Chapter 20: Management of Anger, Aggression, and Violence
A nurse is working with a client on strategies to help disrupt the pattern associated with the escalation of his aggression. Which of the following would the nurse most likely include in the education plan? Select all that apply. a) "Try counting to 10 when you begin to have those feelings." b) "Attempt to do something different, like watch television to help distract you." c) "Sit down and think about what is happening and how you are feeling." d) "Use a rapid breathing pattern, like panting to help rid you of the feelings." e) "Remove yourself from the situation when you start to have the feelings."
a) "Try counting to 10 when you begin to have those feelings." b) "Attempt to do something different, like watch television to help distract you." e) "Remove yourself from the situation when you start to have the feelings."
A group of psychiatric nurses working in a community mental health center are participating in a training program for preventing and managing aggressive behavior offered regularly by the center. Which statement by the nurses indicates that the program was successful in achieving its outcome? a) "We have the most up-to-date information on the best ways to handle this problem." b) "We still have little confidence in how to cope with aggression." c) "It is important to be aware of current incidences reported in other hospitals." d) "There's very little we can do to minimize the effect of aggression on ourselves."
a) "We have the most up-to-date information on the best ways to handle this problem."
After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which is the most helpful response to the client at this time? a) "What happened that got you so upset?" c) "You really scared me. I'm glad you are okay." d) "What can you do differently next time you get angry?" e) "We will have to talk about this later."
a) "What happened that got you so upset?"
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? a) "What have I done or said that is disrespectful?" b) "I am not going to talk to you while you are angry." c) "Do you need to take your medication to help calm down?" d) "If you don't calm down, I will need you to go to your room."
a) "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? a) "What works best is what fits the client and the situation." b) "I've always had good results with medications." c) "Make sure that another colleague knows where you are at all times." d) "You need to confront the client to show you are in charge."
a) "What works best is what fits the client and the situation."
The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. Which is the best action by the nurse? a) Engage the attention of the client who is still yelling and ask what is happening. b) Comfort the client huddled in the corner. c) Take an authoritative step between the two clients. d) Directly address both clients and ask what is going on.
a) Engage the attention of the client who is still yelling and ask what is happening.
When interacting with a client in the day room, Which staff behaviors are most likely to trigger clients who are predisposed to aggressive or violent behavior? a) Engaging in disputes over medication, supplies, or rules on the unit b) Asking personal questions when they are inappropriate c) Providing the client with a list of possible goals for behavior change d) Talking excessively with the client in front of other clients
a) Engaging in disputes over medication, supplies, or rules on the unit
In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression? a) Engaging the hostile person in dialogue b) Ensuring that the client gets his or her way c) Getting as far away from him or her as possible d) Yelling at the client to settle down now
a) Engaging the hostile person in dialogue
The nurse is interviewing a client with a history of physical aggression. Which should the nurse avoid? a) Explaining the consequences the client will face if control is lost b) Anticipating that a loss of control is possible and planning accordingly c) Interviewing the client with another staff member present d) Responding to verbal threats by terminating the interview and obtaining assistance
a) Explaining the consequences the client will face if control is lost
A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the benefits of managing anger constructively, which of the following points should the nurse include? Select all that apply. a) Improved overall health b) Reduced self-efficacy c) Improved blood pressure control d) An improvement in mood e) Increased likelihood for weight gain
a) Improved overall health c) Improved blood pressure control d) An improvement in mood
Which personality trait is associated with aggressive behavior? a) Impulsivity b) Pessimism c) Lying d) Self-centeredness
a) Impulsivity
A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by possession of which attribute? a) Low self-esteem b) Therapeutic relationship c) Assertive behavior d) Mindfulness
a) Low self-esteem
A psychiatric-mental health nurse is working as a part of group to improve the unit culture to reduce the risk of violence. Which factor would the nurse identify as contributing to violence? Select all that apply. a) Patronizing staff behavior b) Empathetic staff c) Strict authority hierarchy d) Flexible unit rules e) Lack of client privacy
a) Patronizing staff behavior c) Strict authority hierarchy e) Lack of client privacy
The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as ... a) Progress b) Regression c) Controlling d) Manipulation
a) Progress
Which is one of the most common nursing diagnoses for clients experiencing intense anger and aggression? a) Risk for Self-Directed Violence b) Ineffective Therapeutic Regimen c) Disturbed Body Image d) Altered Nutrition, Less Than Body Requirements
a) Risk for Self-Directed Violence
Low levels of which neurotransmitter may lead to aggressive behavior? a) Serotonin b) Acetylcholine c) Norepinephrine d) Dopamine
a) Serotonin
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? a) Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. b) Use should be limited to emergency situations in which the client is demonstrating a potential to be violent. c) Use should be limited to times when a client has demonstrated violence and has inflicted harm to self or others. d) Use should be limited to times when medications have been unsuccessful in de-escalating a situation.
a) Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent.
What is a characteristic of unit culture that predicts client violence? a) rigid unit rules b) conveyance of empathy c) client's control of the treatment plan d) client autonomy
a) rigid unit rules
A nurse is assessing a client. Which behaviors would alert the nurse to a possible impending aggressive episode? Select all that apply. a) staring eye contact b) pacing c) quiet tone of voice d) sarcastic comments e) mumbling
a) staring eye contact b) pacing d) sarcastic comments e) mumbling
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? a) strict hierarchy of authority b) scheduled unit activities c) flexible unit rules d) reduced use of restraints
a) strict hierarchy of authority
The client is being assessed for anger attacks. Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression? a) Dementia b) Delirium c) Depression d) Delusions
c) Depression
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? a) "I would be upset too but we cannot make any change." b) "You look like you are upset and I want to understand why." c) "If you can't calm down, you won't be able to watch television." d) "I know you are angry but you must calm down."
b) "You look like you are upset and I want to understand why."
A nurse has determined that a client requires restraint. Based on guidelines, the nurse contacts the physician who must examine the client within which time frame? a) 3 hours b) 1 hour c) 4 hours d) 2 hours
b) 1 hour
After teaching a class about aggression and violence, the instructor determines that the education was successful when the class states which of the following? a) Violence involves less forceful than aggression. b) All violence is aggressive. c) Aggression involves behavior directed inwardly. d) Aggression is primarily physical.
b) All violence is aggressive.
Some people try to express their angry feelings by engaging in aggressive but safe activities, such as hitting a punching bag or yelling. Which of the following terms is used to describe an activity used to release anger? a) Physical aggression b) Catharsis c) Hostility d) Anger
b) Catharsis
Which is most important to maintain therapeutic boundaries when working with aggressive clients? a) Encourage clients to express how the nurse can avoid causing emotional irritation. b) Do not personalize a client's anger. c) Discuss difficult client care situations with a supervisor. d) Reflect on actions that may have instigated the client's anger.
b) Do not personalize a client's anger.
Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger? a) Encourage catharsis b) Encourage verbalization c) Improve self-esteem d) Isolate the client from others
b) Encourage verbalization
Which intervention would assist the client with the appropriate expression of anger? a) Isolate the client from others b) Encourage verbalization c) Improve self-esteem d) Encourage catharsis
b) Encourage verbalization
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? a) Encourage the client to engage in a relaxation exercise prior to joining the group the the rest of the session b) Explore what is underlying the client's physical and emotional state c) Ask another client in the group to respond to the client's comment d) Ask the client if the client feels triggered by another client in the group
b) Explore what is underlying the client's physical and emotional state
When applying the general aggression model, which area would the nurse most likely identify as an affect component? Select all that apply. a) Personality trait b) Expressive motor response c) Mood d) Gender e) Emotion
b) Expressive motor response c) Mood e) Emotion
The nurse is reviewing the medical record of a client who is experiencing aggressive and violent behavior for possible risk factors. What factors would the nurse identify? Select all that apply. a) Gender b) Family history of aggression c) Environment rewarding emotional control d) Low testosterone levels e) Damage to the frontal lobe of the brain
b) Family history of aggression e) Damage to the frontal lobe of the brain
When the client is in restraints or seclusion, which of the following must occur? a) He or she must be given water at least every 2 hours. b) He or she must be monitored continually. c) He or she must be seen by a physician or licensed independent practitioner within the first 3 hours of initiation of seclusion or restraint. d) He or she must be fed at least every 2 hours.
b) He or she must be monitored continually.
When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which would be most important for the nurse to do? a) Offer the client choices b) Obtain assistance from other staff members c) Confront the client d) Tell the client to calm down
b) Obtain assistance from other staff members
The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize what? a) Severe muscle tension b) Restlessness and irritability c) Decreased problem-solving ability d) Remorse
b) Restlessness and irritability
A client is diagnosed with intermittent explosive disorder. A nurse would expect to administer what as part of the treatment plan? a) Atypical antipsychotics b) Selective serotonin reuptake inhibitors c) Serotonin norepinephrine reuptake inhibitors d) Monoamine oxidase inhibitors
b) Selective serotonin reuptake inhibitors
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? a) Ask the husband to discuss why he spends so much time with his friends. b) Teach the client to make "I" statements. c) Ask the wife to provide details about what she means by "all his time." d) Encourage the wife to express exactly what she wants her husband to do on weekends.
b) Teach the client to make "I" statements.
When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor? a) age b) client's history c) race d) gender
b) client's history
What are clients with a history of damage to the cerebral cortex more likely to exhibit? Select all that apply. a) decreased impulsivity b) increased impulsivity c) decreased judgment d) increased inhibition e) decreased inhibition
b) increased impulsivity c) decreased judgment e) decreased inhibition
A nurse is working with a client who has frequent angry outbursts. Which statement is most helpful when working with this client? a) "You need to learn to suppress your angry feelings." b) "You need to learn how to be less assertive in your communications." c) "Anger is a normal feeling, and you can use it to solve problems." d) "You can reduce your anger by hitting a punching bag."
c) "Anger is a normal feeling, and you can use it to solve problems."
A client is attending anger management class and wants to know how the class will help. What is the nurse's best response? a) "You will be able to stop feeling angry when incidents happen out of your control." b) "We need to explore what makes you want to hit people when you are angry." c) "It will help you to learn how to control the arousal of anger." d) "You will learn how to control your violent behavior."
c) "It will help you to learn how to control the arousal of anger."
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? a) "Do you feel that you can manage your reactions with anger?" b) "Do you know why you are being admitted?" c) "What did you learn about anger when growing up?" d) "What happens when you get angry?"
c) "What did you learn about anger when growing up?"
Neurobiologic factors are increasingly being explored as an explanation for aggressive behavior. Which is true? a) Temperament theory is one of the leading hypotheses for violent behavior. b) Aggressive behavior is associated with clients who later contract Parkinson's disease. c) Brain neuroimaging studies show that aggressive behavior is linked to damage of brain structures located in the limbic, frontal, and temporal lobes. d) There have been no links between neurotransmitters and aggression.
c) Brain neuroimaging studies show that aggressive behavior is linked to damage of brain structures located in the limbic, frontal, and temporal lobes.
An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be what? a) Assist the client to use problem-solving techniques instead of aggression. b) Calmly call the client by name and encourage verbal expression of anger. c) Call for an emergency response from trained personnel. d) Approach the client and firmly say, "Stop, put it down."
c) Call for an emergency response from trained personnel.
The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on what? a) Client's mood b) Court order c) Client's safety d) Physician's order
c) Client's safety
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? a) Panic disorder b) Manic behaviors c) Depression d) Meniere's disease
c) 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? a) Identification of measures to disrupt the anger response b) Client self-monitoring for anger cues c) Development of a therapeutic relationship d) Avoidance of stimuli that provoke the anger
c) Development of a therapeutic relationship
As the nurse is performing an assessment on the client, the client is yelling and is hitting the hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client is exhibiting? a) Recovery b) Crisis c) Escalation d) Triggering
c) Escalation
Which is a true statement regarding anger? a) People have to behave aggressively to get what they want. b) Men are angrier than women. c) Humans can choose to slow their reactions and to think and behave differently in response to various events. d) Anger behavior in adulthood is determined by temperament and childhood experiences.
c) Humans can choose to slow their reactions and to think and behave differently in response to various events.
Which of the following statements is true about aggression and violence? a) Aggression is only physical. b) All aggression is violent, but all violence is not aggressive. c) Instrumental aggression is premeditated and unrelated to immediate feelings. d) Aggression is a manifestation of extreme violence.
c) Instrumental aggression is premeditated and unrelated to immediate feelings.
Which of the following terms is used to describe behavior in which a person attacks or injures another person, or behavior that involves destruction of property? a) Hostility b) Anger c) Physical aggression d) Catharsis
c) Physical aggression
One of the first steps that a nurse should take to deal effectively with aggressive clients is what? a) Become proficient using reflective communication techniques b) Understand how to activate crisis response teams c) Reflect on abilities to handle own feelings of anger d) Learn professional skills of anger management
c) Reflect on abilities to handle own feelings of anger
Which interventions are effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. a) Discouraging clients from expressing angry feelings b) Avoiding discussions among clients on the unit c) Scheduling one-to-one interactions with the client d) Planning group activities such as playing games e) Providing opportunities for clients to resolve conflicts
c) Scheduling one-to-one interactions with the client d) Planning group activities such as playing games e) Providing opportunities for clients to resolve conflicts
A nurse's response to aggressive behavior on the unit is influenced by which characteristic of the nurse? a) Recognition of the reasons for the client's behavior b) Understanding the importance of non-response to escalating behavior c) Self-awareness of reactions to aggression by others d) Appreciation of the value of matching anger with anger
c) 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? a) Estrogen b) Acetylcholine c) Serotonin d) Endorphin
c) Serotonin
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? a) constructive anger discussion b) catharsis of anger c) anger suppression d) expressive anger
c) anger suppression
The nurse is orienting a new staff member in an inpatient mental health unit when a client begins to act in a violent manner. The nurse should explain to the new staff member that some clients use violence and aggression to ... a) practice assertiveness skills. b) relive their childhood experiences. c) have their needs met. d) be placed in their rooms by themselves.
c) have their needs met.
Which describes a strong emotional response to a real or perceived provocation? a) Physical aggression b) Hostility c) Catharsis d) Anger
d) Anger
A psychiatric-mental health nurse is reading a journal article about anger and links to medical conditions. Which condition would the nurse most likely find as being associated with excessive outwardly directed anger? Select all that apply. a) Chronic pain b) Metabolic syndrome c) Arthritis d) Coronary heart disease e) Breast cancer
d) Coronary heart disease
The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? a) Post-crisis b) Triggering c) Escalation d) Crisis
d) Crisis
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? a) The client is having lunch with family members. b) The client is threatening to hit another client. c) The client is having an argument with a roommate. d) The client is sitting in the dayroom reading a book.
d) 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? a) The client has increased self-esteem. b) The client reports increased feelings of self-control. c) The client has gained insight into situations that trigger anger. d) The client uses adaptive coping to manage anger impulses.
d) The client uses adaptive coping to manage anger impulses.
Violent television programs and video games expose children to aggressive models. What part, if any, are these forms of entertainment thought to play in the development of aggressive behavior in children? a) They have no measurable effect on behavior, even if many adults find them unacceptable. b) They only affect children who are exposed to violence in the family. c) They negatively affect aggression by showing that violence has no rewards. d) They teach that aggressive behavior results in social recognition and defeat of enemies.
d) They teach that aggressive behavior results in social recognition and defeat of enemies.
According to Johnson's systematic review of the literature about violence on inpatient psychiatric units, what is a predictor of violence? a) race b) gender c) age d) suspiciousness
d) suspiciousness
