MH Chapter 27 Violence AQ

2 Correct placement of furniture and elimination of obstacles or hazards are important to prevent injury to the nurse if the patient requires physical intervention. The nurse should arrange the setting so that the nurse is near the door in the event a rapid escape is necessary. The patient should not be nearer to the exit than the nurse.

A community psychiatric nurse prepares to assess an adult diagnosed with severe and persistent mental illness. The patient's caregiver reports frequent violent outbursts and use of profanity at home over the past 2 weeks. Select the best office arrangement for the nurse's meeting with this patient. 1 8880508055 2 8880508056 3 8880508057 4 8880508058

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.

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

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 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 In Civilization and Its Discontents, Freud indicated that the conflict between sexual needs and societal norms was the source of humankind's dissatisfaction, aggression, hostility, and violence. There is no research indicating that paranormal phenomena in the mind of mankind can result in violence. Inability to cope with stress of responsibilities, abnormal development of the limbic system, and the wide gap between the rich and poor are all causes for aggression and violence. These factors were not identified by Freud as causes of anger.

According to Freud, what is the source of dissatisfaction, aggression, and violence in humans? 1 Inability to cope with stress due to responsibilities 2 Wide gap between the rich and the poor in the society 3 The conflict between sexual needs and societal norms 4 Abnormal development of the limbic system in the brain

4 Physical aggression is preceded by anger, which may be expressed by swearing and shouting, pacing, and other menacing behaviors.

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

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.

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."

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.

The most restrictive method for dealing with an aggressive patient who is out of control is 1 Seclusion 2 A show of force 3 Verbal intervention 4 Antipsychotic medication

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.

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

4 It is important for the nurse to de-escalate the parent's behavior to engage in productive problem solving. The nurse should be assertive but not aggressive. "I am sorry your daughter was hurt. We are short staffed today," "It seems like you yell about something every time you come for a visit," or "I am unable to answer your question. Your child was assigned to another nurse today" are blaming or use confrontation, which is likely to precipitate a power struggle.

The parent of a hospitalized adolescent enters the inpatient unit yelling, "What is wrong with you people? My daughter cut herself and you let it to happen. I thought my child would be safe here." Select the nurse's appropriate response. 1 "I am sorry your daughter was hurt. We are short staffed today." 2 "It seems like you yell about something every time you come for a visit." 3 "I am unable to answer your question. Your child was assigned to another nurse today." 4 "I can't understand you when your voice is so loud. Let's go to a private area and talk about it."

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.

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

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.

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 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 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 The patient who is intoxicated is at an increased risk for violence.

Which patient is at the highest risk for violence directed at others? 1 The patient who has delusions of grandeur. 2 The patient who has been abusing alcohol all day. 3 The patient who has a history of recurrent severe depression. 4 The patient who has somatic symptoms for which no organic basis is found.

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.

Which term describes an emotional response to frustration of desires or a challenge? 1 Anger 2 Violence 3 Restraint 4 Aggression