Deck 23: Anger, Aggression, and Violence

Question 1

A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, "Back off!" and then goes to the day room. While following the patient into the day room, the nurse should do which of the following?

A) Make sure there is adequate physical space between the nurse and patient
B) Move into a position that places the patient close to the door
C) Maintain one arm's-length distance from the patient
D) Begin talking to the patient about appropriate behaviour

Answer 1

Make sure there is adequate physical space between the nurse and patient

Question 2

A confused older adult patient in a nursing home was asleep when unlicensed assistive personnel (UAP) entered the room quietly and touched the bed to see if it was wet. The patient awakened and hit the UAP in the face. Which statement best explains the patient's action?

A) Older adult patients often demonstrate exaggerations of behaviours used earlier in life.
B) Crowding in nursing homes increases an individual's tendency toward violence.
C) The patient learned violent behaviour by watching other patients act out.
D) The patient interpreted the UAP's behaviour as potentially harmful.

Answer 2

The patient interpreted the UAP's behaviour as potentially harmful.

Question 3

A patient with a history of anger and impulsivity was hospitalized after an accident resulting in injuries. When in pain, the patient loudly scolded nursing staff for "not knowing enough to give me pain medicine when I need it." Which nursing intervention would best address this problem?

A) Teach the patient to use coping strategies such as deep breathing and progressive relaxation to reduce the pain.
B) Talk with the health care provider about changing the pain medication from pro re nata (PRN) to patient-controlled analgesia.
C) Tell the patient that verbal assaults on nurses will not shorten the wait for analgesic medication.
D) Talk with the patient about the risks of dependency associated with overuse of analgesic medication.

Answer 3

Talk with the health care provider about changing the pain medication from pro re nata (PRN) to patient-controlled analgesia.

Question 4

A patient was arrested for breaking windows in the home of a former domestic partner. The patient's history also 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) Ineffective coping
C) Impaired social interaction
D) Risk for other-directed violence

Question 5

An adult patient assaulted another patient and was then restrained. One hour later, which statement by the restrained patient requires the nurse's immediate attention?

A) "I hate all of you!"
B) "My fingers are tingly."
C) "You wait until I tell my lawyer."
D) "The other patient started the fight."

Question 6

Which behaviour best demonstrates aggression?

A) Stomping away from the nurses' station, going to the hallway, and grabbing a tray from the meal cart.
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."

Question 7

A patient sat in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stood, paced back and forth, clenched and unclenched fists, and then stopped and stared in the face of a staff member. Which of the following is the patient doing?

A) Demonstrating withdrawal
B) Working though angry feelings
C) Attempting to use relaxation strategies
D) Exhibiting clues to potential aggression

Question 8

A patient with multi-infarct dementia lashes out and kicks at people who walk past in the hall of a nursing home. Intervention by the nurse should begin by which of the following?

A) Gently touching the patient's arm
B) Asking the patient, "What do you need?"
C) Saying to the patient, "This is a safe place."
D) Directing the patient to cease the behaviour

Question 9

Which assessment finding presents the greatest risk for violent behaviour directed at others?

A) Severe agoraphobia
B) Substance abuse disorder
C) Bizarre somatic delusions
D) Verbalized hopelessness and powerlessness

Question 10

A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say which of the following?

A) "What is going on?"
B) "Please be quiet and sit down in this chair immediately."
C) "I'd like to talk with you about how you're feeling right now."
D) "You must go to your room and try to get control of yourself."

Question 11

A patient has a history of impulsively acting out anger by striking others. Select the most appropriate intervention for avoiding similar incidents.

A) Teach the patient about herbal preparations that reduce anger.
B) Help the patient identify incidents that trigger impulsive anger.
C) Explain that restraint and seclusion will be used if violence occurs.
D) Offer one-on-one supervision to help the patient maintain control.

Question 12

A cognitively impaired patient has been a widow for 30 years. This patient frantically tries to leave the facility, saying, "I have to go home to cook dinner before my husband arrives from work." To intervene with validation therapy, the nurse will say which of the following?

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 husband's dinner?"
D) "Your husband gets angry if you do not have dinner ready on time?"

Question 13

Which scenario predicts the highest risk for directing violent behaviour toward others?

A) Major depression with delusions of worthlessness
B) Obsessive-compulsive disorder; performs many rituals
C) Paranoid delusions of being followed by alien monsters
D) Completed alcohol withdrawal; beginning a rehabilitation program

Question 14

Which medication from the medication administration record should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behaviour continues to escalate despite verbal intervention?

A) Lithium
B) Lorazepam (Ativan)
C) Olanzapine (Zyprexa)
D) Alprazolam (Xanax)

Question 15

A patient with severe injuries is irritable and angry and belittles the nurses. As a nurse changes a dressing, the patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which intervention uses a cognitive technique to help the patient?

A) Wordlessly discontinue the dressing change and then leave the room.
B) Stop the dressing change, saying, "Perhaps you would like to change your own dressing."
C) Continue the dressing change, saying, "This dressing change is needed so your wound will not get infected."
D) Continue the dressing change, saying, "Unfortunately, you have no choice in this because your health care provider ordered this dressing change."

Question 16

After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse says, "That patient should not be allowed to get away with that behaviour." Which of the following responses poses the greatest barrier to the nurse's ability to provide therapeutic care?

A) Startle reactions
B) Difficulty sleeping
C) A wish for revenge
D) Preoccupation with the incident

Question 17

The staff development coordinator plans to teach physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize?

A) Practice and teamwork
B) Spontaneity and surprise
C) Caution and superior size
D) Diversion and physical outlets

Question 18

An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive and refusing to leave the day room. Which of the following should the nurse do?

A) Enter the day room and say, "Would you like to come to your room and take some medication your health care provider prescribed for you?"
B) Enter the day room accompanied by three staff members and say, "Please come to your room so I can give you some medication that will help you regain control."
C) Enter the day room 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) Enter the day room accompanied by a male security guard and tell the patient, "Come to your room willingly so I can give you this medication, or the guard and I will take you there."

Question 19

An emergency code was called after a patient pulled a knife from a pocket and threatened, "I will kill anyone who tries to get near me." The patient was safely disarmed and placed in seclusion. What was the justification for use of seclusion?

A) The patient was threatening to others.
B) The patient was experiencing psychosis.
C) The patient presented an undeniable escape risk.
D) The patient presented a clear and present danger to others.

Question 20

Which is an effective nursing intervention to assist an angry patient to learn how to manage anger without violence?

A) Help the patient identify a thought that produces anger, evaluate the validity of 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 anti-anxiety medication.

Question 21

Because an intervention was required to control a patient's aggressive behaviour, the nurse plans a critical-incident debriefing with staff members. Which topics should be the primary focus of this discussion?

A) Patient behaviours associated with the incident
B) Genetic factors associated with aggression
C) Intervention techniques used by the staff
D) Effects of environmental factors
E) Theories of aggression

Question 22

Family members describe the patient as "a difficult person who finds fault with others." The patient verbally abuses nurses for their poor care. The most likely explanation lies in which of the following?

A) Poor childrearing that did not teach respect for others
B) Automatic thinking leading to cognitive distortions
C) A personality style that externalizes problems
D) Delusions that others wish to deliver harm

Question 23

A nurse directs the intervention team that is placing an aggressive patient in seclusion. Before approaching the patient, which actions will the nurse direct team members to take?

A) Appoint a person to clear a path and open, close, or lock doors.
B) Quickly approach the patient and take the closest extremity.
C) Select the person who will communicate with the patient.
D) Move behind the patient when the patient is not looking.
E) Remove jewelry, glasses, and harmful items.

Question 24

A new patient acts out so aggressively that seclusion is required before the admission assessment is completed or orders written. Immediately after safely secluding the patient, which action is the nurse's priority?

A) Complete the physical assessment.
B) Notify the health care provider to obtain a seclusion order.
C) Document the incident objectively in the patient's medical record.
D) Explain to the patient that seclusion will be discontinued when self-control is regained

Question 25

Which indications warrant the use of seclusion?

A) To protect from self-harm
B) To increase self-isolation
C) To decrease environmental stimulation
D) To prevent assault
E) To encourage self-reflection

Question 26

An emergency department nurse realizes that the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should the nurse use to prevent further escalation of the spouse's anger?

A) Offer the waiting spouse a cup of coffee.
B) Explain that the patient's condition is not life threatening.
C) Periodically provide an update and progress report on the patient.
D) Suggest that the spouse return home until the patient's treatment is complete.

Question 27

Which central nervous system structures are most associated with anger and aggression?

A) Amygdala
B) Cerebellum
C) Basal ganglia
D) Temporal lobe
E) Prefrontal cortex

Question 28

Which information from a patient's record would indicate marginal coping skills and the need for careful assessment of the risk for violence?

A) A history of academic problems
B) A history of family involvement
C) A history of childhood trauma
D) A history of substance abuse