PREP U CHPT 11

Catharsis

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

Lorazepam

A client with aggressive behavior shows no psychotic symptoms. Which medication should the nurse expect to be ordered for this client?

Nurses' beliefs about themselves as

individuals and professionals will influence their responses to aggressive behaviors.

The primary goal of de-escalation

to resolve angry or violent conflicts in nonviolent ways. Stopping dangerous behavior by pointing out unacceptable behavior is behavior correction. Role modeling is one part of behavior correction.

The primary goal of de-escalation is

to resolve angry or violent conflicts in nonviolent ways. The primary goal of de-escalation is not to resolve nurse bias, social stigmatization, or staffing issues.

depression

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?

The client uses adaptive coping to manage anger impulses.

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?

In the crisis phase

seclusion or restraint may be used to deal with aggression quickly.

Acceptance

would involve encouraging information in a nonjudgmental and interested manner

Monitor facial expressions Monitor emotional responses Ensure availability of assistance

A client with schizophrenia has been brought to the hospital in an agitated state. In order for the nurse to perform the initial assessment, which approaches should the nurse use to manage the situation?

anger suppression

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?

Catharsis of anger

would reflect the client being able to express feelings.

crisis

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?

The client apologizes for the hostile behavior. The client cries and is remorseful for the event. The client remains withdrawn from others.

A client has recovered from an episode of aggressive and hostile behavior. Which behaviors in the client indicate that the client is in the post-crisis stage of the aggression cycle?

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

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

serotonin.

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter?

Take the client to the gym for exercise.

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?

"What works best is what fits the client and the situation."

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?

Development of a therapeutic relationship

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?

Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent.

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?

Explore what is underlying the client's physical and emotional state

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?

low self esteem

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

Own awareness and reaction to aggression

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

Show an increased tolerance for frustration

Aggression control can be measured by the nurse's observation of a client's ability to do what?

Identifying the feelings reduces the frustration

Attempt to discover the concern and respond with empathy, interest, and willingness to help. Encourage the client to describe and clarify the client's experience using open-ended questions to increase the client's awareness of problematic feelings and what triggers them.

true

Dementia is usually not seen in adolescents. The depressed client does not typically exhibit aggressive behaviors. The client with paranoid delusions would not exhibit episodic aggression.

Recovery

During which phase of the aggression cycle does the client regain physical and emotional control?

While clients can learn to move past learned behaviors as a child, it is important to understand what these learned behaviors are.

While all of these questions are pertinent to assessment of anger reactions in a client, questions related to culture need to center around how clients learned about anger when growing up and how it is displayed.

crisis.

In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly?

post crisis

In which phase of the aggression cycle is the client removed from restraint or seclusion as soon as he or she meets the behavioral criteria?

aggressive behavior

Low levels of serotonin have been linked to

Aggression control is the term used in the Nursing Outcomes Classification

The nurse may observe that the client shows decreased psychomotor activity (e.g., less pacing), has a more relaxed posture, speaks more directly about feelings of anger and personal needs, requires less sedating medication, shows increased tolerance for frustration and the ability to consider alternatives, and makes effective use of other coping strategies.

"People say I withdraw and pout about the problem."

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?

validation

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?

strict hierarchy of authority

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?

angry conflicts

The primary goal of de-escalation is to resolve which that can happen on an inpatient unit?

internalizing this emotion

The client is not expressing anger based on the incident and therefore has anger suppression which means the client is

There are five phases of an aggression cycle.

These include triggering, escalation, crisis, recovery, and post-crisis. In the post-crisis phase, the client attempts reconciliation with others and returns to a normal level of functioning. The client may realize that the aggressive behavior was wrong and may apologize for it. The client may cry and feel remorse for the aggression episode. Due to the guilt related to the aggression episode, the client remains withdrawn from others. The client talking in a loud voice, exhibiting irritable behavior, and pacing restlessly indicates that the client is in the triggering phase of the aggression cycle.

crisis phase of aggression cycle

The client's signs of shouting, screaming, hitting others, and throwing objects suggest that the client is in crisis phase of the aggression cycle. This phase is characterized by loss of emotional and physical control. In the triggering phase, the client often becomes angry in response to an event or circumstance in the environment. In the escalation phase, the client may move toward a loss of control. In the recovery phase, the client regains the emotional and physical control.

Immediately approach the client to engage in communication

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?

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

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?

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

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?

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

The nurse is assessing a client who is aggressive. Which safety measures must the nurse ensure are in place prior to continuing the assessment?

previous episodes of rage

The nurse is assessing a group of clients on an inpatient psychiatric unit. The nurse determines that a client most likely to be violent has what?

intermittent explosive behavior

The nurse is assessing an adolescent in a psychiatric facility. The parent tells the nurse that the adolescent has intense sporadic anger episodes. The adolescent becomes angry for petty reasons and starts throwing objects at home. The adolescent also feels guilty and repents for the actions. Based on this history, the nurse would expect the client to be diagnosed with:

serotonin

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?

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

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

Resolution of anger in nonviolent ways

The nurse is demonstrating de-escalation techniques on an aggressive client in a forensic setting. Which is the best explanation of this technique?

Ulcers Coronary artery disease Migraine headaches

The nurse is explaining the importance of expressing anger to a client. What should the nurse mention as the possible physical complications associated with suppressing anger?

have their needs met

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 ...

Confirm that the utility and storage rooms are kept locked.

The nurse is planning the environment for a newly-admitted client with a history of violence toward others. Which modification would the nurse implement?

"Why do you think I am not being respectful to you?"

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 client with a history of violence. A client with history of being personally victimized. A client with a history of substance abuse.

Which clients in the psychiatric inpatient unit should the nurse watch closely for risk of aggressive behavior?

anger

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

lithium

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

impulsivity

Which personality trait is associated with aggressive behavior?

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

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

Validation involves

a clarification of the client's feelings and when a client is angry, many times it can be due to feeling isolated and anxious.

With biologic theories,

a history of schizophrenia, substance abuse, and noncompliance with medications, particularly combined together in an individual, can contribute to having aggressive behavior. Having a history of depression or obsessive-compulsive disorder are not considered factors in development of aggression.

anger is

a strong, uncomfortable, emotional response to a real or perceived provocation.

Anger suppression is characterized by

acting as though nothing has happened; withdrawing from people; and sulking, pouting, or ruminating. Unhealthy, outward anger expression is characterized by flying off the handle or expressing anger in an attacking or blaming way, yelling, or using profanity. Approaching a person directly to talk about it, or discussing how the person feels with a close friend, reflects constructive anger discussion.

hostility is

an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

The nurse needs to be authentic with the client

and try to determine what behavior is interpreted as not being respectful. While it is hard not to feel defensive when being targeted in this way, the nurse does not need to threaten the client with medication or send the client to his or her room. The nurse also doesn't need to ignore the client's feeling but instead stay engaged with the client to try to help understand the client's feelings.

Nurses who show respect and empathy

are more likely to defuse a client's anger than are nurses who are authoritarian. Examples of authoritarian behavior include preventing clients from leaving the ward, engaging in disputes with them over medication, generally enforcing rules or denying requests, physically restraining clients, taking something from them, ignoring them, or requesting clients to do or not to do something.

Valproate, haloperidol, and carbamazepine

drugs are useful in reducing aggression in those clients who have coexistent psychotic symptoms.

The nurse should monitor the client's

facial expressions and emotional responses during the assessment. This may help prevent the client from experiencing feelings of rejection or ridicule during the assessment. Restraint and medication should be used as last resorts for managing clients who have the potential to harm themselves or others.

Anger turned inward has

frequently been associated with mood disorders, particularly depression. It has also been associated with essential hypertension, migraine headaches, psoriasis, rheumatoid arthritis, and Raynaud's disease.

Irritability, resentment, and impulsivity

have been linked with conflict, aggression, and the potential for medical conditions such as essential hypertension, cardiovascular disease, and atherosclerotic heart disease.

It is unrealistic for someone to stop feeling angry altogether

however, the goal of anger management therapy can help a client learn how to control the arousal of anger. Anger management therapy is not utilized for clients who are violent when angry because it has not been found to be effective in modifying violent behavior.

Lorazepam is the most effective drug

in reducing aggression in a client who does not have any other psychotic symptoms.

Intermittent explosive disorder involves

inadequate production or functioning of serotonin. Other neurotransmitters such as dopamine, norepinephrine, or GABA are not involved.

Early recognition involves

increase client self-awareness of early signs of their aggressive behavior and reinforces self-management skills that decrease the likelihood of using aggression in future situations.

confrontation

involves presenting the client with a different reality of the situation.

Intermittent explosive disorder

is a rare disorder characterized by intermittent episodes of aggressive impulses that are disproportionate to the precipitating factors. The individual with intermittent explosive disorder can cause severe destruction of property or assault individuals during an anger episode.

Physical aggression

is behavior in which a person attacks or injures another person or that involves destruction of property.

reflection

is redirection of an idea back to the client for classification of emotional overtones.

The nurse determines that the client most likely to be violent

is the client with a history of past violence and rage. Other clients with diagnoses of bipolar disorder, reduced impulse control, schizophrenia, or organic brain syndrome are also at greater risk for violent episodes.

The nurse who intervenes from within the context of the therapeutic relationship

must be cognizant of the fit of a particular intervention. Thus, the best intervention is the one that fits the situation and the client. Administering medications and making sure that others know where the nurse is may be helpful but it depends on the situation. Confronting the client should be avoided.

Suppressing rage or anger could lead to

physical complications such as ulcers, coronary artery disease, and migraine headaches. Depression and low self-esteem are emotional problems associated with suppression of anger.

Having a strict hierarchy of authority can be

predictive of a client being aggressive or violent; others include having rigid, not flexible, unit rules. The unit having a lack of autonomy for clients which would include use of restraints or locked doors is also predictive of client aggression or violence. Another contributing factor would be having a lack of predictable and meaningful ward activities so if there are scheduled activities this would help reduce this potential for clients.

Overall goals for aggressive or violent clients are to

refrain from threatening or harming anyone during episodes of anger. Using adaptive coping to manage angry impulses indicates the client has gained insight into and skill at managing aggressive impulses. Although gaining insight into situations that trigger anger, increasing self esteem, and reporting increased feelings of self-control are critical elements in working toward effective management of anger, the goal of treatment is achieved when the client can put what he or she has learned into action.

research suggests

that particular characteristics are predictive of violent behaviors. Low self-esteem that may be further eroded during hospitalization or treatment may influence a client to use force to meet his or her needs or to experience some sense of empowerment.

Catharsis includes activities

that provide a release of the anger.

The nurse should explain to the new staff member

that some clients use violence and aggression to get what they want or to force change or regain control. The client may also be seeking attention.

In the postcrisis phase,

the client is removed from restraint or seclusion as soon as he or she meets the behavioral criteria. The client would not be able to demonstrate control in any of the other phases.

During the recovery phase of the aggression cycle

the client regains physical and emotional control. The nurse should help the client relax, sleep, and return to a calmer state.

With expressive anger,

the client would also be able to talk about the emotion of anger with either the roommate or a trusted source for advice.

with constructive discussion

the client would have been able to talk to the roommate about reasons for yelling at the client.

The client's behavior and history of aggression indicates

the nurse should explore the underlying cause of the escalating behavior in order to address the client's needs prior to moving into the escalation stage of aggression.

While assessing an aggressive client

the nurse should give the client plenty of space, sit in an open area, and request the presence of another staff person. The nurse should not restrain the client by him- or herself, but rather get the client restrained by trained personnel. Encouraging the client to talk about the situation in which he or she has been aggressive should be done in the recovery phase of the anger cycle.

As part of keeping the environment safe with clients who are potentially violent,

the nurse should keep storage and utility rooms locked to decrease access to items that may be used for self-harm or harm to others. The client should be in a single room, and not a semi-private room with another client. The client should be near the nurse's station, and have plastic, not metal, hangers with the clothes closet due to the risk for injury to self or others.

With cognitive-behavioral therapy,

the recommendation is to first establish the therapeutic alliance because some angry individuals are not in a stage of readiness to change their behavior. When clients are more receptive, cognitive-behavioral therapy involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors.