Ch 11 Anger, Hostility, and Aggression

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

Catharsis

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

Banging the head against the wall

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

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

Crisis

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?

"I am here so we can talk about what is making you angry."

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."

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 psychiatric-mental health nurse is teaching a class for a group of colleagues about anger, aggression, and violence. Which statement by the nurse would be most appropriate to include?

"Women experience anger as frequently as men do."

The nurse is explaining the importance of expressing anger to a client. What should the nurse mention as the possible physical complications associated with suppressing anger? Select all that apply.

-Coronary artery disease -Ulcers -Migraine headaches

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.

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.

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

A cognitive intervention.

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

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

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

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

Own awareness and reaction to aggression

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

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

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

Recovery

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

Recovery

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

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

Serotonin

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

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

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 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.

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?

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

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

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 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?"

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."

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. -Request the presence of additional staff. -Sit in an open area

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

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.

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

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.

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.

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

Client's history

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.

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.

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 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

Which personality trait is associated with aggressive behavior?

Impulsivity

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

Lorazepam

A nurse must assess a client's thought process and content to identify risk for aggression. The assessment of the client's thought process and content would allow the nurse to identify what?

Perceptions and delusions

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 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.

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.

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.