Chapter 27: Anger, Aggression, and Violence Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition(BEST AND RATED 5 STAR - MOVE FROM D"s TO A:s)

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1. Which behavior best demonstrates aggression? a. Stomping away from the nurses‘ station, going to the hallway, and grabbing a tray from the meal cart. b. Bursting into tears, leaving the commun... ity meeting, and sitting on a bed hugging a pillow and sobbing. c. Telling the primary nurse, ―I felt angry when you said I could not have a second helping at lunch.‖ d. Telling the medication nurse, ―I am not going to take that, or any other, medication you try to give me.‖ ANS: A Aggression is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. Refusing medication is a patient‘s right and may be appropriate. The other incorrect options do not feature violation of another‘s rights. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 27-2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which clinical scenario predicts the highest risk for directing violent behavior toward others? a. Major depressive disorder with delusions of worthlessness b. Obsessive-compulsive disorder; performs many rituals c. Paranoid delusions of being followed by alien monsters d. Completed alcohol withdrawal; beginning a rehabilitation program ANS: C Patients who are delusional, hyperactive, impulsive, or predisposed to irritability are at higher risk for violence. The patient in the correct response has the greatest disruption of ability to perceive reality accurately. People who feel persecuted may strike out against those believed to be persecutors. The other patients have better reality-testing ability. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 27-3, 4, 8, 50 (Box 27-1) TOP: Nursing Process: Analysis/Diagnosis MSC: Client Needs: Safe, Effective Care Environment testbanks_and_xanax 3. A patient was arrested for breaking windows in the home of a former domestic partner. The patient‘s history also reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Risk for other-directed violence ANS: D Defining characteristics for risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. There is no indicator that the patient will experience injury. Ineffective coping and impaired social interaction have lower priorities. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 27-8, 12, 13, 50 (Box 27-1) TOP: Nursing Process: Analysis/Diagnosis MSC: Client Needs: Psychosocial Integrity 4. A confused older adult patient in a skilled nursing facility was asleep when unlicensed assistive personnel (UAP) entered the room quietly and touched the bed to see if it was wet. The patient awakened and hit the UAP in the face. Which statement best explains the patient‘s action? a. Older adult patients often demonstrate exaggerations of behaviors used earlier in life. b. Crowding in skilled nursing facilities increases an individual‘s tendency toward violence. c. The patient learned violent behavior by watching other patients act out. d. The patient interpreted the UAP‘s behavior as potentially harmful. ANS: D Confused patients are not always able to evaluate the actions of others accurately. This patient behaved as though provoked by the intrusive actions of the staff. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 27-3, 4, 30, 31 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. A patient is pacing the hall near the nurses‘ station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say: a. ―What is going on?‖ b. ―Please be quiet and sit down in this chair immediately.‖ c. ―I‘d like to talk with you about how you‘re feeling right now.‖ d. ―You must go to your room and try to get control of yourself.‖ ANS: C Intervention should begin with analysis of the patient and the situation. When anger is escalating, a patient's ability to process decreases. It is important to speak to the patient slowly and in short sentences, using a low and calm voice. Use open-ended statements designed to hear the patient‘s feelings and concerns. This leads to the next step of planning an intervention. testbanks_and_xanax PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 27-21 to 23, 54 (Box 27-4) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 6. A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, ―Back off!‖ and then goes to the dayroom. While following the patient into the dayroom, the nurse should a. make sure there is adequate physical space between the nurse and patient. b. move into a position that places the patient close to the door. c. maintain one arm‘s length distance from the patient. d. begin talking to the patient about appropriate behavior. ANS: A Making sure space is present between the nurse and the patient avoids invading the patient‘s personal space. Personal space needs increase when a patient feels anxious and threatened. Allowing the patient to block the nurse‘s exit from the room may result in injury to the nurse. Closeness may be threatening to the patient and provoke aggression. Sitting is inadvisable until further assessment suggests the patient‘s aggression is abating. One arm‘s length is inadequate space. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 27-21 to 23, 51 (Box 27-2), 54 (Box 27-4) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 7. An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive and refused to leave the day room. The nurse should enter the day room a. and say, ―Would you like to come to your room and take some medication your health care provider prescribed for you?‖ b. accompanied by three staff members and say, ―Please come to your room so I can give you some medication that will help you regain control.‖ c. and place the patient in a basket-hold and then say, ―I am going to take you to your room to give you an injection of medication to calm you.‖ d. accompanied by a male security guard and tell the patient, ―Come to your room willingly so I can give you this medication, or the guard and I will take you there.‖ ANS: B A patient gains feelings of security if he or she sees others are present to help with control. The nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that the intervention will be helpful. This positive approach assumes the patient can act responsibly and will maintain control. Physical control measures are used only as a last resort. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 27-14, 15, 21 to 23, 51 (Box 27-2), 54 (Box 27-4) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment testbanks_and_xanax 8. After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse said, ―That patient should not be allowed to get away with that behavior.‖ Which response poses the greatest barrier to the nurse‘s ability to provide therapeutic care? a. Startle reactions b. Difficulty sleeping c. A wish for revenge d. Preoccupation with the incident ANS: C The desire for revenge signals an urgent need for professional supervision to work through anger and counter the aggressive feelings. Feelings of revenge create a risk for harm to the patient. The distracters are normal in a person who was assaulted. They usually are relieved with crisis intervention, help the individual regain a sense of control, and make sense of the event. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 27-23, 24, 55 (Box 27-5) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 9. The staff development coordinator plans to teach use of physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize? a. Practice and teamwork b. Spontaneity and surprise c. Caution and superior size d. Diversion and physical outlets ANS: A Intervention techniques are learned behaviors and must be practiced to be used in a smooth, organized fashion. Every member of the intervention team should be assigned a specific task to carry out before beginning the intervention. The other options are useless if the staff does not know how to use physical techniques and how to apply them in an organized fashion. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 27-15, 16, 18, 19 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. An adult patient assaulted another patient and was then restrained. One hour later, which statement by the restrained patient requires the nurse‘s immediate attention? a. ―I hate all of you!‖ b. ―My fingers are tingly.‖ c. ―You wait until I tell my lawyer.‖ d. ―The other patient started the fight.‖ ANS: B testbanks_and_xanax The correct response indicates impaired circulation and necessitates the nurse‘s immediate attention. The incorrect responses indicate the patient has continued aggressiveness and agitation. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 27-20, 21, 52 (Box 27-3) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity 11. Which is an effective nursing intervention to assist an angry patient learn to manage anger without violence? a. Help a patient identify a thought that produces anger, evaluate the validity of the belief, and substitute reality-based thinking. b. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present. c. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings. d. Administer an antipsychotic or antianxiety medication. ANS: A Anger has a strong cognitive component, so using cognition techniques to manage anger is logical. The incorrect options do nothing to help the patient learn anger management. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 27-20, 21, 52 (Box 27-3) | Page 27-54 (Box 27-4) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity [Show More]

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