D. "Let's set some guidelines and goals for your visit here."



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A patient comes to the crisis clinic after an unexpected job termination. The patient paces around the room sobbing, 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."

b. "I see you are feeling upset. I'm going to stay and talk with you to help you feel better."



A patient being seen in the clinic for superficial cuts on both wrists is pacing and sobbing. 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 just before you started to feel this way?"

d. "What was happening just before you started to feel this way?"



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.

b. anxious and fearful.



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?


a. Maturational 
b. Adventitious 
c. Situational
d. Organic

b. Adventitious



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.

a. speak in short, concise sentences.



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?



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?"

d. "Are you having thoughts of hurting yourself or others?"



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?


a. Maturational 
b. Adventitious 
c. Situational
d. Recurring

c. Situational



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?


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."

d. Clarify what the patient means by "I can't take anymore."



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, "What else can happen?" If the woman's immediate family is unable to provide sufficient support, the nurse should:



a. suggest hospitalization for a short period.
b. ask what other relatives or friends are available for support.
c. tell the patient, "You are a strong person. You can get through this crisis."
d. foster insight by relating the present situation to earlier situations involving loss.

b. ask what other relatives or friends are available for support.



A woman says, "I can't take anymore. Last year my husband had an affair, and now we do not communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college and moving in with her boyfriend." Which issue should the nurse focus on during crisis intervention?


a. The possible mastectomy
b. The disordered family communication
c. The effects of the husband's extramarital affair
d. Coping with the reaction to the daughter's events

d. Coping with the reaction to the daughter's events



A patient who is visiting the crisis clinic for the first time asks, "How long will I be coming here?" The nurse's reply should consider that the usual duration of crisis intervention is:


a. 1 to 2 weeks.
b. 3 to 4 weeks. 
c. 4 to 8 weeks.
d. 8 to 12 weeks.

c. 4 to 8 weeks.



A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, "I cannot teach nor do any research. My mind is totally preoccupied with these false accusations." What is the priority nursing diagnosis?



a. Ineffective denial related to threats to professional identity
b. Deficient knowledge related to sexual harassment protocols
c. Impaired social interaction related to loss of teaching abilities
d. Ineffective role performance related to distress from false accusations

d. Ineffective role performance related to distress from false accusations



Which communication technique will the nurse use more in crisis intervention than traditional counseling?


a. Role modeling 
b. Giving direction 
c. Information giving
d. Empathic listening

b. Giving direction



Which situation demonstrates use of primary care related to crisis intervention?


a. Implementation of suicide precautions for a depressed patient
b. Teaching stress reduction techniques to a first-year college student
c. Assessing coping strategies used by a patient who attempted suicide
d. Referring a patient with schizophrenia to a partial hospitalization program

b. Teaching stress reduction techniques to a first-year college student



A victim of spousal violence comes to the crisis center seeking help. Crisis intervention strategies the nurse uses will focus on:


a. supporting emotional security and reestablishing equilibrium.
b. long-term resolution of issues precipitating the crisis.
c. promoting growth of the individual.
d. providing legal assistance.

a. supporting emotional security and reestablishing equilibrium.



After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred?


a. Reactive 
b. Situational 
c. Maturational
d. Adventitious

c. Maturational



Which scenario is an example of an adventitious crisis?


a. The death of a child from sudden infant death syndrome
b. Being fired from a job because of company downsizing
c. Retirement of a 55-year-old person
d. A riot at a rock concert

d. A riot at a rock concert



Which agency provides coordination in the event of a terrorist attack?


a. Food and Drug Administration (FDA)
b. Environmental Protection Agency (EPA)
c. National Incident Management System (NIMS)
d. Federal Emergency Management Agency (FEMA)

c. National Incident Management System (NIMS)



During the initial interview at the crisis center, a patient says, "I've been served with divorce papers. I'm so upset and anxious that I can't think clearly." Which comment should the nurse use to assess personal coping skills?


a. "In the past, how have you handled difficult or stressful situations?"
b. "What would you like us to do to help you feel more relaxed?"
c. "Tell me more about how it feels to be anxious and upset."
d. "Can you describe your role in the marital relationship?"

a. "In the past, how have you handled difficult or stressful situations?"



An adult has cared for a debilitated parent for 10 years. The parent's condition recently declined, and the health care provider recommended placement in a skilled nursing facility. The adult says, "I've always been able to care for my parents. Nursing home placement goes against everything I believe." Successful resolution of this person's crisis will most closely relate to:



a. resolving the feelings associated with the threat to the person's self-concept.
b. ability of the person to identify situational supports in the community.
c. reliance on assistance from role models within the person's culture.
d. mobilization of automatic relief behaviors by the person.

a. resolving the feelings associated with the threat to the person's self-concept.



The principle most useful to a nurse planning crisis intervention for any patient is that the patient:


a. is experiencing a state of disequilibrium.
b. is experiencing a type of mental illness.
c. poses a threat of violence to others.
d. has high potential for self-injury.

a. is experiencing a state of disequilibrium.



A nurse assesses a patient in crisis. Select the most appropriate question for the nurse to ask to assess this patient's situational support.


a. "Has anything upsetting occurred in the past few days?"
b. "Who can be helpful to you during this time?"
c. "How does this problem affect your life?"
d. "What led you to seek help at this time?"

b. "Who can be helpful to you during this time?"



An adult comes to the crisis clinic after termination from a job of 15 years. The patient says, "I don't know what to do. How can I get another job? Who will pay the bills? How will I feed my family?" Which nursing diagnosis applies?


a. Hopelessness 
b. Powerlessness 
c. Chronic low self-esteem
d. Disturbed thought processes

b. Powerlessness



A troubled adolescent pulled out a gun in a school cafeteria, fatally shooting three people and injuring many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next?



a. Ask police to encircle the school campus with yellow tape to prevent parents from entering.
b. Announce over the loudspeakers, "The campus is now secure. Please return to your classrooms."
c. Require parents to pass through metal detectors and then allow them to look for their children in the school.
d. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.

d. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents



At the last contracted visit in the crisis intervention clinic, an adult says, "I've emerged from this a stronger person. You helped me get my life back in balance." The nurse responds, "I think we should have two more sessions to explore why your reactions were so intense." Which analysis applies?



a. The patient is experiencing transference.
b. The patient demonstrates need for continuing support.
c. The nurse is having difficulty terminating the relationship.
d. The nurse is empathizing with the patient's feelings of dependency.

c. The nurse is having difficulty terminating the relationship.



Which health care worker should be referred for critical incident stress debriefing?


a. A nurse who works at an oncology clinic where patients receive chemotherapy
b. A case manager whose patients have serious mental illness and are cared for at home
c. A health care employee who worked 12 hours at the information desk of a critical care unit
d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall

d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall



A nurse driving home after work comes upon a serious automobile accident. The driver gets out of the car with no apparent physical injuries. Which assessment findings would the nurse expect from the driver immediately after this event? Select all that apply.



a. Difficulty using a cell phone
b. Long-term memory losses
c. Fecal incontinence
d. Rapid speech
e. Trembling

A, D, E




A team of nurses report to the community after a category 5 hurricane devastates many homes and businesses. The nurses provide emergency supplies of insulin to persons with diabetes and help transfer patients in skilled nursing facilities to sites that have electrical power. Which aspects of disaster management have these nurses fulfilled? Select all that apply.


a. Preparedness
b. Mitigation
c. Response
d. Recovery
e. Evaluation

B, C


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Which of the following rationales is most important to understand when working with schizophrenic patients?


a.) Environmental stimulation can improve thought process.
b.) Providing external control assists their self control.
c.) Increasing daily social contact increases their self esteem.
d.) Non-structured group therapy enhances their energy level.

b.) Providing external control assists their self control.



Previous to being hospitalized, a patient diagnosed with schizophrenia was reported to be unresponsive, mute and refusing food for several days. What is the highest priority for this patient upon admission to the hospital?


a.) Contacting family members
b.) List of current medications
c.) Assessment of the intake and output
d.) Assign patient to a room near the nurses' station

c.) Assessment of the intake and output



Which symptoms of the schizophrenia are most amenable to treatment with both low- and high-potency antipsychotic medications?


a.) Hallucinations and delusions
b.) Lack of motivation and initiative
c.) Inadequate hygiene and grooming
d.) Social withdrawal and isolation

a.) Hallucinations and delusions



A patient with paranoid schizophrenia is delusional, unkempt and annoying to other patients. The priority intervention for this patient is to:


a.) encourage the patient to maintain ADLS.
b.) provide a safe environment.
c.) determine the frequency of the delusions.
d.) assess need for a private room.

b.) provide a safe environment.



Which nursing diagnosis is universally applicable to patients with schizophrenia?


a.) Noncompliance
b.) Disturbed body image
c.) Disturbed thought processes
d.) Risk for other-directed violence

c.) Disturbed thought processes



All mental activity has its locus in the:


a.) environmental stimuli of the patient
b.) brain
c.) personality structure
d.) emotions

b.) brain



Standard anti-psychotic drugs: (select all that apply)


a.) Lower the seizure threshold
b.) Increase blood pressure
c.) Can cause extrapyramidal symptoms (EPS)
d.) May lead to neuroleptic malignant syndrome

a.) Lower the seizure threshold


c.) Can cause extrapyramidal symptoms (EPS)
d.) May lead to neuroleptic malignant syndrome




A psychiatric nurse routinely administers the following drugs to patients in the community mental health center. The patients who should be most carefully assessed for untoward cardiac side effects are those receiving:
a.) lithium
b.) clozapine
c.) diazepam
d.) sertraline

a.) lithium



Clozaril: (select all that apply)


a.) is an atypical anti-psychotic drug
b.) may cause agranulocytosis
c.) is indicated for severely ill schizophrenics
d.) is used for first-line treatment of psychosis

a.) is an atypical anti-psychotic drug


b.) may cause agranulocytosis




Pharmacological agents:
a.) are equally effective with all cultural groups
b.) rarely cause side effects
c.) may have undesired effects in some cultural groups
d.) are best if they are naturally processed

c.) may have undesired effects in some cultural groups



An elderly man, accompanied by his son with whom he lives, arrives in the ED with many bruises and states he as difficulty moving his left shoulder. The priority nursing action is to:


a.) discuss the injuries with the patient without his son present
b.) call the police to report possible abuse
c.) arrange for a social work consultation
d.) have the patient call in another family member as a witness

a.) discuss the injuries with the patient without his son present



When treating a woman who has been trapped in an abusive marriage for many years, which statement would a nurse expect not to hear?


a.) If I'm patient, he'll change.
b.) I deserve to be beaten.
c.) I'll stay for the sake of the children.
d.) No adult has the right to control or harm another.

d.) No adult has the right to control or harm another.



When making assessments the nurse should bear in mind that a common characteristic of an abusing parent is:


a.) being female
b.) having poor coping skills
c.) having realistic expectations of child behavior
d.) abstaining for use of chemical substances of abuse

b.) having poor coping skills



During a nursing assessment, which of the following is a red flag for suspecting that a patient has been a victim of physical violence?


a.) Patient's explanations does not match the injury
b.) Patient has no history of stress-related physical problems
c.) Patient mentions having a concerned, supportive spouse
d.) Patient is anxious but open and direct in explaining the compliant or injury

a.) Patient's explanations does not match the injury



An elderly woman has been emotionally and financially abused by her family for years. The nurse has difficulty understanding why she allows this abuse to recur. The best approach is to:


a.) encourage the patient to break ties with her family
b.) avoid talking about the concept of abuse
c.) understand that the patient may feel helpless to make change
d.) believe that the patient is not concerned about the abuse

c.) understand that the patient may feel helpless to make change



A 19-yr-old college student, Jan is taken to the ED by her friend. Her friend states that she was sexually assaulted a frat party. Jan has given permission for a forensic examination (photos and specimens). Choose the nursing action you would take when working with a victim of sexual assault.


a.) Suggest she should clean up before the vaginal exam in order to feel less violated.
b.) Explain that everything will be okay, and that is usually takes a month or two to get over, in order to calm her down.
c.) Try to get her to tell you as much about the assault that she can remember, so you can put the information in your report to the police.
d.) Explain all the procedures before doing them (e.g., vaginal and rectal exams, obtaining forensic specimens (e.g., semen samples, debris pubic hair, etc.).

d.) Explain all the procedures before doing them (e.g., vaginal and rectal exams, obtaining forensic specimens (e.g., semen samples, debris pubic hair, etc.).



In the medical record of a victim of rape, which of the following types of data are inappropriate to document?


a.) Observations of the patient's physical trauma using body map
b.) Assessment of signs and symptoms of emotional trauma
c.) Verbatim statements made by the patient
d.) Details of the patient's sexual history

d.) Details of the patient's sexual history



When an ED nurse is providing care to a rape victim, which two of the following are important elements of care?


a.) Providing nonjudgement care
b.) Conveying disgust that this would happen
c.) Aligning with her sense of blaming herself
d.) Assuring confidentiality

a.) Providing nonjudgement care


d.) Assuring confidentiality




Which of the following observations, if found in the medical record of a sexual assault survivor, would indicate that reorganization after a rape crisis was not yet complete? The patient is:
a.) free from somatic reactions
b.) generally positive about self
c.) calm and relaxed during interactions
d.) experiencing frequent nightmares

d.) experiencing frequent nightmares



A patient asks the nurse if she should leave her husband who has been sexually violent to her. The best response by the nurse would be:


a.) It would be safer for you to divorce your husband.
b.) Often women are in more danger during the separation period.
c.) He will appreciate you more after you leave him.
d.) I cannot professionally respond to your question.

d.) I cannot professionally respond to your question.



Federal and state categorization of mental illness according to levels of severity has tremendous implication for which of the following? Select all that apply


a.) Providing a standard, nationally based medical classification to facilitate diagnosis
b.) Setting mental heal policy
c.) Facilitating access to appropriate care
d.) Providing employers with the basis to understand work capacities for mentally ill employees

b.) Setting mental heal policy


c.) Facilitating access to appropriate care




NAMI has been developed to:
a.) regulate neurotransmission along critical pathways involved in schizophrenia
b.) provide social and employment opportunities for patients with mental health disorders through partial hospitalization programs
c.) provide a structured, phased approach for improved management of ADHD symptoms.
d.) offer support and education for patients and families of patients with mental health disorders

d.) offer support and education for patients and families of patients with mental health disorders



Which of the following are accurate statements about impulse control disorders? Select all that apply


a.) Causes of impulse control disorders are not clearly understood
b.) Genetic factors are not considered to contribute to impulse control disorders
c.) Anxiety may play an important role in impulse control disorders
d.) Impulse control disorders are frequently associated with depression

a.) Causes of impulse control disorders are not clearly understood


c.) Anxiety may play an important role in impulse control disorders



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