Question 1

A patient is hospitalized after an arrest for breaking windows in the home of a former intimate partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority?

Accepted Answer

A)  Risk for injury 
B)  Post-trauma response 
C)  Disturbed thought processes 
D)  Risk for other-directed violence

Question 2

A cognitively impaired patient has been a widow for 30 years. This patient is frantically trying to leave the unit, saying, "I have to go home to cook dinner before my husband arrives from work." To intervene with validation therapy, the nurse should first say:

Accepted Answer

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)  "Was your husband angry if you did not have dinner ready on time?"

Question 3

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

Accepted Answer

A)  "I hate all of you!" 
B)  "My fingers are tingly." 
C)  "You wait until I tell my lawyer." 
D)  "It was not my fault. The other patient started it."

Question 4

The staff development coordinator plans to teach use of physical management techniques when patients become assaultive. Which topic should be emphasized?

Accepted Answer

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

Question 5

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

Accepted Answer

A)  Help the patient identify a thought that increases anger, find proof for or against 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 antianxiety medication when the patient feels angry.

Question 6

A new patient immediately requires seclusion on admission. The assessment is incomplete, and the health care provider has not examined the patient. Immediately after safely secluding the patient, which action has priority?

Accepted Answer

A)  Provide an opportunity for the patient to go to the bathroom. 
B)  Notify the health care provider and obtain a seclusion order. 
C)  Notify the hospital risk manager. 
D)  Debrief the staff.

Question 7

A nurse directs the intervention team who must take an aggressive patient to seclusion. Other patients were removed from the area. Before approaching the patient, the nurse should ensure that which actions are taken by staff? (Select all that apply.)

Accepted Answer

A)  Remove jewelry, glasses, and harmful items from the patient and staff members. 
B)  Appoint a person to clear a path and open, close, or lock doors. 
C)  Quickly approach the patient, and grab the closest extremity. 
D)  Select the person who will communicate with the patient. 
E)  Move behind the patient to use the element of surprise.

Question 8

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

Accepted Answer

A)  Major depressive disorder with delusions of worthlessness 
B)  Obsessive-compulsive disorder; performing many rituals 
C)  Paranoid delusions of being followed by a military attack team 
D)  Completion of alcohol withdrawal and beginning a rehabilitation program

Question 9

A patient with a history of command hallucinations approaches the nurse, yelling obscenities. The patient mumbles and then walks away. The nurse follows. Which nursing actions are most likely to be effective in de-escalating this scenario? (Select all that apply.)

Accepted Answer

A)  State the expectation that the patient will stay in control. 
B)  State that the patient cannot be understood when mumbling. 
C)  Tell the patient, "You are behaving inappropriately." 
D)  Offer to provide the patient with medication to help. 
E)  Speak in a firm but calm, caring voice.

Question 10

A confused older adult patient in a skilled care facility is sleeping. A health care worker enters the room quietly and touches the bed to see if it is wet. The patient awakens and hits the health care worker in the face. Which statement best explains the patient's action?

Accepted Answer

A)  Older adult patients often demonstrate exaggerations of behaviors used earlier in life. 
B)  Crowding in skilled care facilities increases individual tendencies toward violence. 
C)  The patient interpreted the health care worker's behavior as potentially harmful. 
D)  This patient learned violent behavior by watching other patients act out.

Exam 24: Anger, Aggression, and Violence