Question 1

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.

Accepted Answer

The nurse should suspect compromised coping skills in a patient with daily substance abuse. He or she is often anxious, may be concerned about inadequate pain relief, and may have a personality style that externalizes blame. The incorrect options do not signal as high a degree of risk as substance abuse.

Question 2

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.

Accepted Answer

Injury to staff members and to the patient should be prevented. Only one person should explain what will happen and direct the patient; this person might be the nurse or staff member who has a good relationship with the patient. A clear pathway is essential; those restraining a limb cannot use keys, move furniture, or open doors. The nurse is usually responsible for administering the medication once the patient is restrained. Each staff member should have an assigned limb rather than just grabbing the closest limb. This system could leave one or two limbs unrestrained. Approaching in full view of the patient reduces suspicion.

Question 3

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

Accepted Answer

The amygdala mediates anger experiences and helps a person judge an event as either rewarding or aversive. The temporal lobe, which is part of the limbic system, also plays a role in aggressive behavior. The cerebellum manages equilibrium, muscle tone, and movement. The basal ganglia are involved in movement. The parietal lobe is involved in interpreting sensations.

Question 4

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.

Accepted Answer

Patients whose personality style causes them to externalize blame see the source of their discomfort and anxiety as being outside themselves. They displace anger and are often unable to soothe themselves. The incorrect options are less likely to have a bearing on this behavior.

Question 5

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

Accepted Answer

Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently. The other behaviors are consistent with the increased risk for other-directed violence.

Question 6

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.

Accepted Answer

Standards of care require that staff members use the least restrictive measure possible. This becomes the guiding principle for intervention. Physical containment is seldom the least restrictive measure. Asking the out-of-control patient what to do is rarely helpful. It may be an effective strategy during the pre-assaultive phase, but is less effective during escalation.

Question 7

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.

Accepted Answer

When a patient with good coping skills is angry and overwhelmed, the goal is to reestablish a means of dealing with the situation. The nurse should solve the problem with the patient's input by acknowledging the patient's feelings, validating them as understandable, apologizing if necessary, and then seeking an acceptable solution. Often patients can tell the nurse what they would like to have happen as a reasonable first step.

Question 8

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.

Accepted Answer

Emergency seclusion can be effected by a credentialed nurse, but must be followed by securing a medical order within the period specified by the state and agency. The incorrect options are not immediately necessary from a legal standpoint.

Question 9

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.

Accepted Answer

Stating the expectation that the patient will maintain control of behavior reinforces positive, healthy behavior and avoids challenging the patient. Offering an as-needed medication provides support for the patient trying to maintain control. A firm but calm voice will likely comfort and calm the patient. Belittling remarks may lead to aggression. Criticism will probably prompt the patient to begin shouting.

Question 10

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

Accepted Answer

The patient's behavior, the intervention techniques used, and the environment in which the incident occurred are important to establish realistic outcomes and effective nursing interventions. Discussing the views about the theoretical origins of aggression is less effective.

Quiz 24: Anger, Aggression, and Violence

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 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.)

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

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:

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

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

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 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 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.)

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.)