Aggression and Violence

The nurse is caring for a psychiatric patient who is shouting and aggressively turning over the furniture in the common room. Which medication intervention should the nurse take?

Administer IM haloperidol. In emergent situations, antipsychotics may be administered IM to help calm patients more quickly.

Which statement accurately describes the positive nature of aggression?

Aggression can be used for self-protection. Aggression can be used positively, such as when it is used for self-protection.

After deescalating the situation successfully, the nurse completes Mr. Wagner's assessment. The data collected supports the following nursing diagnoses. Which nursing diagnosis is of highest priority to the nurse caring for Mr. Wagner?

Risk for other-directed violence Risk for other-directed violence is the nurse's highest priority because it involves the safety of Mr. Wagner and those in his environment.

A patient diagnosed with chronic schizophrenia has been medicated after demonstrating severely aggressive behavior toward members of the milieu. Which question by the nurse focuses on the patient's need to maintain a sense of autonomy?

"How can I help you to be in more control of your emotions and behavior?" Asking the patient how the nurse can help supports the patient's autonomy by letting the patient know that he or she has the ability to change, conveys concern, and fosters therapeutic communication.

An aggressive patient is removed from the unit and placed in restraints after the failure of several less restrictive de-escalation techniques. Which nursing documentation example is appropriate for this patient?

"Patient was placed into restraints for immediate danger to others; was agitated and threatened harm during restraint application. After medication was administered, patient verbalized understanding of restraint use and safety." This documentation includes the rationale for the nursing intervention implemented, the patient's behavior during the procedure, and the patient's response to the intervention.

The nurse meets with Mr. Wagner to discuss the aggressive episode that occurred during his admission. Which statement made by the nurse is most likely to encourage communication with the patient?

"Something triggered you to react aggressively toward the other patient. Let's discuss that." The nurse should use an open-ended statement to engage Mr. Wagner in a therapeutic discussion.

An aggressive patient requires restraint. Which statement best reflects what the nurse should say to the patient?

"We are now going to place restraints on your arms and legs." After the restraints and medication have been gathered, the nurse describes the procedure to the patient.

Place the actions in the order in which they occur in the assault cycle.

An internal or external trigger moves person away from typical "baseline" behavior. Person moves further away from baseline behavior and behaviors escalate. Assault occurs directed at another person, object, or self. Person returns to pre-trigger, baseline behavior. Person becomes depressed, remorseful or even suicidal. Exactly! In the first phase of the assault cycle, the trigger phase, an internal or external trigger moves the person away from typical, or baseline, behavior. During the next phase, escalation, the person moves further away from baseline behavior and verbal and non-verbal assaultive behaviors escalate. In the third phase, crisis, assault occurs; the assault can be self-directed or directed at another person or an object. The next phase of the assault cycle is the recovery phase, when the person returns to his or her pre-trigger, baseline behavior. The final phase is the post-crisis depression phase, during which the person becomes remorseful and possibly suicidal before returning again to baseline behavior.

The nurse is caring for a psychiatric patient whose agitation with another patient has escalated to aggression and threats of violence. Which step should the nurse take to safely manage this patient?

Ask the patient to breathe deeply and move to the nurse's station. The nurse should present the patient with clear, reasonable options that could help de-escalate the situation.

An increasingly agitated patient is disrupting group therapy on the inpatient unit. Which is the best course of action for the nurse?

Asking the patient if it would help him to take a walk outside the group in the hallway. Asking the patient to leave the environment and take a time-out in a different space promotes safety and security for the patient and others. It also gives the patient a choice.

The nurse documents that an aggressive patient tends to experience decreased agitation when sharing the common room with others and increased agitation when left alone in the patient's room. Which action should the nurse take as regards the patient's plan of care?

Update the nursing interventions to include opportunities to engage the patient in unit social activities. The nurse should evaluate the patient's progress and update the nursing interventions to reflect the patient's progress.

During which phase of the assault cycle is increased agitation recognized in the aggressive patient?

Escalation During the escalation phase, the patient becomes increasingly more agitated and may make threats toward others.

The nurse prepares to administer a PRN antipsychotic medication prescribed for an aggressive patient. Which action should the nurse take to demonstrate compliance with the patient's rights?

Explain to the patient why the medication is being given and the side effects. Even when the patient is out of control, the nurse should explain in a clear, simple manner why the medication is being given and the possible side effects.

An aggressive patient verbally threatens and lunges for the nurse. Which action should the nurse take first?

Immediately protect him- or herself by asking the patient to stop while physically moving back from patient and calling for assistance. The nurse must first protect him- or herself from immediate threat of injury and assemble the behavior response team to decide how to best handle the situation.

Which behaviors are physical aspects of assaultive behavior?

Jabbing Jabbing is a physical aspect of assaultive behavior where one person is physically touching another person, such as by using a finger to jab someone's chest with the intent to injure someone. Throwing Throwing objects such as furniture is an aspect of assaultive behavior because it is a physical act and could seriously harm others. Ramming Ramming a person into a wall or other object is an aspect of assaultive behavior because it is meant to physically injure someone.

During which phase of the assault cycle is the patient at highest risk for suicide?

Post-crisis The patient is most likely to demonstrate depression, remorse, and suicidal ideation during the post-crisis depression phase.

Which statement regarding the nurse's care of an aggressive patient is correct?

The nurse uses the technique of behavior modeling to demonstrate acceptable coping skills. The nurse uses behavior modeling to demonstrate to the patient acceptable ways to cope with anger. One method that can be used is a "do over." The patient who responds in a negative manner to a situation can try again to respond in a more constructive way while being coached by the nurse.

Match the assaultive behavior type with its corresponding characteristic.

Threatening harm Verbal Pounding the fists Non-verbal Throwing objects Physical