ch 11 NCLEX questions

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?" "Has your parent injured the back of the head or neck in the past week?" "Has your parent exhibited previous problems expressing anger appropriately?" "Does your parent have a history of an anxiety disorder, such as panic disorder?"

"Has your parent suffered any traumatic injury to the brain recently?" Rationale:Asking about injury to the brain would be most appropriate because the limbic system and cerebral cortex are the brain structures most frequently associated with aggressive behavior. Clients with a history of damage to the cerebral cortex are more likely to exhibit increased impulsivity, decreased inhibition, and decreased judgment than are those who have not experienced such damage. Schizophrenia and substance abuse are also associated with violent behavior. Asking about previous problems with anger would be important to know but would not be the priority. Additionally, the person states that the parent has never done this before. Injury to the back of the head or neck is not associated with aggression.

An adult client is pacing and yelling. Which is the best response by the nurse? "With whom are you angry?" "When did these feelings begin?" "Why do you feel angry?" "What are you doing?"

"When did these feelings begin?" Rationale:When a client is angry, use open-ended questions to clarify the client's behavior. Use an empathetic approach to assist the client to discover the source of the anger. Asking a "why" question implies criticism of the feeling. The client may become defensive and angrier. Similarly asking, "What are you doing?" asks the client to explain behavior when the client may not be fully aware of the source. The question also implies criticism rather than offering empathy. Asking, "With whom are you angry," is a closed-ended question that will not open the thinking and dialogue with the client. Further, asking about the object of the anger focuses on an external reason for the anger rather than assisting the client to look within for the source.

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 often supress their feelings of anger." "The terms used to describe anger are very precise." "Anger, aggression, and violence are points along a continuum." "Anger is a knee-jerk reaction to external events."

"Women often supress their feelings of anger." Rationale:Societal constraints often inhibit women's expression of their anger; they have been socialized to maintain and enhance relationships with others and avoid expressing so-called negative or unfeminine emotions such as anger. Anger, aggression, and violence should not be viewed as a continuum because one does not necessarily lead to another. Language related to anger is imprecise and confusing. People can choose to slow down their reactions and to think and behave differently in response to events; therefore, anger is not a knee-jerk reaction to external events.

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include? Suggest that the client is still in control and can maintain that control Help the client relax and return a calmer state Allow the client to take a "time out" in a quiet area Use seclusion or restraint

Allow the client to take a "time out" in a quiet area Rationale:During the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client's emotion and behavior. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation.

Which describes a strong emotional response to a real or perceived provocation? Catharsis Hostility Anger Physical aggression

Anger Rationale: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. 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.

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 in increasing relaxation. Anger helps in improving emotional stability. Anger helps to focus attention. Anger helps in resolving conflicts. Anger helps in decision making.

Anger helps to focus attention. Anger helps in resolving conflicts. Anger helps in decision making. Rationale: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.

Which term is used to describe an activity used to release anger? Anger Hostility Physical aggression Catharsis

Catharsis Rationale: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.

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

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

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? Anxiety disorder Depression Schizophrenia Obsessive-compulsive disorder

Depression Rationale: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? Client self-monitoring for anger cues Development of a therapeutic relationship Avoidance of stimuli that provoke the anger Identification of measures to disrupt the anger response

Development of a therapeutic relationship Rationale: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.

Increased activity in which neurotransmitter is implicated in increased impulsivity and violent behavior? Acetylcholine Epinephrine Serotonin Dopamine

Dopamine Rationale:Increased activity of dopamine is implicated in increased impulsivity and violent behavior as a result of changes in cognition and decreased emotional regulation.

Which term is used to describe an emotion expressed through verbal abuse and violation of rules or norms? Physical aggression Catharsis Anger Hostility

Hostility Rationale: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.

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. Try to talk down the client Leave the area immediately Shift other clients to a safe place Remove glass piece from client Summon help from others

Leave the area immediately Shift other clients to a safe place Summon help from others Rationale:The aggressive client with a potentially harmful weapon in hand can be dangerous to self, staff, and other clients. The nurse should summon help to help control the client. The nurse should leave the area immediately if unable to calm the client and the situation is an emergent one. The other clients should be shifted to another area to ensure safety. Attempting to remove the weapon from the client may increase the risk of injury to the nurse. The client may not be able to understand the instructions; therefore, taking down the client may not be helpful.

Which drug has been effective in treating aggressive clients diagnosed with bipolar disorders? Valproic acid Carbamazepine Clozapine Lithium

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

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? Triggering Postcrisis Crisis Escalation

Postcrisis Rationale: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.

During which phase of the aggression cycle does the staff usually have a debriefing session? Postcrisis Escalation Triggering Recovery

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

During which phase of the aggression cycle does the client regain physical and emotional control? Recovery Escalation Postcrisis Triggering

Recovery Rationale: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.

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 Try to subdue the client Reach out for the client's knife Instruct the client to put the knife down

Shield oneself with a pillow Rationale:An armed, aggressive client is dangerous and potentially harmful. The nurse should shield oneself form the client's weapon using a pillow, mattress, or folded blanket. It helps to protect against any potential harm. The nurse should never try to subdue an armed client as the client may harm the nurse. Reaching out to the client's weapon may increase harm to the nurse. Instructing the client may not be helpful, as the client may not be able to follow the instructions.

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 paranoid delusions and hallucinations. The client had health-related issues due to suppression of anger. The client had somatization disorder. The client had intermittent episodes of anger outbursts.

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

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

Triggering Rationale:During the triggering phase of the aggression cycle, an event or circumstance in the environment initiates the client's response, which is often anger or hostility. None of the other phases of the cycle are focused on the initiation of the anger.

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. Ulcers Low self-esteem Coronary artery disease Migraine headaches Depression

Ulcers Coronary artery disease Migraine headaches Rationale: Suppressing rage or anger could lead to physical complications such as ulcers, coronary artery disease, and migraine headaches. Depression and low self-esteem are emotional problems associated with suppression of anger.