Violence

Question 1

Appropriate medication to manage long-term anger with impulsive violence.

Answer 1

SSRI

Question 2

Med management of aggression associated with mania, seizure disorders, brain injury.

Answer 2

Mood stabilizers

Question 3

Med management for impulsive anger and agitation in ADHD

Answer 3

Clonidine or Tenex (guanfacine)

Question 4

Med management of intermittent explosive disorder

Answer 4

Depakote or lamictal

Question 5

Med management of aggression in children and adolescents with autism

Answer 5

Risperdal

Question 6

Ascertain cause of changes in patient behavior; triggering event may be internal or external. First technique: offer self and active listening, discover underlying emotion causing behavior. Second technique: supportive problem solving to alleviate distress, identify source of frustration and practical ways to attain unmet needs, and identify source of anger and methods to reduce sense of threat/harm. I.e use of stress model for emotional arousal related to fear and anxiety or frustration and anger.

Answer 6

Management of early escalation

Question 7

Patient is fully stimulated, engage in crisis communication not problem solving, respond to emotion driving escalation, minimal words, simple enforceable limits/simple choices. Determine if fearful and anxious or frustrated and angry.

Answer 7

Management of late escalation

Question 8

Threat reduction skills of standing 5-8 ft away at angle, maintain relaxed posture, keep hands visible, speak in low confident tone, keep expression neutral, allow patient to determine eye contact, offer help, deny intent to harm, and ask patient what is needed to feel safe.

Answer 8

Fearful and anxious escalation

Question 9

Exert control by standing at angle directly out of reach, use pointed gestures, maintain ready/non-aggressive posture, speak in soft firm tone, give simple commands, repeat until directions followed.

Answer 9

Frustrated and angry

Question 10

Patient in panic and striking out. Remove self and vulnerable people out of range but remain available for de-escalation. Do not attempt to problem solve until patient reaches stability.

Answer 10

Crisis

Question 11

Intentional injury or harm to an individual which may include emotional, psychological, physical and sexual.

Answer 11

Abuse

Question 12

Failure to fulfill caretaking functions either knowingly or accidentally.

Answer 12

Neglect

Question 13

In addition to physical indicators, may also be wary or overly attached to adults, frightened of parents, constant effort to please parents, have behavioral extremes, fear of going home, calls attention to self, monosyllabic speech, sexually inappropriate behavior, fear of going to bathroom or changing clothing, regressed or infantile behavior, suicidal or self-destructive behavior. Parents may express lack of concern for child health or injuries or may blame child for clumsiness, be overly responsive in view of others or ascribe malevolent intentionality to child’s behavior/acts.

Answer 13

Signs of child abuse

Question 14

Somatic symptoms of unknown cause and multiple provider visits for different issues, physical injuries including burns/bruises/scarring, “accidents/falls”, incongruence in explanation of injuries, depressed mood, anxious, sleep problems, substance use.

Answer 14

Signs of abuse of adult (dependent or otherwise)

Question 15

Mandated reporting of all suspected child abuse/maltreatment, and abuse/neglect/exploitation of endangered or impaired adult, except (without victim consent):

Answer 15

Intimate partner violence or sexual assault

Question 16

Arrange for safe environment/plan for safety, prevent further abuse through referrals for medical treatment or social work, shelters, support groups/counseling, psychoeducation, psychotherapy if appropriate (CBT, EMDR, trauma-informed, family therapy, group therapy), and med management as appropriate for symptoms (SSRIs, anxiolytics, sleep aids/hypnotics, prazosin for nightmares).

Answer 16

Nursing care of abuse/trauma victim