Chapter 27: Anger, Aggression, and Violence |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. Which behavior 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.‖ ANS: A Aggression is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. Refusing medication is a patient‘s right and may be appropriate. The other incorrect options do not feature violation of another‘s rights. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 27-2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which clinical scenario predicts the highest risk for directing violent behavior toward others? a. Major depressive disorder 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 ANS: C Patients who are delusional, hyperactive, impulsive, or predisposed to irritability are at higher risk for violence. The patient in the correct response has the greatest disruption of ability to perceive reality accurately. People who feel persecuted may strike out against those believed to be persecutors. The other patients have better reality-testing ability. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 27-3, 4, 8, 50 (Box 27-1) TOP: Nursing Process: Analysis/Diagnosis MSC: Client Needs: Safe, Effective Care Environment 3. 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 ANS: D Defining characteristics for risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. There is no indicator that the patient will experience injury. Ineffective coping and impaired social interaction have lower priorities. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 27-8, 12, 13, 50 (Box 27-1) TOP: Nursing Process: Analysis/Diagnosis MSC: Client Needs: Psychosocial Integrity 4. A confused older adult patient in a skilled nursing facility 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 behaviors used earlier in life. b. Crowding in skilled nursing facilities increases an individual‘s tendency toward violence. c. The patient learned violent behavior by watching other patients act out. d. The patient interpreted the UAP‘s behavior as potentially harmful. ANS: D Confused patients are not always able to evaluate the actions of others accurately. This patient behaved as though provoked by the intrusive actions of the staff. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 27-3, 4, 30, 31 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. 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: 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.‖