Deck 24: Anger, Aggression, and Violence

Question 1

The staff development coordinator plans to teach use of physical management techniques when patients become assaultive. Which topic should be emphasized?

A) Practice and teamwork
B) Spontaneity and surprise
C) Caution and superior size
D) Diversion and physical outlets

Answer 1

Practice and teamwork

Question 2

A patient sits in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stands and paces back and forth, clenching and unclenching fists, and then stops and stares in the face of a staff member. The patient is:

A) demonstrating withdrawal.
B) working through angry feelings.
C) attempting to use relaxation strategies.
D) exhibiting clues to potential aggression.

Answer 2

exhibiting clues to potential aggression.

Question 3

An emergency department nurse realizes that the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should the nurse use to prevent escalation of anger?

A) Explain that the patient's condition is not life threatening.
B) Periodically provide an update and progress report on the patient.
C) Explain that all patients are treated in order, based on their medical needs.
D) Suggest that the spouse return home until the patient's treatment is completed.

Answer 3

Periodically provide an update and progress report on the patient.

Question 4

A cognitively impaired patient has been a widow for 30 years. This patient is frantically trying to leave the unit, saying, "I have to go home to cook dinner before my husband arrives from work." To intervene with validation therapy, the nurse should first say:

A) "You must come away from the door."
B) "You have been a widow for many years."
C) "You want to go home to prepare your husband's dinner?"
D) "Was your husband angry if you did not have dinner ready on time?"

Question 5

Which behavior best demonstrates aggression?

A) Stomping away from the nurses' station, darting to another room, and grabbing a snack from another patient.
B) Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing.
C) Telling the primary nurse, "I felt angry when you said I could not have a second helping at lunch."
D) Telling the medication nurse, "I am not going to take that or any other medication you try to give me."

Question 6

An adult patient assaulted another patient and was restrained. One hour later, which statement by this restrained patient necessitates the nurse's immediate attention?

A) "I hate all of you!"
B) "My fingers are tingly."
C) "You wait until I tell my lawyer."
D) "It was not my fault. The other patient started it."

Question 7

Which medication should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?

A) Lithium (Eskalith)
B) Trazodone (Desyrel)
C) Olanzapine (Zyprexa)
D) Valproic acid (Depakene)

Question 8

A patient being admitted suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone who tries to get near me." An emergency code is called. The patient is safely disarmed and placed in seclusion. Justification for the use of seclusion is that the patient:

A) evidences a thought disorder, rendering rational discussion ineffective.
B) presents a clear and present danger to others.
C) demonstrates an apparent escape risk.
D) displays features of psychotic thinking.

Question 9

A patient is hospitalized after an arrest for breaking windows in the home of a former intimate partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority?

A) Risk for injury
B) Post-trauma response
C) Disturbed thought processes
D) Risk for other-directed violence

Question 10

Which is an effective nursing intervention to assist an angry patient to learn to manage anger without violence?

A) Help the patient identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking.
B) Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present.
C) Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings.
D) Administer an antipsychotic or antianxiety medication when the patient feels angry.

Question 11

Which scenario predicts the highest risk for directing violent behavior toward others?

A) Major depressive disorder with delusions of worthlessness
B) Obsessive-compulsive disorder; performing many rituals
C) Paranoid delusions of being followed by a military attack team
D) Completion of alcohol withdrawal and beginning a rehabilitation program

Question 12

A patient has been responding to auditory hallucinations throughout the day. The patient approaches the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse follows the patient into the day room, the nurse should:

A) make sure adequate physical space exists between the nurse and the patient.
B) move into a position that allows the patient to be close to the door.
C) maintain one arm's length distance from the patient.
D) sit down in a chair near the patient.

Question 13

An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive. The patient is in the day room where there are other patients. The nurse should enter the day room:

A) and say, "Would you like to come to your room and take some medication your doctor prescribed for you?"
B) accompanied by three staff members and say, "Please come to your room so I can give you some medication that will help you feel more comfortable."
C) and place the patient in a basket-hold and then say, "I am going to take you to your room to give you an injection of medication to calm you."
D) accompanied by two security guards and tell the patient, "You can come to your room willingly so I can give you this medication or the security guards will take you there."

Question 14

After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse says, "I dread facing potentially violent patients." Which response would be the most urgent reason for this nurse to seek supervision?

A) Startle reactions
B) Difficulty sleeping
C) A wish for revenge
D) Preoccupation with the incident

Question 15

A patient has a history of impulsively acting out anger by striking others. Which would be an appropriate plan for avoiding such incidents?

A) Explain that restraint and seclusion will be used if violence occurs.
B) Help the patient identify incidents that trigger impulsive acting out.
C) Offer one-on-one supervision to help the patient maintain control.
D) Administer lorazepam (Ativan) every 4 hours to reduce the patient's anxiety.

Question 16

A confused older adult patient in a skilled care facility is sleeping. A health care worker enters the room quietly and touches the bed to see if it is wet. The patient awakens and hits the health care worker in the face. Which statement best explains the patient's action?

A) Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
B) Crowding in skilled care facilities increases individual tendencies toward violence.
C) The patient interpreted the health care worker's behavior as potentially harmful.
D) This patient learned violent behavior by watching other patients act out.

Question 17

A patient with a history of anger and impulsivity is hospitalized after an accident resulting in injuries. When in pain, the patient loudly scolds the nurse for "not knowing enough to give me pain medicine when I need it." Which intervention would best address this problem?

A) Tell the patient to notify the nurse 30 minutes before the pain returns so the medication can be prepared.
B) Urge the health care provider to change the prescription for pain medication from as needed to a regular schedule.
C) Tell the patient that verbal assaults on nurses will not shorten the wait for pain medication.
D) Have the clinical nurse leader request a psychiatric consultation.

Question 18

A patient is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:

A) "What is going on?"
B) "Quiet down immediately. You are scaring others."
C) "I'd like to talk with you about how you're feeling right now."
D) "You must go to your room and try to get control of yourself."

Question 19

Which assessment finding presents the greatest risk for violent behavior? A patient who:

A) is severely agoraphobic.
B) has a history of intimate partner violence.
C) complains of bizarre somatic delusions.
D) verbalizes hopelessness and powerlessness.

Question 20

A patient with severe physical injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which intervention uses a cognitive technique to help this patient?

A) Discontinue the dressing change without comments and leave the room.
B) Stop the dressing change, saying, "Perhaps you would like to change your own dressing."
C) Continue the dressing change, saying, "Do you know this dressing change is needed so your wound will not get infected?"
D) Continue the dressing change, saying, "Unfortunately, you have no choice. Your doctor ordered this dressing change."

Question 21

What information from a patient's record indicates compromised coping skills and the need for careful assessment of the risk for violence? A history of:

A) childhood trauma.
B) family involvement.
C) academic problems.
D) daily substance abuse.

Question 22

A nurse directs the intervention team who must take an aggressive patient to seclusion. Other patients were removed from the area. Before approaching the patient, the nurse should ensure that which actions are taken by staff? (Select all that apply.)

A) Remove jewelry, glasses, and harmful items from the patient and staff members.
B) Appoint a person to clear a path and open, close, or lock doors.
C) Quickly approach the patient, and grab the closest extremity.
D) Select the person who will communicate with the patient.
E) Move behind the patient to use the element of surprise.

Question 23

Which central nervous system structures are most associated with anger and aggression? (Select all that apply.)

A) Amygdala
B) Cerebellum
C) Basal ganglia
D) Temporal lobe
E) Parietal lobe

Question 24

A patient diagnosed with pneumonia has been hospitalized for 4 days. Family members describe the patient as "a difficult person who finds fault with others." The patient verbally abuses nurses for providing poor care. The most likely explanation for this behavior lies in:

A) poor childrearing that did not teach respect for others.
B) automatic thinking, leading to cognitive distortion.
C) personality style that externalizes problems.
D) delusions that others wish to deliver harm.

Question 25

Which behaviors are most consistent with the clinical picture of a patient who is becoming increasingly aggressive? (Select all that apply.)

A) Pacing
B) Crying
C) Withdrawn affect
D) Rigid posture with clenched jaw
E) Staring with narrowed eyes into the eyes of another

Question 26

When a patient's aggression quickly escalates, which principle applies to the selection of nursing interventions?

A) Staff members should match the patient's affective level and tone of voice.
B) Ask the patient what intervention would be most helpful.
C) Immediately use physical containment measures.
D) Begin with the least restrictive measure possible.

Question 27

A patient with burn injuries has had good coping skills for several weeks. Today, a new nurse is poorly organized and does not follow the patient's usual schedule. By mid-afternoon, the patient is angry and loudly complains to the nurse manager. Which is the nurse manager's best response?

A) Explain the reasons for the disorganization, and take over the patient's care for the rest of the shift.
B) Acknowledge and validate the patient's distress and ask, "What would you like to have happen?"
C) Apologize and explain that the patient will have to accept the situation for the rest of the shift.
D) Ask the patient to control the anger and explain that allowances must be made for new staff members.

Question 28

A new patient immediately requires seclusion on admission. The assessment is incomplete, and the health care provider has not examined the patient. Immediately after safely secluding the patient, which action has priority?

A) Provide an opportunity for the patient to go to the bathroom.
B) Notify the health care provider and obtain a seclusion order.
C) Notify the hospital risk manager.
D) Debrief the staff.

Question 29

A patient with a history of command hallucinations approaches the nurse, yelling obscenities. The patient mumbles and then walks away. The nurse follows. Which nursing actions are most likely to be effective in de-escalating this scenario? (Select all that apply.)

A) State the expectation that the patient will stay in control.
B) State that the patient cannot be understood when mumbling.
C) Tell the patient, "You are behaving inappropriately."
D) Offer to provide the patient with medication to help.
E) Speak in a firm but calm, caring voice.

Question 30

Because an intervention is required to control a patient's aggressive behavior, a critical incident debriefing takes place. Which topics should be the focus of the discussion? (Select all that apply.)

A) Patient behavior associated with the incident
B) Genetic factors associated with aggression
C) Intervention techniques used by staff
D) Effect of environmental factors
E) Review of theories of aggression