Psych Chapter 11 Point
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 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?" "Has your parent injured the back of the head or neck in the past week?"
"Has your parent suffered any traumatic injury to the brain recently?" 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.
Which term is used to describe an activity used to release anger? Physical aggression Anger Hostility Catharsis
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 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 Obsessive-compulsive disorder Schizophrenia Depression
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? Avoidance of stimuli that provoke the anger Identification of measures to disrupt the anger response Client self-monitoring for anger cues Development of a therapeutic relationship
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.
Increased activity in which neurotransmitter is implicated in increased impulsivity and violent behavior? Serotonin Epinephrine Acetylcholine Dopamine
Dopamine 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? Catharsis Hostility Anger Physical aggression
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 drug has been effective in treating aggressive clients diagnosed with bipolar disorders? Clozapine Valproic acid Lithium Carbamazepine
Lithium 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? Escalation Crisis Triggering Postcrisis
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
During which phase of the aggression cycle does the client regain physical and emotional control? Postcrisis Recovery Triggering Escalation
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.
During which phase of the aggression cycle does the staff usually have a debriefing session? Recovery Postcrisis Escalation Triggering
Recovery During the recovery phase, the staff has a debriefing session to discuss the aggressive episode
Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response? Escalation Crisis Recovery Triggering
Triggering 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. Depression Low self-esteem Ulcers Migraine headaches Coronary artery disease
Ulcers, Migraine headaches, Coronary artery disease 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.
An adult client is pacing and yelling. Which is the best response by the nurse? "When did these feelings begin?" "What are you doing?" "With whom are you angry?" "Why do you feel angry?"
"When did these feelings begin?" 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 suppress their feelings of anger." "Anger is a knee-jerk reaction to external events." "The terms used to describe anger are very precise." "Anger, aggression, and violence are points along a continuum."
"Women often suppress their feelings of anger." 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 Use seclusion or restraint Allow the client to take a "time out" in a quiet area Help the client relax and return a calmer state
Allow the client to take a "time out" in a quiet area 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 Anger Hostility Physical aggression
Anger 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 decision making. Anger helps in resolving conflicts. Anger helps in improving emotional stability. Anger helps in increasing relaxation. Anger helps to focus attention.
Anger helps in decision making., Anger helps in resolving conflicts., Anger helps to focus attention. 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.
In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly? Crisis Escalation Recovery Triggering
Crisis In the crisis phase, seclusion or restraint may be used to deal with aggression quickly.
An aggressive client is holding a weapon and threatening to harm other clients in the unit. How should the nurse handle this situation? Try to subdue the client Instruct the client to put the knife down Reach out for the client's knife Shield oneself with a pillow
Shield oneself with a pillow 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.
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 Remove glass piece from client Leave the area immediately Shift other clients to a safe place Try to talk down the client
Summon help from others, Leave the area immediately, Shift other clients to a safe place 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.
