Deck 17: Angeraggression Management

Question 1

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

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

Answer 1

The defense mechanism of displacement

Question 2

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."

Answer 2

"Anger and aggression are essentially the same."

Question 3

A client begins to smash furniture, cannot be "talked down," and refuses medications. Which is the most appropriate 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.

Answer 3

Call a violence code.

Question 4

A nurse is caring for four clients. Which client should the nurse identify as 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 5

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 6

How often should a nurse plan to observe a client who is in restraints?

A)At least every 5 minutes
B)Continually for the first hour
C)At least every 15 minutes
D)Every 2 hours

Question 7

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, withdrawn, and maintains a flat affect, this is an indicator of potential violence."

Question 8

The client states, "I get into trouble because I respond violently without thinking. That usually gets me into a mess." Which nursing reply would be most therapeutic to address this client's problem?

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 9

After restraints are removed from a client, 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)Postrestraint intervention
B)Treatment planning
C)Crisis intervention
D)Debriefing

Question 10

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 11

Which client statement demonstrates improvement in terms of anger/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 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 12

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 should be 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 13

An adult client assaults another client and is placed in restraints at 1345 hours. While the client is in restraints, which client statement should alert a 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."

Question 14

A client diagnosed with paranoid schizophrenia has a history of aggravated assault. A nurse assigns "Risk for other-directed violence" as the client's priority nursing diagnosis. Based on this diagnosis, which would be an appropriate outcome for this 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 15

At 3 a.m., when less restrictive methods fail, a physician orders restraints for an angry, aggressive client. To meet Joint Commission standards, at what time and by whom should a nurse expect an in-person client evaluation?

A)At 8 a.m., by a licensed independent practitioner or a clinical nurse specialist
B)At 4 a.m., by a physician or a licensed independent practitioner (LIP)
C)At 3:30 a.m.by a physician or the client's case manager
D)At 6 a.m.by the psychiatrist or a clinical nurse specialist

Question 16

Which initial nursing approach makes limit setting better accepted by clients who are aggressively acting out?

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

Question 17

On an inpatient psychiatric unit, a restrained 16-year-old client continues to verbally lash out, and threatens to abuse staff and kill self when released. To meet Joint Commission standards, at what time should a nurse expect the physician 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 18

A client diagnosed with psychotic disorder NOS is pacing the milieu and occasionally punches the wall. Which should be 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 19

For select clients, physical restraint is considered to be a beneficial intervention. 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.

Question 20

A nursing instructor is teaching about violence-intervention protocols. Which student statement would indicate 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 21

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

A)Places hand on the client's shoulder and states, "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)Smiles and states, "I am your nurse.When do you want to go to your room?"

Question 22

A nurse notices a client clenching fists periodically and pacing the hallway. Which of the following nursing interventions would best assist the client at this time? (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.