Chapter 11: Anger, Hostility, and Aggression PREPU

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?

strict hierarchy of authority

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

A client is attending anger management class and wants to know how the class will help. What is the nurse's best response?

"It will help you to learn how to control the arousal of anger."

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."

The nurse is assessing a client of an Eastern culture who is admitted due to the need for anger management. What question should the nurse ask to determine the effect of culture on the client's expression of anger?

"What did you learn about anger when growing up?"

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?

"What have I done or said that is disrespectful?"

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."

An adult client is pacing and yelling. Which is the best response by the nurse?

"When did these feelings begin?"

A client is becoming increasingly angry while talking with the nurse. Which statement reflects the nurses's appropriate use of de-escalation with the client?

"You look like you are upset and I want to understand why."

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 Extreme aggression Hallucinations

Which describes a strong emotional response to a real or perceived provocation?

Anger

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

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

Catharsis

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

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 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

Which staff behaviors are most likely to trigger clients who are predisposed to aggressive or violent behavior?

Engaging in disputes over medication, supplies, or rules on the unit

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

Which term is used to describe an emotion expressed through verbal abuse and violation of rules or norms?

Hostility

Which personality trait is associated with aggressive behavior?

Impulsivity

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include?

Listen to the client's concerns and convey empathy for the client's frustration or anger.

Which drug has been effective in treating aggressive clients diagnosed with bipolar disorders?

Lithium

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 for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by possession of which attribute?

Low self-esteem

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 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. Anticipate the use of sedatives. Use a low calm voice Make arrangements for possible restraint.

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 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.

Request the presence of additional staff. Give the client plenty of space. Sit in an open area

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

Self-awareness of reactions to aggression by others

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

An aggressive client has obtained a piece of sharp glass and holds it threateningly to prevent anyone from entering the room. What interventions can the nurse reasonably perform to ensure safety of the client, staff, and other clients? Select all that apply.

Summon help from others. Shift other clients to a safe place.

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 planning education for a client who has exhibited aggression on techniques to manage anger. Which situation would be best for providing this education?

The client is sitting in the dayroom reading a book.

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.

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? Choose the best answer.

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

A client's roommate yells at the client and the client acts as if nothing has occurred and ignores the roommate. The nurse identifies that the client may have which style of anger expression related to this incident?

anger suppression

The nurse is performing an assessment on a client admitted with a diagnosis of schizophrenia. Which factor is the most predictive of the client's potential for aggression and violence?

client's history

The nurse is asking a client who has developed aggressive behavior about medical history. Which risk factors would the nurse want to explore related to aggression? Select all that apply.

history of schizophrenia history of substance abuse history of noncompliance with medications

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.

The nurse states "I know this must be frightening for you" to a client who is angry and has a potential for violence. Which communication technique is the nurse utilizing with this statement?

validation