Chapter 23, 8ed. (24 9ed.)

The emergency department (ED) has seen an increase in violent behavior over the past year. The manager has voiced concerns to the chief nurse officer (CNO) regarding the safety of the ED staff. What should be done as a first step in addressing this issue? 1. The manager should consult with local law enforcement. 2. The CNO should review the management of violent incidents procedure policy. 3. The CNO should discuss the matter with hospital security. 4. The CNO should have the manager discuss the matter with the ED staff.

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A nurse enters a client's room and sees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation? 1. Keep a safe distance from the visitor. 2. Yell for another nurse to assist with the visitor. 3. Leave the room. 4. Threaten the visitor with assault charges.

Correct Answer: 1

Question 5 Type: MCSA An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days the client's son has been increasingly verbally abusive to the nursing staff. The unit secretary tells the nurse that the son is at the nurse's station demanding to see the client. Which action by the nurse is most important? 1. Remove the central line tray from the room. 2. Inform the son regarding the client's condition. 3. Ignore the son as he enters the clients room. 4. Limit the son's visitation.

Correct Answer: 1

The nurse has just been notified that a client is to be admitted from the emergency department (ED) with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client's lethargic state. Which action is an appropriate intervention by the nurse? 1. Approach the client with caution when obtaining vital signs and shift assessments. 2. Place the client in a room farthest from the nurse's station so as not to disturb other clients. 3. Place the client in four-point restraints as a protective measure. 4. Post an armed security person at the client's door.

Correct Answer: 1 Rationale 1: Alcohol withdrawal clients may lash out in violence. Rationale 2: Placing the client farthest away from the nurse's station may cause added liability to the organization due to the client's lethargic state and potential for harm if not closely monitored. Rationale 3: There is no evidence that it is necessary to place this client is restraints. Rationale 4: There is no evidence that it is necessary to post an armed guard at the door.

An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses. The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate? 1. The unit has been so busy, I must allow for the nurses to have time to provide client care. 2. The visitor hours have not been adjusted in years. It was time to change them. 3. The physicians have requested limited visiting hours. 4. The visiting hours allowed for added stress and commotion to the nursing staff.

Correct Answer: 4 Rationale 1: It is true that nurses need time to care for clients, but this is probably not the real reason for the change. Rationale 2: Visiting hours are not changed simply because they have not been changed in years. Rationale 3: There is no indication that the physicians have anything to do with changing these hours. Rationale 4: Open visiting hours do allow for added stress and commotion. When visitors are aggressive toward nurses, restricting visiting hours may be essential.

Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, I'm sorry you are upset. What can I do for you? The visitor continues to complain more loudly. What should the other nurse do? Standard Text: Select all that apply. 1. Quietly direct other people out of the room. 2. Leave the room and call security. 3. Say, who are you? 4. Move toward the visitor and say, Keep your voice down. 5. Stay next to the other nurse.

Correct Answer: 1,2 Rationale 1: Isolating a person who is angry and aggressive helps by taking away part of the audience. This is also a strategy to protect others. Rationale 2: It may be that the visitor is just upset and will calm down quickly with the other nurse's verbal intervention, but that is not assured. Rationale 3: This question may further infuriate the visitor because the nurses don't know him or his mother. Also, one nurse should carry the conversation. Rationale 4: The nurse should not make a move toward the visitor or demean him. Rationale 5: The nurse should move away and out of the room to call security.

As part of a presentation on health care workplace violence, the speaker says, Injuries to nurses from violent acts in the workplace are probably underreported. What rationale should the speaker offer for this statement? Standard Text: Select all that apply. 1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. 5. Most violence against nurses is initiated by physicians, and nurses are afraid to report them.

Correct Answer: 1,2,3,4 Rationale 1: The definition of workplace violence may not be clear. Rationale 2: Reporting policies may not be in place. Rationale 3: For many years, violence was tolerated in health care. Rationale 4: Some believe that being the target of a violent act is the result of poor job performance. Rationale 5: Most violence against nurses is from clients.

A geriatric client in a long-term-care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Standard Text: Select all that apply. 1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 3. The client suddenly becomes alert and oriented. 4. The client raises his fist. 5. The client says, I know where there is a gun.

Correct Answer: 1,2,4 Rationale 1: The client may be about to flee the room, or may be blocking the nurses exit. Rationale 2: A blank stare could be related to pathology such as dementia or may signal a violent episode. Rationale 3: Alertness and orientation do not signal impending violence. Rationale 4: Preparing for battle signals impending violence. Rationale 5: It is fairly unlikely that a geriatric client in a long-term-care facility has access to a gun. The nurse must be aware of the statement, but should consider the context.

A manager is following up on an employee's injuries. The manager has contacted human resources to initiate the process of workers compensation. Which action would be appropriate by the manager? 1. Contact the employee's physician and inform him or her of the injuries. 2. Follow up with human resources regarding scheduling staff to cover the employee's absences. 3. Follow up with the employee to express concern and answer any questions regarding the situation. 4. Follow up with the workers compensation nurse.

Correct Answer: 3 Rationale 1: It is not appropriate for the manager to contact the employee's physician. Rationale 2: Human resources is not responsible for covering staff absences. Rationale 3: The manager should contact the injured employee to express concern for their well-being and follow up with any questions they may have. Rationale 4: The manager should not contact the workers compensation nurse.

A nurse hears screaming from a client's room. A male visitor leaves the clients room. Which is the nurse's priority action? 1. Call the police. 2. Notify the clients physician. 3. Follow the visitor. 4. Check on the client.

Correct Answer: 4

A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says, we have lots of threatening behaviors on our unit. What is the most important question for the supervisor to ask? 1. Why is so much threatening behavior happening on your unit? 2. Why haven't you reported that? 3. Where do you work? 4. When you report threats to your manager, is action taken quickly?

Correct Answer: 4

The emergency department (ED) staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate? 1. Arrange an agreement with law enforcement for rapid response on these incidents. 2. Post a sign stating that pain management medications are not given unless the client is admitted to the hospital. 3. Develop a team of staff who would be on call for these types of situations. 4. Organize a training program to educate staff on how to manage these types of situations.

Correct Answer: 4 Rationale 1: It is unlikely that the manager has the authority to institute such an arrangement. The staff also must know what to do until security or law enforcement arrives. Rationale 2: It is not possible to eliminate the use of pain medications in the ED. Rationale 3: Such a team might help in some situations, but the staff must still know what to do until they arrive. Rationale 4: The staff needs to be prepared in case of an emergency such as this one. This preparedness can occur through education.

A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. The behavior has never been violent, but today it is becoming more threatening. The nurse just came into the station and said, my nurse assistant is stupid. I'm not going to put up with that much longer. She needs to be put in her place. How should the manager respond to this situation? Standard Text: Select all that apply. 1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 3. The manager should explain that this is a good nurse who has difficulty tolerating stress. 4. Security should be notified of the behaviors. 5. The manager should warn other staff to stay clear of this nurse for the rest of the shift.

Correct Answer: 1,2,4 Rationale 1: The nurse should be removed from the situation. Rationale 2: This behavior should be documented. Rationale 3: Making excuses for this nurse is not appropriate. The nurses temper is escalating and may grow out of control. Excuses violate the zero-tolerance policy. Rationale 4: As the behaviors are escalating, security should be notified. Rationale 5: The nurse should not be allowed to remain on the unit for the rest of the shift.

A highly intoxicated client is brought to the emergency department. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Standard Text: Select all that apply. 1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 3. Ask the paramedics to place the client in leather restraints. 4. Enter the room calmly, with a smile. 5. Give the client 20 minutes or so to calm down before the assessment begins.

Correct Answer: 1,2,4 Rationale 1: The nurse should remove any potential weapons. Rationale 2: A stethoscope hung around the neck is a convenient handle for anyone who would like to gain control of the nurse. Rationale 3: The nurse should not ask the paramedics to perform this intervention. Rationale 4: Being calm and pleasant can help defuse potentially violent situations. Rationale 5: The nurse should not wait 20 minutes to see a client who is highly intoxicated.

During orientation a newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says, Well, I guess you should call 911. What is incorrect about this statement? Standard Text: Select all that apply. 1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 3. The nurse should never call 911 from the hospital. 4. The nurse should have been told to follow the reporting policy. 5. The nurse should have been reported as suspicious for asking the question.

Correct Answer: 1,2,4 Rationale 1: The person conducting the orientation should be aware of the policy and relay the information accurately and with certainty. Rationale 2: Notification of security is essential. Rationale 3: There could be instances in which a nurse should call 911 from the hospital. In a small hospital with no full-time security, calling 911 may be the immediate response. Rationale 4: The hospital must have a bomb threat reporting policy. This would be a good time to introduce it to the orientation group. Rationale 5: There is no reason to report the nurse.

A nurse manager has required that all nursing staff attend an in-service on dealing with verbal threats. A staff nurse wonders why this is necessary since, words don't hurt me. I just ignore them. What is the nurse managers most appropriate response to this statement? 1. Don't argue with me, I said everyone has to be in-serviced. 2. Verbal threats often precede physical violence. 3. I want my staff to be prepared to handle anything. 4. This is a requirement from our accrediting agency.

Correct Answer: 2

A nurse manager is investigating a report made by a staff nurse. The nurse states that a visitor backed the nurse up against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the human resources (HR) director? 1. As an encounter with a disgruntled family member 2. As violence against the nurse 3. As an incident with a family member 4. As a physical attack against an employee

Correct Answer: 2

An emergency department (ED) has doubled its client visits within the past year. This has led to increased wait times and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the chief nurse officer (CNO) would be most effective? 1. Increase the size of the waiting room and add more beds to the ED unit. 2. Hire more ED nursing staff to manage the increased volume of clients. 3. Hire another ED physician. 4. Hire another registration employee to improve the intake process and reduce the volume in the waiting areas.

Correct Answer: 2

The nurse appears in the nursing station with multiple facial lacerations and says, A visitor hit me. What is the managers priority action? 1. Ask the nurse why the visitor became violent. 2. Ask a nurse to accompany the employee to the emergency department. 3. Call security to report the incident. 4. Call administration and inform them of the incident.

Correct Answer: 2

The nurse is caring for a client who is aggressive, demanding, and verbally abusive toward staff and visitors. The client says, I'm getting out of here. I'm going to end it all. What immediate action should the nurse take? 1. Attempt to block the exit door. 2. Call security. 3. Attempt to administer a sedative to the client. 4. Notify the clients family.

Correct Answer: 2

When a nurse enters the room, the client states, He has a gun, and points toward a male visitor. The nurse does not see a gun. What should the nurse do? 1. Question the visitor regarding the statement. 2. Contact security. 3. Call for another nurse to assist in confronting the visitor. 4. Notify the clients physician.

Correct Answer: 2

An emergency department (ED) client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions? 1. Distract the client. 2. De-escalate the situation. 3. Determine the clients real reason for seeking treatment. 4. Assess the clients level of pain.

Correct Answer: 2 Rationale 1: The physician's tactics may distract the client but this is not the reason for this action. Rationale 2: The physician's tactics is an attempt to de-escalate the situation until security arrives. Rationale 3: Determining the real reason the client is seeking treatment is not the current priority. Rationale 4: Assessing the level of pain is not the current priority.

Question 6 The hospital operator announced over the paging system, Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing. A newly hired nurse asks another nurse, who is Dr. Strong? The nurse replies, this is the announcement that alerts security there is violent behavior on that unit. Which statement would be an appropriate report to this unit's manager? 1. Our new nurse does not know what Dr. Strong means. 2. There was an incident in which a staff person did not know what Dr. Strong meant. Could we have an in-service on this policy? 3. The operator paged a Dr. Strong and we didn't know what to do. 4. Why do they use Dr. Strong when there is trouble? They should just call for help.

Correct Answer: 2 Rationale 1: This statement does not offer any plan for correction. Rationale 2: Since this is a newly hired nurse, one would expect that the Dr. Strong page would have been covered in orientation. Since this nurse did not understand the meaning of the page, it is likely others will not. An in-service is needed. Rationale 3: The newly hired nurse did not know what to do, which indicates that others in the same orientation may also be uninformed. The more experienced nurse did know what the page meant. Rationale 4: The nurse needs to understand the policy, not make comments on its worth.

A chief nurse officer (CNO) is contacted by the organizations supervisor on a Saturday night regarding a problem in the hospital's emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report? 1. This is a typical occurrence in the emergency department. 2. Health care violence is more likely to occur in emergency departments. 3. Health care violence generally occurs on the weekend. 4. Health care violence is likely to occur on the night shift.

Correct Answer: 2 Rationale 1: Violence should not be characterized as a typical or expected aspect of the workplace. Rationale 2: In health care, violence is more likely to occur in psychiatric settings, emergency departments, waiting rooms, and geriatric units. Rationale 3: Violence can occur on any day. Rationale 4: Violence can occur at any time of day.

Question 7 A hospitals safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Standard Text: Select all that apply. 1. Reserving parking spaces closest to the facility for staff 2. Security cameras throughout the facility 3. Curved mirrors in the corridors 4. Using restraints on all confused clients 5. Requiring all personnel to take physical self-defense training

Correct Answer: 2,3 Rationale 1: While isolated or unlit parking can be a safety concern, there is no reason that staff should have the parking next to the facility. There are also concerns for visitor and client safety to consider. Rationale 2: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. Rationale 3: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. Rationale 4: Just because a client is confused does not indicate a tendency toward violence or a need for restraints. Rationale 5: While all staff should be trained regarding violence, physical self-defense training is not practical for every staff member.

A newly formed task force is addressing the prevention of violence in the health care organization. Which group of employees is most likely to experience violence? Standard Text: Select all that apply. 1. Private practice physicians 2. Nurses working in a geriatric unit 3. Nurses working in a pediatric clinic 4. Nurses whose work space includes large waiting rooms 5. Technicians working in the medical laboratory

Correct Answer: 2,4 Rationale 1: Physicians in private practice can control their practice environment. Physicians are not in the group that experiences the most violence. Rationale 2: Geriatric units are among the sites in which violence is most likely to occur. Rationale 3: Clinics are among the sites in which violence is least likely to occur. Rationale 4: Waiting rooms are among the most common sites of health care violence. Rationale 5: Medical laboratories are isolated areas and are not among the places where health care violence commonly occurs.

The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Standard Text: Select all that apply. 1. When addressing the client, use powerful body language. 2. Remain calm and speak in a moderate tone. 3. Approach the client with an aggressive I'm in charge attitude. 4. Speak in simple terms. 5. Allow the client to speak.

Correct Answer: 2,4,5 Rationale 1: Powerful body language may be interpreted as threatening. Rationale 2: A calm manner and moderate tone are calming to the client. Rationale 3: Aggression or aggressive attitudes can escalate this client's hostility. Rationale 4: The nurse should use simple terms when talking to this client. Rationale 5: The client should be allowed to speak, and the nurse should respectfully listen.

A night shift supervisor has been called to the emergency department to assist in managing a violent situation with a visitor. Once the violent person has been contained and security and police have responded, what should be the supervisors next action? 1. Notify staff on other nursing units. 2. Notify the violent persons physician. 3. Complete an incident report. 4. No action is necessary; the situation has been managed.

Correct Answer: 3

An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name the baby's father. A male visitor who comes to visit the client raises the nurses concern that he might be violent. Which behavior would raise this concern? 1. The visitor states, I am the baby's father. 2. The client is very anxious with the visitor present. 3. The visitor moves into the nurse's personal space when asking about the client's status. 4. The visitor sits in a chair in the corner of the client's room, rocking and smiling constantly

Correct Answer: 3

The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matrix and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff over the past 2 days. To which of these distractions is the absenteeism most likely related? 1. The staffing dilemma caused by the scheduler 2. The change in the staffing matrix 3. The decline in staff morale due to a hostile environment 4. The miscommunication between management and nursing administration

Correct Answer: 3