Chapter 21 NURS 2547

1. A patient arrives at the crisis clinic after an unexpected job termination. The patient paces
   around the room sobbing, cringes when approached, and responds to questions with only
   shrugs or monosyllables. Which of the following indicates an appropriate response from
   the nurse?
   a. “Everything is going to be all right. You are here at the clinic, and the staff will
   keep you safe.”
   b. “I see you are feeling upset. I’m going to stay and talk with you to help you feel
   better.”
   c. “You need to try to stop crying and pacing so we can talk about your problems.”
   d. “Let’s set some guidelines and goals for your visit here.”

b. “I see you are feeling upset. I’m going to stay and talk with you to help you feel
better.”

2. A patient being seen in the clinic for superficial cuts on both wrists is pacing and sobbing.
   After a few minutes, the patient is calmer. The nurse attempts to determine the patient’s
   perception of the precipitating event by saying which of the following?
   a. “Tell me why you were crying.”
   b. “How did your wrists get injured?”
   c. “How can I help you feel more comfortable?”
   d. “What was happening just before you started to feel this way?”

d. “What was happening just before you started to feel this way?”

3. A patient arrives at the crisis centre saying, “I’m in a terrible situation. I don’t know what
   to do.” The triage nurse can initially assume that the patient is which of the following?
   a. Suicidal
   b. Anxious and fearful
   c. Misperceiving reality
   d. Potentially homicidal

b. Anxious and fearful

4. An adolescent arrives at the crisis clinic and reports sexual abuse by an uncle. The
   adolescent told both parents about the uncle’s behaviour, but the parents did not believe
   the adolescent. Which type of crisis exists?
   a. Maturational
   b. Adventitious
   c. Situational
   d. Organic

b. Adventitious

5. While conducting the initial interview with a patient in crisis, the nurse should do which of
   the following?
   a. Listen carefully and summarize often.
   b. Convey a sense of urgency to the patient.
   c. Be forthright about time limits of the interview.
   d. Let the patient know the nurse controls the interview.

a. Listen carefully and summarize often.

6. Six months ago, a woman had a prophylactic double mastectomy because of a family
   history of breast cancer. One week ago, this woman learned her husband was involved in
   an extramarital affair. The woman tearfully says to the nurse, “What else can happen?”
   Which type of crisis is this person experiencing?
   a. Maturational
   b. Adventitious
   c. Situational
   d. Recurring

c. Situational

7. During assessment, a patient says, “I can’t take anymore! Last year my husband had an
   affair, and now we don’t communicate. Three months ago, I found a lump in my breast.
   Yesterday my daughter said she’s quitting college.” Which is the nurse’s priority
   assessment?
   a. Identify measures useful to help improve the couple’s communication.
   b. The patient’s feelings about the possibility of having a mastectomy.
   c. Whether the husband is still engaged in an extramarital affair.
   d. Clarify what the patient means by “I can’t take anymore.”

d. Clarify what the patient means by “I can’t take anymore.”

8. Six months ago, a woman had a prophylactic double mastectomy because of a family
   history of breast cancer. One week ago, this woman learned her husband was involved in
   an extramarital affair. The woman tearfully says, “What else can happen?” If the woman’s
   immediate family is unable to provide sufficient support, which of the following should
   the nurse do?
   a. Suggest hospitalization for a short period.
   b. Ask whether other relatives or friends are available for support.
   c. Tell the patient, “You are a strong person. You can get through this crisis.”
   d. Foster insight by relating the present situation to earlier situations involving loss.

b. Ask whether other relatives or friends are available for support.

9. A woman says, “I can’t take anymore. Last year my husband had an affair, and now we do
   not communicate. Three months ago, I found a lump in my breast. Yesterday my daughter
   said she’s quitting college and moving in with her boyfriend.” Which issue should the
   nurse focus on during crisis intervention?
   a. The possible mastectomy
   b. The disordered family communication
   c. The effects of the husband’s extramarital affair
   d. Coping with the reaction to the daughter’s events

d. Coping with the reaction to the daughter’s events

10. A patient who is visiting the crisis clinic for the first time asks, “How long will I be
    coming here?” The nurse’s reply should consider that the usual duration of crisis
    intervention is how long?
    a. 1 to 2 weeks
    b. 3 to 4 weeks
    c. 4 to 6 weeks
    d. 6 to 8 weeks

c. 4 to 6 weeks

11. Which communication technique will the nurse use more in crisis intervention than in
    traditional counselling?
    a. Role modeling
    b. Giving direction
    c. Information giving
    d. Empathic listening

b. Giving direction

12. Which situation demonstrates use of primary care related to crisis intervention?
    a. Implementation of suicide precautions for a depressed patient
    b. Teaching stress reduction techniques to a first-year college student
    c. Assessing coping strategies used by a patient who attempted suicide
    d. Referring a patient with schizophrenia to a partial hospitalization program

b. Teaching stress reduction techniques to a first-year college student

13. A victim of spousal violence arrives to the crisis centre seeking help. Which of the
    following crisis intervention strategy will be the nurse’s focus?
    a. Supporting emotional security and re-establishing equilibrium
    b. Long-term resolution of issues precipitating the crisis
    c. Promoting growth of the individual
    d. Providing legal assistance

a. Supporting emotional security and re-establishing equilibrium

14. After celebrating their fortieth birthday, an individual becomes concerned with the loss of
    youthful appearance. Which type of crisis has occurred?
    a. Reactive
    b. Situational
    c. Maturational
    d. Adventitious

c. Maturational

15. Which scenario is an example of an adventitious crisis?
    a. The death of a child from sudden infant death syndrome
    b. Being fired from a job because of company downsizing
    c. Retirement of a 55-year-old person
    d. A riot at a concert

d. A riot at a concert

16. Which agency plays a major role in mass disaster planning and prevention?
    a. Health Canada
    b. Provincial or territorial disaster management agencies
    c. National Incident Management System
    d. Federal Emergency Management Agency

a. Health Canada

17. During the initial interview at the crisis centre, a patient says, “I’ve been served with
    divorce papers. I’m so upset and anxious that I can’t think clearly.” Which comment
    should the nurse use to assess personal coping skills?
    a. “In the past, how have you handled difficult or stressful situations?”
    b. “What would you like us to do to help you feel more relaxed?”
    c. “Tell me more about how it feels to be anxious and upset.”
    d. “Can you describe your role in the marital relationship?”

a. “In the past, how have you handled difficult or stressful situations?”

18. An adult has cared for a debilitated parent for 10 years. The parent’s condition recently
    declined, and the health care provider recommended placement in a nursing home. The
    adult says, “I’ve always been able to care for my parents. Nursing home placement goes
    against everything I believe.” Successful resolution of this person’s crisis will most closely
    relate to which of the following?
    a. Resolving the feelings associated with the threat to the person’s self-concept
    b. Ability of the person to identify situational supports in the community
    c. Reliance on assistance from role models within the person’s culture
    d. Mobilization of automatic relief behaviours by the person

a. Resolving the feelings associated with the threat to the person’s self-concept

19. Which principle assists a nurse planning crisis intervention for a patient?
    a. That the patient is experiencing a state of disequilibrium
    b. That the patient is experiencing a type of mental illness
    c. That the patient poses a threat of violence to others
    d. That the patient has high potential for self-injury

a. That the patient is experiencing a state of disequilibrium

20. A nurse assesses a patient in crisis. Which is the most appropriate question for the nurse to
    ask to assess this patient’s situational support?
    a. “Has anything upsetting occurred in the past few days?”
    b. “Who can be helpful to you during this time?”
    c. “How does this problem affect your life?”
    d. “What led you to seek help at this time?”

b. “Who can be helpful to you during this time?”

21. An adult arrives to the crisis clinic after termination from a job of 15 years. The patient
    says, “I don’t know what to do. How can I get another job? Who will pay the bills? How
    will I feed my family?” Which nursing diagnosis applies?
    a. Hopelessness
    b. Powerlessness
    c. Chronic low self-esteem
    d. Disturbed thought processes

b. Powerlessness

22. A patient who has recently survived a plane crash has returned to work and reports not
    being able to sleep well at night. The nurse meets with the patient once a month to provide
    ongoing support and encouragement. Which type of crisis intervention is the nurse
    performing?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Critical incident stress debriefing

c. Tertiary

23. At the last contracted visit in the crisis intervention clinic, an adult says, “I’ve emerged
    from this a stronger person. You helped me get my life back in balance.” The nurse
    responds, “I think we should have two more sessions to explore why your reactions were
    so intense.” Which analysis applies?
    a. The patient is experiencing transference.
    b. The patient demonstrates need for continuing support.
    c. The nurse is having difficulty terminating the relationship.
    d. The nurse is empathizing with the patient’s feelings of dependency.

c. The nurse is having difficulty terminating the relationship.

24. Which health care worker should be referred for critical incident stress debriefing?
    a. A nurse who works at an oncology clinic where patients receive chemotherapy
    b. A case manager whose patients have serious mental illness and are cared for at
    home
    c. A health care employee who worked 12 hours at the information desk of a critical
    care unit
    d. An emergency medical technician (EMT) who treated victims of a car bombing at
    a mall

d. An emergency medical technician (EMT) who treated victims of a car bombing at
a mall

25. Asking your patient who has experienced a crisis situation how they see this event
    affecting their future gathers important information about which aspect of the assessment?
    a. Their perception of the event
    b. Their usual coping
    c. Their available supports
    d. Their detailed description of the event

a. Their perception of the event

26. A record flood destroys homes and businesses in a community. Which would this crisis be
    classified as?
    a. Disequilibrium
    b. Adventitious
    c. Maturational
    d. Situational

b. Adventitious

27. Which describes what an individual will experience during the second phase of crisis?
    a. Increased anxiety stimulates the use of problem-solving techniques and defence
    mechanisms to solve the problem and lower anxiety.
    b. If trial-and-error attempts fail, anxiety escalates to panic, and the person mobilizes
    automatic relief behaviours, such as withdrawal and flight.
    c. Transition to a state of overwhelming anxiety can lead to serious personality
    disorganization, depression, confusion, and behavioural disturbances.
    d. If usual defensive responses fail and the threat persists, anxiety continues to rise
    and produces feelings of extreme discomfort.

d. If usual defensive responses fail and the threat persists, anxiety continues to rise
and produces feelings of extreme discomfort.

28. Which describes what an individual will experience during the fourth phase of crisis?
    a. If trial-and-error attempts fail, anxiety escalates to panic, and the person mobilizes
    automatic relief behaviours, such as withdrawal and flight.
    b. If usual defensive responses fail and the threat persists, anxiety continues to rise
    and produces feelings of extreme discomfort.
    c. Transition to a state of overwhelming anxiety can lead to serious personality
    disorganization, depression, confusion, and behavioural disturbances.
    d. Increased anxiety stimulates the use of problem-solving techniques and defence
    mechanisms to solve the problem and lower anxiety.

d. Increased anxiety stimulates the use of problem-solving techniques and defence
mechanisms to solve the problem and lower anxiety.

1. Which are identified as essential, empirically supported elements of mass trauma
   interventions? (Select all that apply.)
   a. Promotion of a sense of safety
   b. Promotion of connectedness
   c. A sense of self-efficacy
   d. Hope
   e. Therapeutic use of self

ABCD

2. A nurse driving home after work comes upon a serious automobile accident. The driver
   gets out of the car with no apparent physical injuries. Which assessment findings would
   the nurse expect from the driver immediately after this event? (Select all that apply.)
   a. Difficulty using a cell phone
   b. Long-term memory losses
   c. Fecal incontinence
   d. Rapid speech
   e. Trembling

ADE

3. Which are characteristics of a mental health emergency? (Select all that apply.)
   a. Self-care limitations
   b. Depression
   c. Effective coping strategies
   d. Behavioural disturbances
   e. Collective self-efficacy

ABD\