days of life?
1. Dyspnea
2. "Death rattle" (terminal secretions)
3. Delirium
4. Myoclonus (quick, involuntary muscle jerk)
What are some symptoms of imminent death?
Decreased urine output, cold/mottled extremities, VS & breathing changes, delirium/confusion, restlessness
What is compassion fatigue?
Physical, emotional, and spiritual result of chronic/continuous self-sacrifice and prolonged exposure to difficult situations - difficult & unable to love, nurture, care for, or empathize with another's suffering.
What is burnout?
Physical and psychological fatigue with a decrease in loss of motivation.
What is a FICA spiritual assessement?
F = Faith
I = Importance, Influence
C = Community
A = Address
What is an MVAST spiritual assessment?
M = Moral authority
V = Vocational
A = Aesthetic
S = Social
T = Transcendent
Is spiritual distress a nursing diagnosis?
Yes:

"At risk for an impaired ability to experience & integrate meaning & purpose in life through connectedness with self, others, art, music, literature, nature,
and/or a power greater than oneself."
What is the definition of spiritual distress?
A disruption in the life principle that constitutes and pervades a person's
entire being and enables them to that integrate and transcend his/her biological and psychological nature.
What are 5 reasons why some nurses neglect spiritual care?
1. Fail to recognize spiritual needs of patient/family
2. Recognize spiritual needs but feel inadequate to meet them
3. Lack of understanding, skill, or confidence to implement appropriate interventions
4. Belief that they must be personally "religious" to address/meet these needs
5. Personal discomfort when discussion an area that does not have concrete answers
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