Mental Health Chapter 11

The nurses on a mental health unit are reviewing aspects of the unit environment in a staff meeting. Which factor would be predictive of a client becoming aggressive or violent?

strict hierarchy of authority

Aggression control can be measured by the nurse's observation of a client's ability to do what?

Show an increased tolerance for frustration

An adult child brings their parent to the clinic and tells the nurse that their parent has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the parent expresses remorse for their outburst. The adult child says, "I've never seen my parent act this way." Which question is most appropriate for the nurse to ask next?

"Has your parent suffered any traumatic injury to their brain recently?"

The nurse interacts with a client who yelled at the staff during the breakfast meal. Which response demonstrates the therapeutic use of role modeling the assertive communication technique?

"I feel disappointed that you yelled at the staff this morning."

The nurse leads an education session regarding the effect of suppressing anger on the body. Which statement by the client indicates a need for further teaching?

"I need to stop feeling angry or I won't be healthy."

A nurse educator has executed an in-service about preventing workplace violence on a psychiatric mental-health unit. Which statement made by a nurse would indicate the need for further education?

"It is okay to feel angry when confronted with an angry client."

A client is attending anger management class and wants to know how the class will help. What is the nurse's best response?

"It will help you to learn how to control the arousal of anger."

The nurse is caring for a client with aggressive behavior. The client tells the nurse, "I am feeling extremely angry. I feel like breaking the windows in here." What would be the most appropriate response of the nurse?

"Let's go to the gym and exercise."

A mental-health nurse is caring for a client who displays aggressive behavior and the client asks about the role of neurobiology in their behavior. Which statement made by the nurse demonstrates understanding of the neurobiology role in aggression?

"Low serotonin levels may lead to increased aggressive behaviors."

The nurse is assessing a client of an Eastern culture who is admitted due to the need for anger management. What question should the nurse ask to determine the effect of culture on the client's expression of anger?

"What did you learn about anger when growing up?"

The nurse is working with a client who yells at the nurse, "I am angry about how you keep treating me without respect!" What is the nurse's best response?

"What have I done or said that is disrespectful?"

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?

"What works best is what fits the client and the situation."

A nurse is presenting to a group of colleagues about the relationships between anger, aggression, and violence. Which statement by the nurse would be most appropriate to include?

"Women experience anger as frequently as men do."

A client is pacing the hall near the nurses' station and swearing loudly. Which is an appropriate initial intervention for the nurse?

"You seem upset. Tell me about it."

A nurse suggests that the client explores new ideas about a particular problem and considers other possibilities to reflect:

A cognitive intervention.

The nurse technician tells the nurse that the client "is grumpy'' and "wouldn't change into a gown." During the admission assessment, the client answers questions sarcastically and displays clenched fists and a closed posture. Which action should the nurse implement first?

Administer 4 mg morphine IV.

The nurse is assessing a school-aged child to determine underlying causes for socially inappropriate behavior. The nurse uses knowledge that which children are likely to have impaired impulse control? Select all that apply.

Children who belong to low-income families. Children who belong to dysfunctional families. Children who get inconsistent responses for their behavior.

The nurse interacts with a client who states "I am so angry and frustrated. I was supposed to be able to go home today and now they are saying I have to stay another day." Which principle should guide the nurse's response?

Clients who can verbalize angry feelings are less likely to display hostile behaviors.

What is an important nursing consideration when administering antipsychotic medications for the treatment of aggression in clients experiencing psychosis?

Antipsychotic medications are associated with the development of extrapyramidal side effects.

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. Which intervention would be most appropriate at this point?

Approach the client to engage in communication while remaining 6 feet or more away

A client throwing chairs at other clients in the recreation room is placed in restraints. Which action would the nurse take to adhere to regulatory requirements?

Ask the health care provider to examine the client within 1 hour.

An adult client on the psychiatric mental-health unit is in the triggering phase of aggression. What is the nurse's best approach to de-escalate the client in this phase of aggression?

Calmly encourage the client to express their feelings.

Which term is used to describe an activity used to release anger?

Catharsis

Which term is used to describe an emotion expressed through verbal abuse and violation of rules or norms?

Hostility

The nurse in the inpatient mental health facility is caring for a new client with a history of aggressive behavior. Which action would the nurse take to promote safety and prevent violent behavior from this client?

Create a therapeutic milieu.

In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly?

Crisis

A client visits the clinic and tells the nurse that no matter how difficult the client's child acts, the client simply cannot express any anger. The nurse should plan to assess the client for symptoms of which mental health condition?

Depression

While working in a psychiatric-mental health facility, the nurse notices a client pacing back and forth and becoming increasingly agitated. Which is a critical step in communicating with the client to prevent the escalation of aggressive behavior?

Discover the source of the distress.

The inpatient psychiatric nurse removes the restraints from a client who had an aggressive episode earlier and is currently calm and rational. The client asks if they can attend the group. Which response demonstrates insight into the postcrisis phase of anger and aggression?

Encourage the client to attend with the expectation that they will remain nonaggressive.

Which staff behaviors are most likely to trigger clients who are predisposed to aggressive or violent behavior?

Engaging in disputes over medication, supplies, or rules on the unit

The nurse is interviewing a client with a history of physical aggression. Which should the nurse avoid?

Explaining the consequences the client will face if control is lost

The nurse recognizes that they are avoiding clients who display hostile behaviors. Which would be the nurse's best response?

Explore opportunities for additional training and practice.

A nurse is leading an anger management group in an inpatient program. A client says, "I'm feeling really tense, and I'm fidgety today." What is the nurse's most appropriate response to the client's comment?

Explore what is underlying the client's physical and emotional state

A nurse technician reports to the nurse manager that a new nurse refuses to inventory client belongings during admission assessments and makes belittling statements to the clients about the nurse technicians. Which consideration(s) by the nurse reflects an understanding of lateral violence? Select all that apply.

Failure to address the behavior could affect joint commission accreditation. The organization should provide a process for managing the behavior.

The nurse is assessing a client who is aggressive. Which safety measures must the nurse ensure are in place prior to continuing the assessment? Select all that apply.

Give the client plenty of space. Sit in an open area Request the presence of additional staff.

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include?

Listen to the client's concerns and convey empathy for the client's frustration or anger.

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by possession of which attribute?

Low self-esteem

A client with schizophrenia has been brought to the hospital in an agitated state. In order for the nurse to perform the initial assessment, which approaches should the nurse use to manage the situation? Select all that apply.

Monitor facial expressions Monitor emotional responses Ensure availability of assistance

The nurse is caring for a client with dementia who has become increasingly agitated. Which is the best action for the nurse to perform?

Provide a snack and fluids frequently.

During which phase of the aggression cycle does the client regain physical and emotional control?

Recovery

The nurse is demonstrating de-escalation techniques on an aggressive client in a forensic setting. Which is the best explanation of this technique?

Resolution of anger in nonviolent ways

A nurse's response to aggressive behavior on the unit is influenced by which characteristic of the nurse?

Self-awareness of reactions to aggression by others

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter?

Serotonin

A client tells the nurse that the client has strong urges to damage property as a result of feelings of hostility and anger. Which is an appropriate nursing action?

Take the client to the gym for exercise.

The nurse is counseling a client couple who are trying to reconcile and hold their marriage together. During therapy the wife states, "He makes me so mad when he spends all his weekend time with his friends instead of us. He makes me want to hurt him back." Using concepts from assertiveness training and effective communication techniques, the nurse implements which intervention after hearing the wife's remarks?

Teach the client to make "I" statements.

A client has recovered from an episode of aggressive and hostile behavior. Which behaviors in the client indicate that the client is in the post-crisis stage of the aggression cycle? Select all that apply.

The client apologizes for the hostile behavior. The client cries and is remorseful for the event. The client remains withdrawn from others.

A nurse is assessing a Korean client. The caregiver of the client tells the nurse that the client had been diagnosed with Hwa-Byung by their local health care provider. What should the nurse interpret from this?

The client had health-related issues due to suppression of anger.

A psychiatric mental-health nurse is evaluating the treatment plan of an adult client diagnosed with schizophrenia disorder with aggressive behaviors. Which outcome of the client would demonstrate successful treatment?

The client is free from aggressive behaviors.

The nurse is planning education for a client who has exhibited aggression on techniques to manage anger. Which situation would be best for providing this education?

The client is sitting in the dayroom reading a book.

A client with a history of angry outbursts that have caused interpersonal and work problems has been in counseling for several months. The nurse judges the plan of care to be effective when which outcome is met?

The client uses adaptive coping to manage anger impulses.

The nurse has been working with the client to develop impulse control over the previous 3 days. Which assessment finding supports that the plan of care was successful?

The client walks away from another client who insulted them.

Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response?

Triggering

A nurse is considering using restraint and seclusion for a client who is acting out. Which is the primary guideline for the use of restraint and seclusion?

Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent.

The nurse working in a psychology clinic finds that suppression of anger is more common in women than in men. What is the possible explanation for such a finding? Choose the best answer.

Women are expected not to express so-called negative feelings like anger.

The nurse is caring for a group of clients on the behavioral health unit. Which client will the nurse prepare to intervene with seclusion and restraint?

a client for whom all other measures of safety have failed

The charge nurse on the inpatient psychiatric unit is considering how best to assign clients with a low potential for aggression to a nurse who is seven months pregnant. What client factor is most significant for the nurse to consider?

a history of violent or aggressive behavior

A client asks the nurse for a date with them when they are discharged. The nurse tells the client that it is against policy to date clients. The client yells obscenities at the nurse and hits the counter before stomping away. Which defense mechanism does the nurse document that the client is using?

acting out

A client's roommate yells at the client and the client acts as if nothing has occurred and ignores the roommate. The nurse identifies that the client may have which style of anger expression related to this incident?

anger suppression

The psychiatric nurse is working in the triage area and has four clients to assess and transfer to the inpatient area for care. Which client should the nurse assess first?

client who is pacing the lobby stating "I am afraid of losing it"

The recreational therapist plans to offer clients a punching bag to release tension in the exercise group. Which client should be counseled to participate in this activity with caution?

client with a history of hostile behavior

When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor?

client's history

The nurse performs an admission assessment on a client who has been diagnosed with intermittent explosive disorder. The nurse anticipates which treatment will be part of the client's treatment plan?

cognitive-behavioral therapy

After working with a client who has a history of violent behavior to identify possible clues that suggest the behavior is escalating, a nurse and the client develop a plan for prevention. Which strategies will the nurse be most likely to include? Select all that apply.

counting to 10 taking slow, deep breaths taking a voluntary time out

An adult client is being seen in the emergency department (ED) for a manic episode. Which risk factor(s) present in the client would increase the risk for violence? Select all that apply.

destruction of property history of arrests restlessness lack of impulse control psychotic symptoms

The nurse is caring for a 17-year-old male client admitted for diagnosis and control of anger. Based upon the information in the medical record, for which condition would the nurse plan care for this client?

intermittent explosive disorder

Which behavior is considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive?

sobbing inconsolably

The nurse is assigned to care for a client who assaulted another nurse the previous day. Which behavior indicates that the nurse is having an issue providing care to the

limits contact with the client

The nurse is observing clients in the recreation room in a mental health facility. Which behavior(s) indicate to the nurse that a client is at risk for demonstrating violence? Select all that apply.

pacing staring at another client making sarcastic comments

The nurse states "I know this must be frightening for you" to a client who is angry and has a potential for violence. Which communication technique is the nurse utilizing with this statement?

validation

An adult client is being counseled in the clinic for anger outbursts. Which nursing intervention would be most effective at decreasing anger when the client is currently angry?

walking or talking with the client