Question 1

A patient is being restrained after biting himself and members of the nursing staff.An appropriate response from the nurse would be:

Accepted Answer

A)   "You have been restrained because you are violent and the staff is unable to deal with you. Until you regain control, we will do our best to make you comfortable and keep you safe."
B)   "You are being restrained because you have been biting yourself and others. Let the staff know if the restraints are uncomfortable. You will be released when you are able to again control your behavior."
C)   "Your thinking is making you violently uncontrollable, and in addition you're trying to bite us. We do not like having to restrain you but it is necessary until you are more in control. We hope to release you soon."
D)   "I know this feels terrible to you, but you are so violent that you may hurt yourself, the staff, and other patients. We won't keep you restrained for long, just long enough for you to regain control of your behavior." B

Question 2

Which response best reflects appropriate assertiveness by a nurse when approached by a patient who demands medications immediately?

Accepted Answer

A)   "I will get your medications as soon as I am finished with what I am doing right now, so please wait for me in your room."
B)   "I will give you your medications as soon as I finish here. It's not appropriate for you to keep asking me for your medications."
C)   "I'll check on your medications as soon as I finish with what I am doing. If it is not quite time for your medications I will bring them to you when it is."
D)   "We need to talk about your impatient behavior before I give you your medications. You must understand that you are not the only patient on the unit." C

Question 3

Which rationale for placing a violent patient into seclusion best reflects the philosophy of nursing?

Accepted Answer

A)   It restricts patients to a physical space in order to reduce sensory overload. The goal is to minimize the risk of harm to others while preserving the patient's personal safety and dignity.
B)   It offers safety by removing all potentially harmful objects and allows for the testing of the patient's interpersonal control by gradually decreasing and/or increasing sensory input.
C)   It provides for a carefully protected milieu that offers safety, permeability of sensory input, and only incrementally increased interpersonal relationships.
D)   It prevents patients from harming themselves or others, reduces the need for proprioception, and provides a protective milieu at the risk of sensory deprivation. A

Question 4

A nurse working in a walk-in clinic is approached by a person with a history of violent behavior.The person states,"I want to go to the hospital for a rest.You better get me in or I'll do something bad.I can get a gun." An appropriate response from the nurse would be:

Accepted Answer

A)   "If I get you admitted, will you promise to behave yourself?"
B)   "You seem very anxious to be hospitalized. What do you think will happen if you aren't hospitalized?"
C)   "Do you have a gun? I'm not sure I believe you. Are you really threatening to kill yourself or someone else?"
D)   "Do you really want to go to the hospital? Would you be satisfied if I were able to find you someplace safe to rest?"

Question 5

At 7 AM,a patient demands in a loud,tremulous voice,"Where's my doctor? The doctor promised to see me first thing in the morning.Call the doctor and say that I'm waiting." An appropriate response from the nurse would be:

Accepted Answer

A)   "Please get ready for breakfast. It's only 7 AM. Your doctor will be in and I'll make sure that you're seen."
B)   "Don't yell at me like that; it isn't polite and certainly isn't necessary. I want to help you, but I will not be verbally abused."
C)   "You seem very angry that your doctor has not come in yet. Your doctor will be in this morning but not until later. The doctor spends time with everyone."
D)   "Your doctor doesn't come to the unit until after breakfast and morning groups are over. Have your breakfast now so you'll be ready when your doctor gets here."

Question 6

A nurse facilitating a social skills group recognizes that one patient monopolizes the group.After the session the psychologist asks the nurse,"Why did you let that patient monopolize the group?" A response from the nurse using appropriate assertiveness would be:

Accepted Answer

A)   "I didn't know what I was supposed to do. You could see how much the patient needed to control the meeting. So you don't think it was appropriate to let it be for today?"
B)   "I didn't let the patient monopolize the group. I wasn't sure if I ought to stop the behavior or let the patient talk. What could I have said to end the patient's monopolizing of the group?"
C)   "Honestly, I never feel you are satisfied with my work. Why don't you lead the group next time? That will give me an opportunity to observe you appropriately managing the patient's need to monopolize the group."
D)   "I felt that the patient needed to express feelings and that the control was a rather tenuous one that required sensitivity and patience. I believe the other patients felt that, too, which is why they let the patient monopolize the group."

Question 7

A patient's contract to be taken outside for a fresh air break after meals has been unavoidably postponed.The patient says,"I've waited patiently for 2 hours,and now I want to stay outside for an extra 10 minutes!" An appropriate response from the nurse would be:

Accepted Answer

A)   "I'm sorry but you will have to wait. You know that as adults we don't always get what we want when we want it."
B)   "I'll arrange to have someone take you after lunch, and you can stay out for as long as you like if you'll just wait patiently."
C)   "You are quite right. Thank you for being so patient. Someone will come right now and take you outside for your break."
D)   "Please show a little consideration; we've been very busy handling other patients' problems. You would understand if it were you with the problem."

Question 8

A nurse is facilitating a social skills group on the inpatient unit for nursing assistants.Which comment would the nurse identify as assertive?

Accepted Answer

A)   "I enjoy my work. I do all my own work, and so I seldom have time to help others. I would if I had the time."
B)   "I love my work. I try to help others whenever they ask because on our unit it's certainly a team effort."
C)   "I enjoy my work. I always try to be helpful, but I am careful not to help those who aren't willing to help others."
D)   "I enjoy my work. I help others after I have spent sufficient time with my patients and feel my assistance is needed."

Question 9

Which statement by a nurse new to the unit best reflects an understanding that staff attitudes and actions have a powerful effect on both patient behavior and milieu management?

Accepted Answer

A)   "I understand that there are going to be days where the unit will be short-staffed or really busy. As new members of the team, how can we contribute to keeping the stress level on the unit from escalating?"
B)   "What are the administration's expectations of us as new employees related to the management of the milieu in general and of individual patient behavior?"
C)   "I'm new, so I will learn best by observing while one of the more experienced staff members manages control over the patients."
D)   "How do I best involve the health care providers in the management of the milieu when a patient begins to escalate?"

Question 10

A newly licensed nurse tells a nurse manager,"I'd like you to stop referring to me as 'the smart new degree nurse.'" The nurse manager replies,"I was only teasing.You are being overly sensitive." Which statement accurately evaluates the newly licensed nurse's comment to the nurse manager?

Accepted Answer

A)   The nurse is appropriately assertive, but now the nurse manager will likely belittle the nurse even more.
B)   The nurse is behaving aggressively because of the newness of being a graduate licensed nurse and owes the nurse manager an apology.
C)   The nurse is assertive, and responding that the nurse does not regard the nurse manager's comments as "teasing" would be an effective follow-up communication.
D)   The nurse is overly sensitive and ought to have ignored the nurse manager's teasing until it was extinguished. Now the nurse manager will be more sarcastic than ever.

Question 11

A patient who is displaying manic behavior enters the unit's dayroom and declares in a loud,threatening voice,"I have friends,and if you don't show me proper respect,you'll be sorry!" The nurse's initial response should be to approach the patient,address him formally,and say in a:

Accepted Answer

A)   soft voice, "You will always have proper respect here. Let's sit over here and talk."
B)   soft voice, "You are really frightening the other patients. Please go to your room."
C)   firm voice, "You are out of control. I expect you to go to your room immediately."
D)   firm voice, "You seem to be escalating again. I've brought an injection that will calm you and slow your thinking."

Question 12

During staff debriefing after placing a patient with a history of violence into seclusion,a nurse new to the unit says,"I think we acted prematurely.We didn't spend enough time trying to deescalate the situation." An appropriate response from the nurse manager would be:

Accepted Answer

A)   "You're new here. Trust the staff to make decisions based on experience and sound, evidence-based practice."
B)   "We're a team. We all need to be open to other possibilities, and I expect that we respect each other's viewpoints."
C)   "I'd like to hear more specifically what you think we could have said or done to talk the patient down and avoid the need for seclusion."
D)   "Professional nurses are familiar with a variety of communication interventions; maybe it's time we had an in-service to improve our communication skills."

Question 13

An adolescent patient says to a nurse,"I'm so glad you've come in.The nurse manager ordered me to stay in my room until dinner just because I got into another fight!" An appropriate response from the nurse would be:

Accepted Answer

A)   "You're not going to split me from the nurse manager. Please go back in your room until your time-out is finished."
B)   "I'm wondering why you've left your room, then. Please return to your room until your time-out is completed. I will talk with you after that."
C)   "I'm sorry to hear that you are being punished. Please return to your room immediately. We can talk about this when your time-out is over."
D)   "It sounds as if you haven't had a very good day. Return to your room, and complete your time-out. I will speak with you after dinner."

Question 14

Which medication would a nurse expect to be prescribed to an adolescent patient diagnosed with a conduct disorder who has a history of physically abusing younger siblings?

Accepted Answer

A)   Propranolol (Inderal) 
B)   Propranolol (Ritalin) 
C)   Clozapine (Clozaril) 
D)   Phenytoin (Dilantin)

Question 15

A nurse leader facilitating a group of recovering alcoholics observes patients drinking nonalcoholic look-alike beer and wine coolers they have brought with them instead of the available decaffeinated coffee and soda.An appropriate response from the nurse would be:

Accepted Answer

A)   telling the patients that they are behaving inappropriately and instructing them to throw the nonalcoholic beer and wine drinks away.
B)   stopping the group and asking the patients who are drinking inappropriately to leave and return next week without the nonalcoholic beverages.
C)   ignoring their behavior but firmly stating "If you want me to return next week, all of you will come prepared to appropriately participate in this group."
D)   stating, "I see that some of you are drinking nonalcoholic beverages and wine coolers. What is your understanding of the purpose of this group?"

Question 16

A nurse observes a patient with a history of aggressive behavior toward others pacing in the dayroom while appearing to talk to himself.The nurse will best intervene with this patient therapeutically by:

Accepted Answer

A)   asking him to sit in the dayroom and watch television with the other patients and staff.
B)   instructing him to go to his room and remain there until he shows that he can be sociable.
C)   asking him if he would like to walk to his room where he and the nurse can sit together quietly to discuss the cause of his behavior.
D)   assigning an ancillary staff member the task of walking him around the unit for several minutes and then returning him to his room.

Question 17

One morning,the nurse manager asks a nurse to work overtime for the fourth week in a row,saying "I know you've done a lot of overtime,but I'm in a bind.Can you help me out?" The nurse had planned to attend a child's recital that evening.Which would be the most appropriate assertive response the nurse could give?

Accepted Answer

A)   "I cannot work tonight. I'm sure you will agree I've worked more than my share of overtime."
B)   "This isn't a good time for me to help you. It's my child's recital and the family has plans."
C)   "Well, my child's recital is tonight. If I work for you this evening you'd have to give me three weekends off on this schedule."
D)   "For goodness sake! Am I the only one working for you? Get someone else. You are not going to take advantage of me anymore!"

Question 18

An adolescent patient who just completed a time-out for having slapped another patient complains,"The other patient started it,but I get punished.It's unfair." An appropriate response from the nurse would be:

Accepted Answer

A)   "Don't expect me to take your side in this. You received punishment because you were violent. It doesn't matter who started it. On this unit, violent behavior will always be punished."
B)   "Let's talk about that. Do you think you were asked to take a time-out because you 'started it' or because your response was both out of control and violent?"
C)   "You make a good point. We need to punish both of you in a similar fashion. Since I believe in fair play, I'll assign the other patient to a time-out as well."
D)   "Sounds to me as if you have really been bullied. I will have to discuss this with the staff. I'm pleased that you accepted the time-out like an adult."

Question 19

A crisis team is working to admit a violent patient who has been both medicated and physically restrained.Which statement made to the patient is the best example of team function?

Accepted Answer

A)   The team leader tells the patient "I believe you're feeling very frightened right now. We can allow you to walk to the unit if you are willing to cooperate."
B)   A team member tells the patient, "Because you have been so violent we had to restrain you." The team leader adds, "Try to cooperate with us. We really don't want to hurt you."
C)   A crisis team member says, "I know that you're feeling very frightened, but we'll help you feel calmer." The admitting nurse says, "Do you feel you can do this without being agitated and physically violent?"
D)   The admitting nurse states, "You were restrained because you are behaving very violently." The crisis team leader adds, "Do you want to be carried into the unit, or will you go quietly?"

Question 20

A unit has experienced several violent outbursts that have resulted in the forcible restraint of patients.On review,each violent event and all crisis management strategies were appropriately followed.To maximize staff efficiency the nurse manager should:

Accepted Answer

A)   determine the institution's policies regarding the management of crisis situations should be reviewed in mandatory staff education sessions.
B)   schedule staff breaks at intervals that allow staff members to leave the unit and relax while discussing the problems in the current milieu.
C)   invite a team of experts to evaluate crisis management on the unit for 1 month to determine whether any procedures are being unintentionally omitted.
D)   schedule a multidisciplinary team education meeting and invite a distinguished expert who can help staff members understand that they managed each crisis appropriately.

Exam 28: Preventing and Managing Aggressive Behavior