Chapter 27

When working with an angry client, it is best to A. encourage the client to fully explore and express his or her anger. B. help the client deny and repress the feelings of anger C. help the client reframe the anger-producing situation. D. ignore the client's anger and change the subject.

C

A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include A. observation every 30 minutes. B. releasing the client every 8 hours. C. releasing the client every 8 hours. D. providing for nutrition and hydration.

D

Which would be the most appropriate response by the nurse to help a client who is demonstrating escalating anger? A. Walk the client to his room and help him practice stress-reduction techniques, such as deep breathing or muscle relaxation B. Suggest that the client spend some time in the gym with a punching bag to relieve his stress C. Suggest that the client spend some time pacing rapidly in the hallway until he feels less stressed D. Sit with the client in the day room so that he can vent his anger and not isolate himself

A

You are working on an adolescent psychiatric unit. Katy, aged 16 years, has been angry all day because her boyfriend was not allowed to visit last night. Katy is in the hallway and begins yelling, "It's not fair! You all hate me! I hate this place!" She begins pounding her fists on the wall. To deal with the situation and prevent further escalation, your best response would be to say: A. "Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?" B. "Katy, you may yell and bang your fists but you must do it in your own room so you don't upset the other patients." C. "Katy, stop that right now! You will not be allowed to behave like that!" D. "Katy, you will have to go into seclusion and restraints right now." a

A

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client/ A. "Stop screaming, and walk with me outside" B. "Why are you so angry and screaming at everyone?" C. "You will not get your way by screaming" D. "What was going through your mind when you started screaming?"

A

Andie is a patient anxiously waiting her turn to speak with you. As you are very busy, you ask Andie if she can wait a few minutes so that you can finish your task. Unfortunately the task takes longer than anticipated and you are delayed getting back to Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak with you. Which response is most likely to be therapeutic at this time? A. "you are angry that I didn't speak with you when I promised I would" B. "I'm sorry for being late, but screaming at me is not the best way to handle it." C. "You are too angry to talk right now. I'll come back in 20 minutes and we can try again." D. "Why are you angry? I told you I was busy and would get to you as soon as I could."

A

The more a nurse's intervention is prompted by emotion A. the less likely it is to be therapeutic B. the less likely it is to be aggressive C. the more likely it is to be effective. D. the more likely it is to be empathetic.

A

The most restrictive method for dealing with an aggressive client who is out of control is A. seclusion. B. a show of force. C. verbal intervention. D. antipsychotic medication.

A

Which assessment finding is the best predictor of violence in a newly admitted client? A. A recent assault on a drinking companion B. A family history of bipolar disorder C. The nurse's subjective feeling that the client is uncooperative. D. A childhood history of being bullied at school

A

Which intervention strategy should be avoided by staff working with a client who is shouting and flailing his arms? A. Defusing the situation by laughing or making a joke of the challenge B. Saying "Let's go to your room to talk about this" C. Moving a few staff close together as a group to provide a show of force D. Allowing one staff person to speak to the client while others provide support

A

You respond to a loud, angry voice coming from the day room, where you find Alex is pacing and shouting that he isn't "going to take his (expletive) anymore." which of the following responses is likely to be helpful in de-escalating Alex? Select all that apply A. Remain calm, quiet, and in control B. Tell Alex that his actions are unacceptable and that he must go to his room C. Match Alex's volume so that he is able to hear over his own shouting D. Ask Alex if he can tell you what is upsetting him so you may be able to help E. Sand close to Alex so you can intervene physically if needed to protect others F. Tell Alex that he could be placed in seclusion if he cannot control himself so that the patient is aware of the negative consequences

AD

A client waiting to see the physician is pacing and looking both angry and tense. When it's determined that the client won't be seen for another 30 minutes, the nurse addresses the client's agitation by A. telling the client that pacing will not help the rate at which clients are seen. B. adjusting the appointment schedule to allow the client to be seen next. C. empathizing with the long wait and asking the client if he would mind sitting down until his turn comes. D. explaining to the client what caused the back-up and suggesting that he has time to go to the coffee shop.

D

A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A. Insist that the client stop yelling B. Request that other staff members remain close by C. Move as close to the client as possible D. Walk away from the client

B

An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior? A. Tell him they will not change his dressing if he is going to abuse them. B. When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control. C. Assure him they will complete the dressing change as quickly as possible. D. Explain that they are professionals and unused to being shouted at by people they are trying to help.

B

Ian makes the following statements to you while admitting him. Which statement indicates and increased likelihood of violent behavior? A. "When I get mad, I want to be left alone" B. "Last time I was in here I ended up in seclusion for punching my roommate C. "My old man was meek and mild, and I've always said I'm not going to be like him" D. "My girlfriend says I yell way too much, and she's threatened to leave me."

B

One older concept that is being used currently that may help in violence reduction in patients is: A. aired grievances. B. trauma-informed care. C. shared governance. D. learned helplessness.

B

When a client diagnosed with a cognitive deficit experiences a catastrophic reaction, the priority intervention is to A. decrease sensory stimuli. B. smile and call the client by name. C. take the client to the bathroom. D. calmly ask the client what's wrong. b

B

When you approach Katy, what considerations should you take? A. Stand close to Katy for reassurance and to convey caring. B. Have other staff as backup, and stand far enough away to avoid injury. C. Take Katy to her room so you can speak with her alone. D. Call security and wait until they arrive before approaching Katy.

B

Which neurotransmitter imbalance has been shown to be related to impulsive aggression? A. Low levels of ã-aminobutyric acid B. Low levels of serotonin C. High levels of dopamine D. High levels of acetylcholine

B

Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression? A. Social isolation B. Risk for other-directed violence C. Ineffective coping: overwhelmed D. Ineffective coping: maladaptive

B

A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A. "I wish you would not make me angry" B. "I feel angry when you leave me." C. "It makes me angry when you interrupt me." D. "You'd better listen to me"

D

Anger can best be defined as A. an unhealthy way of releasing anxiety. B. doing intentional harm to others. C. an expression of conflict with others. D. a normal response to a perceived threat.

D

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of A. isolation. B. confidence. C. competence. D. vulnerability.

D

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (select all that apply) A. Lethargy B. Defensive responses to questions C. Disorientation D. Facial grimacing E. Agitation

BDE

A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by A. continuing to manage the situation personally. B. telling the client, "It isn't safe for me to leave the room." C. moving to the rear of the staff group. D. apologizing for upsetting the client.

C

A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A. Encourage the client to express her feelings B. Maintain eye contact with the client C. Move the client away from others D. Tell the client that the behavior is not acceptable

C

An adolescent male is swearing and shouting at his physician, who refused to give him a pass to leave the unit. This behavior A. is acceptable if directed at staff but not when directed at other clients. B. may reduce tension and prevent the client from physically acting out. C. is a major indicator that the client may become physically aggressive. D. can be attributed to lack of parental controls applied at an early age.

C

Peter, a 21-year-old patient, asks you, "What's wrong with my brain that I have such a problem with aggression?" Your response is based on the knowledge that: A. the prevailing theory is that diminishment of stress hormones causes anger and aggression. B. no abnormalities of the brain have been identified that correlate with anger and aggression. C. the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. D. personality type plays a much greater part in anger and aggression than physical factors.

C

The client at highest risk for violence directed at others is one who A. has a history of recurrent severe depression. B. is in an alcohol rehabilitation program. C. has delusions of persecution. D. who has somatic symptoms for which no organic basis is found.

C

The factor most likely to contribute to a client's escalating anger is A. watching violence on television. B. another client's depressed mood. C. a staff member telling him that he is inappropriate. D. a staff member asking him to help another client.

C

Which statementt about violence and nursing is accurate? A. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence B. To date, no legislation exists that addresses workplace violence against nurses C. Emergency, psychiatric, and step-down units have the highest rates of violence towards staff D. Violence primarily affects inexperienced or unskilled staff who cannot calm their patients

C

You are caring for Malcolm, an 83 y/o African American patient with Alzheimer's disease. Malcolm exhibits agitated behavior at times, especially when he feels he is missing work, and he sometimes attempts to leave the unit to " get to the school where I teach. " which of the following interventions is appropriate for de-escalating Malcolm's agitation. A. Medicate Malcolm with PRN medication at regular intervals to prevent agitation B. Repeatedly explain to Malcolm that he is retired and no longer teaches as the repetition will reinforce the patient's orientation C . Use validation therapy and ask Malcolm about the school and his job D. Reduce stimulation In the environment by having Malcolm sit by himself in his room until the agitation passes

C

A client experiencing manic hyperactivity stands up, glares challengingly at clients and staff, and shouts, "This food is garbage! I'll fight anyone who says it's not!" The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D.has a high potential for other-directed violence.

D

A client has a history of demonstrating aggression physically. An appropriate short-term goal to help the client manage this anger is to A. strike objects rather than people. B. limit aggression to verbal outbursts. C. isolate in lieu of striking people. D. identify situations that precipitate hostility.

D

You are working in the emergency department. You notice Matt, your patient's husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which of the following statements to Matt may help prevent escalation and/or violence? A. "You need to stay with your wife. She needs you." B. "Hey, what's up buddy? You look pissed." C."I am calling security to deal with your behavior." D. You appear upset. Can I help you with anything?"

D