Chapter 34 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 34

Question 1

Type: MCSA

A client who is nearing high school graduation is unable to finish out the year, cries at night, has difficulty sleeping, and does not want to attend classes. Which type of crisis does the nurse identify?

1. Trauma from previous crisis

2. Situational crisis

3. Recoil response

4. Maturational crisis

Correct Answer: 4

Rationale 1: Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. Situational crises typically arise from sudden, unanticipated events or changes. In recoil, the initial stress has passed, which is not the case for the client who is nearing graduation. There is not enough information to assess the presence of a previous trauma.

Rationale 2: Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. Situational crises typically arise from sudden, unanticipated events or changes. In recoil, the initial stress has passed, which is not the case for the client who is nearing graduation. There is not enough information to assess the presence of a previous trauma.

Rationale 3: Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. Situational crises typically arise from sudden, unanticipated events or changes. In recoil, the initial stress has passed, which is not the case for the client who is nearing graduation. There is not enough information to assess the presence of a previous trauma.

Rationale 4: Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. Situational crises typically arise from sudden, unanticipated events or changes. In recoil, the initial stress has passed, which is not the case for the client who is nearing graduation. There is not enough information to assess the presence of a previous trauma.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe the types of maturational and situational crises a person can experience.

Question 2

Type: MCSA

One of the following statements regarding crises is incorrect. Identify the incorrect statement.

1. A maturational crisis involves life cycle changes or transitions of human development.

2. A situational crisis can originate from material, environmental, or personal sources.

3. Experiencing a crisis always develops into post-traumatic stress disorder.

4. A crisis is an acute time-limited state of disequilibrium.

Correct Answer: 3

Rationale 1: Early treatment can lead to crisis resolution. Not all clients develop PTSD after a crisis. The other statements are all true.

Rationale 2: Early treatment can lead to crisis resolution. Not all clients develop PTSD after a crisis. The other statements are all true.

Rationale 3: Early treatment can lead to crisis resolution. Not all clients develop PTSD after a crisis. The other statements are all true.

Rationale 4: Early treatment can lead to crisis resolution. Not all clients develop PTSD after a crisis. The other statements are all true.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Describe the types of maturational and situational crises a person can experience.

Question 3

Type: MCSA

A client who has been divorced for six months has recently been lying in bed most days, unable to care for the children. This is referred to as:

1. A situational crisis.

2. A stressful situation.

3. Lack of resilience.

4. Regression.

Correct Answer: 1

Rationale 1: The stressful situation (divorce) has caused a situational crisis. The client is not using previously developed coping skills, but instead adopted the ineffective coping mechanism of regression. Lack of resilience cannot be identified from the information given.

Rationale 2: The stressful situation (divorce) has caused a situational crisis. The client is not using previously developed coping skills, but instead adopted the ineffective coping mechanism of regression. Lack of resilience cannot be identified from the information given.

Rationale 3: The stressful situation (divorce) has caused a situational crisis. The client is not using previously developed coping skills, but instead adopted the ineffective coping mechanism of regression. Lack of resilience cannot be identified from the information given.

Rationale 4: The stressful situation (divorce) has caused a situational crisis. The client is not using previously developed coping skills, but instead adopted the ineffective coping mechanism of regression. Lack of resilience cannot be identified from the information given.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe the types of maturational and situational crises a person can experience.

Question 4

Type: MCMA

Different types of crises arise from different causes. Maturational crises can involve:

Standard Text: Select all that apply.

1. Transition from student to worker.

2. Normal transitions of human development.

3. Life cycle changes.

4. Changes such as marriage or retirement.

5. Life changes from a flood.

Correct Answer: 1,2,3,4

Rationale 1: Changes in life that relate to maturing (e.g. student to worker, worker to retiree), and transitions of roles (single person to spouse) can precipitate a maturational crisis.

Rationale 2: Transitions of the human body as it develops can precipitate a maturational crisis. This relates to levels of maturity and progression through life.

Rationale 3: Changes in circumstances related to progression through life and the maturing process can precipitate a maturational crisis.

Rationale 4: Changes in life that relate to maturing (e.g. student to worker, worker to retiree), and transitions of roles (single person to spouse) can precipitate a maturational crisis.

Rationale 5: Situational crises arise out of changes, a result of an event, or situation.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe the types of maturational and situational crises a person can experience.

Question 5

Type: MCSA

A client, divorced for one year, has recently had crisis counseling. The client has begun to take classes at the community college and has enrolled the children in day care. These new actions could be referred to as:

1. A response to stress.

2. A situational crisis.

3. A turning point in life.

4. A maturational crisis.

Correct Answer: 3

Rationale 1: Crisis situations such as a divorce can become turning points or junctures in life that result in a change in equilibrium, positive or negative. The client may have experienced a situational crisis and stress, but the events of the clients last year have resulted in a turning point. A maturational crisis is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals.

Rationale 2: Crisis situations such as a divorce can become turning points or junctures in life that result in a change in equilibrium, positive or negative. The client may have experienced a situational crisis and stress, but the events of the clients last year have resulted in a turning point. A maturational crisis is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals.

Rationale 3: Crisis situations such as a divorce can become turning points or junctures in life that result in a change in equilibrium, positive or negative. The client may have experienced a situational crisis and stress, but the events of the clients last year have resulted in a turning point. A maturational crisis is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals.

Rationale 4: Crisis situations such as a divorce can become turning points or junctures in life that result in a change in equilibrium, positive or negative. The client may have experienced a situational crisis and stress, but the events of the clients last year have resulted in a turning point. A maturational crisis is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate between a crisis that is a turning point in a persons life and making an important life decision.

Question 6

Type: MCSA

Which of the following statements by a client would reflect a turning point?

1. This was difficult for me, but I have learned how to manage myself in my new job.

2. If only they would give me another chance, I know I could do better.

3. I will get them for this.

4. I guess I deserved this. I was not a great employee.

Correct Answer: 1

Rationale 1: Acknowledging it has been difficult but the client has learned to manage in a new job demonstrates that the client has reached a turning point and may learn from his or her experience. Thoughts of revenge, resignation, or unrealistic expectations of change do not necessarily reflect a turning point.

Rationale 2: Acknowledging it has been difficult but the client has learned to manage in a new job demonstrates that the client has reached a turning point and may learn from his or her experience. Thoughts of revenge, resignation, or unrealistic expectations of change do not necessarily reflect a turning point.

Rationale 3: Acknowledging it has been difficult but the client has learned to manage in a new job demonstrates that the client has reached a turning point and may learn from his or her experience. Thoughts of revenge, resignation, or unrealistic expectations of change do not necessarily reflect a turning point.

Rationale 4: Acknowledging it has been difficult but the client has learned to manage in a new job demonstrates that the client has reached a turning point and may learn from his or her experience. Thoughts of revenge, resignation, or unrealistic expectations of change do not necessarily reflect a turning point.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate between a crisis that is a turning point in a persons life and making an important life decision.

Question 7

Type: MCMA

Crisis situations are turning points in a clients life. This can result in:

Standard Text: Select all that apply.

1. Something close to a pre-crisis state of functioning.

2. A realistic perception of the event.

3. Dysfunctional personal coping.

4. Anticipatory guidance assistance.

5. A more negative or positive state.

Correct Answer: 1,3,5

Rationale 1: Experiencing something close to a pre-crisis state of functioning is an example of change as a result of a crisis.

Rationale 2: A realistic perception of the event. can develop as a result of crisis counseling.

Rationale 3: Dysfunctional personal coping is an example of change as a result of a crisis.

Rationale 4: Anticipatory guidance assistance is an intervention to assist clients envisioning a future experience.

Rationale 5: Achieving a more negative or positive state is an example of change as a result of a crisis.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Differentiate between a crisis that is a turning point in a persons life and making an important life decision.

Question 8

Type: MCSA

The nursing diagnosis that would not be made for a client having experienced a situational crisis is:

1. Risk for Loneliness.

2. Risk for Self-directed Violence.

3. Spiritual Distress.

4. Impaired Social Interaction.

Correct Answer: 1

Rationale 1: Loneliness may result from an individuals actions following a crisis, but it is not a nursing diagnosis. The other three answers are among the most common nursing diagnoses for people in crisis.

Rationale 2: Loneliness may result from an individuals actions following a crisis, but it is not a nursing diagnosis. The other three answers are among the most common nursing diagnoses for people in crisis.

Rationale 3: Loneliness may result from an individuals actions following a crisis, but it is not a nursing diagnosis. The other three answers are among the most common nursing diagnoses for people in crisis.

Rationale 4: Loneliness may result from an individuals actions following a crisis, but it is not a nursing diagnosis. The other three answers are among the most common nursing diagnoses for people in crisis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Analyze the sequence of a crisis and determine its significance for the nursing care of a client in crisis.

Question 9

Type: MCSA

Effective planning for a clients crisis intervention is:

1. Organized with follow-up.

2. Developed prior to meeting with the client.

3. Based on complete assessment.

4. Focused on long-term problems.

Correct Answer: 3

Rationale 1: Nursing care is based on assessment. Thus, a plan cannot be developed prior to meeting with the client. The time frame, whether short-term or long-term, and the need for follow-up, will be determined by the findings of the assessment.

Rationale 2: Nursing care is based on assessment. Thus, a plan cannot be developed prior to meeting with the client. The time frame, whether short-term or long-term, and the need for follow-up, will be determined by the findings of the assessment.

Rationale 3: Nursing care is based on assessment. Thus, a plan cannot be developed prior to meeting with the client. The time frame, whether short-term or long-term, and the need for follow-up, will be determined by the findings of the assessment.

Rationale 4: Nursing care is based on assessment. Thus, a plan cannot be developed prior to meeting with the client. The time frame, whether short-term or long-term, and the need for follow-up, will be determined by the findings of the assessment.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Analyze the sequence of a crisis and determine its significance for the nursing care of a client in crisis.

Question 10

Type: MCSA

Which statement should include communication strategies when a client has had a situational crisis?

1. I am sorry this happened to you.

2. I know just how you feel.

3. Its best to stay busy.

4. It could have been worse.

Correct Answer: 1

Rationale 1: Stating that the nurse is sorry for what the client has experienced reflects empathy. Assessing the clients current emotional state and coping mechanisms that have been effective in the past require open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt his/her own coping strategies. Telling the client it could have been worse minimizes the clients unique experience.

Rationale 2: Stating that the nurse is sorry for what the client has experienced reflects empathy. Assessing the clients current emotional state and coping mechanisms that have been effective in the past require open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt his/her own coping strategies. Telling the client it could have been worse minimizes the clients unique experience.

Rationale 3: Stating that the nurse is sorry for what the client has experienced reflects empathy. Assessing the clients current emotional state and coping mechanisms that have been effective in the past require open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt his/her own coping strategies. Telling the client it could have been worse minimizes the clients unique experience.

Rationale 4: Stating that the nurse is sorry for what the client has experienced reflects empathy. Assessing the clients current emotional state and coping mechanisms that have been effective in the past require open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt his/her own coping strategies. Telling the client it could have been worse minimizes the clients unique experience.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: Analyze the sequence of a crisis and determine its significance for the nursing care of a client in crisis.

Question 11

Type: MCSA

Balancing factors that help clients after a crisis would not include:

1. Degree of threat to life.

2. Realistic perception of the event.

3. Decreased or limited communication.

4. Adequate coping mechanisms.

Correct Answer: 3

Rationale 1: Communication is encouraged during crisis interventions and decreased or limited communication would not help the client resolve the crisis. The other choices are balancing factors.

Rationale 2: Communication is encouraged during crisis interventions and decreased or limited communication would not help the client resolve the crisis. The other choices are balancing factors.

Rationale 3: Communication is encouraged during crisis interventions and decreased or limited communication would not help the client resolve the crisis. The other choices are balancing factors.

Rationale 4: Communication is encouraged during crisis interventions and decreased or limited communication would not help the client resolve the crisis. The other choices are balancing factors.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Incorporate an understanding of the origins of a crisis, risk factors, and balancing factors during the assessment phase of crisis management.

Question 12

Type: MCSA

Which of the following are risk factors that may continue to promote disequilibrium?

1. Sudden experience, no warning signs

2. Poverty, abuse, pre-existing psychiatric disorder

3. Coping skills, strong self-esteem

4. Communication with others

Correct Answer: 2

Rationale 1: Poverty, abuse, and psychiatric disorders can contribute to instability, making it difficult to establish a new equilibrium. Communication, coping skills, and strong self-esteem are included in balancing factors that may help the client after a crisis. Suddenness and a lack of warning signs are characteristics of events that cause a situational crisis.

Rationale 2: Poverty, abuse, and psychiatric disorders can contribute to instability, making it difficult to establish a new equilibrium. Communication, coping skills, and strong self-esteem are included in balancing factors that may help the client after a crisis. Suddenness and a lack of warning signs are characteristics of events that cause a situational crisis.

Rationale 3: Poverty, abuse, and psychiatric disorders can contribute to instability, making it difficult to establish a new equilibrium. Communication, coping skills, and strong self-esteem are included in balancing factors that may help the client after a crisis. Suddenness and a lack of warning signs are characteristics of events that cause a situational crisis.

Rationale 4: Poverty, abuse, and psychiatric disorders can contribute to instability, making it difficult to establish a new equilibrium. Communication, coping skills, and strong self-esteem are included in balancing factors that may help the client after a crisis. Suddenness and a lack of warning signs are characteristics of events that cause a situational crisis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Incorporate an understanding of the origins of a crisis, risk factors, and balancing factors during the assessment phase of crisis management.

Question 13

Type: MCSA

A client describes being depressed, out of control, and unable to make decisions. Upon assessment, the nurse determines that the client has recently experienced a fire at home in which many important files as well as family mementos were destroyed. Many things that were not totally burned were water damaged. The nurse knows that identifying the origin of the crisis:

1. Motivates the client and family to take significant action in relationships.

2. Promotes an increased opportunity for interventions to be effective.

3. Decreases communication with significant others.

4. Assists with identifying the level of grief.

Correct Answer: 2

Rationale 1: Understanding the origin of the crisis is as important as recognizing the type of crisis. Interventions will vary depending on the origin of a crisis. Identifying the origin of a crisis does not lead to decreased communication with significant others. The clients family relationships may be unrelated to the crisis, and may potentially be a strong resource for the client. Not all clients experience grief in response to a crisis.

Rationale 2: Understanding the origin of the crisis is as important as recognizing the type of crisis. Interventions will vary depending on the origin of a crisis. Identifying the origin of a crisis does not lead to decreased communication with significant others. The clients family relationships may be unrelated to the crisis, and may potentially be a strong resource for the client. Not all clients experience grief in response to a crisis.

Rationale 3: Understanding the origin of the crisis is as important as recognizing the type of crisis. Interventions will vary depending on the origin of a crisis. Identifying the origin of a crisis does not lead to decreased communication with significant others. The clients family relationships may be unrelated to the crisis, and may potentially be a strong resource for the client. Not all clients experience grief in response to a crisis.

Rationale 4: Understanding the origin of the crisis is as important as recognizing the type of crisis. Interventions will vary depending on the origin of a crisis. Identifying the origin of a crisis does not lead to decreased communication with significant others. The clients family relationships may be unrelated to the crisis, and may potentially be a strong resource for the client. Not all clients experience grief in response to a crisis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate an understanding of the origins of a crisis, risk factors, and balancing factors during the assessment phase of crisis management.

Question 14

Type: MCSA

The nurse is working with a client whose brother had recently died as a result of a brain aneurism. The client reports spending the days crying or sleeping. The nurse intervenes in this situation to:

1. Encourage the client to stay busy.

2. Help the client focus on other aspects of life.

3. Provide respite from a painful reality.

4. Restore the client to pre-trauma level of functioning.

Correct Answer: 4

Rationale 1: The outcome of the intervention should be to get the client to the highest level of functioning possible, which typically is consistent with the pre-crisis level of function. Distraction, refocusing on other areas of life, and ignoring the situation that triggered the crisis are not therapeutic interventions.

Rationale 2: The outcome of the intervention should be to get the client to the highest level of functioning possible, which typically is consistent with the pre-crisis level of function. Distraction, refocusing on other areas of life, and ignoring the situation that triggered the crisis are not therapeutic interventions.

Rationale 3: The outcome of the intervention should be to get the client to the highest level of functioning possible, which typically is consistent with the pre-crisis level of function. Distraction, refocusing on other areas of life, and ignoring the situation that triggered the crisis are not therapeutic interventions.

Rationale 4: The outcome of the intervention should be to get the client to the highest level of functioning possible, which typically is consistent with the pre-crisis level of function. Distraction, refocusing on other areas of life, and ignoring the situation that triggered the crisis are not therapeutic interventions.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: Incorporate an understanding of the origins of a crisis, risk factors, and balancing factors during the assessment phase of crisis management.

Question 15

Type: MCMA

The nurse working with a client who is a survivor of a four-car accident knows that there are risk factors that influence this clients response to the traumatic experience. The risk factors are:

Standard Text: Select all that apply.

1. Prior history of crises.

2. Believing that receiving help is a sign of weakness.

3. Cultural expectations that prohibit asking others for help.

4. Feelings of loss.

5. Pre-existing psychiatric symptoms and diagnosis.

Correct Answer: 1,2,3,5

Rationale 1: Prior history of crises. This may amplify the current traumatic experience, causing an increased risk as to how the client will progress with crisis intervention.

Rationale 2: Believing that receiving help is a sign of weakness. Not wanting help prevents crisis intervention. This may particularly be a risk factor for older adults raised during the Great Depression and Second World War.

Rationale 3: Cultural expectations that prohibit asking others for help. This interferes with crisis counseling.

Rationale 4: Feelings of loss. This is a normal emotion in a crisis.

Rationale 5: Pre-existing psychiatric symptoms and diagnosis. This has the potential to influence the clients resources such as resilience and presence of family support, which could affect how the client is able to process the event, interact with others, and be able to progress toward healing.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of the origins of a crisis, risk factors, and balancing factors during the assessment phase of crisis management.

Question 16

Type: MCSA

A client is brought to the emergency department after being in a house fire. After determining the client is stable physically, what is the first phase of crisis intervention?

1. Assess the impact this experience has had on the client

2. Confront the reality of the crisis

3. Reassure client and family

4. Teach coping skills to client

Correct Answer: 1

Rationale 1: Assessment is the first step to evaluate the condition of a client. The clients need to be reassured, to engage with the reality of the crisis, or readiness to receive instruction, cannot be determined without a thorough assessment.

Rationale 2: Assessment is the first step to evaluate the condition of a client. The clients need to be reassured, to engage with the reality of the crisis, or readiness to receive instruction, cannot be determined without a thorough assessment.

Rationale 3: Assessment is the first step to evaluate the condition of a client. The clients need to be reassured, to engage with the reality of the crisis, or readiness to receive instruction, cannot be determined without a thorough assessment.

Rationale 4: Assessment is the first step to evaluate the condition of a client. The clients need to be reassured, to engage with the reality of the crisis, or readiness to receive instruction, cannot be determined without a thorough assessment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize crisis intervention modalities into a plan of care for a person in crisis.

Question 17

Type: MCSA

The nurse has observed a number of behaviors in the client that indicate that stress management is needed. The behavior the nurse did not observe was:

1. Increased tendency to feel frustrated.

2. Verbalization of feelings.

3. Loss of objectivity.

4. Unnecessary risk-taking.

Correct Answer: 2

Rationale 1: A client who can express feelings has the ability to let the nurse know how the crisis has affected his/her life. Increased frustration, unnecessary risk-taking, and loss of objectivity are all indicators that stress management is needed.

Rationale 2: A client who can express feelings has the ability to let the nurse know how the crisis has affected his/her life. Increased frustration, unnecessary risk-taking, and loss of objectivity are all indicators that stress management is needed.

Rationale 3: A client who can express feelings has the ability to let the nurse know how the crisis has affected his/her life. Increased frustration, unnecessary risk-taking, and loss of objectivity are all indicators that stress management is needed.

Rationale 4: A client who can express feelings has the ability to let the nurse know how the crisis has affected his/her life. Increased frustration, unnecessary risk-taking, and loss of objectivity are all indicators that stress management is needed.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize crisis intervention modalities into a plan of care for a person in crisis.

Question 18

Type: MCSA

A client is participating in therapy that explores the effects of unrealistic thought patterns on daily life. Which type of therapy is the client likely engaging in?

1. Family therapy to explore dynamics

2. Cognitive therapy techniques

3. Alternate-Nostril Breathing

4. Repetitive Transcranial Magnetic Stimulation

Correct Answer: 2

Rationale 1: Cognitive therapy techniques promote evaluation of thought patterns and how life is being influenced by thought patterns. The other therapies do not deal with thought patterns.

Rationale 2: Cognitive therapy techniques promote evaluation of thought patterns and how life is being influenced by thought patterns. The other therapies do not deal with thought patterns.

Rationale 3: Cognitive therapy techniques promote evaluation of thought patterns and how life is being influenced by thought patterns. The other therapies do not deal with thought patterns.

Rationale 4: Cognitive therapy techniques promote evaluation of thought patterns and how life is being influenced by thought patterns. The other therapies do not deal with thought patterns.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Synthesize crisis intervention modalities into a plan of care for a person in crisis.

Question 19

Type: MCMA

Which of the following reflects the concepts of crisis intervention?

Standard Text: Select all that apply.

1. Includes interdisciplinary treatment

2. Restoring the individual to a sense of equilibrium

3. Used when client is unable to overcome the effects of a crisis

4. Utilized when client becomes suicidal

5. Short-term, action-oriented assistance, focused on problem-solving

Correct Answer: 1,2,5

Rationale 1: Includes interdisciplinary treatment. Effective crisis intervention care includes various disciplines.

Rationale 2: Restoring the individual to a sense of equilibrium. This is a planned client outcome of crisis intervention.

Rationale 3: Used when client is unable to overcome the effects of the crisis. Crisis intervention should be initiated as soon as possible after a traumatic event to prevent further dysfunction. Delaying intervention until difficulties are evident does not reflect this preventive approach.

Rationale 4: Utilized when client becomes suicidal. Crisis intervention should be initiated as soon as possible after a traumatic event.

Rationale 5: Short-term, action-oriented assistance, focused on problem-solving. This describes the conceptual framework for crisis intervention.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize crisis intervention modalities into a plan of care for a person in crisis.

Question 20

Type: MCSA

Which statement by a client would suggest that the ABCs of crisis counseling have been met?

1. I am really glad we did this counseling.

2. I will call you if I need you.

3. I now know some better ways of coping.

4. I will miss working with you.

Correct Answer: 3

Rationale 1: The ABCs of counseling include achieving contact, boiling down the problem, and coping with the problem. The client understands that coping is important when experiencing a crisis. The other statements are examples of social communication.

Rationale 2: The ABCs of counseling include achieving contact, boiling down the problem, and coping with the problem. The client understands that coping is important when experiencing a crisis. The other statements are examples of social communication.

Rationale 3: The ABCs of counseling include achieving contact, boiling down the problem, and coping with the problem. The client understands that coping is important when experiencing a crisis. The other statements are examples of social communication.

Rationale 4: The ABCs of counseling include achieving contact, boiling down the problem, and coping with the problem. The client understands that coping is important when experiencing a crisis. The other statements are examples of social communication.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate the ABCs of crisis counseling in a plan of care for a client in crisis.

Question 21

Type: MCSA

The first step in crisis intervention is to achieve contact. When initiating contact with a client after a crisis, the nurse should not:

1. Collect information regarding health conditions.

2. Provide for emotional and physical safety of client.

3. Discuss the nurses personal experiences with crises.

4. Identify feelings, reactions, and perceptions of client.

Correct Answer: 3

Rationale 1: Relating personal information takes the focus off the client and is not relevant to the needs of the client. The other interventions are therapeutic, appropriately reflecting the tasks and interactions in the nursing role.

Rationale 2: Relating personal information takes the focus off the client and is not relevant to the needs of the client. The other interventions are therapeutic, appropriately reflecting the tasks and interactions in the nursing role.

Rationale 3: Relating personal information takes the focus off the client and is not relevant to the needs of the client. The other interventions are therapeutic, appropriately reflecting the tasks and interactions in the nursing role.

Rationale 4: Relating personal information takes the focus off the client and is not relevant to the needs of the client. The other interventions are therapeutic, appropriately reflecting the tasks and interactions in the nursing role.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the ABCs of crisis counseling in a plan of care for a client in crisis.

Question 22

Type: MCSA

The nurse is conducting training for crisis counselors. The nurse would include the intervention strategies of safety and security, ventilate and validate, predict and prepare which are:

1. A way to identify when the crisis is maturational.

2. Best used before a crisis.

3. Applied when the clients are unable to progress.

4. Referred to as the ABCs of crisis counseling.

Correct Answer: 4

Rationale 1: Strategies of safety and security, ventilate and validate, and predict and prepare are also considered the ABCs of crisis counseling. These interventions are utilized for preparation if possible and throughout the event.

Rationale 2: Strategies of safety and security, ventilate and validate, and predict and prepare are also considered the ABCs of crisis counseling. These interventions are utilized for preparation if possible and throughout the event.

Rationale 3: Strategies of safety and security, ventilate and validate, and predict and prepare are also considered the ABCs of crisis counseling. These interventions are utilized for preparation if possible and throughout the event.

Rationale 4: Strategies of safety and security, ventilate and validate, and predict and prepare are also considered the ABCs of crisis counseling. These interventions are utilized for preparation if possible and throughout the event.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the ABCs of crisis counseling in a plan of care for a client in crisis.

Question 23

Type: MCMA

Communication intervention strategies are significant for the nurse to utilize. These techniques include:

Standard Text: Select all that apply.

1. Personal revelations about the nurses feelings to break the ice.

2. Reflecting statements that encourage the client to express feelings.

3. Paraphrasing client statements using clinical terms.

4. Statements that promote expression of the clients emotions.

5. Clarifying statements the client has made.

Correct Answer: 2,4,5

Rationale 1: Personal revelations about the nurses feelings to break the ice. The nurses feelings should not be a focus of interventions.

Rationale 2: Reflecting statements that encourage the client to express feelings. This assists the client to put feelings into words.

Rationale 3: Paraphrasing client statements using clinical terms. When used to promote understanding, paraphrasing can assist both the nurse and the client to review what is understood. Clinical jargon may not be known to the client and should be avoided.

Rationale 4: Statements that promote expression of the clients emotions. Emotions are often not shown when a client is in crisis.

Rationale 5: Clarifying statements the client has made. This assists the nurse to understand the clients viewpoint.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop a psychoeducational plan for clients and families who are disaster victims.

Question 24

Type: MCMA

The nurse is working with a family that has just survived a tornado. As part of the intervention, the nurse is reviewing emotions they may be experiencing which are considered normal reactions to a traumatic event, including:

Standard Text: Select all that apply.

1. Each family member talks to the nurse openly and freely.

2. Each member of the family has different ways of coping.

3. Some family members have difficulty accepting help.

4. Anxiety about self and familys safety.

5. All family members will process the experience at about the same pace.

Correct Answer: 2,3,4

Rationale 1: Each family member talks to the nurse openly and freely. Communication is difficult for most clients after a sudden crisis.

Rationale 2: Each member of the family has different ways of coping. Family members are all at a different levels of maturity and each has different coping skills.

Rationale 3: Some family members have difficulty accepting help. Different family members will respond in various ways to offers of help due to each persons individuality and coping style.

Rationale 4: Anxiety about self and familys safety. This is an initial reaction after a persons safety has been in jeopardy.

Rationale 5: All family members will process the experience at about the same pace. Family members different maturity levels and coping skills will affect how quickly or slowly they process the experience.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop a psychoeducational plan for clients and families who are disaster victims.

Question 25

Type: MCSA

Clients require stress management when they are easily frustrated, feel hopeless, cry easily, and are reluctant to leave home. An action that would not lead to a healthy decrease in the stress is to:

1. Utilize all familiar coping strategies.

2. Spend time with family and friends.

3. Not hold themselves directly responsible.

4. Maintain a daily routine.

Correct Answer: 1

Rationale 1: Healthy coping skills will assist the client to manage stress. However, some familiar coping strategies may be unhealthy, such as increased smoking or alcohol use. Maintaining a daily routine promotes a sense of accomplishment.

Rationale 2: Healthy coping skills will assist the client to manage stress. However, some familiar coping strategies may be unhealthy, such as increased smoking or alcohol use. Maintaining a daily routine promotes a sense of accomplishment.

Rationale 3: Healthy coping skills will assist the client to manage stress. However, some familiar coping strategies may be unhealthy, such as increased smoking or alcohol use. Maintaining a daily routine promotes a sense of accomplishment.

Rationale 4: Healthy coping skills will assist the client to manage stress. However, some familiar coping strategies may be unhealthy, such as increased smoking or alcohol use. Maintaining a daily routine promotes a sense of accomplishment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop a psychoeducational plan for clients and families who are disaster victims.

Question 26

Type: MCMA

The caregiving team may also need support to process traumatic events in the community or in the care setting. Critical Incident Stress Debriefing (CISD) is a model of effective group crisis intervention. This group intervention:

Standard Text: Select all that apply.

1. Includes a several-phase group discussion.

2. Includes psychological and psychoeducational elements.

3. Includes guidelines similar to AA.

4. Is most effective in emergency settings.

Correct Answer: 1,2

Rationale 1: CISD was originally formulated in the 1980s in response to an air disaster in Washington, DC. The original approach, known as critical incident stress debriefing, was intended to include four major elementson-scene crisis intervention; post-incident small group discussion (known as defusing); a more formalized several-phase group discussion, which included debriefing; and follow-up support services. In practice, however, only one element, the group discussion, often to the exclusion of the others, became the focus of disaster mental health intervention. Its ease of use and the perception that it prevented PTSD led to its popularity. Although the small group meeting has both psychologic and psychoeducation elements, it should not by itself be considered psychotherapy.

Rationale 2: CISD was originally formulated in the 1980s in response to an air disaster in Washington, DC. The original approach, known as critical incident stress debriefing, was intended to include four major elementson-scene crisis intervention; post-incident small group discussion (known as defusing); a more formalized several-phase group discussion, which included debriefing; and follow-up support services. In practice, however, only one element, the group discussion, often to the exclusion of the others, became the focus of disaster mental health intervention. Its ease of use and the perception that it prevented PTSD led to its popularity. Although the small group meeting has both psychologic and psychoeducation elements, it should not by itself be considered psychotherapy.

Rationale 3: CISD was originally formulated in the 1980s in response to an air disaster in Washington, DC. The original approach, known as critical incident stress debriefing, was intended to include four major elementson-scene crisis intervention; post-incident small group discussion (known as defusing); a more formalized several-phase group discussion, which included debriefing; and follow-up support services. In practice, however, only one element, the group discussion, often to the exclusion of the others, became the focus of disaster mental health intervention. Its ease of use and the perception that it prevented PTSD led to its popularity. Although the small group meeting has both psychologic and psychoeducation elements, it should not by itself be considered psychotherapy.

Rationale 4: CISD was originally formulated in the 1980s in response to an air disaster in Washington, DC. The original approach, known as critical incident stress debriefing, was intended to include four major elementson-scene crisis intervention; post-incident small group discussion (known as defusing); a more formalized several-phase group discussion, which included debriefing; and follow-up support services. In practice, however, only one element, the group discussion, often to the exclusion of the others, became the focus of disaster mental health intervention. Its ease of use and the perception that it prevented PTSD led to its popularity. Although the small group meeting has both psychologic and psychoeducation elements, it should not by itself be considered psychotherapy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop a psychoeducational plan for clients and families who are disaster victims.

Question 27

Type: MCSA

A nurse working with clients affected by a disaster event must be conscious not only of the clients responses, but also the nurses own responses. Which of the following would not be a common experience?

1. Not wanting to leave the scene until work is finished

2. Denying the need for rest and recovery time

3. Inability to engage in problem solving

4. Profound sadness, grief, and anger toward an abnormal event

Correct Answer: 3

Rationale 1: It is necessary for a nurse to be able to problem-solve using the nursing process. The nurse who is not able to cognitively function may be affected by exhaustion or some level of severe grief. The other responses are common reactions and are not necessarily negative, but can reach harmful levels.

Rationale 2: It is necessary for a nurse to be able to problem-solve using the nursing process. The nurse who is not able to cognitively function may be affected by exhaustion or some level of severe grief. The other responses are common reactions and are not necessarily negative, but can reach harmful levels.

Rationale 3: It is necessary for a nurse to be able to problem-solve using the nursing process. The nurse who is not able to cognitively function may be affected by exhaustion or some level of severe grief. The other responses are common reactions and are not necessarily negative, but can reach harmful levels.

Rationale 4: It is necessary for a nurse to be able to problem-solve using the nursing process. The nurse who is not able to cognitively function may be affected by exhaustion or some level of severe grief. The other responses are common reactions and are not necessarily negative, but can reach harmful levels.

Global Rationale:

Cognitive Level: Creating

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze personal feelings and attitudes that may affect professional practice when caring for clients in crisis.

Question 28

Type: MCSA

Identify which of the following would be detrimental for the nurse desiring to manage stress when working with a client/family in crisis.

1. Drink plenty of water and eat a balanced and healthy diet

2. Participate in memorials and rituals

3. Talk about your emotions

4. Maintain a consistent work assignment

Correct Answer: 4

Rationale 1: Knowledge of ways to manage stress is necessary when working with clients/families in crisis. It is often more beneficial to rotate work assignments away from the scene, from high-stress to lower-stress assignments. The other choices are beneficial in maintaining psychological and physical well-being for those who care for clients in crisis, especially at disaster sites.

Rationale 2: Knowledge of ways to manage stress is necessary when working with clients/families in crisis. It is often more beneficial to rotate work assignments away from the scene, from high-stress to lower-stress assignments. The other choices are beneficial in maintaining psychological and physical well-being for those who care for clients in crisis, especially at disaster sites.

Rationale 3: Knowledge of ways to manage stress is necessary when working with clients/families in crisis. It is often more beneficial to rotate work assignments away from the scene, from high-stress to lower-stress assignments. The other choices are beneficial in maintaining psychological and physical well-being for those who care for clients in crisis, especially at disaster sites.

Rationale 4: Knowledge of ways to manage stress is necessary when working with clients/families in crisis. It is often more beneficial to rotate work assignments away from the scene, from high-stress to lower-stress assignments. The other choices are beneficial in maintaining psychological and physical well-being for those who care for clients in crisis, especially at disaster sites.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Analyze personal feelings and attitudes that may affect professional practice when caring for clients in crisis.

Question 29

Type: MCSA

The nurse working in disaster situations should also attend to his/her own self-care. To maintain positive self-care, the nurse should avoid:

1. Utilizing healthy coping mechanisms.

2. Monitoring ones own reactions.

3. Keeping a journal to write thoughts and feelings.

4. Focusing on improving interventions for the next crisis.

Correct Answer: 4

Rationale 1: Though it is important to evaluate actions for improvement in responding to future crises, focusing on what was done correctly promotes encouragement. Monitoring ones own reactions helps the nurse to continue to choose therapeutic interventions. Utilizing healthy coping mechanisms promotes mental health. Keeping a journal to write thoughts and feelings is helpful to express feelings and emotions, a key step in processing the experience.

Rationale 2: Though it is important to evaluate actions for improvement in responding to future crises, focusing on what was done correctly promotes encouragement. Monitoring ones own reactions helps the nurse to continue to choose therapeutic interventions. Utilizing healthy coping mechanisms promotes mental health. Keeping a journal to write thoughts and feelings is helpful to express feelings and emotions, a key step in processing the experience.

Rationale 3: Though it is important to evaluate actions for improvement in responding to future crises, focusing on what was done correctly promotes encouragement. Monitoring ones own reactions helps the nurse to continue to choose therapeutic interventions. Utilizing healthy coping mechanisms promotes mental health. Keeping a journal to write thoughts and feelings is helpful to express feelings and emotions, a key step in processing the experience.

Rationale 4: Though it is important to evaluate actions for improvement in responding to future crises, focusing on what was done correctly promotes encouragement. Monitoring ones own reactions helps the nurse to continue to choose therapeutic interventions. Utilizing healthy coping mechanisms promotes mental health. Keeping a journal to write thoughts and feelings is helpful to express feelings and emotions, a key step in processing the experience.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Analyze personal feelings and attitudes that may affect professional practice when caring for clients in crisis.

Question 30

Type: MCMA

A nurse is effective in crisis work when the nurse:

Standard Text: Select all that apply.

1. Collaborates with other health professionals.

2. Stays in control of clients.

3. Has realistic expectations.

4. Respects clients.

5. Develops own outlets for stress.

Correct Answer: 1,3,4,5

Rationale 1: Collaborates with other health professionals. This promotes evaluation of self and progress of client.

Rationale 2: Stays in control of clients. Nursing care should promote guidance, not control.

Rationale 3: Has realistic expectations. This minimizes stress.

Rationale 4: Respects clients. Being respectful to clients promotes a therapeutic relationship.

Rationale 5: Develops his or her own outlets for stress. Frustration and anger should be managed with a plan for an outlet to constructively relieve stress outside of client interactions.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Analyze personal feelings and attitudes that may affect professional practice when caring for clients in crisis.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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