Deck 25: Aggression and Violence

Question 1

A patient presents for an annual physical. As the nurse conducts the assessment, which statement will suggest the patient is experiencing workplace bullying?

A) "My manager has not given me a raise in over 10 years."
B) "My manager criticizes my work all the time, despite the fact that my annual performance review is always positive."
C) "My manager does not invite me to team meetings and I miss out on important information, affecting my annual performance review."
D) "My manager does not provide any positive feedback on my work at all and my annual performance review remains unchanged."

Answer 1

"My manager does not invite me to team meetings and I miss out on important information, affecting my annual performance review."

Question 2

The nurse is caring for a patient with a history of violent behaviors. Which nursing interventions are most likely to prevent the patient from responding with aggressive or violent behavior? Select all that apply.

A) Address the patient's anxiety as needed.
B) Determine the patient's coping mechanisms.
C) Ensure the patient's needs are met in a timely manner.
D) Assess the patient's family history of violent behaviors.
E) Avoid intervention with the patient if he or she is displaying aggression.

Answer 2

Address the patient's anxiety as needed.
Determine the patient's coping mechanisms.
Ensure the patient's needs are met in a timely manner.

Question 3

A patient tells the nurse, "I have been waiting two hours to be discharged. What is the problem?" The patient is pacing the room and glaring at staff members. What is the nurse's best action to prevent patient aggression?

A) Call hospital security to be prepared if the patient becomes aggressive.
B) Ask the patient to remain seated and retrieve the patient's discharge paperwork.
C) Acknowledge the patient's feelings and leave the room in order to avoid confrontation.
D) Acknowledge the patient's feelings and determine the status of the patient's discharge paperwork.

Answer 3

Acknowledge the patient's feelings and determine the status of the patient's discharge paperwork.

Question 4

The nurse manager is teaching the staff nurses in the emergency department about violence in health care settings. What information will the nurse include when teaching about hospital risk factors that increase risk of violence? Select all that apply.

A) High census levels
B) Low staffing levels
C) Characteristics of staff
D) Characteristics of services delivered
E) Waiting times for services delivered

Question 5

The nurse manager is providing education to staff regarding the prevention of workplace aggression. Which statement, made by a staff nurse, best displays that teaching has been effective?

A) "Cyberbullying does not typically occur in the hospital environment."
B) "Bullying may occur in social groups as well as professional groups."
C) "Type IV aggression may occur if a staff member is injured by a patient."
D) "Type I aggression may occur if a staff member is injured by another staff member."

Question 6

The nurse preceptor is caring for a patient who has a history of aggressive behavior. The novice nurse asks, "Why is the patient taking a cardiac medication if he does not have a heart condition?" What is the preceptor's best response?

A) "Calcium channel blockers increase dopamine levels, decreasing the risk of violence."
B) "Calcium channel blockers decrease dopamine levels, decreasing the risk of violence."
C) "Beta-adrenergic agonists decrease norepinephrine levels, decreasing the risk of violence."
D) "Beta-adrenergic antagonists decrease norepinephrine levels, decreasing the risk of violence."

Question 7

The nurse is caring for a patient who is making obscene gestures to other staff members and is raising his voice in protest of an ordered test. What is the nurse's best action?

A) Determine the patient's level of anxiety.
B) Determine what basic patient needs are not being met.
C) Review the patient's chart for previous violent episodes.
D) Contact the health care provider regarding the patient's actions.

Question 8

A nurse educator is teaching a group of staff nurses on environmental risk factors that may lead to violence in the psychiatric setting. Which response by the staff nurse demonstrates that teaching has been effective?

A) "I will maintain the established patient routines."
B) "I will carefully manage patient transitions of care."
C) "I will allow visitors in the patient's room as permitted."
D) "I will assist the patient to maintain self-care."

Question 9

The nurse educator is presenting a review course on workplace safety and prevention of aggression. The nurse discusses the various types of workplace aggression. Which action will the nurse manager recommend for nurses to take to prevent type I aggression while at work?

A) Recognize escalating anxiety in visitors and family members of patients.
B) Report to the charge nurse when a health care provider gets angry at the nurse.
C) Report to the charge nurse any threats that a colleague or peer makes to the nurse.
D) Have a security guard escort the nurse outside if it is dark when the nurse leaves.

Question 10

The nurse educator is teaching an in-service on the recognition of patient aggression within the hospital. One of the nurse participants is asked to classify her patient's behavior to determine if the patient is at risk for aggression. Which patient does the nurse classify as displaying manifestations that may lead to aggression? Select all that apply.

A) 47-year-old female who appears fearful and angry
B) 20-year-old male who is experiencing acute anxiety
C) 25-year-old female who is experiencing sadness regarding a death in the family
D) 75-year-old male who is expressing frustration due to a delay in hospital discharge
E) 36-year-old male who has expressed apprehension regarding his upcoming medical procedure

Question 11

The nurse is researching violence in the community as part of a community health assessment. Using the broken windows theory, which factor will the nurse research?

A) Level of finances of the community members
B) Level of parental guidance in the community members
C) Level of education in both the community members and the larger society
D) Level of engagement by both the community members and the larger society

Question 12

A nurse is conducting a community risk assessment of the relationship between mental health and violence in the community. Which components would it be important for the nurse to include in the assessment? Select all that apply.

A) A method to determine the prevalence of violence within the community
B) A method to sample a diverse group of individuals across various communities
C) A method to determine the prevalence of mental disorders within the community
D) A method to quantify the number of individuals within the community who have mental illness and are currently being treated for the condition.
E) A method to quantify the number of individuals within the community who have mental illness and are not currently being treated for the condition.

Question 13

The nurse is conducting research on violence in the community for a community health assessment. Which socioeconomic factors will the nurse include in the research? Select all that apply.

A) Age
B) Race
C) Poverty
D) Inequality
E) Substance use

Question 14

The staff nurses at a local psychiatric unit are participating in a skills refresher day. The nurse manager is presenting information for the staff regarding the different types of workplace aggression. What information will the nurse manager include in the teaching, when discussing prevention of the various types of workplace aggression?

A) Installing metal detectors at the hospital entrance may help to prevent type IV aggression
B) Promoting and establishing interpersonal relationships may help to prevent type III aggression
C) Improving the lighting in the parking lot of the hospital may help to prevent type II aggression
D) Limiting the number of visitors and family members in the hospital may help to prevent type I aggression

Question 15

The school nurse is a member of the school's student support team. The team is meeting with parents of one of the football players to discuss his increasingly aggressive behaviors. Which risk factors will the nurse be prepared to discuss? Select all that apply.

A) Age
B) Ethnicity
C) Substance use
D) Parental occupation
E) History of head injury

Question 16

The nurse manager is reviewing risk factors for workplace aggression during a monthly staff meeting. The nurse manager includes risk factors for aggression related to the psychiatric patient population. Which statement by the staff nurse indicates that teaching has been effective?

A) "Patients who are being treated for depression have an increased risk for aggression."
B) "Patients who have been diagnosed with dementia have an increased risk for aggression."
C) "Patients who are receiving group therapy for somatic symptom disorders have an increased risk for aggression."
D) "Patients who are receiving cognitive-behavioral therapy for eating disorders have an increased risk for aggression."

Question 17

The nurse educator is teaching a review course to the staff nurses on the role of neurobiology in aggressive behavior. The nurse educator asks a staff nurse to identify the patient on the unit who is most at risk for aggression, based on neurobiology. Which statement by the staff nurse indicates that the teaching has been effective?

A) "A 73-year-old female with a history of chronic neuropathy."
B) "A 42-year-old female with a history of multiple sclerosis (MS)."
C) "A 55-year-old male with a history of chronic migraine headaches."
D) "A 32-year-old male with a history of a traumatic brain injury (TBI)."

Question 18

The nurse is caring for a patient with aggressive behavior. The health care provider has ordered a selective serotonin reuptake inhibitor (SSRI). The nurse is providing patient education related to the medication when the patient asks, "Why is this being prescribed for me? I'm not depressed." What is the nurse's best response? Select all that apply.

A) "SSRIs are sometimes used to minimize anxiety."
B) "SSRIs are sometimes used to minimize impulsivity."
C) "SSRIs are sometimes used to improve coping skills."
D) "SSRIs increase serotonin levels, decreasing aggression."
E) "SSRIs decrease serotonin levels, decreasing aggression."

Question 19

The nurse is working in the emergency department (ED) of a local hospital. Which response by a patient or family member would alert the nurse to the greatest risk for displaying aggression?

A) "My brother is in a lot of pain and can't get comfortable."
B) "I am worried about my husband's condition after his heart attack."
C) "I am nervous about the upcoming surgery to repair my broken arm."
D) "My mother is very short of breath but the medication seems to be helping."

Question 20

The nurse is conducting a health history on a newly admitted patient. The patient's wife tells the nurse, "Ever since my husband's head injury, he is easily agitated, cannot focus, and is impulsive." What is the best response from the nurse?

A) "Your husband's injuries may have damaged the prefrontal cortex of the brain, causing these symptoms."
B) "Your husband's injuries may have damaged the occipital lobe of the brain, causing these symptoms."
C) "Your husband's injuries may have damaged the parietal lobe of the brain, causing these symptoms."
D) "Your husband's injuries may have damaged the cerebellum of the brain, causing these symptoms."

Question 21

The nurse is caring for a patient who is verbally aggressive. What is the nurse's best response to the patient's behavior?

A) "Why are you so mad at me?"
B) "This behavior is unacceptable. I am here to help you."
C) "If you continue with this behavior, I will have to restrain you."
D) "I am going to call your health care provider for medication to calm you down."

Question 22

The nurse educator is providing education to the staff nurses regarding the use of seclusion in the psychiatric setting. The educator asks the nurses to describe patients who would best benefit from seclusion. Which statements by the nurses would indicate that teaching has been effective? Select all that apply.

A) "The patient who throws a book on the ground in frustration."
B) "The patient who is loud and disrupting the milieu of the unit."
C) "The patient who attempts to cut herself with an object found on the unit."
D) "The patient who hits another patient in the face during a therapy session."
E) "The patient who is confused and disoriented with altered thought processes."

Question 23

The nurse is caring for a patient whom the nurse suspects is a victim of intimate partner violence (IPV). What screening question made by the nurse is most appropriate?

A) "Can you tell me how you got your injuries?"
B) "Can you tell me if it is safe for you to go home?"
C) "Can you tell me what you know about intimate partner violence?"
D) "Can you tell me what your spouse was doing when you sustained your injuries?"

Question 24

The emergency department nurse educator is providing an in-service to the nursing staff on recognizing the signs and symptoms of interpersonal violence (IPV) and rape. Which assessment finding will the educator include in the teaching?

A) Sores around the mouth, brittle hair
B) Multiple bruises, abrasions at various stages of healing
C) Acting-out behaviors, disobedience, trouble with the law
D) Poor eye contact, depressed mood, unwillingness to give history data

Question 25

The nurse preceptor is caring for a patient in physical restraints who is aggressive and threatening the safety of the staff. The nurse preceptor discusses the implications and requirements of this procedure with a novice nurse. What statement made by the graduate nurse indicates that the nurse preceptor's teaching has been effective?

A) "It is acceptable for the nurse to monitor the patient in physical restraints every hour to ensure the patient's safety."
B) "It is acceptable to place the patient in physical restraints if pharmacological methods have been unsuccessful."
C) "It is acceptable for the health care provider to assess the patient in restraints within 24 hours of restraint application."
D) "It is acceptable for the nurse to turn and reposition the patient in physical restraints every 2 hours to ensure the patient's skin integrity."

Question 26

The nurse is caring for a patient who is a victim of interpersonal violence (IPV). What is the nurse's first priority?

A) Assist the patient to devise a safety or escape plan.
B) Encourage the patient to take charge of the situation.
C) Make it clear to the patient that the partner needs to see a therapist.
D) Offer to contact outpatient services if the patient promises not to return home after discharge.

Question 27

The graduate nurse is researching methods for maintaining resilience in stressful clinical situations. Which actions would the nurse employ, based on the core concept of resilience? Select all that apply.

A) Reading professional journals and maintaining continuing education
B) Choosing to work at a facility where the nurse enjoys the environment.
C) Participating in a staff debriefing after a difficult interaction in the unit
D) Joining a unit-based council that focuses on quality improvement
E) Teaching a seminar to a group of peers on a topic that the nurse enjoys

Question 28

The nurse is observing several patients who are in the activity room of the inpatient psychiatric facility. The nurse notices that one of the patients begins to get upset, raising her voice, pacing the room, and standing with clenched fists. What is the nurse's priority action?

A) Reorient the patient to person, place, and time.
B) Remove other patients from the room to provide more space.
C) Call the health care provider to obtain an order for anti-anxiety medication.
D) Call security and promptly isolate the patient and apply physical restraints.

Question 29

The nurse is caring for a victim of interpersonal violence who tells the nurse, "I am really scared about going back to my apartment. I am afraid my boyfriend might try to hurt me again." What is the nurse's best response?

A) Help the patient contact the police.
B) Help the patient develop a plan of safety.
C) Help the patient find a temporary, safe shelter.
D) Help the patient file a domestic violence report.

Question 30

The nurse assesses a patient and finds several old and fresh bruises in the abdominal area, as well as signs of malnutrition. What is the most appropriate question for the nurse to ask?

A) "Are you dieting?"
B) "Has someone been hurting you?"
C) "Do you have an alcohol problem?"
D) "Have you had any falls lately?"

Question 31

The parent of a patient in physical restraints asks the nurse, "Why is my son tied down? He wouldn't hurt anyone." What is the nurse's best response?

A) "The restraints are placed to control his behavior."
B) "The restraints are placed to prevent harm to him and others."
C) "The restraints are placed because he was angry to the staff."
D) "The restraints are placed to keep him from falling off the bed."

Question 32

A patient tells the nurse, "I don't want to go home. I'm afraid my spouse will hurt me again." What is the nurse's best response?

A) Invite the abuser to the assessment session.
B) Avoid pressuring the patient to leave the abuser.
C) Acknowledge the patient's inability to change the situation.
D) Ensure not to ask direct questions about abuse, as this will intimidate the patient.

Question 33

The nurse is caring for a patient with acute anxiety. What interventions are most beneficial for preventing escalation of anxiety to aggression? Select all that apply.

A) Provide needed food and drink.
B) Assist the patient without delay.
C) Show a calm, positive, friendly demeanor.
D) Express sympathy and concern for the patient.
E) Decrease environmental stimuli.

Question 34

Which statement by a nurse would indicate a nonjudgmental attitude toward violence and abuse?

A) "Many women who have sex when drunk tend to perceive it as rape."
B) "I admitted an 18-year-old for a suicide attempt following a date rape."
C) "Many adolescents call it rape when they don't enjoy a sexual experience."
D) "Parents should not allow their children out at the night; this is when most date rapes happen."

Question 35

Which statements by the patient indicate the patient may be experiencing intimate partner violence (IPV)? Select all that apply.

A) "My partner uses our children as messengers."
B) "My partner humiliates me in front of our friends."
C) "My partner gets upset at me for spending too much money."
D) "My partner will not allow my family to visit, and I cannot visit any of my friends."
E) "My partner gives me a weekly allowance and does not allow me to access our bank account."

Question 36

The nursing staff cared for a patient who was aggressive and violent toward one of the nurses. What is the nurse manager's best immediate response?

A) Schedule a debriefing for all staff involved.
B) Schedule a staff meeting for all staff involved.
C) Schedule an educational session for all staff involved.
D) Schedule a medical record review with all staff involved.

Question 37

The nurse educator is planning various seminars for the staff nurses regarding care of the patient in physical restraints. Which essential nursing interventions will the educator include in the staff seminar? Select all that apply.

A) Turn patient every 4 hours.
B) Toilet the patient as needed.
C) Assign one-to-one observation.
D) Assess skin integrity every hour.
E) Assess circulation, sensation, and movement every 6 hours.

Question 38

The nurse is caring for a patient who appears anxious and is pacing the room and clenching his fists. What action best demonstrates the core concept of effective intervention for this patient?

A) Administering a medication to the patient
B) Deciding to promptly isolate the patient from others
C) Assessing the patient's perception of his level of anxiety
D) Demonstrating therapeutic communication with the patient

Question 39

At an annual employee health fair, the nurse educator is presenting information to staff regarding negative emotions that may occur when caring for patients who are anxious, angry, and aggressive. Which staff member statement indicates that the teaching has been effective?

A) "Self-awareness prevents the nurse's negative emotions."
B) "Self-awareness allows the nurse to express sympathy for the patient."
C) "Intense negative emotions guide the nurse to plan appropriate interventions."
D) "Intense negative emotions interfere with the nurse's assessment and judgment."

Question 40

The community health nurse is teaching a class to a group of college women at the local community college. The nurse's teaching is focused on the risk factors of interpersonal violence (IPV) and rape. Which statement by the college student indicates that the nurse's teaching has been effective?

A) "Interpersonal violence is typically committed by men only."
B) "Interpersonal violence is typically committed by young individuals."
C) "Interpersonal violence is usually related to dynamics of power and control."
D) "Interpersonal violence is usually related to the concepts of self-esteem and self-worth."