Deck 24: Preventing Workplace Violence

Question 1

A nurse is caring for a client who is aggressive, demanding, and verbally abusive toward staff and visitors. The client says, "I'm getting out of here. I'm going to end it all." What immediate action should the nurse take?

A) Attempt to block the exit door.
B) Call security.
C) Attempt to administer a sedative to the client.
D) Notify the client's family.

Answer 1

Call security.

Question 2

A newly formed task force is addressing the prevention of violence in the healthcare organization. Which group of employees is most likely to experience violence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Private practice physicians
B) Nurses working in a geriatric unit
C) Nurses working in a pediatric clinic
D) Nurses whose work space includes large waiting rooms
E) Technicians working in the medical laboratory

Answer 2

Nurses working in a geriatric unit
Nurses whose work space includes large waiting rooms

Question 3

The hospital operator announced over the paging system, "Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing." A newly hired nurse asks another nurse, "Who is Dr. Strong?" The nurse replies, "This is the announcement that alerts security that there is violent behavior on that unit." Which statement would be an appropriate report to this unit's manager?

A) "Our new nurse does not know what 'Dr. Strong' means."
B) "There was an incident in which a staff person did not know what 'Dr. Strong' meant. Could we have an in-service on this policy?"
C) "The operator paged a 'Dr. Strong,' and we didn't know what to do."
D) "Why do they use 'Dr. Strong' when there is trouble? They should just call for help."

Answer 3

"There was an incident in which a staff person did not know what 'Dr. Strong' meant. Could we have an in-service on this policy?"

Question 4

The emergency department (ED) staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate?

A) Arrange an agreement with law enforcement for rapid response on these incidents.
B) Post a sign stating that pain management medications are not given unless the client is admitted to the hospital.
C) Develop a team of staff who would be on call for these types of situations.
D) Organize a training program to educate staff on how to manage these types of situations.

Question 5

A nurse manager is investigating a report made by a staff nurse. The nurse states that a visitor backed the nurse up against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the human resources (HR) director?

A) Encounter with a disgruntled family member
B) Violence against the nurse
C) Incident with a family member
D) Physical attack against an employee

Question 6

The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matrix and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff during the past two days. To which of these distractions is the absenteeism most likely related?

A) The staffing dilemma caused by the scheduler
B) The change in the staffing matrix
C) The decline in staff morale due to a hostile environment
D) The miscommunication between management and nursing administration

Question 7

A nurse hears screaming from a client's room. A male visitor leaves the client's room. Which is the nurse's priority action?

A) Call the police.
B) Notify the client's physician.
C) Follow the visitor.
D) Check on the client.

Question 8

A nurse manager has required that all nursing staff attend an in-service on dealing with verbal threats. A staff nurse wonders why this is necessary since, "Words don't hurt me. I just ignore them." What is the nurse manager's most appropriate response to this statement?

A) "Don't argue with me; I said everyone has to be in-serviced."
B) "Verbal threats often precede physical violence."
C) "I want my staff to be prepared to handle anything."
D) "This is a requirement from our accrediting agency."

Question 9

A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says, "We have lots of threatening behaviors on our unit." What is the most important question for the supervisor to ask?

A) "Why is so much threatening behavior happening on your unit?"
B) "Why haven't you reported that?"
C) "Where do you work?"
D) "When you report threats to your manager, is action taken quickly?"

Question 10

A hospital's safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Reserving parking spaces closest to the facility for staff
B) Security cameras throughout the facility
C) Curved mirrors in the corridors
D) Using restraints on all confused clients
E) Requiring all personnel to take physical self-defense training

Question 11

An emergency department (ED) client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions?

A) Distract the client.
B) De-escalate the situation.
C) Determine the client's real reason for seeking treatment.
D) Assess the client's level of pain.

Question 12

An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name the baby's father. A male visitor who comes to visit the client raises the nurse's concern that he might be violent. Which behavior would raise this concern?

A) The visitor states, "I am the baby's father."
B) The client is very anxious with the visitor present.
C) The visitor moves into the nurse's personal space when asking about the client's status.
D) The visitor sits in a chair in the corner of the client's room, rocking and smiling constantly.

Question 13

An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days, the client's son has been increasingly verbally abusive to the nursing staff. The unit secretary tells the nurse that the son is at the nurse's station demanding to see the client. Which action by the nurse is most important?

A) Remove the central line tray from the room.
B) Inform the son regarding the client's condition.
C) Ignore the son as he enters the client's room.
D) Limit the son's visitation.

Question 14

The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) When addressing the client, use powerful body language.
B) Remain calm and speak in a moderate tone.
C) Approach the client with an aggressive "I'm in charge" attitude.
D) Speak in simple terms.
E) Allow the client to speak.

Question 15

A chief nurse officer (CNO) is contacted by the organization's supervisor on a Saturday night regarding a problem in the hospital's emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report?

A) This is a typical occurrence in the emergency department.
B) Healthcare violence is more likely to occur in emergency departments.
C) Healthcare violence generally occurs on the weekend.
D) Healthcare violence is likely to occur on the night shift.

Question 16

An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate?

A) "The unit has been so busy, I must allow for the nurses to have time to provide client care."
B) "The visitor hours have not been adjusted in years. It was time to change them."
C) "The physicians have requested limited visiting hours."
D) "The visiting hours allowed for added stress and commotion to the nursing staff."

Question 17

When a nurse enters the room, the client states, "He has a gun," and points toward a male visitor. The nurse does not see a gun. What should the nurse do?

A) Question the visitor regarding the statement.
B) Contact security.
C) Call for another nurse to assist in confronting the visitor.
D) Notify the client's physician.

Question 18

A nurse appears in the nursing station with multiple facial lacerations and says, "A visitor hit me." What is the manager's priority action?

A) Ask the nurse why the visitor became violent.
B) Ask a nurse to accompany the employee to the emergency department.
C) Call security to report the incident.
D) Call administration and inform them of the incident.

Question 19

The nurse has just been notified that a client is to be admitted from the emergency department (ED) with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client's lethargic state. Which action is an appropriate intervention by the nurse?

A) Approach the client with caution when obtaining vital signs and shift assessments.
B) Place the client in a room farthest from the nurse's station so as not to disturb other clients.
C) Place the client in four-point restraints as a protective measure.
D) Post an armed security person at the client's door.

Question 20

A manager is following up on an employee's injuries. The manager has contacted human resources to initiate the process of worker's compensation. Which action would be appropriate by the manager?

A) Contact the employee's physician and inform him or her of the injuries.
B) Follow up with human resources regarding scheduling staff to cover the employee's absences.
C) Follow up with the employee to express concern and answer any questions regarding the situation.
D) Follow up with the worker's compensation nurse.

Question 21

A nurse enters a client's room and sees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation?

A) Keep a safe distance from the visitor.
B) Yell for another nurse to assist with the visitor.
C) Leave the room.
D) Threaten the visitor with assault charges.

Question 22

A night shift supervisor has been called to the emergency department to assist in managing a violent situation with a visitor. Once the violent person has been contained and security and police have responded, what should be the supervisor's next action?

A) Notify staff on other nursing units.
B) Notify the violent person's physician.
C) Complete an incident report.
D) No action is necessary; the situation has been managed.

Question 23

Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, "I'm sorry you are upset. What can I do for you?" The visitor continues to complain more loudly. What should the other nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Quietly direct other people out of the room.
B) Leave the room and call security.
C) Say, "Who are you?"
D) Move toward the visitor and say, "Keep your voice down."
E) Stay next to the other nurse.

Question 24

The emergency department (ED) has seen an increase in violent behavior over the past year. The manager has voiced concerns to the chief nurse officer (CNO) regarding the safety of the ED staff. What should be done as a first step in addressing this issue?

A) The manager should consult with local law enforcement.
B) The CNO should review the management of violent incidents procedure policy.
C) The CNO should discuss the matter with hospital security.
D) The CNO should have the manager discuss the matter with the ED staff.

Question 25

A highly intoxicated client is brought to the emergency department. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Remove any hemostats from the pocket.
B) Take off the stethoscope and place it in the pocket.
C) Ask the paramedics to place the client in leather restraints.
D) Enter the room calmly, with a smile.
E) Give the client 20 minutes or so to calm down before the assessment begins.

Question 26

Potential violence in healthcare organizations can include what risk factors?

A) Unlimited public access
B) Inadequate security
C) Locked down units
D) Long wait times
E) Over-crowded waiting rooms

Question 27

An emergency department (ED) has doubled its client visits within the past year. This has led to increased wait times and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the chief nurse officer (CNO) would be most effective?

A) Increase the size of the waiting room and add more beds to the ED unit.
B) Hire more ED nursing staff to manage the increased volume of clients.
C) Hire another ED physician.
D) Hire another registration employee to improve the intake process and reduce the volume in the waiting areas.

Question 28

Incivility includes which of the following behaviors?

A) Laughing
B) Verbal abuse
C) Ignoring a person
D) Sexual harassment
E) Searching the room

Question 29

As part of a presentation on healthcare workplace violence, the speaker says, "Injuries to nurses from violent acts in the workplace are probably underreported." What rationale should the speaker offer for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Nurses may not clearly understand what constitutes workplace violence.
B) Nurses may be unaware of how to report violent actions.
C) Nurses may feel that dealing with violence is an expected part of the job.
D) Nurses may believe that reporting a violent act will mark them as a weak employee.
E) Most violence against nurses is initiated by physicians, and nurses are afraid to report them.

Question 30

A geriatric client in a long-term-care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The client is moving slowly toward the room door.
B) The client is staring blankly at the nurse.
C) The client suddenly becomes alert and oriented.
D) The client raises his fist.
E) The client says, "I know where there is a gun."

Question 31

A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. The behavior has never been violent, but today it is becoming more threatening. The nurse just came into the station and said, "My nurse assistant is stupid. I'm not going to put up with that much longer. She needs to be put in her place." How should the manager respond to this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The nurse should be removed from the unit.
B) A critical incident report should be written about the behavior.
C) The manager should explain that this is a good nurse who has difficulty tolerating stress.
D) Security should be notified of the behaviors.
E) The manager should warn other staff to stay clear of this nurse for the rest of the shift.