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Which health care worker should be referred to critical incident stress debriefing?
- A. Nurse who works at an oncology clinic where patients receive chemotherapy.
- B. Case manager whose patients are seriously mentally ill and are being cared for at home.
- C. Health care employee who worked 8 hours at the information desk of intensive care unit.
- D. Emergency medical technician who treated victims of a car bombing at a department store.
Correct Answer: D
Rationale: The EMT experienced an adventitious crisis (bombing), warranting critical incident stress debriefing due to the traumatic nature of the event.
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A patient comes to the clinic with superficial cuts on the left wrist. The patient paces around the room sobbing but cringes when approached and responds to questions with only shrugs or monosyllables. What is the nurse's best initial statement 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 am going to stay and talk with you to help you feel better.
- C. You need to try to stop crying so we can talk about your problems.
- D. Let's set some guidelines and goals for your visit here.
Correct Answer: B
Rationale: 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 the use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient's safety. The incorrect responses use nontherapeutic techniques, including false reassurance and giving advice.
A woman says, 'I can't take anymore! Last year my husband was diagnosed with cancer. Three months ago, I lost my job. Yesterday my daughter said she's quitting college and moving in with her boyfriend.' Which issue should be the focus for crisis intervention?
- A. Possible mastectomy
- B. Disordered family communication
- C. Effects of the divorce
- D. Coping with the reaction to the daughter's events
Correct Answer: D
Rationale: The focus of crisis intervention is on the most recent problem?'the straw that broke the camel's back.' The daughter's decision is the immediate precipitating event causing disequilibrium.
A patient comes to the clinic with superficial cuts on the left wrist. The patient is pacing and sobbing. After a few minutes with the nurse, the patient is calmer. What should the nurse ask to determine the patient's perception of the precipitating event?
- A. Tell me why you were crying.
- B. How did your wrist get injured?
- C. How can I help you feel more comfortable?
- D. What was happening just before you started feeling this way?
Correct Answer: D
Rationale: A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events permits the assessment of the precipitating event. Asking 'why' questions are a nontherapeutic communication technique.
Which premise is most useful to a nurse planning crisis intervention for any patient?
- A. The patient is experiencing a state of disequilibrium.
- B. The patient is experiencing a type of mental illness.
- C. The patient poses a threat of violence to others.
- D. The patient has a high potential for self-injury.
Correct Answer: A
Rationale: Disequilibrium is universal in crisis, representing a struggle for equilibrium. Other options are not always applicable.
A troubled adolescent opened fire in a high school cafeteria, fatally shooting three people and injuring many others. Hundreds of parents come to the high school after hearing the news reports. After the police arrest the shooter, which action should occur next?
- A. Ask the 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.
Correct Answer: D
Rationale: Organizing reunification by alphabetized zones is a practical solution to manage chaos and reunite families efficiently.