ch 27 Anger, Aggression, and Violence

The nurse is assigned to care for an aggressive patient who is holding a sharp object. What nursing action is most appropriate for this patient? 1 Making firm eye contact with the patient while speaking. 2 Asking another staff member to restrain the patient. 3 Trying to grab the patient's hand and tie him or her up. 4 Informing the primary health care provider about the patient.

1 Making firm eye contact with the patient while speaking.

A patient has been placed in seclusion to control aggressive behavior. Care while the patient is secluded should include 1 Observation every 30 minutes 2 Releasing the patient every eight hours 3 Increasing sensory stimulation 4 Providing for nutrition and hydration

4 Providing for nutrition and hydration

You are working on an adolescent psychiatric unit. Katy, aged 16 years, has been angry all day because her boyfriend was not allowed to visit last night. Katy is in the hallway and begins yelling, "It's not fair! You all hate me! I hate this place!" She begins pounding her fists on the wall. To deal with the situation and prevent further escalation, your best response would be to say: A. "Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?" B. "Katy, you may yell and bang your fists but you must do it in your own room so you don't upset the other patients." C. "Katy, stop that right now! You will not be allowed to behave like that!" D. "Katy, you will have to go into seclusion and restraints right now."

A. "Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?"

A client has a history of demonstrating aggression physically. An appropriate short-term goal to help the client manage this anger is to A. strike objects rather than people. B. limit aggression to verbal outbursts. C. isolate in lieu of striking people. D. identify situations that precipitate hostility.

D. identify situations that precipitate hostility.

A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by A. continuing to manage the situation personally. B. telling the client, "It isn't safe for me to leave the room." C. moving to the rear of the staff group. D. apologizing for upsetting the client.

C. moving to the rear of the staff group.

Peter, a 21-year-old patient, asks you, "What's wrong with my brain that I have such a problem with aggression?" Your response is based on the knowledge that: A. the prevailing theory is that diminishment of stress hormones causes anger and aggression. B. no abnormalities of the brain have been identified that correlate with anger and aggression. C. the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. D. personality type plays a much greater part in anger and aggression than physical factors.

C. the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.

You are working in the emergency department. You notice Matt, your patient's husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which of the following statements to Matt may help prevent escalation and/or violence? A. "You need to stay with your wife. She needs you." B. "Hey, what's up buddy? You look pissed." C. "I am calling security to deal with your behavior." D. "You appear upset. Can I help you with anything?"

D. "You appear upset. Can I help you with anything?"

Anger can best be defined as A. an unhealthy way of releasing anxiety. B. doing intentional harm to others. C. an expression of conflict with others. D. a normal response to a perceived threat.

D. a normal response to a perceived threat.

A client waiting to see the physician is pacing and looking both angry and tense. When it's determined that the client won't be seen for another 30 minutes, the nurse addresses the client's agitation by A. telling the client that pacing will not help the rate at which clients are seen. B. adjusting the appointment schedule to allow the client to be seen next. C. empathizing with the long wait and asking the client if he would mind sitting down until his turn comes. D. explaining to the client what caused the backup and suggesting that he has time to go to the coffee shop.

D. explaining to the client what caused the backup and suggesting that he has time to go to the coffee shop.

A client experiencing manic hyperactivity stands up, glares challengingly at clients and staff, and shouts, "This food is garbage! I'll fight anyone who says it's not!" The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D. has a high potential for other-directed violence.

D. has a high potential for other-directed violence.

A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include A. observation every 30 minutes. B. releasing the client every 8 hours. C. increasing sensory stimulation. D. providing for nutrition and hydration.

D. providing for nutrition and hydration.

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of A. isolation. B. confidence. C. competence. D. vulnerability.

D. vulnerability.

The nurse receives a patient with an injury and provides first aid to the patient. Another patient who had been present in the treatment room suddenly becomes aggressive and shouts at the nurse. The patient threatens the nurse with a pair of scissors to get the nurse to attend to them first. What should be the most appropriate response of the nurse? 1 "Would you please tell me your problem?" 2 "Can't you see what I am doing?" 3 "You can't talk to me like this." 4 "I think I will have to call security."

1 "Would you please tell me your problem?"

An elderly patient is being cared for in a nursing home. The patient shouts that she wants to go home as her children are waiting for her. The patient says the children are very young and need to be fed. What is the most appropriate response by the nurse? 1 "You miss your children. Can you tell me something more about them?" 2 "Your children are all grown up and they do not need your help now." 3 "You cannot go home as you are not well and need treatment." 4 "You should understand that your children want you to be in a nursing home."

1 "You miss your children. Can you tell me something more about them?"

The parent of a hospitalized adolescent enters the inpatient unit yelling, "What is wrong with you people? My daughter cut herself and you let it to happen. I thought my child would be safe here." Select the nurse's appropriate response. 1 "I am sorry your daughter was hurt. We are short staffed today." 2 "It seems like you yell about something every time you come for a visit." 3 "I am unable to answer your question. Your child was assigned to another nurse today." 4 "I can't understand you when your voice is so loud. Let's go to a private area and talk about it."

4 "I can't understand you when your voice is so loud. Let's go to a private area and talk about it."

Which assessment finding is the best predictor of violence in a newly admitted client? A. A recent assault on a drinking companion. B. A family history of bipolar disorder C. The nurse's subjective feeling that the client is uncooperative. D. A childhood history of being bullied at school

A. A recent assault on a drinking companion.

Which intervention strategy should be avoided by staff working with a client who is shouting and flailing his arms? A. Defusing the situation by laughing or making a joke of the challenge B. Saying "Let's go to your room to talk about this" C. Moving a few staff close together as a group to provide a show of force D. Allowing one staff person to speak to the client while others provide support

A. Defusing the situation by laughing or making a joke of the challenge

Which would be the most appropriate response by the nurse to help a client who is demonstrating escalating anger? A. Walk the client to his room and help him practice stress-reduction techniques, such as deep breathing or muscle relaxation B. Suggest that the client spend some time in the gym with a punching bag to relieve his stress C. Suggest that the client spend some time pacing rapidly in the hallway until he feels less stressed D. Sit with the client in the day room so that he can vent his anger and not isolate himself

A. Walk the client to his room and help him practice stress-reduction techniques, such as deep breathing or muscle relaxation

The most restrictive method for dealing with an aggressive client who is out of control is A. seclusion. B. a show of force. C. verbal intervention. D. antipsychotic medication.

A. seclusion.

The more a nurse's intervention is prompted by emotion A. the less likely it is to be therapeutic. B. the less likely it is to be aggressive. C. the more likely it is to be effective. D. the more likely it is to be empathetic.

A. the less likely it is to be therapeutic.

When you approach Katy, what considerations should you take? A. Stand close to Katy for reassurance and to convey caring. B. Have other staff as backup, and stand far enough away to avoid injury. C. Take Katy to her room so you can speak with her alone. D. Call security and wait until they arrive before approaching Katy.

B. Have other staff as backup, and stand far enough away to avoid injury.

Which neurotransmitter imbalance has been shown to be related to impulsive aggression? A. Low levels of ãaminobutyric acid B. Low levels of serotonin C. High levels of dopamine D. High levels of acetylcholine

B. Low levels of serotonin

Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression? A. Social isolation B. Risk for other-directed violence C. Ineffective coping: overwhelmed D. Ineffective coping: maladaptive

B. Risk for other-directed violence

An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior? A. Tell him they will not change his dressing if he is going to abuse them. B. When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control. C. Assure him they will complete the dressing change as quickly as possible. D. Explain that they are professionals and unused to being shouted at by people they are trying to help.

B. When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control.

When a client diagnosed with a cognitive deficit experiences a catastrophic reaction, the priority intervention is to A. decrease sensory stimuli. B. smile and call the client by name. C. take the client to the bathroom. D. calmly ask the client what's wrong.

B. smile and call the client by name.

One older concept that is being used currently that may help in violence reduction in patients is: A. aired grievances. B. trauma-informed care. C. shared governance. D. learned helplessness.

B. trauma-informed care.

The factor most likely to contribute to a client's escalating anger is A. watching violence on television. B. another client's depressed mood. C. a staff member telling him that he is inappropriate. D. a staff member asking him to help another client.

C. a staff member telling him that he is inappropriate.

The client at highest risk for violence directed at others is one who A. has a history of recurrent severe depression. B. is in an alcohol rehabilitation program. C. has delusions of persecution. D. who has somatic symptoms for which no organic basis is found.

C. has delusions of persecution.

When working with an angry client, it is best to A. encourage the client to fully explore and express his or her anger. B. help the client deny and repress the feelings of anger. C. help the client reframe the anger-producing situation. D. ignore the client's anger and change the subject.

C. help the client reframe the anger-producing situation.

An adolescent male is swearing and shouting at his physician, who refused to give him a pass to leave the unit. This behavior A. is acceptable if directed at staff but not when directed at other clients. B. may reduce tension and prevent the client from physically acting out. C. is a major indicator that the client may become physically aggressive. D. can be attributed to lack of parental controls applied at an early age.

C. is a major indicator that the client may become physically aggressive.