Chapter 21: Crisis: Theory and Intervention My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 21: Crisis: Theory and Intervention

Test Bank

MULTIPLE CHOICE

1. Which patient statement is representative of those seen in Phase 2 of the crisis response regarding financial problems?

a.

I cant get evicted and live on the street; Id kill myself first.

b.

I need to get drunk and forget about money problems for a little while

c.

I need to figure out a way to get enough money to meet my rent this month.

d.

Ive always been able to rely on my mother but she wont give it to me this time.

ANS: B

Phase 2: Previous coping and problem-solving strategies fail to relieve the stressor. Phase 1: The individual is exposed to a stressor. Phase 3: Resources from within and outside of the individual are mobilized to resolve the problem and to alleviate the discomfort caused by the stressor. Note that people may drop out of situations in numerous ways, including self-medication with alcohol. Phase 4: The absence of crisis resolution leads to major disorganization such as self-injurious behavior.

DIF: Cognitive Level: Application REF: Pages 483-484

TOP: Nursing Process: Assessing MSC: NCLEX: Psychosocial Integrity

2. Which event has the potential for causing a situational crisis?

a.

Losing ones faith in God

b.

Losing a job after 10 years

c.

Leaving home to attend college

d.

Retirement from teaching school

ANS: B

A situational crisis occurs when a specific, external event, such as job loss, disturbs ones psychologic equilibrium. The other options would be considered internal (subjective) crises.

DIF: Cognitive Level: Application REF: Page 484

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. Which patient statement made by a spouse is representative of those seen in Phase 3 of the crisis response regarding the death of a loved one?

a.

I dont know what Ill do to fill my days now.

b.

Life isnt worth living if I have to live alone.

c.

Prayer doesnt seem to give me the peace it has in the past.

d.

Maybe going and spending time with my daughter will help.

ANS: D

Phase 3: Resources from within and outside of the individual are mobilized to resolve the problem and to alleviate the discomfort caused by the stressor. Phase 1: The individual is exposed to a stressor. Phase 2: Previous coping and problem-solving strategies fail to relieve the stressor. Phase 4: The absence of crisis resolution leads to major disorganization such as self-injurious behavior.

DIF: Cognitive Level: Application REF: Page 484

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. Which patient response demonstrates that the patient whose home was destroyed by a fire is coping with the disaster?

a.

Agreeing to see a grief counselor

b.

Stating, At least no one was hurt in the fire.

c.

Addressing the details regarding the rebuilding of the house

d.

Stating, I knew things were going along too well to be true.

ANS: C

Coping does not imply mastery over the crisis; rather, it is the process that is used to respond to the crisis and find resolution. Working on rebuilding the home is an example of this process. The remaining option show varying degrees of attempting to justify or minimize the crisis.

DIF: Cognitive Level: Application REF: Page 498 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

5. Which factor will have the greatest impact on a patients ability to effectively respond to the loss of a spouse?

a.

The age of the patient

b.

The years they were married

c.

How the patient has handled other deaths

d.

Availability of an effective support system

ANS: C

An individuals interpretation of the crisis is based to a large degree on previous outcomes to similar situations such as experiencing another death crisis. The remaining options do not have the same degree of influence as does the correct option since they are not an example of previous experience.

DIF: Cognitive Level: Analysis REF: Page 490

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. What is the basis for a 1-month crisis intervention follow-up for individuals who have survived a major hurricane?

a.

Symptomology of acute stress disorder can occur within a month of experiencing the trauma.

b.

The patient generally has had time to reflect on the trauma and is now ready to discuss its impact.

c.

Medications prescribed to help manage the initial anxiety caused by the trauma will need to be re-evaluated.

d.

Private insurance carriers require professional mental health follow-ups when initial counseling has occurred.

ANS: A

An acute stress disorder (ASD) may manifest when a person is in crisis. ASD is an anxiety disorder that is characterized by a cluster of dissociative and anxiety symptoms that occur within 1 month of a major traumatic stressor. Although the patient may now be receptive to counseling, there is no reason to believe this will happen within a month. The remaining options are not necessarily true.

DIF: Cognitive Level: Application REF: Page 485 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

7. What intervention has highest priority when a patient diagnosed with acute stress disorder (ASD) reports difficulty sleeping and is observed to have an exaggerated startled response 6 weeks after the trauma occurred?

a.

Short-term therapy will be suggested.

b.

Antianxiety medication will be prescribed.

c.

The patient will be scheduled for a consult at the sleep patient.

d.

The patient will be assessed for possible posttraumatic stress disorder (PTSD).

ANS: D

If symptoms of ASD persist for more than 1 month, an assessment for other diagnoses may also be considered, such as posttraumatic stress disorder (PTSD). The remaining options do not address the issue of a more complex diagnosis and would be treating only isolated symptoms.

DIF: Cognitive Level: Application REF: Pages 489-490

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. Several school-age children injured in a school bus accident were brought to the ED. Family members and friends paced back and forth in the waiting room. Members of the crisis team were called in for the primary purpose of:

a.

Waiting with the families and friends

b.

Facilitating understanding and providing support

c.

Determining the level of individual family coping

d.

Assisting the medical team with the physical injuries

ANS: B

A crisis team is able to provide immediate emotional support to friends and families who are distressed over the event and the state of victims, and they are able to facilitate understanding of the event by teaching. The remaining options do not reflect the function of crisis intervention teams.

DIF: Cognitive Level: Application REF: Page 492

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. Which behavior is observed in the honeymoon stage of a communitys adjustment to a severe flood?

a.

Individuals unselfishly share the limited resources.

b.

The communitys shopping mall and theater reopen.

c.

A community rally is held to show support for the rebuilding of the town.

d.

Individuals protest the governments plan to distribute flood recovery funding.

ANS: C

The honeymoon phase occurs 1 week to 3 to 6 months after the event, when feelings of community sharing and high social attachment exist demonstrated by a community rally. The heroic phase occurs immediately after the event, and it is a time of altruism and heroic behavior in the community such as selfless sharing. The disillusionment phase occurs 2 months to 1 to 2 years after the event, and it is characterized by feelings of disappointment, anger, resentment, and bitterness regarding the expectations of support that were not met and often demonstrated through examples of community protest. The reconstruction phase occurs 2 months to 1 to 2 years after the event, when physical and emotional reinvestment take place as community resources are re-established.

DIF: Cognitive Level: Application REF: Page 487

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A worker has recently been involved in assisting with the cleanup from a flood that washed away many homes in his area and caused loss of life. Which crisis intervention would assist the worker in dealing with the traumatic experience?

a.

Arranging for his minister to meet with him

b.

Suggesting he be admitted to a mental health facility

c.

Providing him the opportunity to talk about the experience

d.

Encouraging him to leave the area in order to forget the experience

ANS: C

The worker needs to be able to express his feelings and deal with the pain associated with the crisis event. Nurses can help facilitate understanding of the event by listening and teaching. The remaining interventions are not considered crisis interventions.

DIF: Cognitive Level: Application REF: Page 495 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

11. A patient who survived a tornado is without shelter and food, has lost his car, and has learned that several friends sustained injuries. To tailor intervention to the patients needs, the nurse would make it a priority to:

a.

Offer antianxiety medication.

b.

Explore earlier life experiences.

c.

Explain computer-based crisis therapy.

d.

Arrange for an agency to provide shelter and food.

ANS: D

Maslows hierarchy of need theory suggests that survival needs should be met first. Thus arranging for food and shelter takes precedence over other concerns.

DIF: Cognitive Level: Analysis REF: Page 492 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

12. A new nurse mentions, I can understand a situational crisis upsetting a persons equilibrium, but I dont understand how something positive, like getting married or having a baby, can precipitate a crisis. To explain, the mentor should answer, You need to think of a crisis as a(n):

a.

Threat to survival.

b.

Threat to the familiar.

c.

Opportunity to learn.

d.

Psychiatric disorder.

ANS: B

By viewing a crisis as a threat to the norm, it is possible to understand why even positive events, such as winning the lottery, may provoke a crisis. Crises are not considered discrete psychiatric disorders nor are they opportunities to learn. Crises are not always threats to ones physical survival.

DIF: Cognitive Level: Application REF: Page 483

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

13. At the crisis center a staff nurse tells the nurse clinician, The patient is dealing with an internal crisis situation. Which situation would qualify as a trigger for that designation?

a.

Job loss

b.

Marital breakup

c.

Death of a friend

d.

Loss of religious faith

ANS: D

Internal (subjective) crises are threats to a persons well-being that are not so obvious to the outside observer. Some are associated with phase-of-life events. Loss of faith in a supreme being would exemplify an internal crisis. The other options are considered external (situational) crises.

DIF: Cognitive Level: Analysis REF: Page 484

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14. Which behavior is observed in the disillusionment stage of a communitys adjustment to a devastating hurricane?

a.

Individuals opening their homes to those without shelter.

b.

Nearby communities provide clothing and food for victims.

c.

The community remembers the event with a rally in its newly rebuilt park.

d.

State leaders attend a community meeting to discuss why funding is slow to arrive.

ANS: D

The disillusionment phase occurs 2 months to 1 to 2 years after the event, and it is characterized by feelings of disappointment, anger, resentment, and bitterness regarding the expectations of support that were not met and often demonstrated through examples of community protest meetings. The heroic phase occurs immediately after the event, and it is a time of altruism and heroic behavior in the community such as selfless sharing. Thereconstruction phase occurs 2 months to 1 to 2 years after the event, when physical and emotional reinvestment take place as community resources are re-established.

DIF: Cognitive Level: Application REF: Page 487

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. Which clinical picture can the nurse expect to see most frequently among patients who have been in a bus-train collision and derailment?

a.

Elation and hyperactivity

b.

Denial of the incident and suspicion

c.

Shock, numbness, confusion, and disorganization

d.

Highly emotional displays, such as begging for help

ANS: C

Common immediate responses to a traumatic event include shock, numbness, denial, dissociative behavior, confusion, disorganization, indecisiveness, and suggestibility. The other options contain behaviors that may be observed, but they are far less common than the behaviors given in the correct option.

DIF: Cognitive Level: Comprehension REF: Page 485

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. To plan effectively for an individual who is in crisis, the nurse must have an understanding of:

a.

Methods to establish rapport

b.

Family counseling techniques

c.

The meaning of the crisis event to the individual

d.

Posttraumatic stress disorder treatment modalities

ANS: C

Knowing the meaning to the individual is crucial, since the mitigating circumstances and support a patient has may reduce the impact of the crisis event. For example, a property loss is likely to be of greater concern to someone with few financial resources than to someone who is wealthy or fully insured. Establishing rapport should occur prior to the planning stage. An understanding of family counseling techniques is not necessary. Crisis intervention may not depend on information about posttraumatic stress disorder.

DIF: Cognitive Level: Comprehension REF: Page 490 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

17. Which nursing intervention is vital to the effective management of a psychiatric emergency resulting from a patients experience of extreme despair?

a.

Suicide precautions

b.

Introduction to a support group

c.

Introducing new coping mechanisms

d.

Assessment for obsessive-compulsive rituals

ANS: A

A psychiatric emergency involves a sudden and serious psychological disturbance that results in a behavioral state that requires intervention to prevent a life-threatening or psychologically damaging consequence. Despair is often associated with the patients attempt at self-harm and so suicide precautions are vital to emergency management in the situation. Obsessive-compulsive behavior is not generally seen as a response to despair. The remaining interventions would not be considered during emergency management.

DIF: Cognitive Level: Application REF: Page 487

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

18. Which patient statement assures the nurse that the patients immediate psychiatric emergency has been resolved?

a.

Will I ever be able to go back to my family and job?

b.

I dont ever want to feel so out of control ever again.

c.

Will you please ask the doctor if I can have a pill for my nerves?

d.

I will let you know if I start feeling the need to hurt myself again.

ANS: D

The primary factor that distinguishes a psychiatric emergency from other types of crises and medical emergencies is the presence or threat of danger to the self or others. When the patient expresses the willingness to alert the staff when such feelings are occurring there is reason to believe the immediate emergency has past. The other options do not exhibit such a sense of willingness on the patients part.

DIF: Cognitive Level: Application REF: Page 488 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

19. Which patient has the greatest risk for the development of a psychiatric emergency?

a.

The schizophrenic older adult living on the streets

b.

The anorexic young adult hospitalized for treatment

c.

The orphaned teenager who lives with grandparents

d.

The teenager who has a problem with authority figures

ANS: A

Populations at high risk for psychiatric emergencies include those with chronic mental pathologies, such as chronic schizophrenia, because their emotional stability can be easily disrupted. The other patients lack that element of emotional and cognitive fragility and have a responsible support system.

DIF: Cognitive Level: Analysis REF: Page 488

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. The crisis nurse working with law enforcement is called to assist at a scene where an overtly psychotic individual is threatening officers with a handgun. He shouts that aliens dressed like police are pursuing him and he has to get away. The priority intervention is:

a.

Evaluate the patient for recent substance use.

b.

Ensure the patients safety and develop rapport.

c.

Screen for the level of psychiatric care needed.

d.

Assist the patient to make sense of the experience.

ANS: B

Patients who feel threatened should be assured of their safety so that rapport building can take place. When rapport has been developed, the nurse may be able to convince the individual to give up any weapons. The patient is not capable of understanding the experience at this point in the scenario. Although relevant, the remaining options do not have the priority of the correct option since they depend upon a therapeutic nurse-patient rapport.

DIF: Cognitive Level: Analysis REF: Page 489 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

21. Which patient behavior assures the nurse that the primary goal of crisis intervention has been achieved by a patient who experiencing extreme mania?

a.

The patient has resumed a healthy sleep pattern.

b.

The patient has asked that their family be allowed to visit.

c.

The patient demonstrates an understanding of manic behaviors.

d.

The patient is compliant with the medication therapy prescribed.

ANS: A

The goal of crisis intervention is to return the individual to their precrisis level of functioning. Resuming healthy sleep patterns would indicate that the crisis had been resolved. The remaining options fail to demonstrate a return to normal or precrisis function or behavior.

DIF: Cognitive Level: Application REF: Page 491 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

22. Which statement is the basis for the combination of both interactive therapy and antidepressant medication for a patient whose chronic depression resulted in a suicide attempt?

a.

Therapy is seldom effective when not supported with appropriately prescribed medications.

b.

The suicide attempt was the deciding factor in determining the need to prescribe an antidepressant.

c.

Patients are more willing to attend therapy sessions when they are prescribed medications to manage acute symptoms.

d.

Research has shown that a combination of therapy and medications achieve expected outcomes more effectively than single interventions.

ANS: D

In general, when medications are indicated, the combination of medication and interactive therapy is more effective than either modality alone. The remaining options are not true statements.

DIF: Cognitive Level: Application REF: Pages 491-492

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which statements are the basis for making counseling available to grade-school children who have experienced the violent death of a classmate? Select all that apply.

a.

It is vital to foster each childs sense of psychologically safety.

b.

The fear of the unknown circumstances of the classmates death will serve to increase their own anxieties.

c.

Counseling will provide mental health professionals with the opportunity to address all the childrens concerns.

d.

The more appropriate information the children are given about their classmates death, the better they will be able to understand why the death occurred.

e.

Although the children may not be capable of understanding the information they are given, the interaction with mental health providers will minimize their anxieties.

ANS: A, B, D

Strategies to enhance a sense of psychological safety for children in crisis include talking with the child about the crisis or trauma in terms that he or she can understand. The more information that the child can be given about who, what, where, why, and how the crisis occurred, the easier it is for the child to make sense of the situation. Fear of the unknown will make a traumatized child more anxious and symptomatic. Although is may not be possible to address or resolve all of the concerns, listening to the child, without necessarily having good answers to his or her questions, can be very therapeutic.

DIF: Cognitive Level: Application REF: Page 492

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. Which nursing interventions are implemented when using the ACT model to manage a patient who has experienced a physical assault while visiting a vacation resort? Select all that apply.

a.

Assessing the patients need for medical attention

b.

Performing a cultural assessment

c.

Arranging for a social service consult

d.

Offering to notify the patients family

e.

Requesting a visit by the hospital clergy

ANS: A, B, C, D

The components of ACT include assessment for immediate medical needs as well as a cultural assessment in order to provide culturally sensitive care. Facilitating connection to support systems such as family and social services will help meet the patients need for physical and emotional support. Requesting a clergy visit should not be done without the first securing the patients consent.

DIF: Cognitive Level: Application REF: Page 491

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. Which assessment observations will be most influential in determining whether a patient exhibiting signs of alcohol intoxication who was brought to the emergency room by friends will be involuntarily admitted for psychiatric evaluation? Select all that apply.

a.

The patients earlier contact with a crisis hotline

b.

Expressing a desire, to just drive myself home

c.

Patients admission that, I dont want to keep living like this.

d.

Uncooperative and disrespectful behavior towards the hospital staff

e.

Announcing that, my girlfriend will pay for leaving me for my best friend.

ANS: C, E

The decision to admit this patient involuntarily is based on whether the person poses a danger to himself or herself, including sharing thoughts or threats of suicide, sharing a suicide plan, or actively using a weapon or situation to injure himself or herself; and/or whether the person poses a danger to others as evidenced by threatening another, brandishing a weapon, or displaying erratic or unpredictable behavior. The remaining options do not fulfill either of these conditions.

DIF: Cognitive Level: Application REF: Page 488

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. Which situations would increase an individuals risk for ineffective coping related to stress? Select all that apply.

a.

Being over 65 years of age

b.

Being unmarried and female

c.

Having been adopted as an infant

d.

Having a history of chronic back pain

e.

Being diagnosed with both depression and hypertension

ANS: D, E

Risk factors may limit an individuals ability to cope or problem solve during stressful life events or situations. These may include the presence of concurrent or multiple biopsychosocial stressors, such as depression and hypertension, as well as chronic physical or psychological pain. The other options are not known to negatively impact an individuals ability to cope or problem solve.

DIF: Cognitive Level: Application REF: Page 484

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. Which characteristic makes a stressful event a crisis situation? Select all that apply.

a.

The event was not expected.

b.

The patient felt emotional or physically threatened.

c.

The event resulted in physical trauma to the patient.

d.

The patient showed immediate signs of anxiety or panic.

e.

The patient has little or no social support system to rely upon.

ANS: A, B

Crises have defining characteristics that include being unexpected and creating the perceptions of threat. The other options are not necessary characteristics of a crisis situation.

DIF: Cognitive Level: Comprehension REF: Page 483

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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