Chapter 21: Crisis Intervention Mohr: Psychiatric Mental Health Nursing, 6th Edition
1. A person in crisis goes through various phases. Which of
... [Show More] the following reflects the third phase of crisis development?
A) The person uses usual coping mechanisms, which are effective.
B) The person seeks help.
C) Usual coping mechanisms fail, and anxiety increases.
D) Stress and anxiety are intolerable.
Ans: B Chapter: 21
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 01
Feedback: The first phase is increased anxiety in response to trauma. A person tries to use familiar coping mechanisms to resolve the feeling of increased anxiety. If coping mechanisms are not effective, a person enters the second phase of crisis, which is marked by further increased anxiety from the failure of usual coping mechanisms. In the third phase, anxiety continues to escalate; the person usually feels compelled to reach out for assistance. In the fourth phase the person's inner resources and support systems are inadequate. The precipitating event is not resolved, and stress and anxiety mount intolerably.
2. A tornado destroys a client's house. This represents which type of crisis?
A) Natural crisis
B) Situational crisis
C) Developmental crisis
D) Adventitious crisis
Ans: D Chapter: 21
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Easy
Objective: 02
Feedback: An adventitious crisis occurs outside the person. Examples include terrorism, natural
disasters, hurricanes, fires, floods, earthquakes, riots, kidnappings, war, and bombings. These crises affect many people who experience both acute and post-traumatic stress reactions.
3. A nursing student has difficulty with the rigorous work load of courses during the first semester of nursing school and does not pass all required classes. The type of crisis the student is experiencing is a:
A) Maturational crisis
B) Situational crisis
C) Social crisis
D) Adventitious crisis
Ans: B Chapter: 21
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Easy
Objective: 02
Feedback: A situational crisis is a response to a sudden and unavoidable traumatic event that largely affects a person's identity and roles. The threat to a person's self-image or roles that maintain that self-image usually leads to a crisis state. Loss of a spouse or job, academic failure, birth of a child with a disability, or diagnosis with a chronic or terminal illness affects how people perceive themselves.
4. Jake and Mary Patterson are sending their only daughter, Allie, off to college. Jake is worried about how he is going to pay for the increased expenses of housing, tuition, fees, and living expenses. Mary is just as distressed about this event, but her worries surround her daughter's safety while being unsupervised in a college town. Which factor determines which parent will experience the worst crisis?
A) Amount of law enforcement in the college town
B) Each parent's perception of their ability to cope
C) Frequency of times Allie calls home to assure that all is well
D) Successful management of the financial resources supporting Allie
Ans: B Chapter: 21
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 01
Feedback: Crisis and stress commonly are used interchangeably; however, they are not synonyms. As long as a person can cope with events and is not overwhelmed by stress, the event is not considered a crisis. Conversely, any stressful event can precipitate a crisis, depending on the person's perceptions, coping skills, and available support.
5. The prime objective of the crisis intervener is to
A) decide for the client until the client can do so independently.
B) help the client find ways to solve the immediate problem.
C) give anticipatory guidance to avert future crises.
D) mobilize the family to provide needed support.
Ans: B Chapter: 21
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 03
Feedback: Crisis intervention focuses on the problem or stressor that precipitated the crisis rather than on personality traits. The goal is to assist the person in distress to resolve the immediate problem and regain emotional equilibrium.
6. A possible disadvantage of crisis groups is that
A) they last only 6 to 8 weeks.
B) they are usually homogeneous.
C) group members may suggest maladaptive coping strategies.
D) they are heterogeneous.
Ans: C Chapter: 21
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 03
Feedback: Crisis groups have some disadvantages. Keeping each client's specific crisis in focus in a group setting is difficult. Members may suggest a destructive form of coping or maladaptive problem. These problems underscore the need for a trained and experienced crisis group leader.
7. A nurse is working with a family in crisis. Which of the following actions should the nurse accomplish first?
A) Teach the family about crisis and its resolution.
B) Discuss available resources.
C) Identify which family member is experiencing crisis symptoms.
D) Plan interventions that will ensure the security of all family members.
Ans: C Chapter: 21
Client Needs: C-1 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: While working with families in crisis, the intervener determines which family member is exhibiting crisis symptoms. Next, he or she attempts to identify what the client needs to ensure safety and security for all members of the family. In collaboration with the client and family, the intervener identifies strategies to reduce the most severe symptoms. He or she also assesses the family's resources and additional social resources. The intervener teaches about crisis and its resolution to the person in crisis and to supportive others.
8. The nurse is holding the first meeting for a family in crisis. The father packed his bags and left while the rest of the family was at church. The mother is distraught, and the two adolescent children are depressed, upset, and angry. Which of the following goals is appropriate for the family at the conclusion of this meeting?
A) The family will acknowledge their feelings of loss.
B) The mother will accept the finality of her husband's actions.
C) The mother will verbalize her feelings of anger and grief.
D) The family will develop a plan of action with specific tasks for each member.
Ans: D Chapter: 21
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: The intervener is directive in bringing together the client in crisis and all members of his or her social system for a meeting. During the meeting, all those involved in the crisis analyze the problem and its effect on each family member. Everyone is given an opportunity to
voice comments or concerns. Available resources and possible solutions are discussed. By the end of the meeting, the participants should develop a definite plan of action, including exactly who is to do what and when.
9. A client who is a lawyer is meeting with a nurse therapist for the first time. The client has been highly anxious and increasingly consumed with thoughts about how he may have mismanaged a case and possibly committed malpractice. He relates that he has been pacing in his office and at home and cannot think clearly about what to do next. Which of the following interventions is appropriate at this time?
A) The nurse asks the client to relate the events that immediately preceded his feelings of anxiety.
B) The nurse addresses the client's psychosocial history.
C) The nurse helps the client to see that his thinking is distorted.
D) The nurse avoids focusing on feelings and discusses his work environment.
Ans: A Chapter: 21
Client Needs: C-1 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Difficult
Objective: 04
Feedback: The nurse first determines the client's perception of the stressful event. How threatened is the client? Is the client realistic or distorting the meaning of the event? The nurse encourages the client to describe his feelings and accepts the client without judgment, thereby helping him to accept his feelings as well.
10. A nurse is working with a client in crisis who does not want to reveal her problem to family members or friends because she believes that doing so will expose her to criticism. The client has developed a realistic plan for managing the crisis; however, it will be hard for her accomplish it alone. The nurse chooses which of the following interventions to help the client get past the crisis?
A) Teach the client positive self-talk.
B) Role-model how to ask for help.
C) Focus on problem resolution.
D) Encourage the potential for personal growth.
Ans: B Chapter: 21
Client Needs: C-1
Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: In a crisis, it is natural to withdraw and feel isolated. Therefore, the nurse helps the client to communicate directly with significant others. Clients who place high value on independence may need particular assistance to recognize interdependence as a healthy balance. Often, the nurse must teach such clients how to ask for help. The nurse can demonstrate this skill to the client through role-playing.
11. The nurse is evaluating the effectiveness of the crisis intervention. Which of the following indicators suggests that the intervention has been effective?
A) The client has developed insight into his use of maladaptive coping strategies.
B) The client can verbalize techniques for preventing future crises.
C) The client has developed a plan for managing the crisis.
D) The client has resumed his usual level of functioning.
Ans: D Chapter: 21
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: In the evaluation process, the nurse and client together evaluate whether the crisis response has been resolved. Has the client regained equilibrium and usual level of functioning?
12. The nurse has been working with a client following the sudden death of her husband in a work accident. The client initiated counseling because she didn't know how to cope with this crisis and felt totally overwhelmed. The nurse and client set goals for their working relationship to include
A) the client resuming dating activities.
B) the client feeling like she is gradually moving toward coping with the loss.
C) the client putting away all reminders of her husband to lessen the pain of her loss.
D) the client resolving her grief in 4 to 6 weeks.
Ans: B Chapter: 21
Client Needs: C-1 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 03
Feedback: The overall goal of crisis intervention is to help the client to reestablish equilibrium. To reach that end, the supporting goals include establishing a working relationship with the nurse, identifying the specific problem, reducing the distortion of her perception of the event, improving self-esteem, decreasing anxiety, and using healthy coping mechanisms.
13. While working with a client experiencing a crisis, the nurse assesses the client's social support network for which of the following reasons?
A) The nurse can delegate to others how to best help the client.
B) Crisis intervention should include bringing all members of the client's support system in for group planning.
C) The client will need support long after the temporary nurse-client relationship is terminated.
D) The nurse needs to assess which supports are therapeutic and which supports may be toxic.
Ans: C Chapter: 21
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: It is best to have several supportive people involved with the client. Because a crisis lasts for a brief time and the nurse will be involved only temporarily, the client needs others, the natural support system, on whom to rely for continued support.
14. An active crisis state is approximately 4 to 6 weeks. This means that
A) the experience of acute crisis involving confusion and disorganization will subside in approximately 4 to 6 weeks.
B) after 4 to 6 weeks the person will have achieved optimum functioning with effective crisis intervention.
C) it will take 4 to 6 weeks for the client to gain an understanding of his or her perception that is causing the crisis.
D) new coping skills must be learned within 4 to 6 weeks or the client will not experience positive resolution of the crisis state.
Ans: A Chapter: 21
Client Needs: C-1
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 01
Feedback: During crisis, an imbalance exists between the magnitude of the problem and the immediate resources available to deal with it. This imbalance causes confusion and disorganization. The active crisis state is relatively short, approximately 4 to 6 weeks. No person can tolerate this level of anxiety and imbalance for long. Quick, appropriate intervention is crucial to help the person in crisis return to optimal functioning.
15. Darrin and Kay's marriage of 7 years is threatened because Darrin has recently found out that Kay has been unfaithful while Darrin is at work. Darrin feels betrayed and wants to confide in his parents about what he is going through. He wants to ask for support but feels both embarrassed and emasculated that he somehow was not a good enough husband to prevent her infidelity. The nurse can assist Darrin to gain enough self-esteem to approach his parents. Darrin needs help with this process because
A) he is struggling with feeling emotionally dependent on his parents.
B) he is going to be judged negatively by his parents.
C) he is giving up on his marriage without enough effort to resolve the crisis.
D) he may discover that he is responsible for his wife's unhappiness.
Ans: A Chapter: 21
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Caring Difficulty: Moderate Objective: 04
Feedback: In a crisis, it is natural to withdraw and feel isolated. Therefore, the nurse helps the client to communicate directly with significant others. Clients who place high value on independence may need particular assistance to recognize interdependence as a healthy balance. Often, the nurse must teach such clients how to ask for help. [Show Less]