anger aggression and violence EAQ
Which neurotransmitter imbalance has been shown to be related to impulsive aggression? 1 - Low levels of serotonin 2 - High levels of dopamine 3 - High levels of acetylcholine 4 - Low levels of γ-aminobutyric acid
1 - Low serotonin levels have been implicated in several research studies as being a factor in impulsive aggression. There is no current research to support low levels of γ-aminobutyric acid, high levels of dopamine, or high levels of acetylcholine.
A patient with diabetic nephropathy requests chocolates and gets aggressive when the nurse denies the request. The patient abuses the staff when the staff refuses to fulfill the demands. What appropriate action should the nurse take for an effective patient-nurse communication? 1 - Acknowledge the patient's demand 2 - Counsel the patient in an isolated room 3 - Make prominent eye contact with patient 4 - Sit near the patient during the conversation
1 - Acknowledging the demands and needs of the aggressive patient makes the patient feel that the nurse is available to help. The nurse should set the goals and should clearly explain the patient's need to control aggressive behavior and anger. The nurse should make the eye contact at the same level to decrease the sense of intimidation in the patient. The aggressive patient can cause physical harm, so the nurse should maintain a distance of one foot farther than the patient can reach with their arms or legs, and avoid sitting any nearer to the patient. The nurse should not counsel the patient in an isolated room. The nurse should counsel in a room which is visible to the staff. This would be helpful in ensuring the nurse's safety.
Which of the following describes anger? 1 - A normal human emotion 2 - Evidence of ineffective coping 3 - An indication of mental illness 4 - Usually accompanied by aggression
1 - Anger is an emotional response to frustration of desires, a threat to one's needs (emotional or physical), or a challenge. It is a normal emotion. It can be healthy and positive when expressed in a healthy way or used as a motivator or an aid in survival.
Which term describes an emotional response to frustration of desires or a challenge? 1 - Anger 2 - Violence 3 - Restraint 4 - Aggression
1 - Anger is the emotional response to frustration of desires, a threat to one's needs, or a challenge. Restraint is a manual method, physical or mechanical, or material that immobilizes or reduces the ability of a patient to act out violently. Violence is an act that involves intentional use of force and can cause injury to others. Aggression is an action or behavior that results in verbal or physical attack.
What is the source of aggression, anger, and violence, according to Menninger? 1 - The threatened control over the life of a person 2 - Stimulus that is perceived as a threat to oneself 3 - The conflict between sexual needs and societal norms 4 - Assault to personal values, moral codes, and protective rules
1 - Different researchers have given different views over the source of aggression, anger, and violence. According to Menninger, everyone wants to control his or her own life. If this control over one's life is threatened, a person experiences trauma and this results in anger, aggression, and violence. Freud indicated that the conflict between sexual desires and societal norms results in aggressive behavior. According to Skinner, anger is caused when any stimulus is perceived as potentially dangerous. According to Beck, assault to values, moral codes, and protective roles causes anger and aggression.
What is the most restrictive method for dealing with an aggressive patient who is out of control? 1 - Seclusion 2 - A show of force 3 - Verbal intervention 4 - Antipsychotic medication
1 - Seclusion is the most restrictive method listed, because it curtails the patient's freedom of ambulation. A show of force, verbal intervention, and antipsychotic medication are not as restricting.
In a workshop, a nurse has taught anger management techniques to inmates at a jail. Which behavior shown by the inmates indicates effective teaching by the nurse? Select all that apply. 1 - The inmates prefer to listen to music every day. 2 - The inmates refrain from bullying the group members. 3 - The inmates maintain a diary to write about aggressive episodes. 4 - The inmates gather information about each other's personal lives.
1, 2, 3 - Patients with a history of violence are at risk for other-directed violence. The effective treatment outcome will be that the patient avoids argument with and stops bullying others. The patient developing self-control indicates an effective treatment outcome. The patient following stress management techniques like listening to music also indicates effective treatment outcomes. The patient identifying situations that increase aggression indicates that the treatment is effective. Gathering personal information of other inmates and minimal interaction with other inmates are suggestive of ineffective treatment outcomes.
When working with an angry patient, it is best to do which of the following? 1 - Ignore the patient's anger and change the subject. 2 - Help the patient reframe the anger-producing situation. 3 - Help the patient deny and repress the feelings of anger. 4 - Encourage the patient to fully explore and express his or her anger.
2 - Deescalation occurs more quickly with reframing the anger-producing situation than when other approaches are used. When a patient is demonstrating angry behavior, it is unlikely that encouraging the patient to fully explore and express his or her anger, helping the patient to deny and repress the feelings of anger or ignoring the patient's anger and changing the subject will be useful.
The nurse is studying about the functions of the different parts of the brain. Which area of the brain is associated with aggression? 1 - Cochlea 2 - Amygdala 3 - Carotid body 4 - Parotid gland
2 - Different areas in the brain control different functions of the body. The area of the brain which is known to be associated with aggression is the amygdala, which is a part of the limbic system. The limbic system mediates primitive emotions and behaviors which are required for the survival of a person. Cochlea is not a part of the brain. It is the auditory portion of the inner ear. Carotid body refers to the group of receptors present in the bifurcation of the carotid artery. It detects changes in blood pressure. The parotid gland is not a part of the brain, but part of the salivary glands.
An adult experiencing a manic episode has flight of ideas and hyperactivity. This patient becomes agitated and threatens to harm a staff person. Which nursing intervention is appropriate? 1 - Maintain the patient's attention by moving closer to the patient. 2 - Address the patient with simple directions and a calming voice. 3 - Explain to the patient, "Your agitation is the result of your illness." 4 - Tell the patient, "If you do not calm down now, we will restraint you."
2 - Patients experiencing mania have marginal coping skills and difficulty with self-control. Hyperactivity is an important predictor of imminent violence. Speaking to the patient with simple directions and a calming voice will help preserve the nurse-patient relationship while giving guidance to the patient. Maintaining the patient's attention by moving closer to the patient, explaining to the patient, "Your agitation is the result of your illness," or telling the patient, "If you do not calm down now, we will restraint you" place the nurse in danger, threaten the patient, challenge the patient, and may contribute to further escalation.
A student nurse is told to assist one of the senior staff with a patient having a catastrophic reaction. What should the student nurse understand by the term catastrophic reaction? 1 - The patient may have assaulted one of the persons in the psychiatric unit. 2 - The patient is screaming out of overwhelming fear due to impaired cognition. 3 - The patient is suddenly showing aggressive behavior with no history of mental illness. 4 - The patient is not calming down after being counseled by the nurse and needs restraint.
2 - Patients with a cognitive disorder can have episodes of severe agitation or aggression, where they may scream, strike out, or cry because of overwhelming fear. Such reactions are called catastrophic reactions. It does not mean assault, being unable to be calmed, or sudden aggressive behavior.
A woman is put in restraints because she tried to kill her daughter and son. All other measures to control her violent behavior failed. The lab reports of the woman revealed that she is positive for HCG. What should be the next best action? 1 - Send her home. 2 - Release her from restraints. 3 - Give her an immunization for rubella. 4 - Give her iron and folic acid tablets daily
2 - Positive blood results for HCG indicate that the patient is pregnant. Pregnant women are more vulnerable to injury due to restraints. Pregnancy is one of the contraindications for restraint and seclusion. Therefore, the woman should not be put in restraint and seclusion, and alternative options should be explored. Since the patient previously attempted to kill her children, she should not be sent home. Immunization for rubella, iron and folic acid supplementation are required for a pregnant patient, but all these should be considered once she is released from seclusion.
Which nursing diagnosis is the priority when planning care for a patient who displays considerable anger and occasional aggression? 1 - Social isolation 2 - Risk for other-directed violence 3 - Ineffective coping: maladaptive 4 - Ineffective coping: overwhelmed
2 - Risk for other-directed violence is the priority diagnosis. The nurse then must determine which of two other diagnoses—ineffective coping: overwhelmed or ineffective coping: maladaptive—is appropriate. Social isolation is not an initial concern. None of these options has the priority over a safety issue.
Which assessment finding is the best predictor of violence in a newly admitted patient? 1 - A family history of bipolar disorder. 2 - A recent assault on a drinking companion. 3 - A childhood history of being bullied at school. 4 - The nurse's subjective feeling that the patient is uncooperative.
2 - The best predictor of violence is past episodes of violent behavior. Although a family history of bipolar disorder, the nurse's subjective feeling that the patient is uncooperative, or a childhood history of being bullied at school may be factors in some incidences, none have the predictive ability of a previous violent act.
A nurse attempts to intervene verbally when an angry patient initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the patient shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the patient de-escalate by doing which of the following? 1 - Apologizing for upsetting the patient 2 - Moving to the rear of the staff group 3 - Continuing to manage the situation personally 4 - Telling the patient, "It isn't safe for me to leave the room."
2 - There is no need for the nurse to stand his or her ground to save face. The goal is to deescalate the situation. When the patient makes a request that can be met without compromising safety, granting the request is acceptable.
During the admission assessment, a new patient makes the statements below. Which statement indicates an increased likelihood of violent behavior? 1 - "When I get mad it's best to leave me alone for a while." 2 - "Sometimes I feel like I'm angry at everything and everybody." 3 - "My friends know I will set them straight if they cross me. I've done it many times." 4 - "When I was growing up, my parents always said I was their most difficult child to care for."
3 - A history of violence is the single best predictor of future violence. Most reactions to stimuli come from one's previous experiences. "My friends know I will set them straight if they cross me. I've done it many times" suggests a history of violence. It is important for the nurse to assess what the patient means by the comment. "When I get mad it's best to leave me alone for a while," "Sometimes I feel like I'm angry at everything and everybody," and "When I was growing up, my parents always said I was their most difficult child to care for" indicate the patient's coping skills may be limited but not necessarily an increased risk for violent behavior.
A patient with schizophrenia and history of chronic aggression is treated with propranolol, a beta blocker, for aggressive behavior. The patient has been recently diagnosed with asthma. Which change in the prescription does the nurse expect for the patient? 1 - Increase the dosage of propranolol 2 - Decrease the dosage of propranolol 3 - Replace propranolol with a different drug 4 - Continue using propranolol without any change in dose
3 - Propranolol should not be given to patients with asthma, as it is a beta-blocker and can constrict the airways. Therefore, the patient should be advised to stop propranolol and consult the primary healthcare provider for further advice regarding the drug to be used for aggressive behavior. Increasing the dose of a beta-blocker may worsen the patient's asthma symptoms. Decreasing the dose will not be effective in reducing aggression in the patient. Continuing propranolol at the same dose may lead to complications such as airway restriction.
The nurse is learning about the different forms of emotional responses. What is the most appropriate term that can be used for the intentional use of force? 1 - Anger 2 - Anxiety 3 - Violence 4 - Aggression
3 - Violence is an act which involves intentional use of force that can result in injury to another person. Anger is an emotional response to frustration or inability to fulfill desires. Anxiety is defined as a feeling of worry or nervousness when a person is in a situation of uncertainty. Aggression refers to the action or behavior which results in a verbal or physical attack.
A patient experiencing manic hyperactivity stands up, glares challengingly at patients and staff, and shouts, "This food is garbage! I'll fight anyone who says it's not!" What is the nurse's most relevant assessment of the patient? 1 - Is upset with the quality of the food. 2 - Is getting rid of tension in a harmless way. 3 - Has a high potential for other-directed violence. 4 - Is frustrated by limits imposed by hospitalization.
3 - the patient's offers to fight are suggestive of a high potential for violence. Patients may have coping skills that are adequate for day-to-day events in their lives but are overwhelmed by the stresses of illness or hospitalization. Other patients may have a pattern of maladaptive coping, which is marginally effective and consists of a set of coping strategies that have been developed to meet unusual or extraordinary situations.
A patient asks, "What's wrong with my brain that causes me to have such a problem with aggression?" The nurse's response is based on what knowledge? 1 - Personality type plays a much greater part in anger and aggression than physical factors. 2 - The prevailing theory is that diminishment of stress hormones causes anger and aggression. 3 - No abnormalities of the brain have been identified that correlate with anger and aggression. 4 - The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.
4 - The limbic system, the prefrontal cortex, and neurotransmitters have all been implicated by research as playing a part in anger and aggression. The theory that diminishment of stress hormones causes anger and aggression, no abnormalities of the brain have been identified that correlate with anger and aggression, and personality type plays a much greater part in anger and aggression than physical factors are all untrue.
What is the best definition of anger? 1 - Doing intentional harm to others 2 - An expression of conflict with others 3 - An unhealthy way of releasing anxiety 4 - A normal response to a perceived threat
4 - Anger is one of the primary emotions and is not in itself a disorder. Anger is not defined as an unhealthy way of releasing anxiety, doing intentional harm to others, or an expression of conflict with others.
The nurse receives a patient with an injury and provides first aid to the patient. Another patient who had been present in the treatment room suddenly becomes aggressive and shouts at the nurse. The patient threatens the nurse with a pair of scissors to get the nurse to attend to them first. What should be the most appropriate response of the nurse? 1 - "You can't talk to me like this." 2 - "Can't you see what I am doing?" 3 - "I think I will have to call security." 4 - "Would you please tell me your problem?"
4 - It is important for a nurse to know how to manage an angry patient. The nurse needs to be calm and speak to the patient slowly and in short sentences. It is helpful to use questions like, "Would you please tell me your problem?" and similar open-ended statements. It helps to understand what is behind the angry feelings of the patient. Telling the patient that the patient cannot talk to the nurse like this, or that the nurse would call security, would further aggravate the anger in the patient.
A patient diagnosed with Alzheimer disease fretfully says, "School is out and I must pick up my children now. I'm going to be late." The patient's children are now adults. The nurse replies, "It sounds like you are feeling the responsibility of caring for young children." Which technique has the nurse used? 1 - Distraction 2 - Reassurance 3 - Reorientation 4 - Validation therapy
4 - Patients with cognitive deficits sometimes become agitated because of concerns related to their past. They believe they are young and feel the need to return to important tasks that were a significant part of those earlier years. Validation therapy is helpful by reflecting back to the patient the feelings behind the worry and shows the nurse's understanding and concern. Distraction is a technique that involves using another activity or subject to alter the patient's focus. Reassurance may support the patient but it does not address the reason for the worry. Reorientation does not address the patient's concerns.
An adolescent male is swearing and shouting at his healthcare provider, who refused to give him a pass to leave the unit. Which of the following is true about this behavior? 1 - Can be attributed to lack of parental controls applied at an early age 2 - May reduce tension and prevent the patient from physically acting out 3 - Is acceptable if directed at staff but not when directed at other patients 4 - Is a major indicator that the patient may become physically aggressive
4 - Physical aggression is preceded by anger, which may be expressed by swearing and shouting, pacing, and other menacing behaviors.
Which factor is most likely to contribute to a patient's escalating anger? 1 - Watching violence on television 2 - Another patient's depressed mood 3 - A staff member asking him or her to help another patient 4 - A staff member telling him or her that he or she is inappropriate
4 - Punitive, threatening, accusatory, or challenging statements to the patient should be avoided; rather, the nurse should determine what is behind the patient's feelings and behaviors. Watching violence on television, another patient's depressed mood, or a staff member asking him or her to help another patient do not present a threat, accusation, or challenge to the patient.
A patient has a history of demonstrating aggression physically. Which of the following is an appropriate short-term goal to help the patient manage this anger? 1 - Isolate in lieu of striking people. 2 - Strike objects rather than people. 3 - Limit aggression to verbal outbursts. 4 - Identify situations that precipitate hostility.
4 - The identification of situations that create hostile feelings must occur if the patient is to develop new coping strategies.
A patient is yelling at those who enter the hospital room and throws a juice box at the wall out of frustration. What kind of behavior is this patient exhibiting? 1 - Anger 2 - Stress 3 - Violence 4 - Aggression
4 - The patient who yells and throws things at the wall is exhibiting aggression, the action or behavior that results in a verbal or physical attack. This is different from violence, in that the patient is not intentionally using force to cause injury to another person. Anger is the emotional response to frustration or other threats. Stress is an emotional or physical pressure.
