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MH Test 3 part 2 ch 11

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wipimebe's version from 2015-10-06 21:26

Section

21. Which of the following initial actions on the part of the nurse are MOST important in delivering compassionate and effective nursing care to clients experiencing a crisis?

 

a. listening to the clientÕs feelings and responding to his or her needs
b. telling the client what to expect and what to do
c. gathering all possible data about the client from all sources
d. instructing the clientÕs family on what to do for the client

 

ANS: A
The initial and most important nursing action when caring for a client experiencing a crisis is to listen to the clientÕs feelings and respond to the clientÕs needs. The nurse must establish trust with the client, ensure confidentiality, and seek to develop a good understanding of the clientÕs experiences and feelings. For the client, describing emotions and reactions to the nurse serves to release feelings.

 

22. A client is experiencing a crisis and is unable to cope emotionally with the situation that precipitated the crisis. Based on caring theories such as those of Jean Watson or Hildegard Peplau, the most immediate intervention for the nurse to provide is:

 

a. reporting any maladaptive responses to the provider
b. educating about the phases of crisis
c. listening to the affective experience of the client
d. assessing the clientÕs level of emotional vulnerability

 

ANS: C
According to caring theories, the most immediate intervention for the nurse is to listen to the affective experience of the client. The nurse will be interested in the clientÕs subjective experience of the crisis. Therefore these caring theories would direct the nurse to meet the client at the clientÕs level with an attitude of sincere caring, accept the clientÕs view as an important perspective of the event, seek to understand the clientÕs subjective experience of the crisis, and interpret the meaning of the crisis to the client.

 

23. You are working with a client who was recently in a building that was bombed. This client has been hospitalized for weeks and is beginning to show progress in physical recovery; however, the client often says something like, ÒI feel like I canÕt control the events in my life. Everything is fate. I have given up trying to order my life.Ó Which of the following nursing diagnoses would you likely find after further assessment of this client?

 

a. anxiety
b. risk for violence
c. powerlessness
d. dysfunctional grieving

 

ANS: C
Powerlessness is a subjective feeling that expresses the clientÕs belief that he cannot control the events in his life. The nurse can make this diagnosis when there is sufficient validation from the client that he, indeed, feels out of control and has given up.

 

24. You have been working with a client whose wife was killed by a burglar who broke into their home while the client was out of town on a business trip. The client comes to his session today and asks about places where he can donate his wifeÕs clothes and belongings Òwhen IÕm ready to give them up.Ó You correctly view this statement as an indication that the client is most likely:

 

a. preparing to commit suicide in order to rejoin his deceased wife
b. entering the impoverishment phase as symbolized by the giving away of possessions
c. stuck in the maladaptive equilibrium phase shown by his need to get rid of her things
d. beginning to shift from the present- to future-directed thinking

 

ANS: D
A client who is beginning to think about disposing of the belongings of a loved one who died tragically is most likely beginning to shift from the present- to future-directed thinking.

 

25. You are working with a client who is postcrisis and who denies having any symptoms of stress. You realize that for some individuals, a common complaint and the only clue that they are still feeling stress in the postcrisis period is which of the following?

 

a. disturbances in sleep patterns
b. uncontrollable anger
c. teeth grinding
d. feeling of euphoria

 

ANS: A
Disturbed sleep pattern is common postcrisis and for some individuals will be the only clue that they are still feeling stress. Thus the nurse must ask questions related to sleep even when clients state there are no immediate stressors or crises in their lives.

 

26. Which of the following is MOST likely to be an effective intervention strategy for clients who have survived a community crisis?

 

a. anxiety medication
b. a support group
c. psychotherapy
d. relocation to another community

 

ANS: B
Support groups have proven to be highly effective when treating the survivors of a community crisis. Through groups, the community members can share experiences and learn from each other possible strategies for dealing with the crisis. Support groups assist individual members that they are not alone in their experience, a concept known as universality.

 

27. The crisis intervention model is aimed at:

 

a. behavior modification
b. increasing the clientÕs functional level
c. problem solving and adaptive coping
d. catharsis and introspection

 

ANS: C
The major aim of the crisis intervention model is to assist the client with problem solving and adaptive coping. Alternate coping strategies are explored, which can facilitate the clientÕs return to precrisis level of function or better.

 

28. The successful outcome of work with the client through a crisis event is BEST evaluated by the:

 

a. clientÕs confidence in returning to a normal life
b. nurseÕs judgment about the resolution of the crisis
c. clientÕs ability to forget the event causing the crisis
d. nurseÕs measure of the clientÕs psychological growth

 

ANS: A
The nurse and client together can determine whether there was a successful resolution of a crisis. However, the clientÕs confidence in returning to a normal life is the best example of a good outcome.

 

29. You are working with a client who has a fatal illness. The client says to you, ÒItÕs not an easy thing to cope with a fatal illness.Ó Which of the following responses is MOST therapeutic?

 

a. ÒI know, because someone in my family close to me went through the same thing.Ó
b. ÒYou are doing an excellent job of coping with this crisis.Ó
c. ÒIt is difficult. I am certain I could not do as well as you do.Ó
d. ÒNo, it never is easy. Can you tell me some of the things that are particularly difficult for you?Ó

 

ANS: D
The most therapeutic response is to say, ÒNo, it never is easy. Can you tell me some of the things that are particularly difficult for you?Ó The nurse acknowledges the clientÕs feelings and offers to listen to the clientÕs concerns. This enhances trust and strengthens the nurse/client relationship. The other responses do not encourage the client to express feelings.

 

30. The BEST example of primary mental-health crisis intervention would be:

 

a. providing CISM to members of the fire department who responded to a series of fatal house fires
b. discussing the psychological aspects to having a loved one injured in a car accident with newly licensed teenage drivers
c. responding on call to the emergency room to counsel the victims of a serial rapist
d. leading group therapy for individuals diagnosed with post-traumatic stress disorder

 

ANS: B
The best example of primary mental-health crisis intervention would be discussing the psychological aspects to having a loved one injured in a care accident with newly licensed teenage drivers. The other options are examples of secondary and tertiary prevention.

 

31. Follow-up for more than 2 decades has shown that what percent of the Buffalo Creek survivors still have significant post-traumatic stress disorder (PTSD) symptoms?

 

a. 10% c. 35%
b. 25% d. 50%

 

ANS: B
Follow-up for more than 2 decades has shown that about 25% of the Buffalo Creek survivors still have significant post-traumatic stress disorder (PTSD) symptoms. Overall the severity of symptoms has been decreasing for most of the survivor cohort. Follow-up of child Buffalo Creek survivors has found a steady decrease in symptomatology with PTSD diagnosed in 7% of persons up to 17 years after the original event.

 

32. Studies of Hurricane Katrina victims have indicated that what percentage of individuals experienced serious mental illness 1 year post Katrina?

 

a. 6.4% c. 14.0%
b. 10.9% d. 20.9%

 

ANS: C
Studies of Hurricane Katrina victims have indicated that 14.0% of the survivors experienced serious mental illnesses 1 year post Katrina. Of the survivors, 10.9% experienced serious mental illness and 20.9% experienced PTST prior to Katrina; while 6.4% experienced suicidal ideations post Katrina.