Question 1

A client is admitted to a psychiatric unit with severe depression and thoughts of suicide.The client is placed on suicide precautions.When caring for this client,the nurse recognizes that

Accepted Answer

A major goal in evaluating suicidal risk is to assess whether the client is imminent danger of doing harm to self.It is a myth that people who talk about harming themselves are at less risk.Clients who verbalize or behaviorally demonstrate "a weight being lifted off the shoulders" should be watched carefully.Suicidal ideation waxes and wanes,so careful observation is critical even after the acute crisis has subsided.

Question 2

A model of psychosocial development in which each stage is associated with a psychosocial crisis to be resolved was developed by which theorist?

Accepted Answer

Erikson's stage model of psychosocial development forms the basis for understanding developmental crises.Each stage is associated with a psychosocial crisis to be resolved.Successful resolution of each maturational stage leaves a person better able to meet the interpersonal challenges and stressors of the next.Lindemann and Caplan are considered primary contributors to the development of crisis theory.Caplan broadened Lindemann's model to include developmental crisis and personal crisis.Although the direct focus of crisis intervention is on secondary prevention because the crisis state is already in motion,Caplan applied concepts of primary,secondary,and tertiary prevention to crisis intervention.Aguilera developed a nursing model identifying how a crisis develops and corresponding factors needed for resolution.Roberts provides a seven-stage sequential blueprint for clinical intervention,which can be used to structure the crisis intervention process in nurse-client relationships.This model is compatible with the nursing process sequencing of assessment,planning,implementation,and evaluation.

Question 3

The nurse is caring for a family that is experiencing a crisis.The nurse recognizes that interventions for initial family responses to crisis include

Accepted Answer

Interventions for initial family responses to crisis include repeating information and frequently reinforcing it.They also include the following: maximizing control within the hospital environment; providing for and encouraging or allowing expression of feelings,even if they are extreme; and giving information that is brief,concise,explicit,and concrete.

Question 4

An older adult client who is mourning the death of her spouse comes to the health clinic for follow-up care for an irregular heartbeat.During the examination the client tells the nurse,"I don't care about my irregular heartbeat; I will be with my husband soon." The best response by the nurse is,

Accepted Answer

When a nurse responds with "It sounds as if you would like to see your husband again," it is an example of a reflective listening response used to identify applicable feelings.Responses that focus on what the client has to live for,the medication,or her children are not examples of therapeutic communication.

Question 5

The nurse is caring for a client who is experiencing a crisis situation.The nurse recognizes that after feeling a sense of shock,the client will go through a period of recoil in which the client

Accepted Answer

Caplan described the initial response to a crisis situation as shock,with variations in emotions ranging from anger,laughing,hysterics,crying,and acute anxiety to social withdrawal.Then follows an extended period of adjustment,a period of recoil.This period can last from 2 to 3 weeks.Client behaviors can appear normal to outsiders,but the person often describes nightmares,phobic reactions,and flashbacks of the crisis event.Caplan uses the term restoration or reconstruction to describe the final phase of crisis intervention.This phase involves taking constructive actions to face and resolve the reality issues present in a crisis situation.If successfully negotiated,the person achieves precrisis functioning,or better.

Question 6

A client states,"I feel like I have no control over my life." The nurse determines the client is experiencing a sense of powerlessness.Which strategy most likely assisted the nurse in the identification of powerlessness?

Accepted Answer

A guideline for identifying major problems is to identify central emotional themes in the client's story (e.g.,powerlessness,shame,hopelessness)to provide a focus for intervention.Another guideline for identifying major problems is to keep the focus on the here and now.Questions should be short and relevant to the crisis.Responses to the client should be brief,empathetic,and clearly related to the client's story.Note changes in expression,body posture,and vocal inflections as clients tell their story and at what points they occur.

Question 7

A client is admitted to a psychiatric unit for crisis intervention.When caring for this client,the nurse recognizes that crisis intervention is

Accepted Answer

Crisis intervention is a time-limited treatment that focuses only on the immediate problem and its resolution.The goal of crisis intervention is to return the client to his or her precrisis level of functioning.

Question 8

When collecting assessment data,the nurse recognizes that a client might be more prone to violent behavior when having a history of which of the following?

Accepted Answer

A history of violence,childhood abuse,substance abuse,mental retardation,problems with impulse control,and psychosis,particularly when accompanied by command hallucinations,are common contributing factors to violent behavior.Problems with impulse control (not lack of impulsivity)is a common contributing factor to violent behavior.

Question 9

A client experiences an unusually stressful life event that exceeds their resources and coping skills.The nurse recognizes the client is experiencing which type of crisis?

Accepted Answer

A situational crisis is an unusually stressful life event that exceeds a person's resources and coping skills.Examples include unexpected illness or injury,rape,car accident,loss of home,spouse,job,etc.Erik Erikson's stage model of psychosocial development forms the basis for understanding developmental crises.Each stage is associated with a psychosocial crisis to be resolved.Successful resolution of each maturational stage leaves a person better able to meet the interpersonal challenges and stressors of the next.Examples of critical incidents associated with developmental crises include: marriage,pregnancy and birth of a child,midlife crisis,retirement,meaning in aging,etc.A private crisis affects individuals and families but not the community at large.Examples include suicide,terminal diagnosis,a car crash,rape,or the death of a family member.An adventitious crisis is not a part of everyday experience.It is unplanned,unusual,horrific,and beyond anyone's control.Examples of adventitious crisis include natural disasters such as floods,earthquakes,fires,mud slides; national disasters such as terrorism,riots,wars; and crimes of violence such as rape,child abuse,assault,or murder.

Question 10

The nurse is performing an initial assessment on a mental health client in the emergency department.The client is uncooperative,and the nurse recognizes the client's behavior is escalating.The most appropriate response by the nurse is to

Accepted Answer

Deescalation tips for mental health emergencies:
.Use a nonthreatening stance-open,but not vulnerable.Have them "take a seat"
.Eye contact-not constant,brief to show concern
.Commands-brief,slow,with simple vocabulary,only as loud as needed,repeat as needed
.Movement-not sudden,announce actions when possible,keep hands where they can be seen
.Attitude-calm,interested,firm,patient,reassuring,respectful,truthful
.Acknowledge legitimacy of feelings,delusions,hallucinations as being real to the client ("I understand you are seeing or feeling this,but I am not")
.Remove distractions,upsetting influences
.Keep the client talking/focused on the here and now
.Ignore,rather than argue with,provocative statements
.Allow verbal venting,within reason
.Be sensitive to personal space/comfort zone
.Remove client to a quiet space; remove others from immediate area (avoid the "group spectators")
.Give some choices or options,if possible
.Set limits,if necessary
.Limit interaction to just one professional and let that person do the talking
.Avoid rushing-slow things down
.Give yourself an out; don't put the client between yourself and the door

Question 11

A client with a history of violence is admitted to a psychiatric unit.The nurse observes the client pacing the halls and speaking to other clients in a menacing way.The nurse is concerned that the client will become physically violent.The nurse should initially

Accepted Answer

Deescalation tips for mental health emergencies:
.Use a nonthreatening stance-open,but not vulnerable.Have them "take a seat"
.Eye contact-not constant,brief to show concern
.Commands-brief,slow,with simple vocabulary,only as loud as needed,repeat as needed
.Movement-not sudden,announce actions when possible,keep hands where they can be seen
.Attitude-calm,interested,firm,patient,reassuring,respectful,truthful
.Acknowledge legitimacy of feelings,delusions,hallucinations as being real to the client ("I understand you are seeing or feeling this,but I am not")
.Remove distractions,upsetting influences
.Keep the client talking/focused on the here and now
.Ignore,rather than argue with,provocative statements
.Allow verbal venting,within reason
.Be sensitive to personal space/comfort zone
.Remove client to a quiet space; remove others from immediate area (avoid the "group spectators")
.Give some choices or options,if possible
.Set limits,if necessary
.Limit interaction to just one professional and let that person do the talking
.Avoid rushing-slow things down
.Give yourself an out; don't put the client between yourself and the door

Question 12

A client enters the emergency department.When performing the initial admission assessment,the nurse recognizes which client behavior as an indicator that the client may become violent?

Accepted Answer

Confusion,paranoid ideation,disorganization,and organic impairment are all mental status behavioral categories that indicate potential for violence.Rapid and pressured speech,incoherent speech,menacing tones,raised voice,and verbal threats are all speech pattern behavioral categories that indicate potential for violence.A belligerent,labile,or angry affect is an indicator of potential violence.Eyes darting,prolonged (staring)eye contact,spitting,pale or red (flushed)face,and a menacing posture are indicators of potential violence.

Question 13

A client who is experiencing a crisis is admitted to a nursing unit.When entering the client's room,the nurse should attempt to establish rapport and engage the client by

Accepted Answer

Clients in crisis look to health professionals to structure interactions.Introduce yourself briefly,and quickly orient the client to the purpose of the crisis questions and how the information will be used.Clients and families experiencing a crisis state require a compassionate,flexible,but clearly directive calm approach from nurses.The client should be placed in a quiet,lighted room with no shadows,away from the mainstream of activity.Ideally,one nurse should be the primary contact for information.

Question 14

When educating a student nurse about the definition of a crisis state,the nurse recognizes that additional instruction is needed when the student nurse states,

Accepted Answer

Everly defines a crisis state as an acute normal human response to severely abnormal circumstances; it is not a mental illness.Because a crisis state represents a personal response,two people experiencing the same crisis event will respond differently to it.A crisis state creates a temporary disconnect from attachment to others,loss of meaning,and a disruption of previous mastery skills.

Question 15

When a disaster strikes within a community,the shock of the disaster pulls people together and outside resources are brought in.This is known as which phase of the community response to disaster?

Accepted Answer

The honeymoon phase occurs when the "community pulls together and outside resources are brought in" after an initial search and recovery phase.The final reconstruction phase occurs when the survivors begin to take the primary responsibility for rebuilding their life.The heroic phase consists of initial search and recovery.The disillusionment phase usually appears as the initial emergency response starts to subside.The "shared community" feeling starts to leave as people begin to realize the extent of their losses and the limitations of external support.Survivors can experience anger,resentment,and bitterness at the loss of support,particularly if it is sudden and complete.

Question 16

The nurse is caring for an older adult client who has recently lost his job,is experiencing a major physical illness,and lives alone.The client states,"I sometimes wish I wasn't here." When working with this client,the nurse recognizes that

Accepted Answer

Verbal indicators of potential suicide include statements such as "I don't think I can go on without ..."; "I sometimes wish I wasn't here"; or "People would be better off without me." Risk factors for suicide include a major physical illness,social isolation,and a recent major loss.A major goal in evaluating suicidal risk is to assess whether the client is in imminent danger of doing harm to self.Irrational behaviors,drug and alcohol abuse,previous suicide attempts,and verbal threats are matters of concern,as is a sudden mood change-especially if the client demonstrates much more energy.Suicide rates are higher for older adults,especially for white males.Behavioral indicators of escalating suicidal ideation include giving away possessions.

Question 17

When working on a psychiatric unit,the nurse recognizes that indicators of potential violence include which of the following?

Accepted Answer

Indicators of potential violence include confusion,exaggerated gestures,and prolonged eye contact.Confusion (not orientation)is an indicator of potential violence.Incoherent (not coherent)speech is an indicator of potential violence.

Question 18

The nurse is communicating with a client who is experiencing a crisis related to marital difficulties.Which of the following statements made by the nurse is the best example of therapeutic communication when working with this client?

Accepted Answer

Clients in crisis generally feel powerless.Nurses can introduce alternative methods that the client may not have considered.Helping a client examine the consequences of proposed solutions and breaking tasks down into small,achievable parts empowers clients.Proposed solutions should accommodate both the problem and client resources.It's helpful to assist clients in discussing the consequences,costs,and benefits of choosing of one action versus another (e.g.,"What would happen if you chose this course of action as compared to…?" or "What is the worst that could happen if you decided to…?").The locus of control for decision making should always remain with the client to whatever extent is possible.Making autonomous choices encourages clients to become invested in the solution-finding process and hopeful about finding a resolution to a crisis situation.

Quiz 20: Communicating With Clients in Crisis