Prep U Psychiatric-Mental Health Nursing Chapter 11: Anger, Hostility, and Aggression

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

Show an increased tolerance for frustration

A person brings a parent to the clinic and tells the nurse that the parent has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the parent expresses remorse for the outburst. The person says, "I've never seen my parent act this way." Which question would be most appropriate for the nurse to ask next?

"Has your parent suffered any traumatic injury to the brain recently?"

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? Select the best answer.

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

A nurse is caring for a family whose older parent with dementia is living in their home. The nurse has instructed the family about how to decrease the parent's agitation. The nurse determines that the child of the parent has understood the instructions when stating:

"If I simplify our home environment, my parent may be less agitated."

The nurse is caring for a client with aggressive behavior. The client tells the nurse, "I am feeling extremely angry. I feel like breaking the windows in here." What would be the most appropriate response of the nurse?

"Let's go to the gym and exercise."

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?

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

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?

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

An adult client is pacing and yelling. Which is the best response by the nurse?

"When did these feelings begin?"

A psychiatric-mental health nurse is teaching a class for a group of colleagues about anger, aggression, and violence. Which statement by the nurse would be most appropriate to include?

"Women experience anger as frequently as men do."

Which clients in the psychiatric inpatient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply.

1. A client with a history of violence. 2. A client with history of being personally victimized. 3. A client with a history of substance abuse.

The nurse is assessing a school-aged child to determine underlying causes for socially inappropriate behavior. The nurse uses knowledge that which children are likely to have impaired impulse control? Select all that apply.

1. Children who belong to low-income families. 2. Children who belong to dysfunctional families. 3. Children who get inconsistent responses for their behavior.

A client who has a history of hostile behavior appears severely agitated. What interventions should the nurse perform to prevent harm to the client and others? Select all that apply.

1. Obtain orders for seclusion if needed. 2. Make arrangements for possible restraint. 3. Anticipate the use of sedatives. 4. Use a low calm voice

The nurse is planning treatment for a client with aggressive and psychotic behavior. What should be the immediate goals of treatment for this client? Select all that apply.

1. The client will not harm the self. 2. The client will demonstrate decreased acting out behavior. 3. The client will withhold from harming others or damaging the hospital property.

The nurse is caring for a client with aggression disorder. The client has an anger episode and is threatening other clients in the emergency room with a knife. What should be the approach of the nurse in this situation? Select all that apply.

1. The nurse should attempt to kick the knife out of the client's hand. 2. The nurse should call for outside assistance.

Under which circumstances can an expression of anger be considered a normal and healthy reaction? Select all that apply.

1. When facing an unjust situation. 2. When personal rights are not respected. 3. When realistic expectations are not met.

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? Select all that apply.

1.The client apologizes for the hostile behavior. 2. The client cries and is remorseful for the event. 3. The client remains withdrawn from others.

A nurse is assessing a Haitian client. The caregiver of the client tells the nurse that the client is having an episode of Bouffée delirante. What symptoms would the nurse expect to find in this client? Select all that apply.

Confusion Hallucinations Extreme aggression

A nurse suggests that the client explores new ideas about a particular problem and considers other possibilities to reflect:

A cognitive intervention.

When communicating with a client in the triggering phase of the aggression cycle, which intervention should the nurse include?

Allow the client to take a "time out" in a quiet area

Which term is used to describe an emotion expressed through verbal abuse and violation of rules or norms?

Hostility

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

Anger

The nurse is teaching a group of clients in a juvenile detention center about anger management and the positive effects of anger, if handled appropriately. What advantages, as explained by the nurse, may be helpful to the clients? Select all that apply.

Anger helps to focus attention. Anger helps in decision making. Anger helps in resolving conflicts.

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

Angry conflicts

Seclusion and restraint are nursing interventions to be used for an individual in which situation?

As a last resort

A nurse is working in a psychiatric-mental health facility. The nurse observes a client pacing and punching the wall. Which measure can the nurse take for personal safety?

Avoid being alone with the client.

Which sign of escalating behaviors, if displayed by a client, requires immediate intervention?

Banging the head against the wall

Neurobiologic factors are increasingly being explored as an explanation for aggressive behavior. Which is true?

Brain neuroimaging studies show that aggressive behavior is linked to damage of brain structures located in the limbic, frontal, and temporal lobes.

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

Catharsis

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?

Crisis

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

Crisis

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?

Depression

A nurse is preparing a presentation for a group of staff nurses on anger. When describing maladaptive anger, which psychiatric condition would the nurse identify as being linked to this anger?

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?

Development of a therapeutic relationship

While working in a psychiatric-mental health facility, the nurse notices a client pacing back and forth and becoming increasingly agitated. Which is a critical step in communicating with the client to prevent the escalation of aggressive behavior?

Discover the source of the distress.

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

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

A nurse assesses a newly admitted client on the unit. When assessing the client in detail about his/her past medical history, it is important for the nurse to also explore which information about the client?

Experience of health problems and health professionals

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?

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

The nurse is caring for a client with depression. The client has an anger episode. What are the possible behaviors expected in this client during and immediately following the episode? Select all that apply.

Expresses anger verbally. Feels guilty for inappropriate anger reaction.

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

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

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?

Immediately approach the client to engage in communication

Which personality trait is associated with aggressive behavior?

Impulsivity

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

Lorazepam

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

Low self-esteem

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? Select all that apply.

Monitor facial expressions Monitor emotional responses Ensure availability of assistance

When determining a client's potential for aggression and violence prior to engaging in a detailed psychosocial assessment, which would be most important for the nurse to do?

Obtain a thorough client history

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

Own awareness and reaction to aggression

A nurse must assess a client's thought process and content to identify risk for aggression. The assessment of the client's thought process and content would allow the nurse to identify what?

Perceptions and delusions

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?

Postcrisis

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?

Previous episodes of rage

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

Recovery

During which phase of the aggression cycle does the staff usually have a debriefing session?

Recovery

The nurse has been working on anger management with the client. The client yells during dinner, "Give me that salt shaker!" What is the best nursing intervention at this time?

Remind the client about communication skills discussed earlier

A client has been admitted to the detoxification unit after binge drinking. Even though the client is not currently intoxicated, the client is combative and exhibits altered thought processes. Which nursing diagnosis would be the priority?

Risk for other-directed violence related to alcohol withdrawal

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

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?

Serotonin

An aggressive client is holding a weapon and threatening to harm other clients in the unit. How should the nurse handle this situation?

Shield oneself with a pillow

Which situation is likely to have the least influence on the a child's ability to develop socially appropriate behaviors?

Spending time in foster care

An aggressive client gets hold of a glass piece and prevents anyone from entering the room. What interventions should the nurse perform to ensure safety of the client, staff, and other clients? Select all that apply.

Summon help from others Leave the area immediately Shift other clients to a safe place

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?

Take the client to the gym for exercise.

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?

Teach the client to make "I" statements.

A nurse is assessing a Korean client. The caregiver of the client tells the nurse that the client had been diagnosed with Hwa-Byung by their local health care provider. What should the nurse interpret from this?

The client had health-related issues due to suppression of anger.

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?

The client uses adaptive coping to manage anger impulses.

The nurse is assessing a client who expresses extreme hostility toward the nurse. What may be the client's intentions? Select all that apply.

To intimidate the nurse To emotionally harm the nurse

To defuse a critical situation, the nurse can use the therapeutic communication techniques for which reason?

Try to clarify what has upset the client

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? Select all that apply.

Ulcers Coronary artery disease Migraine headaches

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?

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

The nurse working in a psychology clinic finds that suppression of anger is more common in women than in men. What is the possible explanation for such a finding? Choose the best answer.

Women are expected not to express so-called negative feelings like anger.

When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor?

client's history

A group of nurses is reviewing information about maladaptive anger. The nurses demonstrate a need for additional study when they identify which physical condition as being linked to suppressed anger?

coronary heart disease

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 ...

have their needs met.

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:

intermittent explosive disorder.

The nurse is performing a physical assessment on a 3-year-old client. During the assessment, the child starts screaming and kicking. The nurse suspects this child:

is acting out.

A nurse is reading a journal article about anger and violence. Which would the nurse expect to see as being linked to excessive, outwardly directed anger?

myocardial infarction