Deck 23: Crisis and Disaster

Question 1

A patient who sought help in a crisis agrees after the first interview to return to the clinic for daily sessions.The nurse offers many suggestions for lifestyle changes the patient should make as crisis intervention progresses and provides after-hours phone support as well.After several sessions,which response on the nurse's part should most alert the nurse to a need for clinical supervision?

A) Occasionally thinking about the patient's situation
B) Searching for other possible interventions to use
C) Feeling empathy for the patient's recent losses
D) Wishing that the patient would be less clingy

Answer 1

Wishing that the patient would be less clingy

Question 2

A 40-year-old man has just helped his youngest child move away to college.On returning home,he feels empty and restless and has difficulty sleeping in the nights that follow.This is an example of a ______________ crisis.

A) situational
B) adventitious
C) maturational
D) midlife

Answer 2

maturational

Question 3

The assumption that will be most useful to the nurse planning crisis intervention for any patient who is experiencing a crisis is that the patient:

A) is experiencing a type of mental illness.
B) is experiencing a state of disequilibrium.
C) has high potential for self-injury.
D) poses a threat of violence to others.

Answer 3

is experiencing a state of disequilibrium.

Question 4

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

A) A nurse who worked 8 hours answering visitor queries at the intensive care unit information desk after a bus crash led to multiple admissions
B) The emergency medical technician who treated victims of a car bomb attack on a large department store
C) A nurse who works at an oncology clinic with patients receiving chemotherapy,many of whom are terminally ill
D) A case manager working day in,day out,with low-functioning severely mentally ill persons in group homes

Question 5

The nurse is asked by the spouse of a patient seeking crisis intervention to give an example of an adventitious crisis.The nurse should mention:

A) the death of a child from sudden infant death syndrome.
B) being fired from one's job because of company downsizing.
C) the retirement of a 64-year-old man after 30 years' service.
D) a riot at a rock concert that results in multiple casualties.

Question 6

A patient presents in crisis.She tells the nurse,"I cannot take it anymore! It has to stop.Last year my husband had an affair,and we do not communicate anymore.Three months ago I found a lump in my breast,and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." After making the assessment that the patient's nuclear family is unable to provide the patient with sufficient support,which intervention would be most appropriate?

A) Suggest that the patient seek admission to the inpatient crisis stabilization unit.
B) Explore other possible sources of support among her extended family and friends.
C) Allow her to vent,and explore her concerns about the daughter's plan to leave.
D) Foster insight by relating the present situation to earlier situations involving loss.

Question 7

The crisis that occurs as an individual moves from young adulthood to middle age and becomes concerned with loss of his youthful appearance would be assessed by the nurse as a(n)____ crisis.

A) situational
B) maturational
C) reactive
D) adventitious

Question 8

A woman goes to the airport to pick up her husband,returning from one of many business trips.Persons awaiting his flight are directed to a conference room where airline counselors explain that the flight crashed into the ocean,and it is believed that there are no survivors.The woman tells a counselor that it is too soon to be sure,he might still be alive,clinging to wreckage and waiting to be found.The patient is demonstrating:

A) trial-and-error problem solving.
B) adaptive denial.
C) ineffective denial.
D) acute confusion.

Question 9

A patient presents in crisis.She tells the nurse,"I cannot take it anymore! It has to stop.Last year my husband had an affair,and we do not communicate anymore.Three months ago I found a lump in my breast,and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." The problem that should be the focus for crisis intervention is:

A) the possible cancer and mastectomy.
B) the impact of her husband's infidelity.
C) coping with her daughter's leaving.
D) the disordered family communication.

Question 10

An appropriate question for the nurse to ask to assess support systems is:

A) "Has anything upsetting occurred in the last few days?"
B) "What led you to seek help at this time?"
C) "How does this problem affect your life?"
D) "Who can be helpful to you during this time?"

Question 11

The nursing diagnosis of Powerlessness related to impaired problem solving has been established for a patient seeking crisis counseling.An appropriate outcome for this nursing diagnosis would be that the patient will:

A) agree to sign a no-suicide contract within 30 minutes.
B) resume meeting pre-crisis role expectations within 36 hours.
C) state he feels less anxious within 4 hours of the interview.
D) describe two possible solutions during the first interview.

Question 12

A woman expecting to pick her husband up at the airport has instead just been told that he has been killed in an airplane crash.Crisis counselors are present to help loved ones cope with the sad and sudden news.Which response by the counselor would be most appropriate to make next?

A) State,"I will stay with you," and allow for a period of silence so she can process the news of her loss.
B) Ask,"What would help you in this difficult time? Would you like to speak with a chaplain?"
C) Ask,"Is there is someone who's supportive,who can take you home and spend time with you over the next few days?"
D) State,"We realize this is very sudden and unexpected and very upsetting.The airline is committed to helping you in this difficult time."

Question 13

The priority assessment the nurse must make during the initial crisis intervention interview is the:

A) need for external controls.
B) adequacy of social supports.
C) patient's perception of the precipitating event.
D) patient's preferred coping mechanism.

Question 14

During the initial interview at the crisis center,a patient reveals that his wife asked him for a divorce.He is so anxious that he "cannot think straight." Which response would best assess the patient's coping skills?

A) "I can see you are upset.You can rely on us to help you feel better."
B) "What would you like us to do to help you feel more relaxed?"
C) "In the past,how did you handle difficult or stressful situations?"
D) "Do you think you deserve to have things like this happen to you?"

Question 15

A patient presents in crisis.She tells the nurse,"I cannot take it anymore! It has to stop.Last year my husband had an affair,and we do not communicate anymore.Three months ago I found a lump in my breast,and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." The nurse can make the assessment that crisis intervention is successful when the patient:

A) resolves her grief regarding the actual and potential losses in her life.
B) permits others to make decisions for her until her anxiety is reduced.
C) develops a higher degree of resilience to use when facing future crises.
D) learns to respond more calmly and logically in crisis situations.

Question 16

A patient,aged 42 years,seeks crisis intervention.She tells the nurse,"I cannot take it anymore! It has to stop.Last year my husband had an affair,and we do not communicate anymore.Three months ago I found a lump in my breast that the doctor is watching closely,and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." Which comment or concern should be the priority for further assessment?

A) What support persons and coping skills the woman has to draw upon
B) The status of the marriage and whether the husband is involved in the affair
C) How the patient feels about the possibility of having a mastectomy
D) What the patient has in mind when she says she "cannot take it anymore"

Question 17

A nurse in the emergency room is responsible for responding to crises involving school children and has spent many days in local schools helping grieving students who have lost peers or teachers unexpectedly.She is also exposed daily to the victims of horrible accidents and other physical and emotional traumas.Which of the following would be most important for her to address in periodic clinical supervision?

A) Vicarious traumatization
B) Evidence-based interventions
C) Research on crisis response
D) Physiological response to crises

Question 18

Which of the following indicators best demonstrates that crisis intervention has been successful?

A) Patient reports that he is no longer distressed.
B) Patient reports that his life is back to normal.
C) Patient reports sleeping 6 hours or more per night.
D) Patient has returned to previous work schedule.

Question 19

A patient being interviewed on his first visit to the crisis center says he is there because he needs help,but then he falters and cannot continue his explanation.Which question would be of value in helping him relate his perception of the precipitating event?

A) "It will be hard to help you if we cannot get more information."
B) "Tell me about what happened that led you to come in today."
C) "Who is available to help and support you with your problem?"
D) "What things do you usually do to get through difficult times?"

Question 20

A patient,aged 16 years,comes to the crisis clinic and tells the nurse that an uncle tried to rape her yesterday.The patient had told her mother of the uncle's behavior,but the mother accused the daughter of lying and,contrary to the patient's hopes,indicated she would still allow the uncle to visit the family.The patient describes feeling "all confused" and shows minor lacerations on her forearms to the nurse,which she indicates she did out of desperation rather than a wish to die.Which nursing diagnosis would be most appropriate as her primary diagnosis?

A) Powerlessness
B) Disturbed thought processes
C) Rape-trauma syndrome
D) Interrupted family process

Question 21

The nurse assigned to implement a critical incident stress debriefing for a group who responded to a plane crash disaster scene must correctly organize the elements of the debriefing for maximal effectiveness.Put the following elements in the order in which they should occur during CISD:

A) Provide resources,summarize the meeting,and convey support and appreciation to all.
B) Affirm members' responses as normal and teach other responses that can occur later.
C) Ask participants to introduce themselves,then discuss the facts of the event.
D) Have members talk about what was worse about the accident,what they'd like to forget.
E) Have participants first share what they were thinking at the scene of the accident.
F) Discus members' physical,emotional and behavioral responses to the accident.

Question 22

A factory abruptly closes during hard economic times.Six weeks later,an office worker has not received a single call-back from a prospective employer.He cannot sleep,is irritable,does not want to interact with his family or peers,paces frequently,and spends several hours most days alone in a local bar.Bills are piling up.He has given up applying for jobs.Which nursing intervention would be most important at this time?

A) Explore his feelings supportively and guide him to focus on one concern at a time.
B) Discuss ways to improve mood and reduce anxiety,such as exercise and interaction.
C) Help him apply for financial assistance such as food stamps and utility reductions.
D) Work with patient and family to assure that any guns have been removed from the home.

Question 23

A factory abruptly closes;workers receive no warning and no explanation.An office worker tells the factory nurse,who is standing by to assist overwhelmed employees: "I do not know what to do.How will I get another job? Who will pay the bills? How will I get money to feed my kids? What will we do?" Which nursing diagnosis best fits this presentation?

A) Hopelessness
B) Powerlessness
C) Chronic low self-esteem
D) Disturbed thought processes

Question 24

A factory abruptly closes.An office worker initially tries to take it in stride,begins the job search,and networks with peers.Five weeks later,he has not received a single call-back from a prospective employer.He cannot sleep,is irritable,does not want to interact with his family or peers,paces,and spends several hours most days alone in a local bar.He has given up applying for jobs.Which three nursing diagnoses would be the highest priority at this time? Select all that apply.

A) Risk for self-injury
B) Risk for compromised resilience
C) Ineffective denial
D) Ineffective coping
E) Chronic low self-esteem

Question 25

A factory abruptly closes.An office worker tries to take it in stride and begins the job search.Three weeks later,he has not received a single call-back from a prospective employer despite submitting over 30 applications.He is having trouble sleeping,is irritable,does not want to interact with his family,paces,and spends several hours most days in a local bar.He is now applying for minimum-wage service jobs.Which phase of the crisis is he experiencing?

A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4

Question 26

A factory abruptly closes;workers receive no warning and no explanation.An office worker tries to take it in stride and begins the job search,updating his resume,submitting applications,and offering support to his peers.Which assessment question would be most important to ask at this time?

A) "Tell me how has this affected you,how things seem to you."
B) "What do you think you will do if your plan does not work?"
C) "Tell me about some other difficult times you've been through."
D) "Tell me who cares about you,supports you,who you can count on."

Question 27

A factory abruptly closes during hard economic times.An office worker initially tries to take it in stride,begins the job search,and networks with peers.Six weeks later,he has not received a single call-back from a prospective employer.He cannot sleep,is irritable,does not want to interact with his family or peers,paces frequently,and spends several hours most days alone in a local bar.Bills are piling up.He has given up applying for jobs.Which short-term indicator would be most important at this time?

A) Patient sleeps at least 6 hours per night.
B) Patient no longer goes to bars each day.
C) Patient no longer paces regularly.
D) Patient considering jobs to apply for.