Chapter 11
A client approaches the nurse and loudly states, "I'm not putting up with this anymore!" The most appropriate response by the nurse would be which of the following? A) "I can see you are angry. Tell me what's going on." B) "You are not allowed to make threats. Please keep your voice down." C) "Why do you say that?" D) "You are here voluntarily. You can leave if you want."
A
A nurse is working with a client who has frequent angry outbursts. Which of the following statements is most helpful when working with this client? A) "Anger is a normal feeling, and you can use it to solve problems." B) "You need to learn to suppress your angry feelings." C) "You can reduce your anger by hitting a punching bag." D) "You need to learn how to be less assertive in your communications."
A
An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be which of the following? A) Call for an emergency response from trained personnel. B) Approach the client and firmly say, "Stop, put it down." C) Calmly call the client by name and encourage verbal expression of anger. D) Assist the client to use problem-solving techniques instead of aggression.
A
One of the first steps that a nurse should take to deal effectively with aggressive clients is which of the following? A) Reflect on abilities to handle own feelings of anger B) Learn professional skills of anger management C) Become proficient using reflective communication techniques D) Understand how to activate crisis response teams
A
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.
A
Which client should be assessed as demonstrating aggression? A) a client who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from another client standing at the pool table B) a client who bursts into tears, leaves the community meeting, and sits on the bed hugging a pillow and sobbing C) a client who tells the primary nurse, "When you told me that I could not have a pass, I felt angry." D) a client who tells the medication nurse, "I am not going to take that, or any other, medication."
A
Which of the following interventions is most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. A) Planning group activities such as playing games B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit D) Avoiding discussions among clients on the unit E) Discouraging clients from negotiating solutions
A B C
The nurse should assess clients' risks for anger or aggression in the care of clients with which of the following psychiatric diagnoses? Select all that apply. A) Alzheimer's dementia B) Schizophrenia C) Anorexia nervosa D) Acute alcohol intoxication E) Generalized anxiety disorder
A B D
Which of the following statements about anger, hostility, and aggression are accurate? Select all that apply. A) Anger is an emotional response to a real or perceived provocation. B) Hostility stimulates the sympathetic nervous system. C) Physical aggression involves harming other persons or property. D) Anger, hostility, and physical aggression are normal human emotions. E) Hostility is also referred to as verbal aggression. F) Physical aggression often progresses to hostility.
A C E
Which of the following are important issues for nurses to be aware of when working with angry, hostile, or aggressive clients? Select all that apply. A) Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. B) Nurses must not allow themselves to become angry under any circumstances. C) Nurses must know that a client's anger or aggressive behavior is preventable by a skilled nurse. D) Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. E) Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.
A D E
A staff development coordinator is planning to teach the use of physical management techniques when clients become physically aggressive. The coordinator should stress the importance of which technique? A) spontaneity and surprise B) practice and teamwork C) caution and superior size D) diversion and physical outlets
B
As the nurse is performing an assessment on the client, the client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting? A) Triggering B) Escalation C) Crisis D) Recovery
B
In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression? A) Getting as far away from him or her as possible B) Engaging the hostile person in dialogue C) Yelling at the client to settle down now D) Ensuring that the client gets his or her way
B
The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? A) Give the client a physical outlet 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.
B
The client is being assessed for anger attacks. Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression? A) Delusions B) Depression C) Dementia D) Delirium
B
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) Client's safety C) Court order D) Physician's order
B
The nurse gathers information to formulate a plan of care for the client with aggressive issues. Which of the following is most likely to be the subject of an aggressive attack from a client with mental illness? A) Other people B) The client C) Animals D) Objects
B
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
B
The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize which of the following? A) Decreased problem-solving ability B) Restlessness and irritability C) Remorse D) Severe muscle tension
B
Which behavior is considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive? A) pacing B) sobbing inconsolably C) rigid posture with a clenched jaw D) staring with narrowed eyes into the eyes of another
B
Which client on the mental health unit should be assessed as being at highest risk for directing violent behavior toward others? A) a client who has obsessive-compulsive disorder and performs many rituals B) a client who has paranoid delusions and believes is being followed by members of the mafia C) a client who has severe depression with delusions of worthlessness D) a client who has completed alcohol withdrawal and is beginning a rehabilitation program
B
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
B
A client is clenching his fists and yelling at another client on the unit. He appears to be close to losing control of his anger. Which of the following actions by the nurse is appropriate at this time? A) Clear others out of the immediate area. B) Prepare a PRN sedative. C) Tell the client to stop and take a time-out. D) Alert the security department of an impending aggressive outburst.
C
A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately in a calm manner to prevent the client from moving to which phase of the aggression cycle? A) Triggering B) Escalation C) Crisis D) Recovery
C
A client is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say which response? A) "Please quiet down." B) "Hey, what's up?" C) "You seem upset. Tell me about it." D) "You need to go to your room until you can control yourself."
C
A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use? A) Have a sense of humor to show a lack of fear. B) Provide close contact to increase the client's sense of safety. C) Use brief statements and questions to obtain information. D) Use open-ended questions, so the client can elaborate.
C
A married man expresses to the nurse that his wife's frequent nagging angers him. The nurse role-plays assertive communication techniques with the husband. Which of the following indicates the husband understands how to use assertive techniques effectively? A) "I really wish you would stop nagging me." B) "You are not perfect either." C) "I feel unappreciated when you criticize me." D) "Are you telling me you want me to change?"
C
After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the client at this time? A) "We will have to talk about this later." B) "You really scared me. I'm glad you are okay." C) "What happened that got you so upset?" D) "What can you do differently next time you get angry?"
C
The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as which of the following? A) controlling B) manipulation C) progress D) regression
C
The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? A) Triggering B) Escalation C) Crisis D) Postcrisis
C
What a culture considers acceptable strongly influences the expression of anger. Which culture-bound syndrome is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects? A) Hwa-Byung B) Hwabyeong C) Amok D) Bouffée delirante
C
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 by the nursing team. Which statement should the nurse make to explain the use of restraints to the client? 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."
D
A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. Which would be the best response by the nurse? 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) "I will limit your smoking privileges if you can't control yourself." D) "You seem angry. Tell me more about how you're feeling."
D
After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive? A) "You still need to work on your problem-solving skills." B) "I will not allow you to get that angry again." ) "You should not have let your anger buildup like you did." D) "What could you have done when you first started to feel angry?"
D
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. Which is the best action by the nurse? A) Take an authoritatively step between the two clients. B) Comfort the client huddled in the corner. C) Directly address both clients and ask what is going on. D) Engage the attention of the client who is still yelling and ask what is happening.
D
Which of the following is most important to maintain therapeutic boundaries when working with aggressive clients? A) Encourage clients to express how the nurse can avoid causing emotional irritation. B) Discuss difficult patient care situations with a supervisor. C) Reflect on your actions that may have instigated the client's anger. D) Do not personalize a client's anger
D
Which of the following statements about the crisis phase of aggression when the client becomes physically aggressive is true? A) All staff should act to take charge of the situation. B) The client must be restrained or sedated at once. C) Staff should avoid communicating with the client. D) Four to six trained staff members are needed to restrain.
D
Which one of the following statements about anger is most accurate? A) Anger is an abnormal human emotion that is always negative. B) It is best to express anger by whatever means possible to minimize its consequences. C) Most men are socialized to suppress anger. D) Anger awareness and expression are necessary for women's growth and development.
D
