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Chapter 10: Intervening in Crises 1)A new mother is concerned about her ability to perform her parental role

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Chapter 10: Intervening in Crises

1)A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis?

A. This type of crisis is precipitated by unexpected external stressors.

B. This type of crisis is precipitated by preexisting psychopathology.

C. This type of crisis is precipitated by an acute response to an external situational stressor.

D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

 

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, “I can’t function any longer under all this stress.” Which type of crisis is the client experiencing?

A. Maturational/developmental crisis

B. Psychiatric emergency crisis

C. Anticipated life transition crisis

D. Traumatic stress crisis

 

3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client’s crisis?

A. The client will change his type A personality traits to more adaptive ones by one week.

B. The client will list five positive self-attributes.

C. The client will examine how childhood events led to his overachieving orientation.

D. The client will return to previous adaptive levels of functioning by week six.

 

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client?

A. Ineffective coping R/T situational crisis AEB powerlessness

B. Anxiety R/T fear of failure

C. Risk for self-directed violence R/T hopelessness

D. Risk for low self-esteem R/T loss events AEB suicidal ideations

 

5. After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?

A. “Are you currently thinking about harming yourself?”

B. “Why do you want to harm yourself?”

C. “Have you thought about the consequences of your actions?”

D. “Who is your emergency contact person?”

 

6. An involuntarily committed client when offered a dinner tray pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior?

A. Initiate forced medication protocol.

B. Help the client to explore the source of anger.

C. Ignore the act to avoid reinforcing the behavior.

D. With staff support and a show of solidarity, set firm limits on the behavior.

 

7. A college student who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?

A. “You’ve really been helpful. Can I count on your for continued support?”

B. “I work out in the college gym rather than jogging outdoors.”

C. “I’m really glad I didn’t go home. It would have been hard to come back.”

D. “I carry mace when I jog. It makes me feel safe and secure.”

 

8. A despondent client who has recently lost her husband of 30 years tearfully states, “I’ll feel a lot better if I sell my house and move away.” Which nursing response is most appropriate?

A. “I’m confident you know what’s best for you.”

B. “This may not be the best time for you to make such an important decision.”

C. “Your children will be terribly disappointed.”

D. “Tell me why you want to make this change.”

 

9. An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression?

A. The client requests prn medications.

B. The client has a tense facial expression and body language.

C. The client refuses to eat lunch.

D. The client sits in group with back to peers.

 

10. What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place on an inpatient unit?

A. Reinforce unit rules with the client population.

B. Create protocols for the future release of tensions associated with anger.

C. Process client feelings and alleviate fears of undeserved seclusion and restraint.

D. Discuss the situation that led to inappropriate expressions of anger.

 

11. An aggressive client has been placed in restraints after all other interventions have failed. Which protocol would apply in this situation?

A. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 1 hour of the initiation of the restraints.

B. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 2 hours of the initiation of the restraints.

C. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 3 hours of the initiation of the restraints.

D. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 4 hours of the initiation of the restraints.

 

12. A combative adolescent client has been placed in seclusion after all other interventions have failed. Which protocol would apply in this situation?

A. The physician or other licensed independent practitioner must reissue a new order for restraints every 24 hours.

B. The physician or other licensed independent practitioner must reissue a new order for restraints every 8 hours.

C. The physician or other licensed independent practitioner must reissue a new order for restraints every 3 to 4 hours.

D. The physician or other licensed independent practitioner must reissue a new order for restraints every 1 to 2 hours.

 

13. A nursing instructor is teaching about the Roberts’ Seven-Stage Crisis Intervention Model. Which nursing action should be identified with Stage IV?

A. Collaboratively implement an action plan.

B. Help the client identify the major problems or crisis precipitants.

C. Help the client deal with feelings and emotions.

D. Collaboratively generate and explore alternatives.

 

14. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.)

A. “Tell me what happened.”

B. “What coping methods have you used, and did they work?”

C. “Describe to me what your life was like before this happened.”

D. “Let’s focus on the current problem.”

E. “I’ll assist you in selecting functional coping strategies.”

 

15. Which of the following interventions should a nurse use when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.)

A. Maintain a calm demeanor.

B. Clearly delineate the consequences of the behavior.

C. Use therapeutic touch to convey empathy.

D. Set limits on the behavior.

E. Teach the client to avoid “I” statements related to expression of feelings.

 

16. Which of the following are behavior assessment categories in the Broset Violence Checklist? (Select all that apply.)

A. Confusion

B. Paranoia

C. Boisterousness

D. Panic

E. Irritability