Question 1

A nurse is assessing a 35-year-old client who is seeking assistance at a local community counseling center. Which statement would indicate that the client is experiencing a crisis?

Accepted Answer

Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. Life is disrupted, and unexpected emotional (e.g., depression) and biologic (e.g., nausea, vomiting, diarrhea, and headache) responses occur. Functioning is severely impaired. Although feelings of upset, confusion, hurt, and sadness may occur with a crisis, the key component is impaired functioning.

Question 2

A client's poodle ran in front of a car and was killed. The client continues to be upset by the pet's death, and explains to a community counseling center nurse, "I can't stop crying because my Precious meant the world to me, and now my world will never be the same!" If the nurse were to determine that the client was experiencing a crisis, which type of crisis would it most likely be?

Accepted Answer

A situational crisis occurs whenever a specific stressful event threatens a person's biopsychosocial integrity and results in some degree of psychological disequilibrium. The pet's death caused the client to experience a degree of psychological disequilibrium. A developmental or maturational crisis is one involving normal growth and development. A traumatic crisis is initiated by unexpected, unusual events that affect an individual or multitude of people.

Question 3

A 62-year-old client experienced the loss of an 87-year-old parent a week ago. A hospice nurse is making a follow-up visit to determine how the client is handling the death. Which statement indicates to the hospice nurse that the client is in the acute mourning stage of bereavement?

Accepted Answer

The fact that the client is crying all the time, feeling angry for much of the time, missing work, and idealizing the father are all indicators of the acute mourning stage of bereavement. This stage is characterized by intense feeling states, social withdrawal, and identification with the deceased person. The statement about having trouble believing he is dead suggests the shock stage. The statement about grieving the father but having to get on with life suggests the beginning of the resolution stage, as does the statement about spending the weekend with children to relax.

Question 4

A 25-year-old client is seeking counseling for recently and unexpectedly losing a job. Which question would be most appropriate for a nurse to use in assessing the client's response to losing the job?

Accepted Answer

Individual responses to a crisis can be best understood by assessing the usual responses of the person to stressful events. The response to the crisis also depends on the meaning of the event to the person. Asking about the cause of job loss, immediate feelings, and how the person expects to handle the situation do not address the client's response to the job loss.

Question 5

An individual is seeking employment as a nurse in a crisis center. The interviewer asks the job candidate what the candidate would ask to determine whether the caller was experiencing a crisis. Which response would be most appropriate?

Accepted Answer

A response to the crisis depends on the meaning of the event to the victim. Telling someone to describe what they are experiencing and what that experience means to them elicits more information than asking a person to quantify the extent of the crisis. Asking someone "why" tends to put an individual on the defensive because the question implies that the individual needs to "justify" his or her perception. Asking about the extent of the crisis would be difficult for the person to answer. In addition, it already assumes that the client is in crisis. Rating the level of functioning would be important information to ask later, after establishing what the client is experiencing.

Question 6

A Red Cross nurse is working with tornado victims. The nurse is interviewing a client whose house was totally destroyed and pet poodle died as a result of the tornado. Which statement would the nurse most likely expect to hear from this client?

Accepted Answer

In the beginning of a crisis, a victim may report the feeling of numbness and shock. The reality of the client's loss has not had sufficient time to "sink in." When it does, the client will experience intense emotions regarding loss.

Question 7

A nurse is part of team working with hurricane victims. One of the hurricane victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with the situation and how much support is needed, which question would be most appropriate for the nurse to ask?

Accepted Answer

By assessing the victim's ability to solve problems, the nurse can evaluate whether the victim can cognitively cope with the crisis situation and determine the kind and amount of support needed. At this point in time, the client may not be able to identify the type of help he needs or what will occur the next few days. Asking about feeling guilty is inappropriate. Additionally, this is a closed-ended question that does not allow the victim to explore current feelings.

Question 8

A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic event. Which priority would the nurse identify for this family?

Accepted Answer

Safety interventions to protect people in crisis from harm should include preventing the individuals from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Additionally, the priorities of physical needs surpass those of psychosocial needs. After the individual's safety needs are met, the nurse can address the psychosocial aspects of the crisis.

Question 9

A nursing instructor is lecturing to students about how to respond to individuals who are in the midst of a disaster. Which statement would be most appropriate to include about initial nursing interventions for such individuals?

Accepted Answer

When responding to a disaster, the nurse would follow the ABCs of psychological first aid: arousal, behavior, and cognition. Thus, the first area to address is arousal. When arousal is present, the intervention goal is to decrease excitement by providing safety, comfort, and consolation. When abnormal or irrational behavior is present, survivors should be assisted to function more effectively in the disaster. If cognitive disorientation occurs, reality testing and clear information should be provided. In the initial phases, the nurse should assist the victim in focusing on the reality of problems that are immediate, with specific goals that are consistent with available resources and with the culture/lifestyle of the victim.

Question 10

A nurse is working as part of a community disaster response team. When responding to a community disaster, the nurse integrates understanding of individuals' reactions by anticipating which response?

Accepted Answer

In a disaster, shelter, money, and food may not be available. The absence of basic human needs, such as food, a place to live, or immediate transportation quickly becomes a priority that may precipitate acts of violence. Additionally, the victims may experience economic distress because of job loss and loss of other resources. This may ultimately lead to psychological distress, potential acts of aggression, and other mental health problems. Long-term mental health consequences are evident in most disasters.

Question 11

A group of nursing students is reviewing information about the types of crisis. The students demonstrate understanding of the information when they identify which happening as a developmental crisis?

Accepted Answer

A developmental crisis is one that occurs with normal growth and development, such as going away to college. Obtaining a job promotion or loss of a pet is an example of a situational crisis. An earthquake is an example of a traumatic crisis.

Question 12

As part of a community program on crisis prevention, a nurse is describing the phases of crisis. Which phase would the nurse identify as occurring first?

Accepted Answer

A crisis occurs in phases as identified by psychiatrist Gerald Caplan. A crisis occurs when a person faces a problem that cannot be solved by customary problem-solving methods. When the usual problem-solving methods no longer work, a person's life balance or equilibrium is upset, and the person uses trial and error to solve the problem. These attempts fail, and the anxiety rises to severe or panic levels, whereby the person then adopts automatic relief behaviors. When these fail, anxiety overwhelms the person and leads to serious personality disorganization, which signals the person is in crisis.

Question 13

A nurse is assessing the parents of a 6-year-old child who has died from leukemia. The nurse is integrating the Dual Process model (DPM) for the assessment. Which action would the nurse identify as reflecting the parents' loss-oriented coping?

Accepted Answer

According to the DPM, a person adjusts to loss by oscillating between loss-orientated coping (in which there is preoccupation with the deceased person, such as thinking about the lost child) and restoration-oriented coping (in which the bereaved person is preoccupied with stressful events as a result of the death, such as financial issues, new identity as a widow, etc.). Engaging in new activities, denying the grief, and developing new relationships reflect restoration-oriented coping.

Question 14

A psychiatric-mental health nurse is describing uncomplicated bereavement to a group of nurses working with terminally ill clients. Which information would the nurse most likely include in the discussion?

Accepted Answer

Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Uncomplicated grief is painful and disruptive. It can be applied to situations other than loss because of death.

Question 15

After teaching a group of nurses about crisis, the group leader determines that the education was successful based on which statement by the group?

Accepted Answer

Crisis is a time-limited event (usually no more than 4-6 weeks) that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences. A crisis can have either positive or negative outcomes. By definition, there is no such thing as a chronic crisis. People who live in constant turmoil are not in crisis but in chaos. Although the feelings associated with a crisis are similar, the precipitating event and circumstances are unusual or rare, perceived as a threat and specific to the individual.

Question 16

The nurse is providing follow-up care to victims of a disaster that occurred several months ago. Which finding would lead the nurse to suspect that the victims are experiencing possible aftereffects of the disaster?

Accepted Answer

Unexplained physical symptoms, such as headache, fatigue, pain, chest pain, and gastrointestinal disturbances have been reported among both traumatized and nontraumatized populations in the aftermath of disasters. Tachycardia, profuse perspiration, and tremors or shakiness are more typically assessed in the period immediately after the disaster.

Question 17

A nurse is working with a client who is in crisis. Which action would be least appropriate for the nurse to take?

Accepted Answer

Telling the client that everything will be okay is false reassurance and blocks communication. Rather, the nurse should focus on what the information means to the client. Supporting the client's cultural beliefs about expressing his or her feelings, encouraging the client to focus on one thing at a time, and explaining information clearly are appropriate.

Question 18

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when making which statement?

Accepted Answer

Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.

Question 19

Assessment of a client indicates complicated grief. Which statement would the nurse identify as supporting this reaction? Select all that apply.

Accepted Answer

Complicated grief, which occurs in about 10% to 20% of bereaved persons, is characterized by the person being frozen or stuck in a state of chronic mourning. They feel bitter over their loss and wish that their lives could revert to the time when they were together. In addition, the person experiences an intense longing and yearning for the deceased for more than 6 months. Additionally, the person may have trouble accepting the death, an inability to trust others since the death, excessive bitterness related to the death, and feeling that life is meaningless without the deceased person.

Quiz 21: Crisis, Loss, Grief, Bereavement, and Disaster Management