Prep U Ch. 32 Anger & Agression

Which of the following best describes the main differences between anger and violence? a) Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. b) Anger is an abnormally exaggerated response to aggression. c) Violence is adaptive if used in the appropriate place and time and as an appropriate response to aggressive behavior. d) Violence is never an adaptive response under any circumstance.

Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. Explanation: Anger is an emotional response to perceived frustration of desires or needs. Aggression may manifest as verbal aggression, physical aggression, or both against objects, people, or self with a potential toward destruction or intent to cause harm. Violence refers to destructive human behaviors and responses and denotes physical aggression by one person against another.

Which of the following best describes the main differences between anger and violence? a) Anger is an abnormally exaggerated response to aggression. b) Violence is never an adaptive response under any circumstance. c) Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. d) Violence is adaptive if used in the appropriate place and time and as an appropriate response to aggressive behavior.

Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. Explanation: Anger is an emotional response to perceived frustration of desires or needs. Aggression may manifest as verbal aggression, physical aggression, or both against objects, people, or self with a potential toward destruction or intent to cause harm. Violence refers to destructive human behaviors and responses and denotes physical aggression by one person against another.

Which of the following best describes the main differences between anger and violence? a) Violence is adaptive if used in the appropriate place and time and as an appropriate response to aggressive behavior. b) Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. c) Anger is an abnormally exaggerated response to aggression. d) Violence is never an adaptive response under any circumstance.

Anger is a normal human emotional response to perceived frustration of desires or needs; violence is a destructive physical or verbal response to anger. Explanation: Anger is an emotional response to perceived frustration of desires or needs. Aggression may manifest as verbal aggression, physical aggression, or both against objects, people, or self with a potential toward destruction or intent to cause harm. Violence refers to destructive human behaviors and responses and denotes physical aggression by one person against another.

Seclusion and restraint are nursing interventions to be used for an individual ... a) As an initial consideration to a patient with a history of violence who is shouting at a co-patient b) Observed pacing quickly on the unit c) As a last resort d) Refusing to take a PRN medication when offered for agitation

As a last resort Explanation: Seclusion and restraint are controversial interventions to be used judiciously and only when other interventions have failed to control the client's behavior.

Seclusion and restraint are nursing interventions to be used for an individual ... a) As an initial consideration to a patient with a history of violence who is shouting at a co-patient b) Refusing to take a PRN medication when offered for agitation c) Observed pacing quickly on the unit d) As a last resort

As a last resort Explanation: Seclusion and restraint are controversial interventions to be used judiciously and only when other interventions have failed to control the client's behavior.

When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which of the following should the nurse do first? a) Call for assistance. b) Give the client choices. c) Remove the other clients. d) Talk to the client calmly.

Call for assistance. Explanation: Safety is the priority; the nurse needs assistance to remove other clients and to deal with the violent outburst. Answer B, C, D may be done after safety has been maintained.

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following? a) Client's safety b) Physician's order c) Court order d) Client's mood

Client's safety Explanation: The use of restraints is warranted only when the client's safety is in jeopardy and other, less restrictive measures have not been effective. The nurse does not base her decision on the client's mood or court order. Just because there is a physician's order for use of restraints, this does not mean that they are appropriate in every situation; this is based on nursing judgment.

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following? a) Client's mood b) Court order c) Client's safety d) Physician's order

Client's safety Explanation: The use of restraints is warranted only when the client's safety is in jeopardy and other, less restrictive measures have not been effective. The nurse does not base her decision on the client's mood or court order. Just because there is a physician's order for use of restraints, this does not mean that they are appropriate in every situation; this is based on nursing judgment.

Which of the following signs of escalating behaviors, if displayed by a client, require immediate intervention? a) Banging the head against the wall b) Staring intensely for a long time c) Using foul language d) Making sarcastic comments

Banging the head against the wall Explanation: Banging one's head against the wall is correct, because the client may cause serious self-harm. Lengthy intense staring and using foul language and sarcasm are not immediate threats.

Therapeutic relationship strategies to de-escalate refer to a) Collaborating with the team and family to decide on the most appropriate action b) Being a client advocate c) Allowing other patients on the unit to share their experiences d) Focusing on responsibility on the unit of nursing to control violent outbursts

Being a client advocate Explanation: Therapeutic relationship strategies, including being available, being a client advocate, providing client education, and collaborating with the client in treatment planning can decrease the potential for violence.

Therapeutic relationship strategies to de-escalate refer to a) Collaborating with the team and family to decide on the most appropriate action b) Focusing on responsibility on the unit of nursing to control violent outbursts c) Allowing other patients on the unit to share their experiences d) Being a client advocate

Being a client advocate Explanation: Therapeutic relationship strategies, including being available, being a client advocate, providing client education, and collaborating with the client in treatment planning can decrease the potential for violence.

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following? a) Client's safety b) Client's mood c) Court order d) Physician's order

Client's safety Explanation: The use of restraints is warranted only when the client's safety is in jeopardy and other, less restrictive measures have not been effective. The nurse does not base her decision on the client's mood or court order. Just because there is a physician's order for use of restraints, this does not mean that they are appropriate in every situation; this is based on nursing judgment.

A nurse suggests that the patient explores new ideas about a particular problem and considers other possibilities to reflect a(n) a) Negative approach intervention b) Psychoanalytical approach c) Affective intervention d) Cognitive intervention

Cognitive intervention Explanation: Cognitive interventions are usually those that provide new ideas, opinions, information, or education about a particular problem. The nurse offers a cognitive intervention with the goal of inviting the client to consider other possibilities.

A nurse suggests that the patient explores new ideas about a particular problem and considers other possibilities to reflect a(n) a) Psychoanalytical approach b) Cognitive intervention c) Affective intervention d) Negative approach intervention

Cognitive intervention Explanation: Cognitive interventions are usually those that provide new ideas, opinions, information, or education about a particular problem. The nurse offers a cognitive intervention with the goal of inviting the client to consider other possibilities.

A group of nursing students is reviewing information about maladaptive anger. The students demonstrate a need for additional review when they identify which of the following as being linked to suppressed anger? a) Arthritis b) Breast cancer c) Coronary heart disease d) Hypertension

Coronary heart disease Explanation: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions. For example, excessive outwardly directed anger is linked to coronary heart disease and myocardial infarction. Suppressed anger is related to arthritis, breast and colorectal cancer, chronic pain, and hypertension.

A group of nursing students is reviewing information about maladaptive anger. The students demonstrate a need for additional review when they identify which of the following as being linked to suppressed anger? a) Hypertension b) Coronary heart disease c) Arthritis d) Breast cancer

Coronary heart disease Explanation: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions. For example, excessive outwardly directed anger is linked to coronary heart disease and myocardial infarction. Suppressed anger is related to arthritis, breast and colorectal cancer, chronic pain, and hypertension.

A nurse is reading a journal article about aggression and violence in health care. Which of the following would the nurse most likely find? a) Assaults by clients toward staff are showing a decrease in incidence. b) Aggression and violence occur over a wide range of health care settings. c) Clients with psychiatric problems are more violent than other clients. d) Psychiatric nurses are the primary individuals requiring the ability to manage aggression in clients.

Aggression and violence occur over a wide range of health care settings. Explanation: Assaults by clients toward the staff of hospitals and nursing homes are on the increase. Aggression and violence occur across a wide spectrum of health care settings, requiring all nurses to develop expertise in prevention and management of aggression. Contrary to a popular misconception, clients who have psychiatric problems are not more violent than other clients.

A nurse is reading a journal article about aggression and violence in health care. Which of the following would the nurse most likely find? a) Clients with psychiatric problems are more violent than other clients. b) Psychiatric nurses are the primary individuals requiring the ability to manage aggression in clients. c) Aggression and violence occur over a wide range of health care settings. d) Assaults by clients toward staff are showing a decrease in incidence.

Aggression and violence occur over a wide range of health care settings. Explanation: Assaults by clients toward the staff of hospitals and nursing homes are on the increase. Aggression and violence occur across a wide spectrum of health care settings, requiring all nurses to develop expertise in prevention and management of aggression. Contrary to a popular misconception, clients who have psychiatric problems are not more violent than other clients.

After teaching a class about aggression and violence, the instructor determines that the education was successful when the class states which of the following? a) Aggression is primarily physical. b) Aggression involves behavior directed inwardly. c) Violence involves less forceful than aggression. d) All violence is aggressive.

All violence is aggressive. Explanation: Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting).

After teaching a class about aggression and violence, the instructor determines that the education was successful when the class states which of the following? a) All violence is aggressive. b) Violence involves less forceful than aggression. c) Aggression involves behavior directed inwardly. d) Aggression is primarily physical.

All violence is aggressive. Explanation: Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting).

After teaching a class about aggression and violence, the instructor determines that the education was successful when the class states which of the following? a) All violence is aggressive. b) Aggression involves behavior directed inwardly. c) Aggression is primarily physical. d) Violence involves less forceful than aggression.

All violence is aggressive. Explanation: Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting). (

When communicating with a client in the triggering phase of the aggression cycle, the nurse should ... a) Allow the client to take a "time out" in a quiet area b) Suggest that the client is still in control and can maintain that control c) Help the client relax and return a calmer state d) Use seclusion or restraint

Allow the client to take a "time out" in a quiet area Explanation: During the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to de-escalate the client's emotion and behavior. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation.

When communicating with a client in the triggering phase of the aggression cycle, the nurse should ... a) Use seclusion or restraint b) Help the client relax and return a calmer state c) Allow the client to take a "time out" in a quiet area d) Suggest that the client is still in control and can maintain that control

Allow the client to take a "time out" in a quiet area Explanation: During the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to de-escalate the client's emotion and behavior. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation

Which of the following describes a strong emotional response to a real or perceived provocation? a) Catharsis b) Hostility c) Anger d) Physical aggression

Anger Explanation: Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Catharsis includes activities that provide a release of the anger. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

Which of the following describes a strong emotional response to a real or perceived provocation? a) Physical aggression b) Anger c) Hostility d) Catharsis

Anger Explanation: Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Catharsis includes activities that provide a release of the anger. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

A nurse is leading an anger management group in the inpatient program. Mark says during the group, "I'm feeling really tense, and I'm fidgety today." What is the nurse's most appropriate response to Mark? a) "Mark, tell us more about those feelings, and what they are like." b) "Susan, how do you feel about Mark's statement?" c) "Mark, why don't you and I just do a very quick relaxation intervention to calm you down before we go on with group today?" d) "Could it be that it's because we started late, and Susan was late again, which you pointed out yesterday makes you angry?"

"Mark, tell us more about those feelings, and what they are like." Explanation: Identifying the feelings reduces the frustration. Attempt to discover the concern and respond with empathy, interest, and willingness to help. Encourage the client to describe and clarify his experience using open-ended questions to increase the client's awareness of problematic feelings and what triggers them.

A nurse is leading an anger management group in the inpatient program. Mark says during the group, "I'm feeling really tense, and I'm fidgety today." What is the nurse's most appropriate response to Mark? a) "Mark, why don't you and I just do a very quick relaxation intervention to calm you down before we go on with group today?" b) "Susan, how do you feel about Mark's statement?" c) "Could it be that it's because we started late, and Susan was late again, which you pointed out yesterday makes you angry?" d) "Mark, tell us more about those feelings, and what they are like."

"Mark, tell us more about those feelings, and what they are like." Explanation: Identifying the feelings reduces the frustration. Attempt to discover the concern and respond with empathy, interest, and willingness to help. Encourage the client to describe and clarify his experience using open-ended questions to increase the client's awareness of problematic feelings and what triggers them.

Joseph is very manipulative and has pushed the limits since his arrival on your unit. His care plan includes a break for cigarettes every hour during the afternoon if he follows his behavioral plan to attend the morning group on anger management. He asks you, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" What is the most therapeutic nursing intervention? a) "Why do you think you should be allowed to go for a break?" b) "Well, I know you were tired from last night. You can go at 2 PM." c) "No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." d) "Joe, let's review your care plan and discuss whether or not it needs to be revised."

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." Explanation: Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security. The nurse describes the client's unacceptable behavior, communicates expected behavior, and offers acceptable alternatives, such as walking with the nurse, talking about feelings and thoughts, or participating in recreational therapy.

The nurse has been working on anger management with the client, Sharon. She yells during dinner, "Give me that salt shaker!" What is the best nursing intervention at this time? a) "Sharon, it's not appropriate for you to ask for the salt that way; besides, you are on a low-salt diet right now." b) "Sharon, what do you think is wrong with the way you are asking for the salt?" c) "Sharon, you need to stop yelling right now and ask for the salt in the correct manner." d) "Sharon, you may have the salt after you ask for it in the way that we talked about earlier."

"Sharon, you may have the salt after you ask for it in the way that we talked about earlier." Explanation: Major treatment strategies include verbal interventions, limit setting, and problem-solving. Three steps in preventing behavioral escalation involve making contact, discovering the source of distress, and assisting the person with alternative behaviors. By setting limits on Sharon's behavior and assisting with an appropriate behavioral alternative, Sharon can learn how to diffuse her frustrations using nonaggressive behaviors. The other options would not be appropriate for this situation.

The nurse has been working on anger management with the client, Sharon. She yells during dinner, "Give me that salt shaker!" What is the best nursing intervention at this time? a) "Sharon, you need to stop yelling right now and ask for the salt in the correct manner." b) "Sharon, what do you think is wrong with the way you are asking for the salt?" c) "Sharon, it's not appropriate for you to ask for the salt that way; besides, you are on a low-salt diet right now." d) "Sharon, you may have the salt after you ask for it in the way that we talked about earlier."

"Sharon, you may have the salt after you ask for it in the way that we talked about earlier." Explanation: Major treatment strategies include verbal interventions, limit setting, and problem-solving. Three steps in preventing behavioral escalation involve making contact, discovering the source of distress, and assisting the person with alternative behaviors. By setting limits on Sharon's behavior and assisting with an appropriate behavioral alternative, Sharon can learn how to diffuse her frustrations using nonaggressive behaviors. The other options would not be appropriate for this situation.

A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints. The nurse will explain the reason for restraints to the client by saying ... a) "The length of time you'll be in restraints is undetermined." b) "The staff will monitor your behavior closely." c) "This is what happens when you lose control." d) "This is a means of keeping you and others safe."

"This is a means of keeping you and others safe." Explanation: Use of restraints is a temporary, short-term way of ensuring the safety of everyone until the client regains behavioral control; it is not a punishment. Answers A, B, and C are not appropriate explanations of the use of restraints.

A new nurse asks the nurse manager about the best intervention to use when trying to de-escalate a potentially violent client. Which response would be most appropriate? a) "What works best is what fits the client and the situation." b) "You need to confront the client to show you are in charge." c) "Make sure that another colleague knows where you are at all times." d) "I've always had good results with medications."

"What works best is what fits the client and the situation." Explanation: The nurse who intervenes from within the context of the therapeutic relationship must be cognizant of the fit of a particular intervention. Thus, the best intervention is the one that fits the situation and the client. Administering medications and making sure that others know where you are may be helpful but it depends on the situation. Confronting the client should be avoided

A new nurse asks the nurse manager about the best intervention to use when trying to de-escalate a potentially violent client. Which response would be most appropriate? a) "I've always had good results with medications." b) "You need to confront the client to show you are in charge." c) "Make sure that another colleague knows where you are at all times." d) "What works best is what fits the client and the situation."

"What works best is what fits the client and the situation." Explanation: The nurse who intervenes from within the context of the therapeutic relationship must be cognizant of the fit of a particular intervention. Thus, the best intervention is the one that fits the situation and the client. Administering medications and making sure that others know where you are may be helpful but it depends on the situation. Confronting the client should be avoided.

An adult client is pacing and yelling. Which of the following is the best response by the nurse? a) "Why do you feel angry?" b) "When did these feelings begin?" c) "What are you doing?" d) "With whom are you angry?"

"When did these feelings begin?" Explanation: When a client is angry, use open-ended questions to clarify the client's behavior. Use an empathetic approach to assist the client to discover the source of the anger. Asking a "why" question implies criticism of the feeling. The client may become defensive and angrier. Similarly asking "What are you doing?" asks the client to explain behavior when the client may not be fully aware of the source. The question also implies criticism rather than offering empathy. Asking "With whom are you angry" is a closed-ended question that will not open the thinking and dialogue with the client. Further, asking about the object of the anger focuses on an external reason for the anger rather than assisting the client to look within for the source

An adult client is pacing and yelling. Which of the following is the best response by the nurse? a) "What are you doing?" b) "With whom are you angry?" c) "Why do you feel angry?" d) "When did these feelings begin?"

"When did these feelings begin?" Explanation: When a client is angry, use open-ended questions to clarify the client's behavior. Use an empathetic approach to assist the client to discover the source of the anger. Asking a "why" question implies criticism of the feeling. The client may become defensive and angrier. Similarly asking "What are you doing?" asks the client to explain behavior when the client may not be fully aware of the source. The question also implies criticism rather than offering empathy. Asking "With whom are you angry" is a closed-ended question that will not open the thinking and dialogue with the client. Further, asking about the object of the anger focuses on an external reason for the anger rather than assisting the client to look within for the source.

A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. The best response by the nurse would be ... a) "I can see that you need attention; you should calmly ask for what you want." b) "I don't want to hear that kind of language; don't ever do that again." c) "You seem angry. Tell me more about how you're feeling." d) "I will limit your smoking privileges if you can't control yourself."

"You seem angry. Tell me more about how you're feeling." Explanation: The nurse recognizes and validates the client's feelings and offers to focus on those feelings and what the client needs. In this situation, the client is not at a point where he can be calm. Taking away privileges will not help the current situation. Answer B is demeaning to the client.

Written orders for restraints or seclusion for psychiatric-mental health clients are limited to a) 4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years. b) 6 hours for adults and adolescents; 2 hours for children; 1 hour for children younger than 9 years. c) 24 hours for adults; 12 for children and adolescents. d) 12 hours for adults; 6 for children and adolescents ages 9 to 17 years; 4 hours for children younger than 9 years.

4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years. Explanation: Joint Commission standards indicate verbal and written orders for restraint or seclusion are limited to 4 hours for clients 18 years and older, 2 hours for children 9 to 17 years, and 1 hour for children younger than 9 years

Written orders for restraints or seclusion for psychiatric-mental health clients are limited to a) 12 hours for adults; 6 for children and adolescents ages 9 to 17 years; 4 hours for children younger than 9 years. b) 24 hours for adults; 12 for children and adolescents. c) 6 hours for adults and adolescents; 2 hours for children; 1 hour for children younger than 9 years. d) 4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years.

4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years. Explanation: Joint Commission standards indicate verbal and written orders for restraint or seclusion are limited to 4 hours for clients 18 years and older, 2 hours for children 9 to 17 years, and 1 hour for children younger than 9 years.

Written orders for restraints or seclusion for psychiatric-mental health clients are limited to a) 24 hours for adults; 12 for children and adolescents. b) 6 hours for adults and adolescents; 2 hours for children; 1 hour for children younger than 9 years. c) 12 hours for adults; 6 for children and adolescents ages 9 to 17 years; 4 hours for children younger than 9 years. d) 4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years.

4 hours for adults; 2 hours for children and adolescents ages 9 to 17 years; 1 hour for children younger than 9 years. Explanation: Joint Commission standards indicate verbal and written orders for restraint or seclusion are limited to 4 hours for clients 18 years and older, 2 hours for children 9 to 17 years, and 1 hour for children younger than 9 years.

The nurse is caring for a group of clients in an inpatient psychiatric setting. The nurse should be on the alert for aggressive behaviors from a client who has an interactional style termed ... a) coercive. b) accommodating. c) manipulative. d) adaptive.

coercive. Explanation: The client likely to be aggressive is the one with coercive interactional style (Morrison, 1992).

The nurse is caring for a group of clients in an inpatient psychiatric setting. The nurse should be on the alert for aggressive behaviors from a client who has an interactional style termed ... a) coercive. b) adaptive. c) manipulative. d) accommodating.

coercive. Explanation: The client likely to be aggressive is the one with coercive interactional style (Morrison, 1992).

The nurse is caring for a client who visits the mental health clinic and tells the nurse that she expresses her anger frequently throughout each day. The client is concerned about her relationships with her husband and family. The nurse should instruct the client that some people experience anger and express anger more often than others because of ... a) genetic predisposition. b) the need for catharsis. c) unwillingness to forgive others. d) lack of education about control.

genetic predisposition. Explanation: The nurse should explain to the client that some people experience anger and express anger more often than others because of a genetic predisposition. Other factors include emotional development during infancy, family environment, and head trauma.

The nurse is orienting a new staff member in an inpatient mental health unit when a client begins to act in a violent manner. The nurse should explain to the new staff member that some clients use violence and aggression to ... a) practice assertiveness skills. b) be placed in their rooms by themselves. c) relive their childhood experiences. d) get what they want.

get what they want. Explanation: The nurse should explain to the new staff member that some clients use violence and aggression to get what they want or to force change or regain control. The client may also be seeking attention.

The nurse is orienting a new staff member in an inpatient mental health unit when a client begins to act in a violent manner. The nurse should explain to the new staff member that some clients use violence and aggression to ... a) be placed in their rooms by themselves. b) practice assertiveness skills. c) relive their childhood experiences. d) get what they want.

get what they want. Explanation: The nurse should explain to the new staff member that some clients use violence and aggression to get what they want or to force change or regain control. The client may also be seeking attention.

The nurse is assessing an adolescent in a psychiatric facility. The mother tells the nurse that the adolescent has intense sporadic anger episodes. The adolescent becomes angry for petty reasons and starts throwing objects at home. The adolescent also feels guilty and repents for the actions. Based on this history, the would expect the client to be diagnosed with: a) dementia. b) paranoid delusions. c) depression. d) intermittent explosive disorder.

intermittent explosive disorder. Explanation: Intermittent explosive disorder (IED) is a rare disorder characterized by intermittent episodes of aggressive impulses which is disproportionate to the precipitating factors. The individual with IED can cause severe destruction of property or assault individuals during an anger episode. Dementia is usually not seen in adolescents. The depressed client does not typically exhibit aggressive behaviors. The client with paranoid delusions would not exhibit episodic aggression.

The nurse is assessing an adolescent in a psychiatric facility. The mother tells the nurse that the adolescent has intense sporadic anger episodes. The adolescent becomes angry for petty reasons and starts throwing objects at home. The adolescent also feels guilty and repents for the actions. Based on this history, the would expect the client to be diagnosed with: a) dementia. b) intermittent explosive disorder. c) depression. d) paranoid delusions.

intermittent explosive disorder. Explanation: Intermittent explosive disorder (IED) is a rare disorder characterized by intermittent episodes of aggressive impulses which is disproportionate to the precipitating factors. The individual with IED can cause severe destruction of property or assault individuals during an anger episode. Dementia is usually not seen in adolescents. The depressed client does not typically exhibit aggressive behaviors. The client with paranoid delusions would not exhibit episodic aggression.

The nurse is assessing an adolescent in a psychiatric facility. The mother tells the nurse that the adolescent has intense sporadic anger episodes. The adolescent becomes angry for petty reasons and starts throwing objects at home. The adolescent also feels guilty and repents for the actions. Based on this history, the would expect the client to be diagnosed with: a) depression. b) dementia. c) intermittent explosive disorder. d) paranoid delusions.

intermittent explosive disorder. Explanation: Intermittent explosive disorder (IED) is a rare disorder characterized by intermittent episodes of aggressive impulses which is disproportionate to the precipitating factors. The individual with IED can cause severe destruction of property or assault individuals during an anger episode. Dementia is usually not seen in adolescents. The depressed client does not typically exhibit aggressive behaviors. The client with paranoid delusions would not exhibit episodic aggression.

The nurse is assessing an adolescent in a psychiatric facility. The mother tells the nurse that the adolescent has intense sporadic anger episodes. The adolescent becomes angry for petty reasons and starts throwing objects at home. The adolescent also feels guilty and repents for the actions. Based on this history, the would expect the client to be diagnosed with: a) paranoid delusions. b) depression. c) dementia. d) intermittent explosive disorder.

intermittent explosive disorder. Explanation: Intermittent explosive disorder (IED) is a rare disorder characterized by intermittent episodes of aggressive impulses which is disproportionate to the precipitating factors. The individual with IED can cause severe destruction of property or assault individuals during an anger episode. Dementia is usually not seen in adolescents. The depressed client does not typically exhibit aggressive behaviors. The client with paranoid delusions would not exhibit episodic aggression.

The nurse is assessing a group of clients on an inpatient psychiatric unit. The nurse determines that a client most likely to be violent is the client with ... a) generalized anxiety disorder. b) previous episodes of rage. c) somatoform disorder. d) panic disorder.

previous episodes of rage. Explanation: The nurse determines that the client most likely to be violent is the client with a history of past violence and rage. Other clients with diagnoses of bipolar disorder, reduced impulse control, schizophrenia, or organic brain syndrome are also at greater risk for violent episodes

The nurse is assessing a group of clients on an inpatient psychiatric unit. The nurse determines that a client most likely to be violent is the client with ... a) panic disorder. b) generalized anxiety disorder. c) previous episodes of rage. d) somatoform disorder.

previous episodes of rage. Explanation: The nurse determines that the client most likely to be violent is the client with a history of past violence and rage. Other clients with diagnoses of bipolar disorder, reduced impulse control, schizophrenia, or organic brain syndrome are also at greater risk for violent episodes

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply. a) "How dare you not listen to me." b) "I am extremely angry at your behavior." c) "How can you behave like this to me?" d) "I feel so angry when you disobey me." e) "You are making me very angry."

• "I am extremely angry at your behavior." • "I feel so angry when you disobey me." Explanation: Expression of anger using assertive communication refers to the use of statements beginning with 'I' while expressing anger. Statements such as "I am extremely angry at your behavior" and "I feel so angry when you disobey me" are examples of assertive communication. Statements such as "You are making me very angry", "How dare you not listen to me", and "How can you behave like this to me?" are not examples of assertive communication.

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply. a) "I feel so angry when you disobey me." b) "How dare you not listen to me." c) "You are making me very angry." d) "I am extremely angry at your behavior." e) "How can you behave like this to me?"

• "I am extremely angry at your behavior." • "I feel so angry when you disobey me." Explanation: Expression of anger using assertive communication refers to the use of statements beginning with 'I' while expressing anger. Statements such as "I am extremely angry at your behavior" and "I feel so angry when you disobey me" are examples of assertive communication. Statements such as "You are making me very angry", "How dare you not listen to me", and "How can you behave like this to me?" are not examples of assertive communication.

A nurse is working with a client on strategies to help disrupt the pattern associated with the escalation of his aggression. Which of the following would the nurse most likely include in the education plan? Select all that apply. a) "Sit down and think about what is happening and how you are feeling." b) "Try counting to 10 when you begin to have those feelings." c) "Use a rapid breathing pattern, like panting to help rid you of the feelings." d) "Attempt to do something different, like watch television to help distract you." e) "Remove yourself from the situation when you start to have the feelings."

• "Try counting to 10 when you begin to have those feelings." • "Attempt to do something different, like watch television to help distract you." • "Remove yourself from the situation when you start to have the feelings." Explanation: Strategies that are helpful in interrupting patterns include: counting to 10; using a relaxation or breathing technique; removing oneself from interactions or stimuli that may contribute to increased distress (voluntarily taking "time-out"). Using a slow, rather than rapid breathing pattern would be more effective. Thinking about the feelings would only help to intensify the feelings and add to the client's distress. ? Doing something different (e.g., reading, listening to quiet music, watching television)

A nurse is working with a client on strategies to help disrupt the pattern associated with the escalation of his aggression. Which of the following would the nurse most likely include in the education plan? Select all that apply. a) "Try counting to 10 when you begin to have those feelings." b) "Sit down and think about what is happening and how you are feeling." c) "Remove yourself from the situation when you start to have the feelings." d) "Use a rapid breathing pattern, like panting to help rid you of the feelings." e) "Attempt to do something different, like watch television to help distract you."

• "Try counting to 10 when you begin to have those feelings." • "Attempt to do something different, like watch television to help distract you." • "Remove yourself from the situation when you start to have the feelings." Explanation: Strategies that are helpful in interrupting patterns include: counting to 10; using a relaxation or breathing technique; removing oneself from interactions or stimuli that may contribute to increased distress (voluntarily taking "time-out"). Using a slow, rather than rapid breathing pattern would be more effective. Thinking about the feelings would only help to intensify the feelings and add to the client's distress. ? Doing something different (e.g., reading, listening to quiet music, watching television)

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with a history of substance abuse. b) A client with history of being personally victimized. c) A client with a history of violence. d) A client with history of obsessive compulsive disorder. e) A client with history of depression.

• A client with a history of substance abuse. • A client with history of being personally victimized. • A client with a history of violence. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with a history of violence. b) A client with a history of substance abuse. c) A client with history of obsessive compulsive disorder. d) A client with history of depression. e) A client with history of being personally victimized.

• A client with a history of violence. • A client with a history of substance abuse. • A client with history of being personally victimized. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with history of being personally victimized. b) A client with a history of violence. c) A client with history of depression. d) A client with a history of substance abuse. e) A client with history of obsessive compulsive disorder.

• A client with a history of violence. • A client with history of being personally victimized. • A client with a history of substance abuse. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with history of obsessive compulsive disorder. b) A client with a history of violence. c) A client with a history of substance abuse. d) A client with history of being personally victimized. e) A client with history of depression.

• A client with a history of violence. • A client with history of being personally victimized. • A client with a history of substance abuse. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the effects of doing so, which of the following would the nurse include? Select all that apply. a) Improved overall health b) Increased likelihood for weight gain c) Reduced self-efficacy d) Improved blood pressure control e) A reduction in depressive feelings

• A reduction in depressive feelings • Improved overall health • Improved blood pressure control Explanation: Research shows that anger discussed with other people in a constructive way has a beneficial effect on blood pressure as well as statistically significant associations with better general health, a higher sense of self-efficacy, less depression, and a lower likelihood of obesity.

A client is receiving cognitive-behavioral therapy as part of the treatment plan for anger. Which of the following would most likely be included? Select all that apply. a) Avoiding stimuli identified to provoke the anger b) Engaging in relaxation training c) Practicing new behaviors as part of a group d) Identifying ways to disrupt the anger response e) Monitoring one's self for cues related to anger arousal

• Avoiding stimuli identified to provoke the anger • Monitoring one's self for cues related to anger arousal • Identifying ways to disrupt the anger response • Engaging in relaxation training Explanation: Cognitive-behavioral therapy involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when angry. Practicing new behaviors as part of a group is used in anger management.

A client is receiving cognitive-behavioral therapy as part of the treatment plan for anger. Which of the following would most likely be included? Select all that apply. a) Monitoring one's self for cues related to anger arousal b) Avoiding stimuli identified to provoke the anger c) Identifying ways to disrupt the anger response d) Practicing new behaviors as part of a group e) Engaging in relaxation training

• Avoiding stimuli identified to provoke the anger • Monitoring one's self for cues related to anger arousal • Identifying ways to disrupt the anger response • Engaging in relaxation training Explanation: Cognitive-behavioral therapy involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when angry. Practicing new behaviors as part of a group is used in anger management.

A client is receiving cognitive-behavioral therapy as part of the treatment plan for anger. Which of the following would most likely be included? Select all that apply. a) Monitoring one's self for cues related to anger arousal b) Engaging in relaxation training c) Identifying ways to disrupt the anger response d) Practicing new behaviors as part of a group e) Avoiding stimuli identified to provoke the anger

• Avoiding stimuli identified to provoke the anger • Monitoring one's self for cues related to anger arousal • Identifying ways to disrupt the anger response • Engaging in relaxation training Explanation: Cognitive-behavioral therapy involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when angry. Practicing new behaviors as part of a group is used in anger management.

A nurse is conducting an in-service program about anger, aggression and violence for a group of staff nurses. When describing the general aggression model, the nurse addresses situational factors. Which of the following would the nurse include? Select all that apply. a) Moods associated with the behavior b) Personality traits of the individual c) Emotions involved with the behavior d) Cues triggering memories of similar situations e) Insults or slights involved in the aggression

• Cues triggering memories of similar situations • Insults or slights involved in the aggression Explanation: Situational factors include the actual provocation (insults, slights, verbal and physical aggression, interference with achieving goals) and cues that trigger memories of similar situations. The person factors include characteristics such as gender, personality traits, beliefs and attitudes, values, goals, and behavior patterns. Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component.

A nurse is conducting an in-service program about anger, aggression and violence for a group of staff nurses. When describing the general aggression model, the nurse addresses situational factors. Which of the following would the nurse include? Select all that apply. a) Emotions involved with the behavior b) Insults or slights involved in the aggression c) Personality traits of the individual d) Moods associated with the behavior e) Cues triggering memories of similar situations

• Cues triggering memories of similar situations • Insults or slights involved in the aggression Explanation: Situational factors include the actual provocation (insults, slights, verbal and physical aggression, interference with achieving goals) and cues that trigger memories of similar situations. The person factors include characteristics such as gender, personality traits, beliefs and attitudes, values, goals, and behavior patterns. Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component.

The nurse is reviewing the medical record of a client who is experiencing aggressive and violent behavior for possible risk factors. Which of the following would the nurse identify? Select all that apply. a) Gender b) Damage to the frontal lobe of the brain c) Family history of aggression d) High level of competitiveness e) Low testosterone levels

• Damage to the frontal lobe of the brain • Family history of aggression • High level of competitiveness Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes. Thus, damage to this area would pose a risk. Sex hormones also play a role in some aggressive behavior. Studies show that violent male offenders have higher testosterone levels than those of control groups. Social learning theory posits that people develop aggressive and violent behaviors by participating in an environment that rewards aggression such as a family history of aggression and observation of the same. Gender is not considered a risk factor; however, high levels of competitiveness from society's demand may pose a risk.

The nurse is reviewing the medical record of a client who is experiencing aggressive and violent behavior for possible risk factors. Which of the following would the nurse identify? Select all that apply. a) Family history of aggression b) Gender c) Damage to the frontal lobe of the brain d) High level of competitiveness e) Low testosterone levels

• Damage to the frontal lobe of the brain • Family history of aggression • High level of competitiveness Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes. Thus, damage to this area would pose a risk. Sex hormones also play a role in some aggressive behavior. Studies show that violent male offenders have higher testosterone levels than those of control groups. Social learning theory posits that people develop aggressive and violent behaviors by participating in an environment that rewards aggression such as a family history of aggression and observation of the same. Gender is not considered a risk factor; however, high levels of competitiveness from society's demand may pose a risk.

The nurse is reviewing the medical record of a client who is experiencing aggressive and violent behavior for possible risk factors. Which of the following would the nurse identify? Select all that apply. a) Gender b) Family history of aggression c) High level of competitiveness d) Low testosterone levels e) Damage to the frontal lobe of the brain

• Damage to the frontal lobe of the brain • Family history of aggression • High level of competitiveness Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes. Thus, damage to this area would pose a risk. Sex hormones also play a role in some aggressive behavior. Studies show that violent male offenders have higher testosterone levels than those of control groups. Social learning theory posits that people develop aggressive and violent behaviors by participating in an environment that rewards aggression such as a family history of aggression and observation of the same. Gender is not considered a risk factor; however, high levels of competitiveness from society's demand may pose a risk.

When providing care to a client experiencing aggressive behavior, the nurse integrates knowledge about potential biologic factors contributing to the condition. Which of the following brain structures would the nurse identify as playing a role in the client's aggression? Select all that apply. a) Limbic system b) Temporal lobe c) Occipital lobe d) Frontal lobe e) Hypothalamus

• Frontal lobe • Limbic system • Temporal lobe Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes.

When providing care to a client experiencing aggressive behavior, the nurse integrates knowledge about potential biologic factors contributing to the condition. Which of the following brain structures would the nurse identify as playing a role in the client's aggression? Select all that apply. a) Limbic system b) Frontal lobe c) Occipital lobe d) Hypothalamus e) Temporal lobe

• Frontal lobe • Limbic system • Temporal lobe Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes.

A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the effects of doing so, which of the following would the nurse include? Select all that apply. a) Improved blood pressure control b) Improved overall health c) A reduction in depressive feelings d) Increased likelihood for weight gain e) Reduced self-efficacy

• Improved blood pressure control • Improved overall health • A reduction in depressive feelings Explanation: Research shows that anger discussed with other people in a constructive way has a beneficial effect on blood pressure as well as statistically significant associations with better general health, a higher sense of self-efficacy, less depression, and a lower likelihood of obesity.

A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the effects of doing so, which of the following would the nurse include? Select all that apply. a) Improved overall health b) Increased likelihood for weight gain c) Improved blood pressure control d) Reduced self-efficacy e) A reduction in depressive feelings

• Improved overall health • A reduction in depressive feelings • Improved blood pressure control Explanation: Research shows that anger discussed with other people in a constructive way has a beneficial effect on blood pressure as well as statistically significant associations with better general health, a higher sense of self-efficacy, less depression, and a lower likelihood of obesity.

A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the effects of doing so, which of the following would the nurse include? Select all that apply. a) Improved blood pressure control b) Improved overall health c) Reduced self-efficacy d) A reduction in depressive feelings e) Increased likelihood for weight gain

• Improved overall health • Improved blood pressure control • A reduction in depressive feelings Explanation: Research shows that anger discussed with other people in a constructive way has a beneficial effect on blood pressure as well as statistically significant associations with better general health, a higher sense of self-efficacy, less depression, and a lower likelihood of obesity.

The nurse is assessing a child who is extremely agitated. The client's medical records include a prescription for lithium. Which are potential comorbid mental illnesses in this child? Select all that apply. a) Dementia b) Conduct disorder c) Bipolar mood disorder d) Mental retardation e) Brain injury

• Mental retardation • Conduct disorder • Bipolar mood disorder Explanation: Lithium is known to be effective in, and is therefore most likely to be prescribed for, treating aggressive clients with bipolar disorder, conduct disorders and mental retardation. Children are less likely to have dementia. Moreover, aggressive clients with dementia are treated with carbamazepine (Tegretol) and valproate (Depakote). Aggressive clients with brain injury are treated with antipsychotic medications like clozapine (Clozaril)and risperidone (Risperdal).

A client who has a history of hostile behavior appears severely agitated. What interventions should the nurse perform to prevent harm to the client and others? Select all that apply. a) Make arrangements for possible restraint. b) Engage participation in a group activity. c) Anticipate the use of sedatives. d) Calm down the client by talking. e) Obtain orders for seclusion if needed.

• Obtain orders for seclusion if needed. • Make arrangements for possible restraint. • Anticipate the use of sedatives. Explanation: A severely agitated client can turn hostile and harm self and others, and cause damage to the facility. The nurse should intervene before the client becomes hostile. The client may need to be secluded, thus the nurse should obtain orders for it. Restraints may need to be used; therefore, appropriate arrangements should be done for placing the restraints. A severely agitated client may need to be sedated; therefore, the nurse should anticipate the use of sedatives. A severely agitated client may not respond to talking. Engaging the client in group activity may increase the risk of harm to others, so it should be avoided.

While interacting with a client experiencing aggression, which of the following client assessments would lead the nurse to suspect that an episode of aggression is about to occur? Select all that apply. a) Pacing b) Mumbling c) Staring in an intimidating fashion d) Using sarcastic comments e) Speaking slowly and unhurriedly

• Staring in an intimidating fashion • Using sarcastic comments • Mumbling • Pacing Explanation: Usually, there are some observable precursors to aggression and violence. In a study of aggressive episodes in an emergency department, the following behaviors indicated an impending aggressive episode: (1) staring and eye contact or glaring as a way of intimidation; (2) tone and volume of voice such as raised voices, sarcastic comments, and urgent or demeaning speech; (3) anxiety in clients, family or friends; (4) mumbling that shows increasing frustration; and (5) pacing that indicates increased agitation.

While interacting with a client experiencing aggression, which of the following client assessments would lead the nurse to suspect that an episode of aggression is about to occur? Select all that apply. a) Staring in an intimidating fashion b) Speaking slowly and unhurriedly c) Mumbling d) Using sarcastic comments e) Pacing

• Staring in an intimidating fashion • Using sarcastic comments • Mumbling • Pacing Explanation: Usually, there are some observable precursors to aggression and violence. In a study of aggressive episodes in an emergency department, the following behaviors indicated an impending aggressive episode: (1) staring and eye contact or glaring as a way of intimidation; (2) tone and volume of voice such as raised voices, sarcastic comments, and urgent or demeaning speech; (3) anxiety in clients, family or friends; (4) mumbling that shows increasing frustration; and (5) pacing that indicates increased agitation.

While interacting with a client experiencing aggression, which of the following client assessments would lead the nurse to suspect that an episode of aggression is about to occur? Select all that apply. a) Using sarcastic comments b) Staring in an intimidating fashion c) Speaking slowly and unhurriedly d) Mumbling e) Pacing

• Staring in an intimidating fashion • Using sarcastic comments • Mumbling • Pacing Explanation: Usually, there are some observable precursors to aggression and violence. In a study of aggressive episodes in an emergency department, the following behaviors indicated an impending aggressive episode: (1) staring and eye contact or glaring as a way of intimidation; (2) tone and volume of voice such as raised voices, sarcastic comments, and urgent or demeaning speech; (3) anxiety in clients, family or friends; (4) mumbling that shows increasing frustration; and (5) pacing that indicates increased agitation.

The nurse is planning treatment for a client with aggressive and psychotic behavior. What should be the immediate goals of treatment for this client? Select all that apply. a) The client will withhold from harming others or damaging the hospital property. b) The client will demonstrate the ability to exercise internal control over his behavior. c) The client will not have auditory hallucinations. d) The client will demonstrate decreased acting out behavior. e) The client will not harm himself.

• The client will not harm himself. • The client will demonstrate decreased acting out behavior. • The client will withhold from harming others or damaging the hospital property. Explanation: The immediate goals of therapy for treatment of a client with aggressive and psychotic behavior include that the client should be able to refrain from harming himself or herself. The aggressive client tends to act out. Therefore, with treatment the client should be able to demonstrate decreased acting out behavior. An aggressive client may harm self or others. The treatment should be aimed help the client refrain from harming others or damaging the hospital property. The client cannot be expected to stop having hallucinations immediately after therapy. The client cannot be expected to demonstrate the ability to exercise internal control over his or her behavior immediately after therapy. These are unrealistic immediate goals.

The nurse is planning treatment for a client with aggressive and psychotic behavior. What should be the immediate goals of treatment for this client? Select all that apply. a) The client will demonstrate decreased acting out behavior. b) The client will withhold from harming others or damaging the hospital property. c) The client will demonstrate the ability to exercise internal control over his behavior. d) The client will not harm himself. e) The client will not have auditory hallucinations.

• The client will not harm himself. • The client will demonstrate decreased acting out behavior. • The client will withhold from harming others or damaging the hospital property. Explanation: The immediate goals of therapy for treatment of a client with aggressive and psychotic behavior include that the client should be able to refrain from harming himself or herself. The aggressive client tends to act out. Therefore, with treatment the client should be able to demonstrate decreased acting out behavior. An aggressive client may harm self or others. The treatment should be aimed help the client refrain from harming others or damaging the hospital property. The client cannot be expected to stop having hallucinations immediately after therapy. The client cannot be expected to demonstrate the ability to exercise internal control over his or her behavior immediately after therapy. These are unrealistic immediate goals.

The nurse is planning treatment for a client with aggressive and psychotic behavior. What should be the immediate goals of treatment for this client? Select all that apply. a) The client will demonstrate the ability to exercise internal control over his behavior. b) The client will withhold from harming others or damaging the hospital property. c) The client will demonstrate decreased acting out behavior. d) The client will not harm himself. e) The client will not have auditory hallucinations.

• The client will not harm himself. • The client will demonstrate decreased acting out behavior. • The client will withhold from harming others or damaging the hospital property. Explanation: The immediate goals of therapy for treatment of a client with aggressive and psychotic behavior include that the client should be able to refrain from harming himself or herself. The aggressive client tends to act out. Therefore, with treatment the client should be able to demonstrate decreased acting out behavior. An aggressive client may harm self or others. The treatment should be aimed help the client refrain from harming others or damaging the hospital property. The client cannot be expected to stop having hallucinations immediately after therapy. The client cannot be expected to demonstrate the ability to exercise internal control over his or her behavior immediately after therapy. These are unrealistic immediate goals.

The nurse is planning treatment for a client with aggressive and psychotic behavior. What should be the immediate goals of treatment for this client? Select all that apply. a) The client will not have auditory hallucinations. b) The client will withhold from harming others or damaging the hospital property. c) The client will demonstrate decreased acting out behavior. d) The client will demonstrate the ability to exercise internal control over his behavior. e) The client will not harm himself.

• The client will not harm himself. • The client will demonstrate decreased acting out behavior. • The client will withhold from harming others or damaging the hospital property. Explanation: The immediate goals of therapy for treatment of a client with aggressive and psychotic behavior include that the client should be able to refrain from harming himself or herself. The aggressive client tends to act out. Therefore, with treatment the client should be able to demonstrate decreased acting out behavior. An aggressive client may harm self or others. The treatment should be aimed help the client refrain from harming others or damaging the hospital property. The client cannot be expected to stop having hallucinations immediately after therapy. The client cannot be expected to demonstrate the ability to exercise internal control over his or her behavior immediately after therapy. These are unrealistic immediate goals.

A nurse is assessing a client who is angry and notes that the client expresses his anger outwardly in an unhealthy manner. Which behaviors would the nurse most likely observe? Select all that apply. a) Using profanity b) Using "I" language to describe feelings c) Yelling nasty things d) Sulking and pouting e) Withdrawing from others when angry

• Yelling nasty things • Using profanity Explanation: A person who expresses anger outwardly in an unhealthy manner would most likely demonstrate behaviors such as yelling, saying nasty things, and using profanity. Withdrawing from others when angry and sulking and pouting are examples of anger suppression. Using "I" language to describe feelings reflects constructive anger discussion.

A client visits the clinic and tells the nurse that no matter how difficult her child acts, the client simply cannot express any anger. The nurse should plan to assess the client for symptoms of ... a) Depression b) Meneire's disease c) Panic disorder d) Manic behaviors

Depression Explanation: Anger turned inward has frequently been associated with mood disorders particularly depression. It has also been associated with essential hypertension, migraine headaches, psoriasis, rheumatoid arthritis, and Raynaud's disease.

A nurse is preparing a presentation for a group of staff nurses on anger. When describing maladaptive anger, which psychiatric condition would the nurse identify as being linked to this anger? a) Obsessive-compulsive disorder b) Anxiety disorder c) Depression d) Schizophrenia

Depression Explanation: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions.

A nurse is preparing a presentation for a group of staff nurses on anger. When describing maladaptive anger, which psychiatric condition would the nurse identify as being linked to this anger? a) Schizophrenia b) Anxiety disorder c) Depression d) Obsessive-compulsive disorder

Depression Explanation: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions.

Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger? a) Encourage catharsis b) Encourage verbalization c) Improve self-esteem d) Isolate the client from others

Encourage verbalization Explanation: Verbally expressing angry feelings is a safe and appropriate way to deal with anger. Isolation and catharsis can increase angry and hostile feelings. Answers A, C, and D are not appropriate responses in this situation.

Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger? a) Encourage catharsis b) Encourage verbalization c) Improve self-esteem d) Isolate the client from others

Encourage verbalization Explanation: Verbally expressing angry feelings is a safe and appropriate way to deal with anger. Isolation and catharsis can increase angry and hostile feelings. Answers A, C, and D are not appropriate responses in this situation.

The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. The nurse's most appropriate action would be to ... a) Take an authoritative step between the two clients b) Comfort the client huddled in the corner c) Directly address both clients and ask what's going on d) Engage the attention of the client who is still yelling and ask what is happening

Engage the attention of the client who is still yelling and ask what is happening Explanation: Engaging the attention of the dominant person will defuse the situation and stop the argument from continuing. Answers A, B, and C would not be appropriate actions in this situation. The nurse placing herself in between two arguing clients is a safety concern.

Which of the following staff behaviors has been found to be particularly provocative when working with clients who are predisposed to aggressive or violent behavior? a) Asking personal questions when they are inappropriate b) Engaging in disputes over medication, supplies, or rules on the unit c) Talking excessively with the client in front of other clients d) Providing the client with a list of possible goals for behavior change

Engaging in disputes over medication, supplies, or rules on the unit Explanation: Nurses who show respect and empathy are more likely to defuse a client's anger than are nurses who are authoritarian. Examples of authoritarian behavior include preventing clients from leaving the ward, engaging in disputes with them over medication, generally enforcing rules or denying requests, physically restraining clients, taking something from them, ignoring them, or requesting clients to do or not to do something.

Which of the following staff behaviors has been found to be particularly provocative when working with clients who are predisposed to aggressive or violent behavior? a) Providing the client with a list of possible goals for behavior change b) Engaging in disputes over medication, supplies, or rules on the unit c) Talking excessively with the client in front of other clients d) Asking personal questions when they are inappropriate

Engaging in disputes over medication, supplies, or rules on the unit Explanation: Nurses who show respect and empathy are more likely to defuse a client's anger than are nurses who are authoritarian. Examples of authoritarian behavior include preventing clients from leaving the ward, engaging in disputes with them over medication, generally enforcing rules or denying requests, physically restraining clients, taking something from them, ignoring them, or requesting clients to do or not to do something.

Which of the following staff behaviors has been found to be particularly provocative when working with clients who are predisposed to aggressive or violent behavior? a) Asking personal questions when they are inappropriate b) Talking excessively with the client in front of other clients c) Engaging in disputes over medication, supplies, or rules on the unit d) Providing the client with a list of possible goals for behavior change

Engaging in disputes over medication, supplies, or rules on the unit Correct Explanation: Nurses who show respect and empathy are more likely to defuse a client's anger than are nurses who are authoritarian. Examples of authoritarian behavior include preventing clients from leaving the ward, engaging in disputes with them over medication, generally enforcing rules or denying requests, physically restraining clients, taking something from them, ignoring them, or requesting clients to do or not to do something.

A nurse assesses a newly admitted patient on the unit. When assessing the patient in detail about his/her past medical history, it is important for the nurse to also explore the patient's a) Delusional content when hospitalized 10 years ago b) Experience of health problems and health professionals c) Preferences of movies that are provided on Thursday nights d) Needs to modify environment to ensure that milieu is achieved

Experience of health problems and health professionals Explanation: What is overlooked is the experience of the health problem or the experience of interactions with professionals. Inviting clients and families to talk about their previous experience with the health care system may highlight both their concerns and resources.

A nurse assesses a newly admitted patient on the unit. When assessing the patient in detail about his/her past medical history, it is important for the nurse to also explore the patient's a) Experience of health problems and health professionals b) Preferences of movies that are provided on Thursday nights c) Delusional content when hospitalized 10 years ago d) Needs to modify environment to ensure that milieu is achieved

Experience of health problems and health professionals Explanation: What is overlooked is the experience of the health problem or the experience of interactions with professionals. Inviting clients and families to talk about their previous experience with the health care system may highlight both their concerns and resources.

A nurse assesses a newly admitted patient on the unit. When assessing the patient in detail about his/her past medical history, it is important for the nurse to also explore the patient's a) Needs to modify environment to ensure that milieu is achieved b) Preferences of movies that are provided on Thursday nights c) Delusional content when hospitalized 10 years ago d) Experience of health problems and health professionals

Experience of health problems and health professionals Explanation: What is overlooked is the experience of the health problem or the experience of interactions with professionals. Inviting clients and families to talk about their previous experience with the health care system may highlight both their concerns and resources.

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? a) Explaining the consequences the client will face if control is lost b) Anticipating that a loss of control is possible and planning accordingly c) Interviewing the client with another staff member present d) Responding to verbal threats by terminating the interview and obtaining assistance

Explaining the consequences the client will face if control is lost Explanation: Giving the client an ultimatum is likely to foster hostile or aggressive behavior; the other measures are all appropriate for a client with a history of aggression.

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? a) Anticipating that a loss of control is possible and planning accordingly b) Explaining the consequences the client will face if control is lost c) Interviewing the client with another staff member present d) Responding to verbal threats by terminating the interview and obtaining assistance

Explaining the consequences the client will face if control is lost Explanation: Giving the client an ultimatum is likely to foster hostile or aggressive behavior; the other measures are all appropriate for a client with a history of aggression.

The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? a) Give the client a variety of choices on how to express anger. b) Give the client permission to be angry. c) Point out the senselessness of anger. d) Tell the client not to be angry all the time.

Give the client permission to be angry. Explanation: Many people view anger as a negative and abnormal feeling in addition to feeling guilty about being angry; the nurse can help the client see anger as a normal, acceptable emotion. Giving choices on how to express anger would not be the next step in the planning stage. Choices C and D are not appropriate responses in this situation.

A nurse on the inpatient unit is talking with a client with a history of violent behavior towards others. It is important for the nurse to minimize her risk during this one-on-one intervention by ... a) Sitting closer to the patient to foster a therapeutic relationship b) Medicating the client to promote sedation c) Closing the door to ensure privacy d) Having the client sit farthest from the door

Having the client sit farthest from the door Explanation: The client should sit farthest from the door and the nurse needs to position herself so that the nurse has immediate access to the door of the room in case the nurse needs to leave the room.

A nurse on the inpatient unit is talking with a client with a history of violent behavior towards others. It is important for the nurse to minimize her risk during this one-on-one intervention by ... a) Sitting closer to the patient to foster a therapeutic relationship b) Having the client sit farthest from the door c) Closing the door to ensure privacy d) Medicating the client to promote sedation

Having the client sit farthest from the door Explanation: The client should sit farthest from the door and the nurse needs to position herself so that the nurse has immediate access to the door of the room in case the nurse needs to leave the room.

When the client is in restraints or seclusion, which of the following must occur? a) He or she must be given water at least every 2 hours. b) He or she must be seen by a physician or licensed independent practitioner within the first 3 hours of initiation of seclusion or restraint. c) He or she must be fed at least every 2 hours. d) He or she must be monitored continually.

He or she must be monitored continually. Explanation: A physician or LIP conducts a face-to-face evaluation of initiation of R/S. Qualified staff assesses the client initially and every 15 minutes thereafter, focusing on signs of injury associated with the application of R/S, nutrition and hydration, circulation and range of motion in the extremities, vital signs, hygiene and elimination needs, physical and psychological status and comfort, and readiness for discontinuation of R/S.

When the client is in restraints or seclusion, which of the following must occur? a) He or she must be fed at least every 2 hours. b) He or she must be given water at least every 2 hours. c) He or she must be monitored continually. d) He or she must be seen by a physician or licensed independent practitioner within the first 3 hours of initiation of seclusion or restraint.

He or she must be monitored continually. Explanation: A physician or LIP conducts a face-to-face evaluation of initiation of R/S. Qualified staff assesses the client initially and every 15 minutes thereafter, focusing on signs of injury associated with the application of R/S, nutrition and hydration, circulation and range of motion in the extremities, vital signs, hygiene and elimination needs, physical and psychological status and comfort, and readiness for discontinuation of R/S.

When the client is in restraints or seclusion, which of the following must occur? a) He or she must be given water at least every 2 hours. b) He or she must be seen by a physician or licensed independent practitioner within the first 3 hours of initiation of seclusion or restraint. c) He or she must be fed at least every 2 hours. d) He or she must be monitored continually.

He or she must be monitored continually. Explanation: A physician or LIP conducts a face-to-face evaluation of initiation of R/S. Qualified staff assesses the client initially and every 15 minutes thereafter, focusing on signs of injury associated with the application of R/S, nutrition and hydration, circulation and range of motion in the extremities, vital signs, hygiene and elimination needs, physical and psychological status and comfort, and readiness for discontinuation of R/S.

Which of the following terms is used to describe an emotion expressed through verbal abuse and violation of rules or norms? a) Anger b) Catharsis c) Hostility d) Physical aggression

Hostility Explanation: Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Catharsis includes activities that provide a release of the anger. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property.

A nurse understands that cognitive theories inform us ... a) Reacting to previous situations of anger b) How not to get angry c) What to do when we get angry d) Predicting the number of angry outbursts within a specific time frame

How not to get angry Explanation: Cognitive theories inform us about how not to get angry in the first place, not about what to do when we become angry.

A nurse understands that cognitive theories inform us ... a) Predicting the number of angry outbursts within a specific time frame b) How not to get angry c) Reacting to previous situations of anger d) What to do when we get angry

How not to get angry Explanation: Cognitive theories inform us about how not to get angry in the first place, not about what to do when we become angry.

After teaching a group of nursing students about anger and aggression, the instructor determines that the education was successful when the students identify which of the following about aggression? a) Aggression involves covert behaviors to hurt or belittle another. b) All aggression is violent. c) It involves the use of strong force or weapons to inflict bodily harm d) Instrumental aggression is premeditated.

Instrumental aggression is premeditated. Explanation: Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting). Mentally healthy people stop themselves from aggression by realizing the negative consequences to themselves or their relationships. Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person, and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Instrumental aggression is premeditated and unrelated to immediate feelings of frustration or threat

After teaching a group of nursing students about anger and aggression, the instructor determines that the education was successful when the students identify which of the following about aggression? a) All aggression is violent. b) It involves the use of strong force or weapons to inflict bodily harm c) Aggression involves covert behaviors to hurt or belittle another. d) Instrumental aggression is premeditated.

Instrumental aggression is premeditated. Explanation: Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting). Mentally healthy people stop themselves from aggression by realizing the negative consequences to themselves or their relationships. Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person, and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Instrumental aggression is premeditated and unrelated to immediate feelings of frustration or threat.

When developing a therapeutic relationship with a client experiencing aggression, which of the following would be most important for the nurse to do first? a) Validate the client's feelings b) Listen to the client c) Set specific limits d) Provide choices

Listen to the client Explanation: Development of the therapeutic nurse-client relationship begins with listening. Some client complaints are valid and deserve a respectful hearing. From this the nurse can then develop an appropriate plan that includes validating the client's feelings, providing choices as well as setting limits.

When developing a therapeutic relationship with a client experiencing aggression, which of the following would be most important for the nurse to do first? a) Validate the client's feelings b) Provide choices c) Listen to the client d) Set specific limits

Listen to the client Explanation: Development of the therapeutic nurse-client relationship begins with listening. Some client complaints are valid and deserve a respectful hearing. From this the nurse can then develop an appropriate plan that includes validating the client's feelings, providing choices as well as setting limits.

When developing a therapeutic relationship with a client experiencing aggression, which of the following would be most important for the nurse to do first? a) Validate the client's feelings b) Set specific limits c) Provide choices d) Listen to the client

Listen to the client Explanation: Development of the therapeutic nurse-client relationship begins with listening. Some client complaints are valid and deserve a respectful hearing. From this the nurse can then develop an appropriate plan that includes validating the client's feelings, providing choices as well as setting limits.

The treatment of aggressive clients often focuses on treating the underlying or comorbid psychiatric diagnosis, such as schizophrenia or bipolar disorder. Which drug has been effective in treating aggressive clients with bipolar disorders? a) Lithium b) Depakote c) Tegretol d) Clozaril

Lithium Explanation: Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

Which drug has been effective in treating aggressive clients with bipolar disorders? a) Depakote b) Clozaril c) Tegretol d) Lithium

Lithium Explanation: Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

The treatment of aggressive clients often focuses on treating the underlying or comorbid psychiatric diagnosis, such as schizophrenia or bipolar disorder. Which drug has been effective in treating aggressive clients with bipolar disorders? a) Clozaril b) Depakote c) Lithium d) Tegretol

Lithium Explanation: Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

Which drug has been effective in treating aggressive clients with bipolar disorders? a) Lithium b) Clozaril c) Depakote d) Tegretol

Lithium Explanation: Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

A client with aggressive behavior shows no psychotic symptoms. Which drug should the nurse expect to be ordered for this client? a) Valproate (Depakote) b) Carbamazepine (Tegretol) c) Haloperidol (Haldol) d) Lorazepam (Ativan)

Lorazepam (Ativan) Explanation: Lorazepam (Ativan) is most effective drug in reducing aggression in client who does not have any other psychotic symptoms. Valproate (Depakote), Haloperidol (Haldol) and Carbamazepine (Tegretol) drug are useful in reducing aggression in those clients who have co-existent psychotic symptoms.

A client with aggressive behavior shows no psychotic symptoms. Which drug should the nurse expect to be ordered for this client? a) Carbamazepine (Tegretol) b) Lorazepam (Ativan) c) Haloperidol (Haldol) d) Valproate (Depakote)

Lorazepam (Ativan) Explanation: Lorazepam (Ativan) is most effective drug in reducing aggression in client who does not have any other psychotic symptoms. Valproate (Depakote), Haloperidol (Haldol) and Carbamazepine (Tegretol) drug are useful in reducing aggression in those clients who have co-existent psychotic symptoms.

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by ... a) Mindfulness b) Assertive behavior c) Low self-esteem d) Therapeutic relationship

Low self-esteem Explanation: Research suggests that particular characteristics are predictive of violent behaviors. Low self-esteem that may be further eroded during hospitalization or treatment may influence a client to use force to meet his or her needs or to experience some sense of empowerment.

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by ... a) Therapeutic relationship b) Assertive behavior c) Low self-esteem d) Mindfulness

Low self-esteem Explanation: Research suggests that particular characteristics are predictive of violent behaviors. Low self-esteem that may be further eroded during hospitalization or treatment may influence a client to use force to meet his or her needs or to experience some sense of empowerment.

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by ... a) Mindfulness b) Low self-esteem c) Assertive behavior d) Therapeutic relationship

Low self-esteem Explanation: Research suggests that particular characteristics are predictive of violent behaviors. Low self-esteem that may be further eroded during hospitalization or treatment may influence a client to use force to meet his or her needs or to experience some sense of empowerment.

When assessing a client's potential for aggression and violence, which of the following would be most important for the nurse to do? a) Observe the client for nonverbal indicators b) Review the client's use of medications c) Ask the client about his living situation d) Obtain a thorough client history

Obtain a thorough client history Explanation: Although assessing the client's living situation, observing for nonverbal indicators, and reviewing medications are important, obtaining a thorough client history is the most important predictor for aggression and violence. Early life adverse circumstances, such as inadequate maternal nutrition, birth complications, traumatic brain injury, and lead exposure can contribute to risk for aggressive and criminal behaviors in adulthood. Important markers in the client's history include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control.

When assessing a client's potential for aggression and violence, which of the following would be most important for the nurse to do? a) Obtain a thorough client history b) Ask the client about his living situation c) Review the client's use of medications d) Observe the client for nonverbal indicators

Obtain a thorough client history Explanation: Although assessing the client's living situation, observing for nonverbal indicators, and reviewing medications are important, obtaining a thorough client history is the most important predictor for aggression and violence. Early life adverse circumstances, such as inadequate maternal nutrition, birth complications, traumatic brain injury, and lead exposure can contribute to risk for aggressive and criminal behaviors in adulthood. Important markers in the client's history include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control.

All of the following groups of children are at increased risk for failing to develop socially appropriate behavior except children a) Whose families are of lower socioeconomic status b) Who receive inconsistent responses to their behavior c) Of higher socioeconomic status d) In dysfunctional families with poor parenting

Of higher socioeconomic status Explanation: Children of higher socioeconomic families are not at higher risk for failing to develop socially appropriate behavior.

As a child matures, he or she is expected to develop impulse control and socially appropriate behavior. All of the following groups of children are at increased risk for failing to develop socially appropriate behavior except children a) Of higher socioeconomic status b) Whose families are of lower socioeconomic status c) In dysfunctional families, with poor parenting d) Who receive inconsistent responses to their behavior

Of higher socioeconomic status Explanation: Children of higher socioeconomic families are not at higher risk for failing to develop socially appropriate behavior.

As a child matures, he or she is expected to develop impulse control and socially appropriate behavior. All of the following groups of children are at increased risk for failing to develop socially appropriate behavior except children a) In dysfunctional families, with poor parenting b) Of higher socioeconomic status c) Whose families are of lower socioeconomic status d) Who receive inconsistent responses to their behavior

Of higher socioeconomic status Explanation: Children of higher socioeconomic families are not at higher risk for failing to develop socially appropriate behavior.

A nurse responds to aggressive behavior on the unit, which is influenced by the nurse's ... a) Recognition of client acting out b) Actions of not responding to the escalating behavior c) Losing control and acting defensively d) Own awareness and reaction to aggression

Own awareness and reaction to aggression Explanation: Nurses' beliefs about themselves as individuals and professionals will influence their responses to aggressive behaviors.

A nurse responds to aggressive behavior on the unit, which is influenced by the nurse's ... a) Recognition of client acting out b) Actions of not responding to the escalating behavior c) Own awareness and reaction to aggression d) Losing control and acting defensively

Own awareness and reaction to aggression Explanation: Nurses' beliefs about themselves as individuals and professionals will influence their responses to aggressive behaviors.

A nurse must assess a client's thought process to identify risk for aggression. This refers to the patient's a) Hunger and thirst b) Perceptions and delusions c) Mood and affect d) Insight

Perceptions and delusions Explanation: The thought processes of greatest interest to the nurse in assessing a client's potential for aggression and violence are perception and delusion.

A nurse must assess a client's thought process to identify risk for aggression. This refers to the patient's a) Insight b) Mood and affect c) Perceptions and delusions d) Hunger and thirst

Perceptions and delusions Explanation: The thought processes of greatest interest to the nurse in assessing a client's potential for aggression and violence are perception and delusion.

A nurse must assess a client's thought process to identify risk for aggression. This refers to the patient's a) Mood and affect b) Insight c) Hunger and thirst d) Perceptions and delusions

Perceptions and delusions Explanation: The thought processes of greatest interest to the nurse in assessing a client's potential for aggression and violence are perception and delusion.

Which of the following terms is used to describe behavior in which a person attacks or injures another person, or behavior that involves destruction of property? a) Catharsis b) Hostility c) Physical aggression d) Anger

Physical aggression Explanation: Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Catharsis includes activities that provide a release of the anger. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

Which of the following terms is used to describe behavior in which a person attacks or injures another person, or behavior that involves destruction of property? a) Hostility b) Anger c) Physical aggression d) Catharsis

Physical aggression Explanation: Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Catharsis includes activities that provide a release of the anger. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

When assessing a client's anger, which of the following must be assessed first? a) Manner of anger expression b) Possibility of an underlying disorder c) Intensity of the anger d) Extent of problems associated with the anger

Possibility of an underlying disorder Explanation: Because anger and aggression can be symptomatic of many underlying psychiatric or medical disorders, from posttraumatic stress disorder (PTSD) and bipolar disorder to toxicities and head injuries, any underlying disorder must first be properly evaluated. Once this information is obtained, then other areas, such as the manner of the anger expression, the intensity and frequency of the anger, and any problems associated with the anger can be assessed.

When assessing a client's anger, which of the following must be assessed first? a) Possibility of an underlying disorder b) Manner of anger expression c) Intensity of the anger d) Extent of problems associated with the anger

Possibility of an underlying disorder Explanation: Because anger and aggression can be symptomatic of many underlying psychiatric or medical disorders, from posttraumatic stress disorder (PTSD) and bipolar disorder to toxicities and head injuries, any underlying disorder must first be properly evaluated. Once this information is obtained, then other areas, such as the manner of the anger expression, the intensity and frequency of the anger, and any problems associated with the anger can be assessed.

The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as ... a) Regression b) Manipulation c) Progress d) Controlling

Progress Explanation: When the client is able to verbalize angry feelings, this is progress from having an outburst. The client is not trying to control the situation. Manipulation occurs when a person tries to persuade another to act in a desired way. Regression occurs when one retreats to an earlier level of functioning and development.

The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as ... a) Progress b) Controlling c) Regression d) Manipulation

Progress Explanation: When the client is able to verbalize angry feelings, this is progress from having an outburst. The client is not trying to control the situation. Manipulation occurs when a person tries to persuade another to act in a desired way. Regression occurs when one retreats to an earlier level of functioning and development.

Nurses working in a clinical setting must be provided with regular training programs in the prevention/management of aggressive behavior in order to ... a) Share personal experiences b) Avoid violent episodes from occurring c) Be aware of current incidences reported in other hospitals d) Reinforce and update what they have learned

Reinforce and update what they have learned Explanation: Clinically, nurses must be provided with training programs in the prevention and management of aggressive behavior. The courses need to be made available to nurses and students regularly so that they have opportunities to reinforce and update what they have learned.

Nurses working in a clinical setting must be provided with regular training programs in the prevention/management of aggressive behavior in order to ... a) Share personal experiences b) Reinforce and update what they have learned c) Be aware of current incidences reported in other hospitals d) Avoid violent episodes from occurring

Reinforce and update what they have learned Explanation: Clinically, nurses must be provided with training programs in the prevention and management of aggressive behavior. The courses need to be made available to nurses and students regularly so that they have opportunities to reinforce and update what they have learned.

A nurse is part of a team developing strategies to help reduce the risk of violence on the mental health unit. Which of the following would the team identify as contributing to the risk for violence? a) Predictable unit activities b) Client involvement in treatment plan c) Adequate client-to-staff ratios d) Rigid unit rules

Rigid unit rules Explanation: Characteristics that can increase the risk of violence on a mental health unit include rigid unit rules, lack of meaningful and predictable unit activities, inadequate staffing, and lack of client involvement in the treatment plan.

A nurse is part of a team developing strategies to help reduce the risk of violence on the mental health unit. Which of the following would the team identify as contributing to the risk for violence? a) Client involvement in treatment plan b) Predictable unit activities c) Rigid unit rules d) Adequate client-to-staff ratios

Rigid unit rules Explanation: Characteristics that can increase the risk of violence on a mental health unit include rigid unit rules, lack of meaningful and predictable unit activities, inadequate staffing, and lack of client involvement in the treatment plan.

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter? a) Norepinephrine b) GABA c) Dopamine d) Serotonin

Serotonin Explanation: Intermittent explosive disorder involves inadequate production or functioning of serotonin. Other neurotransmitters such as dopamine, norepinephrine, or GABA are not involved.

Aggression control can be measured by the nurse's observation of a patient's a) Displaying increasing motor activity b) Showing an increased tolerance for frustration c) Withholding his or her thoughts and feelings d) Using increased doses of medication to reach a desired effect

Showing an increased tolerance for frustration Explanation: Aggression control is the term used in the Nursing Outcomes Classification (NOC; Moorhead, Johnson, & Maas, 2003). The nurse may observe that the client shows decreased psychomotor activity (e.g., less pacing), has a more relaxed posture, speaks more directly about feelings of anger and personal needs, requires less sedating medication, shows increased tolerance for frustration and the ability to consider alternatives, and makes effective use of other coping strategies.

Aggression control can be measured by the nurse's observation of a patient's a) Displaying increasing motor activity b) Withholding his or her thoughts and feelings c) Using increased doses of medication to reach a desired effect d) Showing an increased tolerance for frustration

Showing an increased tolerance for frustration Explanation: Aggression control is the term used in the Nursing Outcomes Classification (NOC; Moorhead, Johnson, & Maas, 2003). The nurse may observe that the client shows decreased psychomotor activity (e.g., less pacing), has a more relaxed posture, speaks more directly about feelings of anger and personal needs, requires less sedating medication, shows increased tolerance for frustration and the ability to consider alternatives, and makes effective use of other coping strategies.

Aggression control can be measured by the nurse's observation of a patient's a) Using increased doses of medication to reach a desired effect b) Withholding his or her thoughts and feelings c) Showing an increased tolerance for frustration d) Displaying increasing motor activity

Showing an increased tolerance for frustration Explanation: Aggression control is the term used in the Nursing Outcomes Classification (NOC; Moorhead, Johnson, & Maas, 2003). The nurse may observe that the client shows decreased psychomotor activity (e.g., less pacing), has a more relaxed posture, speaks more directly about feelings of anger and personal needs, requires less sedating medication, shows increased tolerance for frustration and the ability to consider alternatives, and makes effective use of other coping strategies.

A factor contributing to violence against women varies and can be attributed to a) Women having access to education b) Ability to control number of pregnancies c) Societal attitudes toward gender and violence d) Increased economic independence

Societal attitudes toward gender and violence Explanation: A World Health Organization (WHO) study in 2005 revealed that the incidence of violence against women varies considerably across countries. For instance, the percentage of violence against a woman by a male partner ranged from 13% in Japan to 61% in Peru. Social factors related to violence against women included degree of economic inequality between males and females.

Communal experiences of family and peer settings and the consequences of physical aggression are characteristic of violent behavior. This refers to ... a) Interactional theories b) Sociocultural theories c) Cognitive theories d) Psychoanalytic theories

Sociocultural theories Explanation: Sociocultural theories suggest violent behavior has multiple determinants, including social experiences in family and peer settings and the social consequences (positive and negative) of physical aggression.

Communal experiences of family and peer settings and the consequences of physical aggression are characteristic of violent behavior. This refers to ... a) Interactional theories b) Sociocultural theories c) Psychoanalytic theories d) Cognitive theories

Sociocultural theories Explanation: Sociocultural theories suggest violent behavior has multiple determinants, including social experiences in family and peer settings and the social consequences (positive and negative) of physical aggression.

Which of the following signs of escalating behaviors, if displayed by a client, require immediate intervention? a) Banging the head against the wall b) Making sarcastic comments c) Staring intensely for a long time d) Using foul language

Sociocultural theories Explanation: Sociocultural theories suggest violent behavior has multiple determinants, including social experiences in family and peer settings and the social consequences (positive and negative) of physical aggression.

When describing the psychoanalytic view of aggression and violence, which of the following would the nurse most likely include? a) A learned response to a stimulus b) Interaction of cognition, affect and arousal c) Suppression of instinctual drives d) Way of getting what a person wants

Suppression of instinctual drives Explanation: Psychoanalytic theories focus on aggression and violence as a suppression of instinctual drives. Social learning theory focuses on the role of learning and rewards. Behavioral theories view it as a learned response to a stimulus. The general aggression model is a framework that accounts for the interaction of cognition, affect and arousal during an aggressive episode.

When describing the psychoanalytic view of aggression and violence, which of the following would the nurse most likely include? a) A learned response to a stimulus b) Interaction of cognition, affect and arousal c) Way of getting what a person wants d) Suppression of instinctual drives

Suppression of instinctual drives Explanation: Psychoanalytic theories focus on aggression and violence as a suppression of instinctual drives. Social learning theory focuses on the role of learning and rewards. Behavioral theories view it as a learned response to a stimulus. The general aggression model is a framework that accounts for the interaction of cognition, affect and arousal during an aggressive episode.

The nurse finds that a client with a history of aggressive behavior is restless, is pacing up and down in the hallway, and has clenched fists. The client also talks in a loud voice. What should the nurse interpret from the client's behavior? a) The client is agitated. b) The client is anxious. c) The client is taking a walk. d) The client is depressed.

The client is agitated. Explanation: Restlessness, pacing, clenched fists and talking in loud voice are signs of agitation. These signs precede the actual acting out during aggressive behavior. The nurse should understand that the client is agitated, and should take measures to calm the client. The signs do not indicate the client is taking a walk because during the walk the client may not be restless and not have clenched fists. Restlessness and clenched fists do not indicate depression or anxiety.

The nurse is reviewing the medical history of an extremely agitated client. The nurse has not yet met the client and the history contains previous use of a benzodiazepine to relieve aggression. What might the nurse interpret from this information? a) The client is an older adult with dementia. b) The client is a middle-aged adult with brain injury. c) The client is an adolescent with conduct disorder. d) The client is a child with mental retardation.

The client is an older adult with dementia. Explanation: When benzodiazepines are prescribed to reduce aggression, this suggests the client is an older adult with dementia. Benzodiazepines can reduce irritability and agitation in these clients, but can result in loss of social inhibition for other aggressive clients, thereby increasing aggression. An aggressive client with brain injury is usually prescribed antipsychotic medications. An aggressive child with mental retardation or an adolescent with conduct disorder are usually prescribed lithium.

To defuse a critical situation the nurse can use the therapeutic communication techniques and intervene to ... a) Offer medication as the solution to the outburst b) Shout and let the patient know that this behavior is not tolerated c) Try to clarify what has upset the client d) Inform client that the nurse is in charge of situation

Try to clarify what has upset the client Explanation: Trying to clarify what has upset the client is important. The nurse can use therapeutic communication techniques to prevent a crisis or defuse a critical situation.

To defuse a critical situation the nurse can use the therapeutic communication techniques and intervene to ... a) Offer medication as the solution to the outburst b) Try to clarify what has upset the client c) Inform client that the nurse is in charge of situation d) Shout and let the patient know that this behavior is not tolerated

Try to clarify what has upset the client Explanation: Trying to clarify what has upset the client is important. The nurse can use therapeutic communication techniques to prevent a crisis or defuse a critical situation.

To defuse a critical situation the nurse can use the therapeutic communication techniques and intervene to ... a) Shout and let the patient know that this behavior is not tolerated b) Inform client that the nurse is in charge of situation c) Offer medication as the solution to the outburst d) Try to clarify what has upset the client

Try to clarify what has upset the client Explanation: Trying to clarify what has upset the client is important. The nurse can use therapeutic communication techniques to prevent a crisis or defuse a critical situation.

To defuse a critical situation the nurse can use the therapeutic communication techniques and intervene to ... a) Try to clarify what has upset the client b) Inform client that the nurse is in charge of situation c) Offer medication as the solution to the outburst d) Shout and let the patient know that this behavior is not tolerated

Try to clarify what has upset the client Explanation: Trying to clarify what has upset the client is important. The nurse can use therapeutic communication techniques to prevent a crisis or defuse a critical situation.

A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. The best approach by the nurse would be to ... a) Provide close contact to increase the client's sense of safety b) Have a sense of humor to show a lack of fear c) Use open-ended questions so the client can elaborate d) Use brief statements and questions to obtain information

Use brief statements and questions to obtain information Explanation: Following an aggressive episode, clients may have difficulty expressing themselves; short, concise statements and questions will get needed information. Humor or open-ended questions may be frustrating or annoying for the client.

Which of the following is not a general criterion that characterizes impulse-control disorders? a) Sense of excitement, gratification, or tension relief after a violent act b) Sense of increasing pressure, discomfort, or energy before acting on an impulse c) Inability to control impulses to behave in ways that are harmful toward self or others d) Verbalization of what is causing the impulse to harm someone else prior to doing so

Verbalization of what is causing the impulse to harm someone else prior to doing so Explanation: Three criteria characterizing impulse-control disorders include the inability to control the impulse, drive, or temptation to behave in a way viewed harmful to self or others, a sense of increasing pressure, discomfort, or energy before acting on the impulse, and a sense of excitement, gratification, or and tension-release during the act.

Which of the following is not a general criterion that characterizes impulse-control disorders? a) Inability to control impulses to behave in ways that are harmful toward self or others b) Sense of increasing pressure, discomfort, or energy before acting on an impulse c) Verbalization of what is causing the impulse to harm someone else prior to doing so d) Sense of excitement, gratification, or tension relief after a violent act

Verbalization of what is causing the impulse to harm someone else prior to doing so Explanation: Three criteria characterizing impulse-control disorders include the inability to control the impulse, drive, or temptation to behave in a way viewed harmful to self or others, a sense of increasing pressure, discomfort, or energy before acting on the impulse, and a sense of excitement, gratification, or and tension-release during the act.

Which of the following is not a general criterion that characterizes impulse-control disorders? a) Verbalization of what is causing the impulse to harm someone else prior to doing so b) Inability to control impulses to behave in ways that are harmful toward self or others c) Sense of excitement, gratification, or tension relief after a violent act d) Sense of increasing pressure, discomfort, or energy before acting on an impulse

Verbalization of what is causing the impulse to harm someone else prior to doing so Explanation: Three criteria characterizing impulse-control disorders include the inability to control the impulse, drive, or temptation to behave in a way viewed harmful to self or others, a sense of increasing pressure, discomfort, or energy before acting on the impulse, and a sense of excitement, gratification, or and tension-release during the act.