Chapter 24: Anger, Aggression, and Violence Flashcards
- Which behavior best demonstrates aggression?
a. Stomping away from the nurses station, going 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.
ANS: A
Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not feature violation of anothers rights.
- 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
ANS: C
The correct answer illustrates the greatest disruption of ability to perceive reality accurately. People who feel persecuted may strike out against those believed to be persecutors. The patients identified in the distractors have better reality-testing ability.
- A patient is hospitalized after an arrest for breaking windows in the home of a former domestic 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
ANS: D
The defining characteristics for Risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. The defining characteristics for the other diagnoses are not present in this scenario.
- A confused older adult patient in a skilled care facility is sleeping. The nurse enters the room quietly and touches the bed to see if it is wet. The patient awakens and hits the nurse in the face. Which statement best explains the patients 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 workers behavior as potentially harmful.
d. This patient learned violent behavior by watching other patients act out.
ANS: C
Confused patients are not always able to evaluate accurately the actions of others. This patient behaved as though provoked by the intrusive actions of the staff member.
- 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. Hey, whats going on?
b. Please quiet down immediately.
c. Id like to talk with you about how youre feeling right now.
d. You must go to your room and try to get control of yourself.
ANS: C
Intervention should begin with an analysis of the patient and situation. With this response, the nurse is attempting to hear the patients feelings and concerns, which leads to the next step of planning an intervention. The incorrect responses are authoritarian, creating a power struggle between the patient and nurse.
- A patient was responding to auditory hallucinations earlier in the morning. 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 arms length distance from the patient.
d. sit down in a chair near the patient.
ANS: A
Making sure space is present between the nurse and the patient avoids invading the patients personal space. Personal space needs increase when a patient feels anxious and threatened. Allowing the patient to block the nurses exit from the room is not wise. Closeness may be threatening to the patient and provoke aggression. Sitting is inadvisable until further assessment suggests the patients aggression is abating. One arms length is inadequate space.
- An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming increasingly more aggressive. The patient is in the day room. 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 aide and I will take you there.
ANS: B
A patient gains feelings of security if he or she sees that others are present to help with control. The nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that the intervention will be helpful. This positive approach assumes that the patient can act responsibly and will maintain control. Physical control measures should be used only as a last resort. The security guards are likely to intimidate the patient and increase feelings of vulnerability.
- 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
ANS: C
The desire for revenge signals an urgent need for professional supervision to work through anger and counter the aggressive feelings. The distractors are normal in a person who has been assaulted. Nurses are usually relieved with crisis intervention and follow-up designed to give support, help the individual regain a sense of control, and make sense of the event.
- 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
ANS: A
Intervention techniques are learned behaviors that must be practiced to be used in a smooth, organized fashion. Every member of the intervention team should be assigned a specific task to carry out before beginning the intervention. The other options are useless if the staff does not know how to use physical techniques and how to apply them in an organized fashion.
- An adult patient assaults another patient and is restrained. One hour later, which statement by this restrained patient necessitates the nurses 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.
ANS: B
The correct response indicates impaired circulation and necessitates the nurses immediate attention. The incorrect responses indicate that the patient has continued aggressiveness and agitation.
- 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.
ANS: A
Anger has a strong cognitive component; therefore, using cognition to manage anger is logical. The incorrect options do nothing to help the patient learn anger management.
- 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. demonstrates bizarre somatic delusions.
d. verbalizes hopelessness and powerlessness.
ANS: B
A history of prior aggression or violence is the best predictor of patients who may become violent. Patients diagnosed with anxiety disorders are not particularly prone to violence unless panic occurs. Patients experiencing hopelessness and powerlessness may have co-existing anger, but violence is not often demonstrated. Patients experiencing paranoid delusions are at greater risk for violence than those with bizarre somatic delusions.
- 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. presents a clear escape risk.
d. is psychotic.
ANS: B
The patients threat to kill self or others with the knife he possesses constitutes a clear and present danger to self and others. The distractors are not sufficient reasons for seclusion.
- 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.
ANS: D
The description of the patients behavior shows the classic signs of someone whose potential for aggression is increasing.
- 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 husbands dinner?
d. Was your husband angry if you did not have dinner ready on time?
ANS: C
Validation therapy meets the patient where she or he is at the moment and acknowledges the patients wishes. Validation does not seek to redirect, reorient, or probe. The incorrect options do not validate the patients feelings.
