Psych unit 6

A nurse understands that cognitive theories inform us ... a) Predicting the number of angry outbursts within a specific time frame b) What to do when we get angry c) How not to get angry d) Reacting to previous situations of anger

How not to get angry Explanation: Cognitive theories inform us about how not to get angry in the first place, not about what to do when we become angry.

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter? a) Dopamine b) GABA c) Serotonin d) Norepinephrine

Serotonin Explanation: Intermittent explosive disorder involves inadequate production or functioning of serotonin. Other neurotransmitters such as dopamine, norepinephrine, or GABA are not involved.

The emergency department nurse is assessing a female client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client? a) "It looks like someone has hurt you. Tell me about it." b) "Is your partner being mean to you?" c) "Why do you think your husband has beaten you?" d) "Can you describe the person who did this to you?"

"It looks like someone has hurt you. Tell me about it." Explanation: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize her thoughts and feelings. Asking if the partner is being mean or asking why the client thinks the husband has beaten her already assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next? a) Call the nursing supervisor immediately b) Follow the facility's policy and procedures for reporting abuse c) Notify the physician that abuse is suspected d) Ask the client when and how the bruises occurred

Ask the client when and how the bruises occurred Explanation: The nurse should not assume the bruises were caused by abuse; the client's explanation is an important step in the assessment of potential abuse. A nurse must assess for abuse prior to getting the supervisor and physician involved. Reporting abuse would be initiated after a thorough assessment

The nurse can assess potential victims of domestic violence by ... a) "What is your history of physical injuries?" b) "Do you need the number of a women's shelter?" c) Asking questions such as "Has a past or current partner ever caused you to be afraid or hurt you?" d) "What did you do right before your partner hit you?"

Asking questions such as "Has a past or current partner ever caused you to be afraid or hurt you?" Explanation: In posing this question, nurses are sensitive to the client's reluctance to reveal abuse.

Therapeutic relationship strategies to de-escalate refer to a) Collaborating with the team and family to decide on the most appropriate action b) Allowing other patients on the unit to share their experiences c) Being a client advocate d) Focusing on responsibility on the unit of nursing to control violent outbursts

Being a client advocate Explanation: Therapeutic relationship strategies, including being available, being a client advocate, providing client education, and collaborating with the client in treatment planning can decrease the potential for violence.

The nurse is caring for a client who visits the mental health clinic and tells the nurse that she expresses her anger frequently throughout each day. The client is concerned about her relationships with her husband and family. The nurse should instruct the client that some people experience anger and express anger more often than others because of ... a) the need for catharsis. b) lack of education about control. c) unwillingness to forgive others. d) genetic predisposition.

genetic predisposition. Explanation: The nurse should explain to the client that some people experience anger and express anger more often than others because of a genetic predisposition. Other factors include emotional development during infancy, family environment, and head trauma.

The school nurse is aware that a student has requested aspirin three times during the past week because his "back hurts." The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child if he was being abused? a) Child would give a far-fetched explanation not logically connected to his injuries. b) Child would explain that his father is beating him on a regular basis. c) Child would carefully explain that his mother disciplines him because she loves him. d) Child would give the same reason his sister would give were she asked to explain his injuries.

Child would give a far-fetched explanation not logically connected to his injuries. Explanation: When treating a child with injuries that are the result of physical abuse, professionals should suspect abuse when explanations are implausible and inconsistent with injuries, involved parties give different versions of the incident, or treatment seeking is delayed.

The nurse is legally obligated to report suspected child abuse to local authorities. Which of the following information is essential? a) Child's name, location, age, and suspected perpetrator b) Therapist's name and client address c) Proof that the child has been recently abused d) Child's current school, grade, and teacher

Child's name, location, age, and suspected perpetrator Explanation: Registered nurses are legally mandated to report child abuse. When reporting, the nurse must provide the child's name, location, age, and the suspected perpetrator. The nurse is not required to prove that abuse has occurred.

A nurse suggests that the patient explores new ideas about a particular problem and considers other possibilities to reflect a(n) a) Affective intervention b) Negative approach intervention c) Psychoanalytical approach d) Cognitive intervention

Cognitive intervention Explanation: Cognitive interventions are usually those that provide new ideas, opinions, information, or education about a particular problem. The nurse offers a cognitive intervention with the goal of inviting the client to consider other possibilities.

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? a) Anxiety disorder b) Schizophrenia c) Obsessive-compulsive disorder d) Depression

Depression Explanation: Maladaptive anger (excessive outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression, as well as a plethora of medical conditions.

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. The nurse's most appropriate action would be to ... a) Take an authoritative step between the two clients b) Comfort the client huddled in the corner c) Directly address both clients and ask what's going on d) Engage the attention of the client who is still yelling and ask what is happening

Engage the attention of the client who is still yelling and ask what is happening Explanation: Engaging the attention of the dominant person will defuse the situation and stop the argument from continuing. Answers A, B, and C would not be appropriate actions in this situation. The nurse placing herself in between two arguing clients is a safety concern.

Which of the following staff behaviors has been found to be particularly provocative when working with clients who are predisposed to aggressive or violent behavior? a) Talking excessively with the client in front of other clients b) Providing the client with a list of possible goals for behavior change c) Asking personal questions when they are inappropriate d) Engaging in disputes over medication, supplies, or rules on the unit

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

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? a) Responding to verbal threats by terminating the interview and obtaining assistance b) Interviewing the client with another staff member present c) Anticipating that a loss of control is possible and planning accordingly d) Explaining the consequences the client will face if control is lost

Explaining the consequences the client will face if control is lost Explanation: Giving the client an ultimatum is likely to foster hostile or aggressive behavior; the other measures are all appropriate for a client with a history of aggression.

The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? a) Give the client a variety of choices on how to express anger. b) Give the client permission to be angry. c) Point out the senselessness of anger. d) Tell the client not to be angry all the time.

Give the client permission to be angry. Explanation: Many people view anger as a negative and abnormal feeling in addition to feeling guilty about being angry; the nurse can help the client see anger as a normal, acceptable emotion. Giving choices on how to express anger would not be the next step in the planning stage. Choices C and D are not appropriate responses in this situation.

After teaching a group of nursing students about anger and aggression, the instructor determines that the education was successful when the students identify which of the following about aggression? a) It involves the use of strong force or weapons to inflict bodily harm b) All aggression is violent. c) Aggression involves covert behaviors to hurt or belittle another. d) Instrumental aggression is premeditated.

Instrumental aggression is premeditated. Explanation: Aggression involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. Aggression can be verbal (sarcasm, insults, threats) or physical (property damage, slapping, hitting). Mentally healthy people stop themselves from aggression by realizing the negative consequences to themselves or their relationships. Violence is extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person, and in some cases to kill. Violence connotes greater intensity and destruction than aggression. All violence is aggressive, but not all aggression is violent. Instrumental aggression is premeditated and unrelated to immediate feelings of frustration or threat.

A client with aggressive behavior shows no psychotic symptoms. Which drug should the nurse expect to be ordered for this client? a) Lorazepam (Ativan) b) Carbamazepine (Tegretol) c) Valproate (Depakote) d) Haloperidol (Haldol)

Lorazepam (Ativan) Explanation: Lorazepam (Ativan) is most effective drug in reducing aggression in client who does not have any other psychotic symptoms. Valproate (Depakote), Haloperidol (Haldol) and Carbamazepine (Tegretol) drug are useful in reducing aggression in those clients who have co-existent psychotic symptoms.

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by ... a) Therapeutic relationship b) Assertive behavior c) Low self-esteem d) Mindfulness

Low self-esteem Explanation: 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.

The nurse is caring for a young adult in the mental health clinic. The client tells the nurse that he was physically neglected as a child. The nurse should assess the client for symptoms of which of the following? a) Panic disorder b) Schizophrenia c) Narcissistic personality disorder d) Major depression

Major depression Explanation: The nurse should assess the client for symptoms of major depression. Other mental health consequences associated with violence include anxiety disorders (posttraumatic stress disorder), alcohol addiction, and other disorders.

A group of nursing students is reviewing information about intimate partner violence (IPV). The group demonstrates understanding of this topic when they identify which of the following? a) Men may not consider behaviors such as slapping or shoving as abuse. b) IPV in same-sex couples occurs less frequently as compared with heterosexual relationships. c) Men are more likely to be seriously injured even though more women are typically victims. d) The reactions to IPV are similar in male and female victims.

Men may not consider behaviors such as slapping or shoving as abuse. Explanation: Men are sometimes hesitant to report victimization or may not consider behaviors such as shoving or slapping "abuse." Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. IPV in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but individuals with same-sex partners may not be afforded the same support. The reaction to IPV may differ by gender.

When assessing a client's potential for aggression and violence, which of the following would be most important for the nurse to do? a) Ask the client about his living situation b) Observe the client for nonverbal indicators c) Review the client's use of medications d) Obtain a thorough client history

Obtain a thorough client history Explanation: Although assessing the client's living situation, observing for nonverbal indicators, and reviewing medications are important, obtaining a thorough client history is the most important predictor for aggression and violence. Early life adverse circumstances, such as inadequate maternal nutrition, birth complications, traumatic brain injury, and lead exposure can contribute to risk for aggressive and criminal behaviors in adulthood. Important markers in the client's history include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control.

Nurses working in a clinical setting must be provided with regular training programs in the prevention/management of aggressive behavior in order to ... a) Share personal experiences b) Be aware of current incidences reported in other hospitals c) Avoid violent episodes from occurring d) Reinforce and update what they have learned

Reinforce and update what they have learned Explanation: Clinically, nurses must be provided with training programs in the prevention and management of aggressive behavior. The courses need to be made available to nurses and students regularly so that they have opportunities to reinforce and update what they have learned.

In a toddler, which injury is most likely the result of child abuse? a) A 1-inch forehead laceration b) Several small, circular burns on the child's back c) A small, isolated bruise on the right lower extremity d) A hematoma on the occipital region of the head

Several small, circular burns on the child's back Explanation: Small circular burns on a child's back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries are not uncommon. A small area of ecchymosis is not suspicious in this age group.

When describing the psychoanalytic view of aggression and violence, which of the following would the nurse most likely include? a) Way of getting what a person wants b) A learned response to a stimulus c) Interaction of cognition, affect and arousal d) Suppression of instinctual drives

Suppression of instinctual drives Explanation: Psychoanalytic theories focus on aggression and violence as a suppression of instinctual drives. Social learning theory focuses on the role of learning and rewards. Behavioral theories view it as a learned response to a stimulus. The general aggression model is a framework that accounts for the interaction of cognition, affect and arousal during an aggressive episode.

The nurse is reviewing the medical history of an extremely agitated client. The nurse has not yet met the client and the history contains previous use of a benzodiazepine to relieve aggression. What might the nurse interpret from this information? a) The client is an older adult with dementia. b) The client is a child with mental retardation. c) The client is an adolescent with conduct disorder. d) The client is a middle-aged adult with brain injury.

The client is an older adult with dementia. Explanation: When benzodiazepines are prescribed to reduce aggression, this suggests the client is an older adult with dementia. Benzodiazepines can reduce irritability and agitation in these clients, but can result in loss of social inhibition for other agressive cleints, thereby increasing aggression. An aggressive client with brain injury is usually prescribed antipsychotic medications. An aggressive child with mental retardation or an adolescent with conduct disorder are usually prescribed lithium.

A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. The best approach by the nurse would be to ... a) Use brief statements and questions to obtain information b) Provide close contact to increase the client's sense of safety c) Have a sense of humor to show a lack of fear d) Use open-ended questions so the client can elaborate

Use brief statements and questions to obtain information Explanation: Following an aggressive episode, clients may have difficulty expressing themselves; short, concise statements and questions will get needed information. Humor or open-ended questions may be frustrating or annoying for the client.

An adult client is pacing and yelling. Which of the following is the best response by the nurse? a) "Why do you feel angry?" b) "What are you doing?" c) "When did these feelings begin?" d) "With whom are you angry?"

"When did these feelings begin?" Explanation: When a client is angry, use open-ended questions to clarify the client's behavior. Use an empathetic approach to assist the client to discover the source of the anger. Asking a "why" question implies criticism of the feeling. The client may become defensive and angrier. Similarly asking "What are you doing?" asks the client to explain behavior when the client may not be fully aware of the source. The question also implies criticism rather than offering empathy. Asking "With whom are you angry" is a closed-ended question that will not open the thinking and dialogue with the client. Further, asking about the object of the anger focuses on an external reason for the anger rather than assisting the client to look within for the source.

When communicating with a client in the triggering phase of the aggression cycle, the nurse should ... a) Suggest that the client is still in control and can maintain that control b) Use seclusion or restraint c) Help the client relax and return a calmer state d) Allow the client to take a "time out" in a quiet area

Allow the client to take a "time out" in a quiet area Explanation: During the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to de-escalate the client's emotion and behavior. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation.

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. a) Engage participation in a group activity. b) Obtain orders for seclusion if needed. c) Calm down the client by talking. d) Anticipate the use of sedatives. e) Make arrangements for possible restraint.

• Obtain orders for seclusion if needed. • Make arrangements for possible restraint. • Anticipate the use of sedatives. Explanation: A severely agitated client can turn hostile and harm self and others, and cause damage to the facility. The nurse should intervene before the client becomes hostile. The client may need to be secluded, thus the nurse should obtain orders for it. Restraints may need to be used; therefore, appropriate arrangements should be done for placing the restraints. A severely agitated client may need to be sedated; therefore, the nurse should anticipate the use of sedatives. A severely agitated client may not respond to talking. Engaging the client in group activity may increase the risk of harm to others, so it should be avoided.

While interacting with a client experiencing aggression, which of the following client assessments would lead the nurse to suspect that an episode of aggression is about to occur? Select all that apply. a) Staring in an intimidating fashion b) Mumbling c) Using sarcastic comments d) Speaking slowly and unhurriedly e) Pacing

• Staring in an intimidating fashion • Using sarcastic comments • Mumbling • Pacing Explanation: Usually, there are some observable precursors to aggression and violence. In a study of aggressive episodes in an emergency department, the following behaviors indicated an impending aggressive episode: (1) staring and eye contact or glaring as a way of intimidation; (2) tone and volume of voice such as raised voices, sarcastic comments, and urgent or demeaning speech; (3) anxiety in clients, family or friends; (4) mumbling that shows increasing frustration; and (5) pacing that indicates increased agitation.

A nurse is assessing a client who is angry and notes that the client expresses his anger outwardly in an unhealthy manner. Which behaviors would the nurse most likely observe? Select all that apply. a) Yelling nasty things b) Using profanity c) Withdrawing from others when angry d) Sulking and pouting e) Using "I" language to describe feelings

• Yelling nasty things • Using profanity Explanation: A person who expresses anger outwardly in an unhealthy manner would most likely demonstrate behaviors such as yelling, saying nasty things, and using profanity. Withdrawing from others when angry and sulking and pouting are examples of anger suppression. Using "I" language to describe feelings reflects constructive anger discussion.

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply. a) "How can you behave like this to me?" b) "I feel so angry when you disobey me." c) "How dare you not listen to me." d) "I am extremely angry at your behavior." e) "You are making me very angry."

• "I am extremely angry at your behavior." • "I feel so angry when you disobey me." Explanation: Expression of anger using assertive communication refers to the use of statements beginning with 'I' while expressing anger. Statements such as "I am extremely angry at your behavior" and "I feel so angry when you disobey me" are examples of assertive communication. Statements such as "You are making me very angry", "How dare you not listen to me", and "How can you behave like this to me?" are not examples of assertive communication.

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with a history of violence. b) A client with history of obsessive compulsive disorder. c) A client with a history of substance abuse. d) A client with history of being personally victimized. e) A client with history of depression.

• A client with a history of violence. • A client with history of being personally victimized. • A client with a history of substance abuse. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

Which clients in the psychiatric in-patient unit should the nurse watch closely for risk of aggressive behavior? Select all that apply. a) A client with history of obsessive compulsive disorder. b) A client with history of being personally victimized. c) A client with a history of substance abuse. d) A client with a history of violence. e) A client with history of depression.

• A client with a history of violence. • A client with history of being personally victimized. • A client with a history of substance abuse. Explanation: Some clients are at increased risk of aggressive and hostile behavior. A client who has a past history of violence tends to repeat the behavior again. A client who has been victimized during an aggressive episode tends to be hostile. A client who had been abusing drugs or other substances tends to be more aggressive and hostile, due to lack of self-control. Clients with history of depression or obsessive compulsion disorder are less likely to have aggressive episodes.

A client is receiving cognitive-behavioral therapy as part of the treatment plan for anger. Which of the following would most likely be included? Select all that apply. a) Avoiding stimuli identified to provoke the anger b) Engaging in relaxation training c) Monitoring one's self for cues related to anger arousal d) Practicing new behaviors as part of a group e) Identifying ways to disrupt the anger response

• Avoiding stimuli identified to provoke the anger • Monitoring one's self for cues related to anger arousal • Identifying ways to disrupt the anger response • Engaging in relaxation training Explanation: 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. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when angry. Practicing new behaviors as part of a group is used in anger management.

A nurse is conducting an in-service program about anger, aggression and violence for a group of staff nurses. When describing the general aggression model, the nurse addresses situational factors. Which of the following would the nurse include? Select all that apply. a) Emotions involved with the behavior b) Cues triggering memories of similar situations c) Moods associated with the behavior d) Personality traits of the individual e) Insults or slights involved in the aggression

• Cues triggering memories of similar situations • Insults or slights involved in the aggression Explanation: Situational factors include the actual provocation (insults, slights, verbal and physical aggression, interference with achieving goals) and cues that trigger memories of similar situations. The person factors include characteristics such as gender, personality traits, beliefs and attitudes, values, goals, and behavior patterns. Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component.

When providing care to a client experiencing aggressive behavior, the nurse integrates knowledge about potential biologic factors contributing to the condition. Which of the following brain structures would the nurse identify as playing a role in the client's aggression? Select all that apply. a) Limbic system b) Temporal lobe c) Occipital lobe d) Hypothalamus e) Frontal lobe

• Frontal lobe • Limbic system • Temporal lobe Explanation: The brain structures most frequently associated with aggressive behavior are the limbic system and the cerebral cortex, particularly the frontal and temporal lobes.

The nurse is assessing a child who is extremely agitated. The client's medical records include a prescription for lithium. Which are potential comorbid mental illnesses in this child? Select all that apply. a) Mental retardation b) Dementia c) Conduct disorder d) Brain injury e) Bipolar mood disorder

• Mental retardation • Conduct disorder • Bipolar mood disorder Explanation: Lithium is known to be effective in, and is therefore most likely to be prescribed for, treating aggressive clients with bipolar disorder, conduct disorders and mental retardation. Children are less likely to have dementia. Moreover, aggressive clients with dementia are treated with carbamazepine (Tegretol) and valproate (Depakote). Aggressive clients with brain injury are treated with antipsychotic medications like clozapine (Clozaril)and risperidone (Risperdal).

The nurse is caring for a group of clients in an inpatient psychiatric setting. The nurse should be on the alert for aggressive behaviors from a client who has an interactional style termed ... a) adaptive. b) manipulative. c) coercive. d) accommodating.

coercive. Explanation: The client likely to be aggressive is the one with coercive interactional style