Ch. 27 Anger, Aggression, and Violence

validation therapy

The caregiver accepts values and beliefs of the patient, even though they may differ from reality

A 16 year old being treated on an adolescent psychiatric unit has become angry and is in the hallway yelling, "It's not fair! You all hate me! I hate this place!" When the client begins pounding his/her fists on the wall the nurse should attempt to de-escalate the situation by providing which response? a. "I will help you calm down. Do you want to go to your room and talk or go to the quiet room?" b. "You may yell and bang your fists but you must do it in your own room so you don't upset the other patients." c. "Stop that right now! I will not allow you to behave like that!" d. "You will have to go into seclusion and restraints right now in order to be safe."

a. "I will help you calm down. Do you want to go to your room and talk or go to the quiet room?"

Which assessment finding is the best predictor of violence in a newly admitted client? a. A recent assault on a drinking companion b. A family history of bipolar disorder c. The nurse's subjective feeling that the client is uncooperative d. A childhood history of being bullied at school

a. A recent assault on a drinking companion

A battered woman presents to the emergency department with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. Which of the following is the priority nursing intervention? a. Tending to the immediate care of her wounds b. Providing her with information about a safe place to stay c. Administering the as needed tranquilizer ordered by the physician d. Explaining how she may go about bringing charges against her husband

a. Tending to the immediate care of her wounds

An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through: a. brief, frequent, non-threatening encounters b. regular use of seclusion or punishment c. a casual authoritative demeanor d. keeping patients busy

a. brief, frequent, non-threatening encounters

Anna was abducted and raped at gunpoint by an unknown assailant. When found she was confused and disoriented. What behavior would indicate that Anna is in the acute phase of the rape-trauma syndrome? a. confusion and disbelief b. decreased motor activity c. fears and phobias d. flashbacks and dreams

a. confusion and disbelief

an action or behavior that results in a verbal or physical attack

aggression

the emotional center of the brain

amygdala

An emotional responce to frustration of desires, a threat t stone's needs, or a challenge

anger

A woman who has a long history of being abused by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. Which of the following is the best response by the nurse to the woman's decision? a. "I'm afraid he will kill you or the children when you go back." b. "I hope you have made the right decision. Call this number if you need help." c. "What makes you think things have changed for him?" d. "I can't believe you have decided to go back to that horrible man."

b. "I hope you have made the right decision. Call this number if you need help."

Which of the following statements made by a client is an example of aggressive communication? a. "I feel abandoned when you leave me." b. "If you keep it up you better watch your back." c. "You better listen to me." d. "I wish you would not make me angry."

b. "If you keep it up you better watch your back."

The nurse is delayed in changing the dressing on the client's leg. The client reacts by becoming verbally aggressive and telling the nurse, "None of you can be trusted. You all just make promises you never intend to keep." Which should the nurse do now? a. Leave the room until the client regains control The nurse should not leave but validate the client's feelings first. b. Apologize to the client for being late with the treatment. c. Ask why the client is overreacting. d. Alert other staff the the client's apparent escalation.

b. Apologize to the client for being late with the treatment.

When approaching a client who is acting out aggressively, what interventions should the nurse implement to assure personal safety? a. Stand close to the client for reassurance and to convey caring. b. Have other staff as backup, and stay out of the client's personal space. c. Take the client to his/her room so that his/her privacy will be protected. d. Call security and wait until they arrive before approaching the client.

b. Have other staff as backup, and stay out of the client's personal space.

Which neurotransmitter imbalance has been shown to be related to impulsive aggression? a. Low levels of ã-aminobutyric acid b. Low levels of serotonin c. High levels of norepinephrine d. High levels of acetylcholine

b. Low levels of serotonin

Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression? a. Social isolation b. Risk for other-directed violence c. Ineffective coping: overwhelmed d. Ineffective coping: maladaptive.

b. Risk for other-directed violence

An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior that focuses on behavior therapy concepts? a. Telling him they will not change his dressing if he is going to abuse them. b. When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control. c. Assuring him they will complete the dressing change as quickly as possible. d. Explaining that they are professionals and unused to being shouted at by people they are trying to help.

b. When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control

When making assessments the nurse should keep in mind that a common characteristic of an abusing parent is? a. abstaining from use of chemical substances b. having poor coping skills c. being female d. having realistic expectations of child behavior

b. having poor coping skills

neurological conditions associated with anger and aggression

brain tumors, Alzhiemers disease, temporal lobe epilepsy, and traumatic brain injury

A client has been placed in restraints for violent behavior. Which statement best indicates the nurse's understanding of the risk for client injury while being restrained? a. "I need to make sure the restraint' release mechanisms are working properly." Although the proper working of the restraints is important, it cannot be achieved without appropriate client monitoring. b. "The client's feet feel a little cool, but they have a good pulse. I'll get a pair of socks." c. "I need someone to continuously monitor the client and relieve me for a few minutes." d. "Can you arrange to order the client's favorite sandwich for lunch?"

c. "I need someone to continuously monitor the client and relieve me for a few minutes."

Mary, who was attacked and sexually assaulted, states to the ER nurse, "I should have never been out on the street alone." The most helpful response by the nurse would be? a. "Blaming yourself only increases your anxiety and discomfort." b. "Your actions had nothing to do with what happened." c. "You believe this wouldn't have happened if you hadn't been on the street alone." d. "You're right. You should not have been alone on the street at night."

c. "You believe this wouldn't have happened if you hadn't been on the street alone."

Which event is most likely to contribute to a client's escalating anger? a. Watching violence on television b. Another client's depressed mood c. A staff member challenging them d. A staff member asking them to help another client

c. A staff member challenging them

Which characteristic places the client at highest risk for violence directed at others? a. Has a history of recurrent severe depression b. Is in an alcohol rehabilitation program c. Has delusions of persecution d. Is experiencing somatic symptoms for which no organic basis is found

c. Has delusions of persecution

An adolescent male is swearing and shouting at his physician who refused to give him a pass to leave the unit. What is the primary importance of this behavior? a. It is acceptable if directed at staff but not when directed at other clients. b. It may reduce tension and prevent the client from physically acting out. c. It is a major indicator that the client may become physically aggressive. d. It can be attributed to lack of parental controls applied at an early age.

c. It is a major indicator that the client may become physically aggressive.

A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by implementing which intervention? a. Continuing to manage the situation personally. b. Telling the client, "It isn't safe for me to leave the room." c. Moving outside of the client's personal space. d. Apologizing for upsetting the client.

c. Moving outside of the client's personal space.

sometimes patients with cognitive disorder experience such severe aggression and agitation that it is refered to as a

catastrophic reaction

The nurse in an emergency department notices a patient's husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which statement should the nurse make to the spouse to help prevent escalation and/or violence? a. "You need to stay with your wife. She needs you." b. "Hey, what's up? You look out of control." c. "I am calling security to deal with your behavior." d. "You appear upset. Can I help you with anything?"

d. "You appear upset. Can I help you with anything?"

How is anger best defined? a. An unhealthy way of releasing anxiety b. Doing intentional harm to others c. An expression of conflict with others d. A normal response to a perceived threat

d. A normal response to a perceived threat

A client has a history of demonstrating aggression physically. What short-term goal will best help the client manage this anger? a. Strike objects rather than people. b. Limit aggression to verbal outbursts. c. Isolate in lieu of striking people. d. Identify situations that precipitate hostility.

d. Identify situations that precipitate hostility.

A client has been placed in seclusion to control aggressive behavior. Nursing care while the client is in mechanical restraints should include which intervention? a. Observation every 30 minutes b. Releasing the client every 8 hours c. Increasing sensory stimulation d. Providing regularly scheduled nutrition and hydration

d. Providing regularly scheduled nutrition and hydration

As a public health nurse you are providing immunizations to a family with 3 children ages 2, 4 & 6. Which one of the following characteristics of the parent does not indicate possible abuse. a. There is a history of abuse and neglect for the mother as a child b. The family lives in a very rural area with no friends and describes feeling isolated c. The children's father is using alcohol and marijuana d. The parent accepts help from the local CMH and Infant support services

d. The parent accepts help from the local CMH and Infant support services

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of which personal characteristic? a. Isolation b. Confidence c. Hopelessness d. Vulnerability

d. Vulnerability

based on the notion that disruptive patients often have histories of violence and victimization

trams-informed care

an objectionable act that involves intentional use of force that results in, or has the potential to result in, injury to another person

violence