Crisis & Abuse

Question 1

Should the nurse ever leave a client in physical or emotional distress?

Answer 1

Never leave a client in distress.

Question 2

What is a crisis?

Answer 2

A stressful time when there is a breakdown or disruption in the usual or normal daily activities for a person, group, or community.

Question 3

What is a maturational crisis?

Answer 3

Relates to normal developmental stages that a client would go through such as marriage, birth of a child, or retirement.

These changes can be very traumatic for some.

Question 4

What is a situational crisis?

Answer 4

An unanticipated life event such as losing a job, death of a loved one, divorce, abortion, or severe illness.

Question 5

What is an adventitious crisis?

Answer 5

The result of a disaster and is not a part of everyday life.

Examples are natural disasters, violence, or abuse.

Question 6

What is the nurse’s role when a client is experiencing a crisis?

Answer 6

• assess the client’s perception of the crisis
• encouraging expression of feelings and ways to cope

Clients will have different responses to the same crisis.

Question 7

What is grief?

Answer 7

A normal emotional response to loss.

Question 8

What is the first stage of grief?

Answer 8

Denial

Question 9

What is the second stage of grief?

Answer 9

Anger

Question 10

What is the third stage of grief?

Answer 10

Bargaining

Question 11

What is the fourth stage of grief?

Answer 11

Depression

Question 12

What is the fifth stage of grief?

Answer 12

Acceptance

Question 13

What is dysfunctional grief?

Answer 13

When there is prolonged emotional instability and a lack of moving through the stages of grief.

Question 14

What is loss?

Answer 14

Loss is the absence of something desired.

Question 15

What is mourning?

Answer 15

The outward and social expression of loss.

Question 16

What is bereavement?

Answer 16

Includes grief and mourning. It is the feeling of sadness and loneliness someone experiences from a loss.

Question 17

What is the main role of the nurse when a client is experiencing grief and loss?

Answer 17

To communicate with the client, family members, and significant other:

• figure out who is the spokesperson for the family
• consider cultural, religious, or spiritual practices
• use therapeutic communication
• seek help if unsure how to respond

Question 18

Is it OK to cry with the client and family during the grieving process?

Answer 18

Yes, don’t be afraid to show some emotion.

Contact a bereavement specialist if unsure how to proceed with client.

Question 19

What are reported feelings of suicidal clients?

Answer 19

Overwhelming feelings of worthlessness, guilt, and hopelessness.

Question 20

What are risk factors for suicide?

Answer 20

• previous attempts and family history of suicide attempts
• past psychiatric hospitalizations

Question 21

Which age is most at risk for suicide?

Answer 21

Adolescents and older adults.

Question 22

What types of mental health disorders put a client at risk for suicide?

Answer 22

• disabled or terminally ill clients
• dementia
• depressed
• psychotic
• substance abuse

Always ask these clients if they have a plan for suicide.

Question 23

What are cues that the client may have a plan for suicide?

(Immediate complication)

Answer 23

• giving away meaningful belongings
• sudden improvement in mood
• making a will or getting an insurance policy
• statements indicating intent to attempt suicide
• sudden overall physical and mental deterioration

Question 24

What is asked in a suicide assessment?

Answer 24

• Do you have a suicide plan?
• Do you have any guns in the house?
• Have you attempted suicide in the past?
• Are there any mental health disorders?
• Do you live alone or alienated from others?

Question 25

What are the **interventions** for acute suicide risk?

Answer 25

* **one-on-one constant monitoring** * take out all harmful objects in room * develop a no-suicide contract with client * document behavior and mood assessment every 15 minutes * don't allow client to leave unit unless with a staff member

Question 26

What are the **interventions** for suicide after the acute period of suicide risk is over?

Answer 26

* encourage client to talk about feelings * encourage participation in own care * keep client active * identify support systems

Question 27

What are some common **abusive behaviors** exhibited by clients?

Answer 27

* anger * aggression * violence

Question 28

What should the nurse do **immediately** if a client is being violent? | (Immediate complication)

Answer 28

* approach the client calmly and communicate with a calm and clear tone of voice * maintain a safe distance away from client * maintain a non-aggressive posture * listen actively and acknowledge anger * determine what their need is * call security if client does not calm down

Question 29

If a client or caretaker's life is in **immediate danger** what should the nurse do as a last resort?

Answer 29

Implement **restraints and/or seclusion.**

Question 30

What is **abuse**?

Answer 30

Includes **nonaccidental physical injury, neglect, and physical/sexual/emotional maltreatment.**

Question 31

What is a common **assessment** question for **violence and abuse screening** that every client should be asked?

Answer 31

Ask the client, **"Do you feel safe in your work and home environment?"** ## Footnote May interview client privately if abuse is suspected.

Question 32

What should the nurse **teach** parents about child abduction?

Answer 32

**To speak with children about personal safety:** * don't go anywhere alone * Say NO if you are in an uncomfortable situation * report to a trusted adult if the child is asked to keep a secret, help to look for a lost dog or gets offers of candy or gifts

Question 33

What are **signs** of neglect in a child?

Answer 33

* poor hygiene * malnourished * consistent hunger and fatigue * misses a lot of school

Question 34

What are **signs** of physical abuse in a child?

Answer 34

* unexplained bruises, burns, and fractures * bald spots on head * extremely aggressive (seen in boys) * very withdrawn (seen in girls) * doesn't cry * poor school performance

Question 35

What are **signs** of emotional abuse in a child?

Answer 35

* speech disorders * habits such as rocking and sucking * learning disorders * suicide attempts * caretaker won't leave the room

Question 36

What are **signs** of sexual abuse in a child?

Answer 36

* difficulty walking and sitting * pain, swelling, itching, and trauma of genitals * bloody and torn underwear * refuses to change clothes or participate in gym activities

Question 37

What are **signs** of shaken baby syndrome?

Answer 37

* no obvious outside signs of trauma * retinal hemorrhage * full and bulging fontanels due to increased ICP ## Footnote *Teach clients to NEVER shake a baby.*

Question 38

What should a nurse do if there is **suspected abuse or neglect** of a client?

Answer 38

* report to appropriate authorities * assess for injuries * help develop a safety plan * encourage support groups ## Footnote Appropriate authorities would be: child protective services or adult protective services.

Question 39

Which type of **older adults** are most at risk for abuse?

Answer 39

* dependent and immobile due to illness * altered mental status

Question 40

What are **signs** of neglect in an older client?

Answer 40

* disheveled appearance * dehydrated and malnourished * missing adaptive needs such as glasses, hearing aids, and dentures

Question 41

Is an adult rape victim required by law to **report the incident**?

Answer 41

**No,** the victim does not have to report.

Question 42

What should the nurse do if a client is **suspected of being raped**?

Answer 42

* stay with victim * treat immediate physical injuries * assess stress level before treatments and procedures

Question 43

What should the rape victim **avoid** before the examination by the nurse?

Answer 43

The rape victim should **not shower, bathe, douche or change clothing** until the exam is performed. ## Footnote The evidence can get washed away.

Question 44

What should be done next **after the physical exam** for rape is over?

Answer 44

Refer the rape victim to **crisis intervention and support groups**.