Deck 16: Anger and Aggression Management

Question 1

Once the nurse initiates restraint for an out-of-control 45-year-old patient,per JCAHO standards,what must occur within 1 hour?

A)The patient must be let out of restraint.
B)A physician or other LIP must conduct an in-person evaluation.
C)The patient must be bathed and fed.
D)The patient must be included in debriefing.

Answer 1

A physician or other LIP must conduct an in-person evaluation.

Question 2

Physical restraints are sometimes a necessary intervention for clients.This is based on which premise?

A)Clients with poor boundaries do not respond to verbal redirection,and they need firm and consistent limit setting.
B)Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others.
C)Clients with antisocial tendencies need to submit to authority.
D)Clients with behavioral dysfunction need behavioral interventions.

Answer 2

Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others.

Question 3

An adult client assaults another client and is placed in restraints.Which client statement alerts the nurse that further assessment is necessary?

A)"I hate all of you!"
B)"My fingers are tingly."
C)"You wait until I tell my lawyer."
D)"I have a sinus headache."

Answer 3

"My fingers are tingly."

Question 4

On an inpatient psychiatric unit,a restrained 16-year-old client continues to lash out verbally and threatens to abuse staff and kill self when released.Per JCAHO standards,when does the nurse expect the physician or LIP to renew the client's restraint order?

A)Within 1 hour of the original restraint order
B)Within 2 hours of the original restraint order
C)Within 3 hours of the original restraint order
D)Within 4 hours of the original restraint order

Question 5

A client begins to smash furniture,cannot be "talked down," and refuses medications.Which is the priority nursing intervention?

A)Call a violence code.
B)Ask the ward clerk to put in a call for the physician.
C)Place the client in seclusion.
D)Place the client in four-point restraints.

Question 6

A student nurse has just entered a psychiatric rotation.The student asks a nursing instructor,"How will we know if someone may get violent?" Which is the most appropriate reply by the nursing instructor?

A)"You can't really say for sure.There are limited indicators of potential violence."
B)"Certain behaviors indicate a potential for violence.They are labeled as a 'prodromal syndrome' and include rigid posture,clenched fists,and raised voice."
C)"Any client can become violent,so it is best to be aware of your surroundings at all times."
D)"When a client suddenly becomes quiet,is withdrawn,and maintains a flat affect,this is an indicator of potential violence."

Question 7

The nurse observes a client's escalating anger.The client begins to pace the hall and shouts,"You all better watch out.I'm going to hurt anyone who gets in my way." Which is the priority nursing intervention?

A)Calmly tell the client,"Staff will help you to control your impulse to hurt others."
B)Remove other clients from the area and maintain milieu safety.
C)Gather a show of force by contacting security for assistance.
D)Calmly tell the client,"You will need to be medicated and secluded."

Question 8

When least restrictive methods fail for an angry,aggressive client,a physician orders restraints at 3 a.m.Per JCAHO standards,at what time and by whom does the nurse expect an in-person client evaluation?

A)No later than 8 a.m. ,by a LIP or a clinical nurse specialist
B)No later than 4 a.m. ,by a physician or a LIP
C)No later than 3:30 a.m. ,by a physician or the client's case manager
D)No later than 6 a.m. ,by the psychiatrist or a clinical nurse specialist

Question 9

A client diagnosed with Paranoid Schizophrenia has a history of aggravated assault.The nurse assigns "Risk for other-directed violence" as the client's priority nursing diagnosis.Which is an appropriate,correctly written outcome for the client?

A)The client will not verbalize anger or hit anyone.
B)The client will verbalize anger rather than hit others.
C)The client will not inflict harm on others during this shift.
D)The client will be restrained if verbal or physical abuse is observed during this shift.

Question 10

After the client's restraints are removed,the staff discusses the incident and establishes guidelines for the client's return to the therapeutic milieu.Which unit procedure is the staff implementing?

A)Milieu reenactment
B)Treatment planning
C)Crisis intervention
D)Debriefing

Question 11

A nursing instructor is teaching about the concept of anger.Which student statement indicates the need for further instruction?

A)"Anger is physiological arousal."
B)"Anger and aggression are essentially the same."
C)"Anger expression is a learned response."
D)"Anger is not a primary emotion."

Question 12

Which client statement demonstrates improvement in anger and aggression management?

A)"I realize I have a problem expressing my anger appropriately."
B)"I know I can't use physical force anymore,but I can intimidate someone with my words."
C)"It's bad to feel as angry as I feel.I'm working on eliminating this poisonous emotion entirely."
D)"Because my wife seems to be the one to set me off,I've decided to remain separated from her."

Question 13

After less restrictive means have been attempted,an order for client restraints has been obtained for a hostile,aggressive 30-year-old client.If client aggression continues,how long will the nurse expect the client to remain in restraints without a physician order renewal?

A)1 hour
B)2 hours
C)3 hours
D)4 hours

Question 14

Which risk factor should a nurse recognize as the most reliable indicator of potential client violence?

A)A diagnosis of schizotypal personality disorder
B)History of assaultive behavior
C)Family history of violence
D)Recent eviction from a homeless shelter

Question 15

A nursing instructor is teaching about violence-intervention protocols.Which student statement indicates the need for further instruction?

A)"Administering psychotropic medications can be a part of violence-intervention protocols."
B)"Soothing the client by stroking an arm or shoulder can be a part of violence-intervention protocols."
C)"Applying leather restraints can be a part of violence-intervention protocols."
D)"Calling for assistance is a part of violence-intervention protocols."

Question 16

A nurse is caring for four clients.Which client does the nurse identify is least prone to developing problems with anger and aggression?

A)A child raised by a physically abusive parent
B)An adult with a history of epilepsy
C)A young adult living in the ghetto of an inner city
D)An adolescent raised by Scandinavian immigrant parents

Question 17

A client diagnosed with Brief Psychotic Disorder is pacing the milieu and occasionally punches the wall.Which is the initial nursing action?

A)Assertively instruct the client to stop punching the wall.
B)Encourage the client to write down feelings in a journal.
C)With the help of staff,initiate seclusion protocol.
D)Ensure adequate physical space between the nurse and the client.

Question 18

Which initial nursing approach assists clients who are aggressively acting out to accept limit setting better?

A)Confronting clients with their needs for secondary gains
B)Teaching relaxation techniques
C)Empathizing with the client about the client's distress
D)Presenting appropriate values that need to be modified

Question 19

A client is served divorce papers while on the inpatient psychiatric unit.When the nurse tells the client that the unit telephone cannot be used after hours,the client raises his fists,swears,and spits at the nurse.Which negative coping mechanism is the client exhibiting?

A)The defense mechanism of projection
B)The defense mechanism of reaction formation
C)The defense mechanism of sublimation
D)The defense mechanism of displacement

Question 20

The client states,"I get into trouble because I respond violently without thinking.That usually gets me into a mess." Which nursing reply is most therapeutic?

A)"Everybody loses their temper.It's good that you know that about yourself."
B)"I'll bet you have some interesting stories to share about overreacting."
C)"Let's explore methods to help you stop and think before taking action."
D)"It's good that you are showing readiness for behavioral change."

Question 21

A person who demonstrates the ability to exert _________ __________ over feelings of anger would demonstrate a successful nursing outcome in the care of the client needing assistance with anger management.

Question 22

___________ ____________ is a personal signal of threat or injustice against the self.The signal elicits coping responses to deal with the distress.

Question 23

Which of the following statements about anger are true? Select all that apply.

A)Anger is not a primary emotion.
B)Anger is physiological arousal.
C)Anger reflects a desire for dominance and control.
D)Anger,in general,may range from a self-protective response to a destructive,violent act.

Question 24

When assessing for _______________,the nurse would observe pacing,defensive posturing,increased agitation,and restlessness.

Question 25

Which of the following client statements would appear in a nursing assessment of a person exhibiting the appropriate expression of anger?

A)"I'm sick and tired of my family asking me how I am doing.How do they think I'm doing?"
B)"I wonder how he would feel if I got drunk then drove head-on into his wife's car?"
C)"I hit the wall and broke a table.It's not like I hit my wife or anything."
D)"I don't really hit my kids.I just tell them I'm going to beat their backside if they don't clean their room."

Question 26

Yelling,name calling,hitting others,and temper tantrums as expressions of anger are all evidence supporting which nursing diagnosis?

A)Risk for self-directed or other-directed violence related to socioeconomic factors
B)Anger related to dysfunctional relationships and ineffective coping skills
C)Ineffective coping related to negative role modeling and dysfunctional family systems
D)Complicated grieving related to a loss

Question 27

Which nursing approach is likely to be most therapeutic when dealing with a newly admitted,hostile,suspicious client?

A)Place a hand on the client's shoulder and state,"I will help you to your room."
B)Slowly and matter-of-factly state,"I am your nurse and I will show you to your room."
C)Firmly set limits by stating,"If your behavior does not improve you will be secluded."
D)Smile and state,"I am your nurse.When do you want to go to your room?"

Question 28

What is likely to happen if anger is communicated passive-aggressively or aggressively?

A)The individual uses the power to intimidate others.
B)It is discharged against an object or person unrelated to the true target of the anger.
C)Impulsive behavior can result,disregarding possible negative consequences.
D)Conflict escalates,and the problem that created the conflict goes unresolved.

Question 29

A nurse notices a client clenching fists periodically and pacing the hallway.Which nursing interventions should the nurse implement? Select all that apply.

A)Acknowledge the client's behavior.
B)Initiate forced medication protocol.
C)Assist the client to a quiet area.
D)Initiate confinement measures.
E)Speak with a soft and calming voice.

Question 30

A female client arrives at her primary care physician with complaints of increased symptoms of colitis.During the intake interview,the patient mentions having two migraines in the past 3 weeks and asks for a new medication,stating,"It doesn't seem like the current medication is working as well as I expected." In reviewing her medical record,it is noted that the client was prescribed medication for depression and a referral to a marriage counselor at her last visit 2 months ago.Which of the following might the nurse suspect given the aforementioned information?

A)Maladaptive expression of anger
B)Hypersensitivity to migraine medication
C)Exhibiting signs of domestic abuse
D)Operant conditioning