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d. Remove the patient’s eyeglasses to prevent self-injury.

e. Interact with the patient every 15 minutes.

ANS: A, B, C

One-on-one observation is necessary for anyone who has limited or unreliable control over suicidal impulses. Finger foods allow the patient to eat without silverware; “no silver or glassware” orders restrict access to a potential means of self-harm. Every-15-minute checks are inadequate to assure the safety of an actively suicidal person. Placement in a public area is not a substitute for arm’s-length direct observation; some patients will attempt suicide even when others are nearby. Vision impairment requires eyeglasses (or contacts); although they could be used dangerously, watching the patient from arm’s length at all times would allow enough time to interrupt such an attempt and would prevent the disorientation and isolation that uncorrected visual impairment could create.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 25-15, 16, 47 (Table 25-2), 52 (Box 25-2)

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment a. Shame b. Panic attack c. Humiliation d. Self-imposed isolation e. Recent stressful life event

3. A college student is extremely upset after failing two examinations. The student said, “No one understands how this will hurt my chances of getting into medical school.” The student then suspends access to his social networking website and turns off his cell phone. Which suicide risk factors are evident? (Select all that apply.)

ANS: A, C, D, E

Failing examinations in the academic major constitutes a recent stressful life event. Shame and humiliation related to the failure can be hypothesized. The statement, “No one can understand,” can be seen as recent lack of social support. Terminating access to one’s social networking site and turning off the cell phone represents self-imposed isolation. The scenario does not provide evidence of panic attack.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 25-5, 6, 50 (Box 25-1), 52 (Box 25-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Chapter 26: Crisis and Disaster

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A patient comes to the crisis clinic after an unexpected job termination. The patient paces, sobs, cringes when approached, and responds to questions with only shrugs or monosyllables. Choose the nurse’s best initial comment to this patient.

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.”

ANS: B

A crisis exists for this patient. The two primary thrusts of crisis intervention are to provide for the safety of the individual and use anxiety-reduction techniques to facilitate use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient’s safety, and interpersonal reassurance.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 26-18, 19, 45 (Box 26-2) | Page 26-24 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. A patient is seen in the clinic for superficial cuts on both wrists. Initially the patient paces and sobs but after a few minutes, the patient is calmer. The nurse attempts to determine the patient’s perception of the precipitating event by asking: 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 when you started feeling this way?”

ANS: D

A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events facilitates assessment of the precipitating event. The patient is unlikely to be able to articulate what interventions will increase feelings of comfort. “Why” questions are nontherapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 26-10, 11 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

3. A patient comes to the crisis center saying, “I’m in a terrible situation. I don’t know what to do.” The triage nurse can initially assume that the patient is a. suicidal. b. anxious and fearful. c. misperceiving reality. d. potentially homicidal.

ANS: B

Individuals in crisis are universally anxious. They are often frightened and may be mildly confused. Perceptions are often narrowed with anxiety.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 26-15, 42 (Table 26-3)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis/Analysis a. Maturational b. Tertiary c. Situational d. Organic

4. An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle’s behavior, but the parents did not believe the adolescent. What type of crisis exists?

ANS: C

A situational crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. Sexual molestation falls within this classification. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. “Organic” and “Tertiary” are not types of crisis.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 26-7, 8

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

5. While conducting the initial interview with a patient in crisis, the nurse should a. speak in short, concise sentences. 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.

ANS: A

Severe anxiety narrows perceptions and concentration. By speaking in short concise sentences, the nurse enables the patient to grasp what is being said. Conveying urgency will increase the patient’s anxiety. Letting the patient know who controls the interview or stating that time is limited is nontherapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 26-15, 19, 42 (Table 26-3), 45 (Box 26-2) | Page 26-24 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “Would you like to talk to a psychiatrist about some medication to help you cope during the trial?” b. “What resources do you need to help you cope with this situation?” c. “Do you have enough support from your family and friends?” d. “Are you having thoughts of hurting yourself or others?”

6. An adult seeks counseling after the spouse was murdered. The adult angrily says, “I hate the beast that did this. It has ruined my life. During the trial, I don’t know what I’ll do if the jury doesn’t return a guilty verdict.” What is the nurse’s highest priority response?

ANS: D

The highest nursing priority is safety. The nurse should assess suicidal and homicidal potential. The distracters are options, but the highest priority is safety.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 26-10, 42 (Table 26-3) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Maturational b. Mitigation c. Situational d. Recurring

7. 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?” What type of crisis is this person experiencing?

ANS: C

Severe physical or mental illness is a potential cause of a situational crisis. The potential loss of a loved one also serves as a potential cause of a situational crisis. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. No classification of recurring crisis exists. Mitigation refers to attempts to limit a disaster’s impact on human health and community function.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 26-7, 8

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: 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.”

8. A woman said, “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.” What is the nurse’s priority assessment?

ANS: D

During crisis intervention, the priority concern is patient safety. This question helps assess personal coping skills. The other options are incorrect because the focus of crisis intervention is on the event that occurred immediately before the patient sought help.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 26-10, 42 (Table 26-3)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment