Question 1

A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, "Back off!" and then goes to the day room. While following the patient into the day room, the nurse should do which of the following?

Accepted Answer

The nurse should ensure there is adequate physical space between themselves and the patient to maintain safety and reduce the potential for escalation of aggression.

Question 2

A confused older adult patient in a nursing home was asleep when unlicensed assistive personnel (UAP) entered the room quietly and touched the bed to see if it was wet. The patient awakened and hit the UAP in the face. Which statement best explains the patient's action?

Accepted Answer

The patient likely perceived the UAP's action as a threat or intrusion, leading to a defensive reaction.

Question 3

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

Accepted Answer

Patient-controlled analgesia allows the patient to manage their pain relief, reducing frustration and anger associated with waiting for medication.

Question 4

A patient was arrested for breaking windows in the home of a former domestic partner. The patient's history also reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority?

Accepted Answer

The patient's history of breaking windows at the home of a former domestic partner, childhood abuse, and torturing family pets suggests a pattern of violent behavior towards others. This places the patient at risk for other-directed violence and requires immediate attention and intervention to prevent harm to others.

Question 5

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

Accepted Answer

The statement "My fingers are tingly" could indicate that the restrained patient is experiencing impaired circulation or nerve damage from the restraints, which requires immediate attention from the nurse. The other statements may require attention, but not as urgently as potential physical harm to the patient.

Question 6

Which behaviour best demonstrates aggression?

Accepted Answer

Stomping away and grabbing a tray demonstrates physical aggression and a lack of control over emotions, which is characteristic of aggressive behavior.

Question 7

A patient sat in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stood, paced back and forth, clenched and unclenched fists, and then stopped and stared in the face of a staff member. Which of the following is the patient doing?

Accepted Answer

The patient's behavior, such as pacing, clenching fists, and staring, are common indicators of potential aggression or agitation.

Question 8

A patient with multi-infarct dementia lashes out and kicks at people who walk past in the hall of a nursing home. Intervention by the nurse should begin by which of the following?

Accepted Answer

The answer of A patient with multi-infarct dementia lashes out...

Question 9

Which assessment finding presents the greatest risk for violent behaviour directed at others?

Accepted Answer

Substance abuse disorder is associated with an increased risk of violent behavior due to impaired judgment, lowered inhibitions, and potential withdrawal symptoms.

Question 10

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

Accepted Answer

This approach is non-confrontational and shows empathy, inviting the patient to express their feelings and concerns, which can help de-escalate the situation.

Question 11

A patient has a history of impulsively acting out anger by striking others. Select the most appropriate intervention for avoiding similar incidents.

Accepted Answer

Identification of trigger incidents allows the patient and nurse to plan interventions to reduce irritation and frustration, which lead to acting-out anger, and eventually to put into practice more adaptive coping strategies.

Question 12

A cognitively impaired patient has been a widow for 30 years. This patient frantically tries to leave the facility, saying, "I have to go home to cook dinner before my husband arrives from work." To intervene with validation therapy, the nurse will say which of the following?

Accepted Answer

Validation therapy involves acknowledging the patient's feelings and experiences without correcting them, which helps to reduce anxiety and distress.

Question 13

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

Accepted Answer

Paranoid delusions, especially those involving being followed or persecuted, can lead to defensive or aggressive behavior as the individual may feel threatened and act out to protect themselves.

Question 14

Which medication from the medication administration record should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behaviour continues to escalate despite verbal intervention?

Accepted Answer

The answer of Which medication from the medication administration record...

Question 15

A patient with severe injuries is irritable and 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 the patient?

Accepted Answer

This response uses a cognitive technique by providing the patient with information about the necessity of the dressing change, which may help the patient understand the rationale and reduce anxiety or resistance.

Question 16

After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse says, "That patient should not be allowed to get away with that behaviour." Which of the following responses poses the greatest barrier to the nurse's ability to provide therapeutic care?

Accepted Answer

A wish for revenge indicates unresolved anger and a desire for retribution, which can hinder the nurse's ability to provide unbiased and compassionate care.

Question 17

The staff development coordinator plans to teach physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize?

Accepted Answer

Practice and teamwork are crucial in managing assaultive behavior safely and effectively, ensuring that staff can respond in a coordinated and controlled manner.

Question 18

An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive and refusing to leave the day room. Which of the following should the nurse do?

Accepted Answer

The nurse should approach the situation with a calm and assertive demeanor, accompanied by staff for safety, and communicate clearly to the patient about the need for medication to help regain control. This approach balances safety, respect, and the need for medication.

Question 19

An emergency code was called after a patient pulled a knife from a pocket and threatened, "I will kill anyone who tries to get near me." The patient was safely disarmed and placed in seclusion. What was the justification for use of seclusion?

Accepted Answer

The justification for the use of seclusion was that the patient presented a clear and present danger to others, as evidenced by the threat to kill anyone who approached.

Question 20

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

Accepted Answer

Helping the patient identify and evaluate thoughts that produce anger and substituting them with reality-based thinking is a cognitive-behavioral approach that can effectively help manage anger without resorting to violence.

Quiz 23: Anger, Aggression, and Violence