Evolve Ch 27: Anger, Aggression, and Violence

1. A 21-year-old client asks the nurse, "What's wrong with my brain that's causing me to be so angry and aggressive?" The nurse's response should be grounded on what research-supported basis?

a. The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.

b. The diminishment of stress hormones causes anger and aggression.

c. No abnormalities of the brain have been identified that correlate with anger and aggression.

d. Personality type plays a much greater part in anger and aggression than physical factors.

a. The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.

2. What older concept of care is being used currently to help in violence reduction in disruptive clients?

a. Aired grievances

b. Shared governance

c. Learned helplessness

d. Trauma-informed care

d. Trauma-informed care

3. The nurse in an emergency department notices a patient's spouse, pacing in the hallway, muttering silently, and looking angrily around the emergency department. Which statement should the nurse make to the spouse to help prevent escalation and/or violence?

a. "Hey, what's up? You look out of control."

b. "You need to stay calm for your spouse's sake."

c. "I am calling security to deal with your behavior."

d. "You appear upset. Can I help you with anything?"

d. "You appear upset. Can I help you with anything?"

4. A 16 year old being treated on an adolescent psychiatric unit has become angry and is in the hallway yelling, "It's not fair! You all hate me! I hate this place!" When the client begins pounding on the wall the nurse should attempt to de-escalate the situation by providing which response?

a. "Stop that right now! I will not allow you to behave like that!"

b. "I will help you calm down. Do you want to go to your room and talk or go to the quiet room?"

c. "You will have to go into seclusion and restraints right now in order to be safe."

d. "You may yell and bang your fists but you must do it in your own room so you don't upset the other patients."

b. "I will help you calm down. Do you want to go to your room and talk or go to the quiet room?"

5. When approaching a client who is acting out aggressively, what interventions should the nurse implement to assure personal safety?

a. Take the client to his/her room so that his/her privacy will be protected.

b. Stand close to the client for reassurance and to convey caring.

c. Call security and wait until they arrive before approaching the client.

d. Have other staff as backup, and stay out of the client's personal space.

d. Have other staff as backup, and stay out of the client's personal space.

6. How is anger best defined?

a. An unhealthy way of releasing anxiety

b. Doing intentional harm to others

c. A normal response to a perceived threat

d. An expression of conflict with others

c. A normal response to a perceived threat

7. Which event is most likely to contribute to a client's escalating anger?

a. A staff member challenging them

b. A staff member asking them to help another client

c. Another client's depressed mood

d. Watching violence on television

a. A staff member challenging them

8. Which assessment finding is the best predictor of violence in a newly admitted client?

a. The nurse's subjective feeling that the client is uncooperative

b. A family history of bipolar disorder

c. A recent assault on a drinking companion

d. A childhood history of being bullied at school

c. A recent assault on a drinking companion

9. Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression?

a. Ineffective coping: maladaptive

b. Risk for other-directed violence

c. Social isolation

d. Ineffective coping: overwhelmed

b. Risk for other-directed violence

10. Which neurotransmitter imbalance has been shown to be related to impulsive aggression?

a. High levels of norepinephrine

b. Low levels of ã-aminobutyric acid

c. Low levels of serotonin

d. High levels of acetylcholine

c. Low levels of serotonin

11. Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of which personal characteristic?

a. Hopelessness

b. Vulnerability

c. Isolation

d. Confidence

b. Vulnerability

12. Which characteristic places the client at highest risk for violence directed at others?

a. Is experiencing somatic symptoms for which no organic basis is found

b. Is in an alcohol rehabilitation program

c. Has a history of recurrent severe depression

d. Has delusions of persecution

d. Has delusions of persecution

13. An adolescent is swearing and shouting at the primary care provider who refused to agree to a pass to leave the unit. What is the primary importance of this behavior?

a. It can be attributed to lack of parental controls applied at an early age.

b. It is a major indicator that the client may become physically aggressive.

c. It is acceptable if directed at staff but not when directed at other clients.

d. It may reduce tension and prevent the client from physically acting out.

b. It is a major indicator that the client may become physically aggressive.

14. An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior that focuses on behavior therapy concepts?

a. Explaining that they are professionals and unused to being shouted at by people they are trying to help.

b. Telling him they will not change his dressing if he is going to abuse them.

c. Assuring him they will complete the dressing change as quickly as possible.

d. When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control.

d. When the client begins to become abusive, the nurse suggests returning in 20 minutes when he has regained control.

15. A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by implementing which intervention?

a. Continuing to manage the situation personally.

b. Apologizing for upsetting the client.

c. Telling the client, "It isn't safe for me to leave the room."

d. Moving outside of the client's personal space.

d. Moving outside of the client's personal space.

16. A client has a history of demonstrating aggression physically. What short-term goal will best help the client manage this anger?

a. Strike objects rather than people.

b. Isolate in lieu of striking people.

c. Limit aggression to verbal outbursts.

d. Identify situations that precipitate hostility.

d. Identify situations that precipitate hostility.

17. A client has been placed in seclusion to control aggressive behavior. Nursing care while the client is in mechanical restraints should include which intervention?

a. Providing regularly scheduled nutrition and hydration

b. Releasing the client every 8 hours

c. Increasing sensory stimulation

d. Observation every 30 minutes

a. Providing regularly scheduled nutrition and hydration