Chapter 14 PrepU: Management of Anger, Aggression and Violence

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?

Immediately approach the client to engage in communication.

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.

An aggressive client gets hold of a glass piece and prevents anyone from entering the room. What interventions should the nurse perform to ensure safety of the client, staff, and other clients? Select all that apply.

- Summon help from others. - Leave the area immediately. - Shift other clients to a safe place.

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.

- The client will not harm the self. - The client will demonstrate decreased acting out behavior. - The client will withhold from harming others or damaging the hospital property.

The nurse is assessing a client who expresses extreme hostility toward the nurse. What may be the client's intentions? Select all that apply.

- To intimidate the nurse - To emotionally harm the nurse

The nurse is performing a physical assessment on a 3-year-old client. During the assessment, the child starts screaming and kicking. The nurse suspects this child:

Is acting out.

The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as what?

Progress.

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

Recovery During the recovery phase of the aggression cycle, the client regains physical and emotional control. The nurse should help the client relax, sleep, and return to a calmer state.

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.

Nurses working in a clinical setting must be provided with regular training programs in the prevention/management of aggressive behavior in order to ensure what?

Use evidence-based interventions.

Which describes a strong emotional response to a real or perceived provocation?

Anger

The nurse is planning the environment for a newly-admitted client with a history of violence toward others. Which modification would the nurse implement?

Confirm that the utility and storage rooms are kept locked.

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. 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.

In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression?

Engaging the hostile person in dialogue.

When determining a client's potential for aggression and violence prior to engaging in a detailed psychosocial assessment, which would be most important for the nurse to do?

Obtain a thorough client history.

A nurse is assessing a client. Which behaviors would alert the nurse to a possible impending aggressive episode? Select all that apply.

Staring eye contact. Using sarcastic comments. Mumbling. Pacing.

A nurse is working in a psychiatric-mental health facility. The nurse observes a client pacing and punching the wall. Which measure can the nurse take for personal safety?

Avoid being alone with the client.

Which sign of escalating behaviors, if displayed by a client, requires immediate intervention?

Banging the head against the wall

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

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

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 learn how to control the arousal of anger."

Under which circumstances can an expression of anger be considered a normal and healthy reaction? Select all that apply.

- When facing an unjust situation. - When personal rights are not respected. - When realistic expectations are not met.

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

A cognitive intervention. 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.

The nurse is caring for a client with rheumatoid arthritis. Upon entering the client's room, the nurse finds that the client is very angry and is punching pillows to express the anger. What should be the nurse's response to this behavior? Select the best answer.

"I am here so we can talk about what is making you angry." Expression of anger by engaging in aggressive but safe activities like punching a pillow is referred to as catharsis. It is now known that this behavior increases feelings of anger rather than alleviate them. The nurse knows that encouraging the client to engage in nonaggressive activities, such as speaking with someone, is more likely to reduce the anger. Asking the client to not damage the hospital's property indicates that the nurse is more concerned about property than the client. Telling the client that the anger would be reduced by punching pillows indicates that the nurse is encouraging the client to express anger through catharsis. Expressing appreciation to the client for expressing anger in an appropriate manner encourages expression of anger through catharsis.

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?

"Why do you think I am not being respectful to you?"

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." When the client is verbally informing the nurse about feeling extremely agitated, the nurse should help the client to express the feelings in a nondestructive and healthy way. Taking the client to the gym for exercise can help reduce aggression. Telling the client to sleep is an inappropriate response by the nurse. The client is feeling extremely agitated and the client would not be able to sleep because of the agitation. Telling the client to have a cigarette is encouraging the use of maladaptive coping mechanisms. A healthier alternative suggestion must first be offered to the client. Telling the client to punch pillows indicates that the nurse is encouraging catharsis. Catharsis is known to increase agitation and thus should not be encouraged.

While interviewing a client, a nurse asks, "What do you do when you get angry?" Which client response would indicate to the nurse that the client engages in anger suppression?

"People say I withdraw and pout about the problem." Anger suppression is characterized by acting as though nothing has happened; withdrawing from people; and sulking, pouting, or ruminating. Unhealthy, outward anger expression is characterized by flying off the handle or expressing anger in an attacking or blaming way, yelling, or using profanity. Approaching a person directly to talk about it, or discussing how the person feels with a close friend, reflects constructive anger discussion.

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."

An adult client is pacing and yelling. Which is the best response by the nurse?

"When did these feelings begin?"

A nursing instructor is educating a class of nursing students on anger, aggression, and violence. Which statement by the instructor would be most appropriate to include?

"Women experience anger as frequently as men do."

Which clients in the psychiatric inpatient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply.

- A client with a history of violence. - A client with history of being personally victimized. - A client with a history of substance abuse.

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.

A nurse is assessing a Haitian client. The caregiver of the client tells the nurse that the client is having an episode of Bouffée delirante. What symptoms would the nurse expect to find in this client? Select all that apply.

- Confusion. - Hallucinations. - Extreme aggression. Bouffée delirante is a culture-bound syndrome observed in West Africa and Haiti. This condition is characterized by sudden outbursts of aggression. The client is confused and may have auditory and visual hallucinations. Insomnia and abdominal pain are not associated with Bouffée delirante. These symptoms are associated with Hwa-Byung, which is a culture-bound syndrome in Korea.

The nurse is caring for a client with depression. The client has an anger episode. What are the possible behaviors expected in this client during and immediately following the episode? Select all that apply.

- Expresses anger verbally. - Feels guilty for inappropriate anger reaction. Clients with depression tend to express their anger verbally. After the anger episode, the client feels remorse and guilt for the anger reactions. Clients with depression are unlikely to exhibit physical aggression or to act out. An anger episode in a client with depression does not indicate that the client has paranoid delusions.

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. While assessing an aggressive client, the nurse should give the client plenty of space, sit in an open area, and request the presence of another staff person. The nurse should not restrain the client by him- or herself, but rather get the client restrained by trained personnel. Encouraging the client to talk about the situation in which he or she has been aggressive should be done in the recovery phase of the anger cycle.

The nurse is working with a client who is glaring at the other clients and has begun to pace in the dayroom. In determining an intervention to prevent escalation to violence, which would the nurse choose? Select all that apply.

- Giving the client personal space. - Approaching the client calmly. -Overlooking the client's behavior.

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.

- 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.

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. There are five phases of an aggression cycle. These include triggering, escalation, crisis, recovery, and post-crisis. In the post-crisis phase, the client attempts reconciliation with others and returns to a normal level of functioning. The client may realize that the aggressive behavior was wrong and may apologize for it. The client may cry and feel remorse for the aggression episode. Due to the guilt related to the aggression episode, the client remains withdrawn from others. The client talking in a loud voice, exhibiting irritable behavior, and pacing restlessly indicates that the client is in the triggering phase of the aggression cycle.

The nurse is caring for a client with aggression disorder. The client has an anger episode and is threatening other clients in the emergency room with a knife. What should be the approach of the nurse in this situation? Select all that apply.

- The nurse should attempt to kick the knife out of the client's hand. - The nurse should call for outside assistance. When necessary to remove the weapon, the nurse should try to kick the weapon out of the client's hand. The nurse should not reach for a weapon with his or her hand. The nurse should know the hospital's staff assistance plan and summon for outside assistance, especially in the event the client has a gun. The nurse should talk to the client in a low, calm voice; yelling may only exacerbate the situation. The nurse should remain aware of the client's body space or territory and not trap the client.

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

Allow the client to take a "time out" in a quiet area.

A psychiatric-mental health nurse wants to decrease frustration and potential anger among clients on the unit where he is working. Which of the following would aid in decreasing frustration and anger?

Allowing privileges like access to phones, televisions, or rooms.

The nurse is teaching a group of clients in a juvenile detention center about anger management and the positive effects of anger, if handled appropriately. What advantages, as explained by the nurse, may be helpful to the clients? Select all that apply.

Anger helps to focus attention. Anger helps in decision making. Anger helps in resolving conflicts. Anger can help a person to solve problems and make decisions, if handled appropriately. Anger also energizes the body physically by activating the fight or flight response, which helps the person focus their attention on the stressor. When handled inappropriately, anger can cause physical and emotional problems and, as such, does not improve emotional stability or help in increasing relaxation.

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.

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

Client's history The client's history is the most important predictor of potential for aggression and violence. The age, gender, and race of clients are not good predictors.

Neurobiologic factors are increasingly being explored as an explanation for aggressive behavior. Which is true?

Brain neuroimaging studies show that aggressive behavior is linked to damage of brain structures located in the limbic, frontal, and temporal lobes. Tumors or trauma in the limbic and hypothalamic areas, as well as the frontal and temporal lobes, can stimulate loss of impulse control, aggression, rage, mania, mood lability, altered sexual behavior, and delusions. Examination of the frontal lobe reveals that damage to the orbitofrontal cortex is associated with impulsive outbursts of rage and violence.

Some people try to express their angry feelings by engaging in aggressive but safe activities, such as hitting a punching bag or yelling. Which of the following terms is used to describe an activity used to release anger?

Catharsis

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

Catharsis 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. 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.

A group of nursing students is reviewing information about maladaptive anger. The students demonstrate a need for additional study when they identify which physical condition as being linked to suppressed anger?

Coronary heart disease Suppressed anger is related to arthritis, breast and colorectal cancer, and hypertension. Excessive, outwardly directed anger is linked to coronary heart disease, reduced left ventricular ejection fraction, and myocardial infarction

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

Crisis In the crisis phase, seclusion or restraint may be used to deal with aggression quickly.

A client has lost emotional and physical control. The client is shouting, screaming, hitting others, and throwing objects. Which phase of the aggression cycle is this client expressing?

Crisis. The client's signs of shouting, screaming, hitting others, and throwing objects suggest that the client is in crisis phase of the aggression cycle. This phase is characterized by loss of emotional and physical control. In the triggering phase, the client often becomes angry in response to an event or circumstance in the environment. In the escalation phase, the client may move toward a loss of control. In the recovery phase, the client regains the emotional and physical control.

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

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

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. 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?

Depression. 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 beginning the process of providing therapy to a client with anger management problems. When implementing this therapy, which should occur first to promote optimal effectiveness?

Development of a therapeutic relationship With cognitive-behavioral therapy, the recommendation is to first establish the therapeutic alliance because some angry individuals are not in a stage of readiness to change their behavior. When clients are more receptive, 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.

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. Five important steps in communicating with clients to prevent the escalation of aggressive behavior include (1) making personal contact, (2) discovering the source of distress, (3) relieving the distress, (4) keeping everyone safe, and (5) assisting with alternative behaviors and problem solving.

Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger?

Encourage verbalization.

A nurse assesses a newly admitted client on the unit. When assessing the client in detail about his/her past medical history, it is important for the nurse to also explore which information about the client?

Experience of health problems and health professionals.

A nurse is leading an anger management group in the 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 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 the client's experience using open-ended questions to increase the client's awareness of problematic feelings and what triggers them.

Structural damage to which of the following lobes of the brain may alter the person's ability to modulate aggression?

Frontal.

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 ...

Have their needs met.

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

Hostility 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.

Which personality trait is associated with aggressive behavior?

Impulsivity Irritability, resentment, and impulsivity have been linked with conflict, aggression, and the potential for medical conditions such as essential hypertension, cardiovascular disease, and atherosclerotic heart disease.

The general aggression model (GAM) is a framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode. Which is a situational factor according to this model?

Interference with achieving goals.

The nurse is assessing an adolescent in a psychiatric facility. The parent 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 nurse would expect the client to be diagnosed with:

Intermittent explosive disorder. Intermittent explosive disorder is a rare disorder characterized by intermittent episodes of aggressive impulses that are disproportionate to the precipitating factors. The individual with intermittent explosive disorder 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.

Which drug has been effective in treating aggressive clients diagnosed with bipolar disorders?

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

A client with aggressive behavior shows no psychotic symptoms. Which medication should the nurse expect to be ordered for this client?

Lorazepam Lorazepam is the most effective drug in reducing aggression in a client who does not have any other psychotic symptoms. Valproate, haloperidol, and carbamazepine drugs are useful in reducing aggression in those clients who have coexistent psychotic symptoms.

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 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 is reading a journal article about anger and violence. Which would the nurse expect to see as being linked to excessive, outwardly directed anger?

Myocardial infarction 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. Furthermore, suppressed anger was a predictor of early mortality for both men and women in a large, 17-year study.

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.

Obtain orders for seclusion if needed. Make arrangements for possible restraint. Anticipate the use of sedatives. Use a low calm voice 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 but using a low calm voice may help prevent increasing the agitation. Engaging the client in group activity may increase the risk of harm to others, so it should be avoided.

In which phase of the aggression cycle is the client removed from restraint or seclusion as soon as he or she meets the behavioral criteria?

Postcrisis. In the postcrisis phase, the client is removed from restraint or seclusion as soon as he or she meets the behavioral criteria. The client would not be able to demonstrate control in any of the other phases.

The nurse is assessing a group of clients on an inpatient psychiatric unit. The nurse determines that a client most likely to be violent has what?

Previous episodes of rage 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

During which phase of the aggression cycle does the staff usually have a debriefing session?

Recovery During the recovery phase, the staff has a debriefing session to discuss the aggressive episode.

The nurse has been working on anger management with the client. The client yells during dinner, "Give me that salt shaker!" What is the best nursing intervention at this time?

Remind the client about communication skills discussed earlier. 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. Reminding the client about communication skills or strategies discussed earlier emphasizes the use of personal strengths in communication as well as the therapeutic relationship as a means to assist the client in using more adaptive communication. The other options would not be appropriate for this situation.

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?

Rigid unit rules.

What is a characteristic of unit culture that predicts client violence?

Rigid unit rules.

Which is one of the most common nursing diagnoses for clients experiencing intense anger and aggression?

Risk for Self-Directed Violence.

A client has been admitted to the detoxification unit after binge drinking. Even though the client is not currently intoxicated, the client is combative and exhibits altered thought processes. Which nursing diagnosis would be the priority?

Risk for other-directed violence related to alcohol withdrawal.

The nurse is caring for a client hospitalized in an inpatient psychiatric setting for a history of violent behaviors and delusions. The nurse should instruct the client's family that aggression has been linked to low levels of which bodily chemical?

Serotonin Low levels of serotonin have been linked to aggressive behaviors.

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

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

An aggressive client is holding a weapon and threatening to harm other clients in the unit. How should the nurse handle this situation?

Shield oneself with a pillow.

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

Show an increased tolerance for frustration.

Which situation is likely to have the least influence on the a child's ability to develop socially appropriate behaviors?

Spending time in foster care In a situation where the child is taken into foster care, the circumstances surrounding the child being removed from the family home is detrimental to the development of socially appropriate behaviors; however, the child in foster care can receive effective parenting from a functional care provider.

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.

A nurse is facilitating anger management classes. A client states she is verbally and sometimes physically abusive to her teenaged children when they are defiant. The client explains, "That's how I was raised!" Which of the following interventions is best to meet the client's treatment goals?

Teach the client to identify and monitor anger cues.

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. Assertiveness skills are an effective method for controlling aggression by teaching clients appropriate tools for meeting their needs without infringing on the rights of others. The client can be taught about making "I" statements ("I feel hurt by your remarks") instead of "you" statements ("You hurt my feelings") to avoid making judgments by relating feelings rather than opinions and to develop better listening skills.

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. Hwa-Byung, or fire illness, is a culture-bound syndrome in Korea where a client has symptoms such as abdominal pain and insomnia as a result of suppression of anger. A nurse who is aware of the culture bound syndromes would understand that the client's health-related complaints are due to suppression of anger. Somatization is an incorrect diagnosis for this condition, often given by Western practitioners unaware of Hwa-Byung. Paranoid delusions and hallucinations are not seen in this culture-bound syndrome. This condition is not known to include intermittent episodes of anger outbursts.

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. Overall goals for aggressive or violent clients are to refrain from threatening or harming anyone during episodes of anger. Using adaptive coping to manage angry impulses indicates the client has gained insight into and skill at managing aggressive impulses. Although gaining insight into situations that trigger anger, increasing self esteem, and reporting increased feelings of self-control are critical elements in working toward effective management of anger, the goal of treatment is achieved when the client can put what he or she has learned into action.

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 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.

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.