ch11: anger,hostility,aggression

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

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 planning the environment for a newly-admitted client with a history of violence toward others. Which modification would the nurse implement? Confirm that the utility and storage rooms are kept locked. Ensure the client is at the end of the hall away from the nurse's station. Provide the client metal hangers instead of plastic hangers in closet. Place the client in a semi-private room with another client.

Confirm that the utility and storage rooms are kept locked. As part of keeping the environment safe with clients who are potentially violent, the nurse should keep storage and utility rooms locked to decrease access to items that may be used for self-harm or harm to others. The client should be in a single room, and not a semi-private room with another client. The client should be near the nurse's station, and have plastic, not metal, hangers with the clothes closet due to the risk for injury to self or others.

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

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 personality trait is associated with aggressive behavior? Impulsivity Lying Pessimism Self-centeredness

Impulsivity Irritability, resentment, and impulsivity have been linked with conflict, aggression, and the potential for medical conditions such as essential hypertension, cardiovascular disease, and atherosclerotic heart disease.

The nurse is preparing teaching material for a client who agrees to attend an anger management program. Which information would the nurse explain that the client will learn during this program? Select all that apply. Modify maladaptive anger behavior. Modulate physiological arousal of anger. Alter irrational thoughts fueling anger. Receive individual therapy about anger. Expect chronic anger to be eliminated.

Modify maladaptive anger behavior. Modulate physiological arousal of anger. Alter irrational thoughts fueling anger. Anger management is an effective intervention that nurses can deliver to persons whose anger behavior is maladaptive in some way. The desired outcomes of any anger management interventions are to teach clients to modify maladaptive anger behavior, alter irrational thoughts that fuel anger, and modulate physiological arousal of anger. Individuals with chronic anger should be referred to individual counseling or psychotherapy if the anger is chronic. The leader of an anger management group or program is not a therapist and the client will not receive individual therapy about anger during the sessions.

The nurse has been physically assaulted by a client on a mental health care area. Which behavior(s) indicates that the nurse is experiencing physiologic symptoms from the attack? Select all that apply. avoids others appears tense unable to sleep develops headaches reports stomach aches

appears tense unable to sleep develops headaches reports stomach aches Assaults on nurses by clients can have immediate and long-term consequences. The nurse's interpretation of the assaultive behavior will depend on many factors such as experience with assault, the type of assault, and the nurse's injury. Physical responses to an assault include tension, disturbed sleep, headaches, and stomachaches. Avoiding others is a behavioral response to an assault.

Which characteristics should a nurse observe a client for that may be predictive of aggression and violence? Select all that apply. breaking unit rules expressing anxiety acting impulsive being suspicious crying easily

breaking unit rules acting impulsive being suspicious The client who is being impulsive or suspicious or is not following unit rules is demonstrating characteristics that are predictive of aggression and violence. The client who is expressing anxiety without outward signs of agitation would not be predictive with this characteristic alone. If the client does become agitated, however, this is a predictor of aggression. The client who is crying easily does have a mood that has been affected; however, this is not a predictor of aggression.

The nurse manager of a mental health care area changes the process of hand-off report during change of shift to reduce the risk of aggressive episodes. Which additional time(s) would the nurse be concerned that the risk for aggression could occur? Select all that apply. during a recreational activity during meals when providing medications after group therapy sessions during morning care

during meals when providing medications Angry or out-of-control behavior is highly influenced by contextual factors. Successful psychiatric stabilization and treatment in a hospital often depend on the nature of the unit itself. Documented times of increased violence include during mealtimes and when providing medications. Morning care, after group therapy, and during recreational activities are not identified as times when the risk for violence is increased.

A client with a history of violence is demonstrating signs of agitation. Which communication technique(s) will the nurse use to deescalate the situation? Select all that apply. seek information client partnership false reassurance observation validation

seek information client partnership validation observation De-escalating is a skill that can be developed and used with therapeutic communication techniques to prevent a crisis or diffuse a critical situation. Communication techniques include validation as an attempt to understand the client's issue, observation or stating the client's behavior, seeking information or asking the client to explain the problem, and client partnership or asking the client to work with the nurse to resolve the problem. False reassurance is not a technique that will prevent a crisis and may cause one to escalate if the assurance does not materialize or occur.

The nurse is observing clients in the recreation room in a mental health facility. Which behavior(s) indicate to the nurse that a client is at risk for demonstrating violence? Select all that apply. changing the television channel sitting in a chair with eyes partially closed making sarcastic comments staring at another client pacing

staring at another client pacing making sarcastic comments The age, gender, and race of a client are not considered predictors of potential aggression and violence; however, there is evidence of specific characteristics that may predict violent behavior. These characteristics include pacing, staring in an intimidating manner, and making sarcastic or demeaning comments. Changing the television channel and sitting in a chair with the eyes partially closed are not behaviors that suggest aggression or violence.

The nurses on a mental health unit are reviewing aspects of the unit environment in a staff meeting. Which factor would be predictive of a client becoming aggressive or violent? scheduled unit activities strict hierarchy of authority reduced use of restraints flexible unit rules

strict hierarchy of authority Having a strict hierarchy of authority can be predictive of a client being aggressive or violent; others include having rigid, not flexible, unit rules. The unit having a lack of autonomy for clients which would include use of restraints or locked doors is also predictive of client aggression or violence. Another contributing factor would be having a lack of predictable and meaningful ward activities so if there are scheduled activities this would help reduce this potential for clients.

The nurse is working with a client who yells at the nurse, "I am angry about how you keep treating me without respect!" What is the nurse's best response? "I am not going to talk to you while you are angry." "If you don't calm down, I will need you to go to your room." "What have I done or said that is disrespectful?" "Do you need to take your medication to help calm down?"

"What have I done or said that is disrespectful?" The nurse needs to be authentic with the client and try to determine what behavior is interpreted as not being respectful. While it is hard not to feel defensive when being targeted in this way, the nurse does not need to threaten the client with medication or send the client to his or her room. The nurse also doesn't need to ignore the client's feeling but instead stay engaged with the client to try to help understand the client's feelings.

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? "You need to confront the client to show you are in charge." "What works best is what fits the client and the situation." "I've always had good results with medications." "Make sure that another colleague knows where you are at all times."

"What works best is what fits the client and the situation." The nurse who intervenes from within the context of the therapeutic relationship must be cognizant of the fit of a particular intervention. Thus, the best intervention is the one that fits the situation and the client. Administering medications and making sure that others know where the nurse is may be helpful but it depends on the situation. Confronting the client should be avoided.

Which clients in the psychiatric inpatient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. A client with a history of violence. A client with history of being personally victimized. A client with a history of substance abuse. A client with history of depression. A client with history of obsessive compulsive disorder.

A client with a history of substance abuse. A client with a history of violence. A client with history of being personally victimized. Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile due to lack of self-control. Clients with a history of depression or obsessive compulsion disorder are less likely to have aggressive episodes unless there was a documented history of aggressive behavior.

A client with schizophrenia has been brought to the hospital in an agitated state. In order for the nurse to perform the initial assessment, which approaches should the nurse use to manage the situation? Select all that apply. Ensure availability of assistance Restrain the client Monitor facial expressions Inform the client medication is required Monitor emotional responses

Ensure availability of assistance Monitor facial expressions Monitor emotional responses The nurse should monitor the client's facial expressions and emotional responses during the assessment. This may help prevent the client from experiencing feelings of rejection or ridicule during the assessment. Restraint and medication should be used as last resorts for managing clients who have the potential to harm themselves or others.

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 Needs to modify environment to ensure that milieu is achieved Delusional content when hospitalized 10 years ago Preferences of movies that are provided on Thursday nights

Experience of health problems and health professionals What is overlooked is the experience of the health problem or the experience of interactions with professionals. Inviting clients and families to talk about their previous experience with the health care system may highlight both their concerns and resources.

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include? Encourage social interaction with other clients. Help the client express anger verbally and through nonharmful physical actions if necessary. Listen to the client's concerns and convey empathy for the client's frustration or anger. Help the client understand the complexity and nuances of the client's condition.

Listen to the client's concerns and convey empathy for the client's frustration or anger. In the triggering phase, the client is responding to something in the environment with anger or hostility. The client shows one or more of restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger. The nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client's emotion and behavior. The nurse should express empathy and listen to the client's concerns. Using clear, simple, short statements and allowing the client time for self-expression are helpful techniques. This is not a good time for socialization with other clients; the nurse may suggest that the client go to a quiet area or get assistance to move other clients to decrease stimulation. Physical activity, such as walking, may also help the client relax and become calmer, but expression of anger in an angry way (e.g., punching a pillow) tends to escalate the emotion.

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? Ask the client what the client believes is wrong with the communication style Remind the client about communication skills discussed earlier Set limits with the client regarding hostile communication at the dinner table Inform the client that the client is being inappropriate

Remind the client about communication skills discussed earlier Major treatment strategies include verbal interventions, limit setting, and problem solving. Three steps in preventing behavioral escalation involve making contact, discovering the source of distress, and assisting the person with alternative behaviors. Reminding the client about communication skills or strategies discussed earlier emphasizes the use of personal strengths in communication as well as the therapeutic relationship as a means to assist the client in using more adaptive communication. The other options would not be appropriate for this situation.

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. Inform the client that restraints may be applied. Place the client in a separate room. Speak to the client in a firm voice.

Take the client to the gym for exercise. For a client who expresses hostile and aggressive feelings, the nurse can help the client vent the anger and hostility in a nondestructive way by taking the client to the gym to perform physical exercise. As the client is not severely agitated, the nurse should not put the client in seclusion. Restraints are not required unless the client is a potential threat to safety of self and others. Talking to the client in a firm voice may increase the agitation of the client.

A client has been attending group therapy sessions to reduce agitation and aggressive behavior. Which observation indicates to the nurse that the treatment has been effective? sits forward in chair while bouncing both legs paces back and forth in the recreation room avoids a situation that caused agitation in the past walks in hallway with fists clenched

avoids a situation that caused agitation in the past The desired outcomes after care to regain or maintain control over aggression would be for the client to demonstrate less agitation and risk for aggression and violence. An observation that indicates effectiveness of care would be the client avoiding a situation that caused agitation in the past. Walking with clenched fists, pacing, and sitting in a position while bouncing both legs indicates increased psychomotor activity, which is nonverbal behavior associated with agitation.

An adult child brings their parent to the clinic and tells the nurse that their parent has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the parent expresses remorse for their outburst. The adult child says, "I've never seen my parent act this way." Which question is most appropriate for the nurse to ask next? "Has your parent injured the back of the irhead or neck in the past week?" "Has your parent exhibited previous problems expressing anger appropriately?" "Has your parent suffered any traumatic injury to their brain recently?" "Does your parent have a history of an anxiety disorder, such as panic disorder?"

"Has your parent suffered any traumatic injury to their 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 use disorders 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.

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? Select the best answer. "I appreciate that you are expressing anger in an appropriate manner." "I am sure your anger would be reduced by punching the pillows." "I am here so we can talk about what is making you angry." "Please do not damage the hospital's property."

"I am here so we can talk about what is making you angry." Expression of anger by engaging in aggressive but safe activities like punching a pillow is referred to as catharsis. It is now known that this behavior increases feelings of anger rather than alleviate them. The nurse knows that encouraging the client to engage in nonaggressive activities, such as speaking with someone, is more likely to reduce the anger. Asking the client to not damage the hospital's property indicates that the nurse is more concerned about property than the client. Telling the client that the anger would be reduced by punching pillows indicates that the nurse is encouraging the client to express anger through catharsis. Expressing appreciation to the client for expressing anger in an appropriate manner encourages expression of anger through catharsis.

A client is attending anger management class and wants to know how the class will help. What is the nurse's best response? "You will be able to stop feeling angry when incidents happen out of your control." "We need to explore what makes you want to hit people when you are angry." "It will help you to learn how to control the arousal of anger." "You will learn how to control your violent behavior."

"It will help you to learn how to control the arousal of anger." It is unrealistic for someone to stop feeling angry altogether; however, the goal of anger management therapy can help a client learn how to control the arousal of anger. Anger management therapy is not utilized for clients who are violent when angry because it has not been found to be effective in modifying violent behavior.

A client with a history of violence becomes aggressive and threatens to harm the nurse. Which client statement indicates to the nurse that the unit culture contributed to the client's behavior? "That guy who runs the group session has no idea what he's doing." "There isn't anything to do here and I'm bored to death." "That nurse assigned to me doesn't like me." "I don't need someone talking down to me-I know I have problems."

"There isn't anything to do here and I'm bored to death." There are characteristics of a unit's culture that can contribute to or predict client violence. One of the unit characteristics is a lack of meaningful and predictable ward activity. The client being bored because there is nothing to do would indicate a lack of predictable ward activities. Staff behavior can contribute to and predict client violence. The statement that a nurse does not like a client, the comment about the group therapy leader, and being talked down to are all examples of staff behavior that can predict or contribute to violence.

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

"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 nurse is working with a client who has lost unit privileges due to inappropriate behavior. Which statement by the nurse demonstrates appropriate offering of choices? "Can you select an outfit to wear to group therapy?" "Would you rather go to the cafeteria or have dinner in the dayroom?" "Would you like to have your family come visit you in your room today?" "Which activity would you like to participate in today?"

"Would you rather go to the cafeteria or have dinner in the dayroom?" The nurse should try to provide clients with choices so that the client has some control over his/her situation. The choices should be concrete rather than open-ended; therefore, the client having a choice on where to eat dinner would be considered concrete due to limited choices. Being able to select an outfit or an activity would be more open-ended. While having the client be visited in the room does give a choice between having visitors or not, this would have a negative consequence with not having visitors unless the visitors could come to the room.

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? Approach the client to engage in communication while remaining 6 feet or more away Ask colleagues to contact hospital security for support Offer the client an antianxiolytic medication Prepare to seclude the client

Approach the client to engage in communication while remaining 6 feet or more away The client's behavior and history of aggression indicates the nurse should explore the underlying cause of the escalating behavior in order to address the client's needs prior to moving into the escalation stage of aggression. The nurse should be close enough to communicate but maintain a safe distance.

The nurse in the inpatient mental health facility is caring for a new client with a history of aggressive behavior. Which action would the nurse take to promote safety and prevent violent behavior from this client? Review behavior expectations. Orient to the care area. Discuss consequences for aggression. Create a therapeutic milieu.

Create a therapeutic milieu. The goals of care for clients in an inpatient mental health facility include promoting safety and preventing violence. Actions to achieve these goals would be for the nurse to create a therapeutic milieu. Orienting to the care area, reviewing behavior expectations, and discussing consequences for aggression would be specific interventions for the plan of care and would be appropriate after the therapeutic milieu is established.

Which staff behaviors are most likely to trigger clients who are predisposed to aggressive or violent behavior? Talking excessively with the client in front of other clients Asking personal questions when they are inappropriate Engaging in disputes over medication, supplies, or rules on the unit Providing the client with a list of possible goals for behavior change

Engaging in disputes over medication, supplies, or rules on the unit Nurses who show respect and empathy are more likely to defuse a client's anger than are nurses who are authoritarian. Examples of authoritarian behavior include preventing clients from leaving the ward, engaging in disputes with them over medication, generally enforcing rules or denying requests, physically restraining clients, taking something from them, ignoring them, or requesting clients to do or not to do something.

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 Ask the client about the client's living situation Observe the client for nonverbal indicators Review the client's use of medications

Obtain a thorough client history Although assessing the client's living situation, observing for nonverbal indicators, and reviewing medications are important, a thorough client history is the most important data for determining potential for aggression and violence. This is because a history of violent or aggressive behavior is one of the best predictors of future aggression. Early life adverse circumstances, such as inadequate maternal nutrition, birth complications, traumatic brain injury, and lead exposure, can contribute to risk for aggressive and criminal behaviors in adulthood. Important markers in the client's history include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control. If the client is determined to be at risk for becoming violent, then the nurse will take particular care to observe nonverbal indicators that identify the beginning of an aggression cycle.

The nurse talks with a client who easily demonstrates aggressive behavior. Which action(s) would the nurse take to help the client maintain control? Select all that apply. Perform deep breathing. Encourage leaving the situation. Suggest counting to 10. Do something different. Explain the reason for the anger.

Perform deep breathing. Encourage leaving the situation. Suggest counting to 10. Do something different. Escalation of behavior from calmness to violence may follow a pattern. The nurse could instruct the client to disrupt the pattern by counting to 10, doing something different, performing deep breathing, and leaving the situation. Explaining the reason for the anger will not break the pattern and would not be effective to deescalate the situation.

The nurse is caring for a client with dementia who has become increasingly agitated. Which is the best action for the nurse to perform? Place the client in their room with the door closed. Place the client in restraints in a chair by the nurse's station. Provide a snack and fluids frequently. Sedate the client with medication.

Provide a snack and fluids frequently. The client with impaired verbal communication has trouble expressing basic needs such as hunger, thirst, and need to urinate. Having the urge to void can cause a client with dementia to have increasing agitation. Therefore, providing a snack and fluid can help keep the client from having agitation due to an unrecognized need. The client would not be medicated with an anti-anxiety medication or placed in restraints without first exploring basic physiologic needs. While the client would be safe with a staff member at the bedside, it does not address the physiological needs.

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

Recovery

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

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.

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter? Dopamine Norepinephrine Serotonin gamma-aminobutyric acid (GABA)

Serotonin Intermittent explosive disorder involves inadequate production or functioning of serotonin. Other neurotransmitters such as dopamine, norepinephrine, or GABA are not involved.

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. Sit in an open area Encourage the client to talk about this situation Give the client plenty of space. Request the presence of additional staff. Restrain the client.

Sit in an open area Give the client plenty of space. Request the presence of additional staff. While assessing an aggressive client, the nurse should give the client plenty of space, sit in an open area, and request the presence of another staff person. The nurse should not restrain the client by him- or herself, but rather get the client restrained by trained personnel. Encouraging the client to talk about the situation in which he or she has been aggressive should be done in the recovery phase of the anger cycle.

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? Ask the wife to provide details about what she means by "all his time." Encourage the wife to express exactly what she wants her husband to do on weekends. Teach the client to make "I" statements. Ask the husband to discuss why he spends so much time with his friends.

Teach the client to make "I" statements. Assertiveness skills are an effective method for controlling aggression by teaching clients appropriate tools for meeting their needs without infringing on the rights of others. The client can be taught about making "I" statements ("I feel hurt by your remarks") instead of "you" statements ("You hurt my feelings") to avoid making judgments by relating feelings rather than opinions and to develop better listening skills.

A client has recovered from an episode of aggressive and hostile behavior. Which behaviors in the client indicate that the client is in the post-crisis stage of the aggression cycle? Select all that apply. The client cries and is remorseful for the event. The client apologizes for the hostile behavior. The client talks to others in a loud voice. The client remains withdrawn from others. The client is irritable and paces restlessly.

The client cries and is remorseful for the event. The client apologizes for the hostile behavior. The client remains withdrawn from others. There are five phases of an aggression cycle. These include triggering, escalation, crisis, recovery, and post-crisis. In the post-crisis phase, the client attempts reconciliation with others and returns to a normal level of functioning. The client may realize that the aggressive behavior was wrong and may apologize for it. The client may cry and feel remorse for the aggression episode. Due to the guilt related to the aggression episode, the client remains withdrawn from others. The client talking in a loud voice, exhibiting irritable behavior, and pacing restlessly indicates that the client is in the triggering phase of the aggression cycle.

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 reports increased feelings of self-control. The client has gained insight into situations that trigger anger. The client has increased self-esteem. The client uses adaptive coping to manage anger impulses.

The client uses adaptive coping to manage anger impulses. Overall goals for aggressive or violent clients are to refrain from threatening or harming anyone during episodes of anger. Using adaptive coping to manage angry impulses indicates the client has gained insight into and skill at managing aggressive impulses. Although gaining insight into situations that trigger anger, increasing self esteem, and reporting increased feelings of self-control are critical elements in working toward effective management of anger, the goal of treatment is achieved when the client can put what he or she has learned into action.

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. Use should be limited to emergency situations in which the client is demonstrating a potential to be violent. Use should be limited to times when medications have been unsuccessful in de-escalating a situation. Use should be limited to times when a client has demonstrated violence and has inflicted harm to self or others.

Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. Because of the risks of restraint and seclusion, a primary guideline is that use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. Furthermore, restraint and seclusion should be applied only when other less restrictive methods to ensure client safety have failed. Nonphysical interventions are the first choice.

During a conversation, a hospitalized client reports having frequent angry outbursts. Which condition(s) would the nurse recall are associated with excessive outward directed anger? Select all that apply. coronary heart disease myocardial infarction breast cancer hypertension metabolic syndrome

coronary heart disease myocardial infarction metabolic syndrome Although anger arousal is normal, anger becomes maladaptive when it is too frequent, too intense, or managed in unhealthy ways to include excessive outward expression. Excessive outwardly directed anger is linked to metabolic syndrome, myocardial infarction, and coronary heart disease. Hypertension and breast cancer are related to suppressed anger.

The nurse manager is concerned because staff members are talking about a client assaulting a staff nurse; however, the nurse did not inform the manager about the incident. For which reason(s) would the manager encourage the nurse to report the assault? Select all that apply. could threaten other clients increase public awareness could cause harm to other care professionals prevent litigation against the facility support protective legislation

could threaten other clients could cause harm to other care professionals support protective legislation increase public awareness Client aggression directed toward nurses is often downplayed or tolerated as being a "part of the job." Attacks on nurses are seldom reported to the police or prosecution of the attackers; however, the incidents should be reported to supervisors and possibly to legal authorities depending on the circumstances. Client aggression needs to be addressed to increase public awareness of the problem, protect other clients, support legislation that addresses violence in the workplace, and prevent harm to other care professionals. Reporting assaults would not be done to prevent litigation against the facility.

The nurse is utilizing the general aggression model to determine what may have contributed to one client's violence toward a roommate. Which would be considered a situational factor? the client's previous disagreement with the roommate the client feeling depressed about own progress the client's work ethic the client being called lazy by the roommate

the client being called lazy by the roommate The general aggression model is a framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode, which in this case is the client's violence toward a roommate. The situational factor is the actual insult- in this scenario, the client being called lazy. Cognition includes hostile thoughts and scripts; with this situation, this involves the client having a previous disagreement with the roommate. The client's affect involves the client feeling depressed; this could have contributed to the roommate thinking the client was lazy. The client's work ethic is a person factor that also could have contributed.