Anger, Aggression, And Violence

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Practicing the Science and Art of Psychiatric Nursing
Mental Health and Mental Illness
Theories and Therapies
Biological Basis for Understanding Psychopharmacology
Settings for Psychiatric Care
Legal and Ethical Basis for Practice
Nursing Process and QSEN: The Foundation for Safe and Effective Care
Communication Skills: Medium for All Nursing Practice
Therapeutic Relationships and the Clinical Interview
Trauma and Stress-Related Disorders
Anxiety, Anxiety Disorders, and Obsessive-Compulsive and Related Disorders
Somatic Symptom Disorders and Dissociative Disorders
Personality Disorders
Eating Disorders
Mood Disorders: Depression
Bipolar Spectrum Disorders
Schizophrenia Spectrum Disorders and Other Psychotic Disorders
Neurocognitive Disorders
Substance-Related and Addictive Disorders
Crisis and Mass Disaster
Child, Partner, and Elder Violence
Sexual Violence
Suicidal Thoughts and Behavior
Anger, Aggression, and Violence
Care for the Dying and Those Who Grieve
Children and Adolescents
Adults
Older Adults

All Questions

Question 1

Free

Multiple Choice

Which behavior best demonstrates aggression?

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Stomping away from the nurses' station, darting to another room, and grabbing a snack from another patient.

Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing.

Telling the primary nurse, "I felt angry when you said I could not have a second helping at lunch."

Telling the medication nurse, "I am not going to take that or any other medication you try to give me."

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Question 2

Free

Multiple Choice

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

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Major depressive disorder with delusions of worthlessness

Obsessive-compulsive disorder; performing many rituals

Paranoid delusions of being followed by a military attack team

Completion of alcohol withdrawal and beginning a rehabilitation program

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Question 3

Free

Multiple Choice

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?

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Risk for injury

Post-trauma response

Disturbed thought processes

Risk for other-directed violence

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Question 4

Free

Multiple Choice

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?

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Older adult patients often demonstrate exaggerations of behaviors used earlier in life.

Crowding in skilled care facilities increases individual tendencies toward violence.

The patient interpreted the health care worker's behavior as potentially harmful.

This patient learned violent behavior by watching other patients act out.

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Question 5

Free

Multiple Choice

A patient is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:

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"What is going on?"

"Quiet down immediately. You are scaring others."

"I'd like to talk with you about how you're feeling right now."

"You must go to your room and try to get control of yourself."

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Question 6

Multiple Choice

A patient has been responding to auditory hallucinations throughout the day. The patient approaches the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse follows the patient into the day room, the nurse should:

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make sure adequate physical space exists between the nurse and the patient.

move into a position that allows the patient to be close to the door.

maintain one arm's length distance from the patient.

sit down in a chair near the patient.

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Question 7

Multiple Choice

An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive. The patient is in the day room where there are other patients. The nurse should enter the day room:

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and say, "Would you like to come to your room and take some medication your doctor prescribed for you?"

accompanied by three staff members and say, "Please come to your room so I can give you some medication that will help you feel more comfortable."

and place the patient in a basket-hold and then say, "I am going to take you to your room to give you an injection of medication to calm you."

accompanied by two security guards and tell the patient, "You can come to your room willingly so I can give you this medication or the security guards will take you there."

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Question 8

Multiple Choice

After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse says, "I dread facing potentially violent patients." Which response would be the most urgent reason for this nurse to seek supervision?

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Startle reactions

Difficulty sleeping

A wish for revenge

Preoccupation with the incident

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Question 9

Multiple Choice

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

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Practice and teamwork

Spontaneity and surprise

Caution and superior size

Diversion and physical outlets

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Question 10

Multiple Choice

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

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"I hate all of you!"

"My fingers are tingly."

"You wait until I tell my lawyer."

"It was not my fault. The other patient started it."

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Question 11

Multiple Choice

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

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Help the patient identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking.

Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present.

Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings.

Administer an antipsychotic or antianxiety medication when the patient feels angry.

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Question 12

Multiple Choice

Which assessment finding presents the greatest risk for violent behavior? A patient who:

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is severely agoraphobic.

has a history of intimate partner violence.

complains of bizarre somatic delusions.

verbalizes hopelessness and powerlessness.

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Question 13

Multiple Choice

A patient being admitted suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone who tries to get near me." An emergency code is called. The patient is safely disarmed and placed in seclusion. Justification for the use of seclusion is that the patient:

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evidences a thought disorder, rendering rational discussion ineffective.

presents a clear and present danger to others.

demonstrates an apparent escape risk.

displays features of psychotic thinking.

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Question 14

Multiple Choice

A patient sits in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stands and paces back and forth, clenching and unclenching fists, and then stops and stares in the face of a staff member. The patient is:

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demonstrating withdrawal.

working through angry feelings.

attempting to use relaxation strategies.

exhibiting clues to potential aggression.

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Question 15

Multiple Choice

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:

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"You must come away from the door."

"You have been a widow for many years."

"You want to go home to prepare your husband's dinner?"

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

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Question 16

Multiple Choice

A patient with a history of anger and impulsivity is hospitalized after an accident resulting in injuries. When in pain, the patient loudly scolds the nurse for "not knowing enough to give me pain medicine when I need it." Which intervention would best address this problem?

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Tell the patient to notify the nurse 30 minutes before the pain returns so the medication can be prepared.

Urge the health care provider to change the prescription for pain medication from as needed to a regular schedule.

Tell the patient that verbal assaults on nurses will not shorten the wait for pain medication.

Have the clinical nurse leader request a psychiatric consultation.

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Question 17

Multiple Choice

A patient has a history of impulsively acting out anger by striking others. Which would be an appropriate plan for avoiding such incidents?

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Explain that restraint and seclusion will be used if violence occurs.

Help the patient identify incidents that trigger impulsive acting out.

Offer one-on-one supervision to help the patient maintain control.

Administer lorazepam (Ativan) every 4 hours to reduce the patient's anxiety.

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Question 18

Multiple Choice

A patient with severe physical injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which intervention uses a cognitive technique to help this patient?

Choose correct answer/s

Discontinue the dressing change without comments and leave the room.

Stop the dressing change, saying, "Perhaps you would like to change your own dressing."

Continue the dressing change, saying, "Do you know this dressing change is needed so your wound will not get infected?"

Continue the dressing change, saying, "Unfortunately, you have no choice. Your doctor ordered this dressing change."

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Question 19

Multiple Choice

Which medication should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?

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Lithium (Eskalith)

Trazodone (Desyrel)

Olanzapine (Zyprexa)

Valproic acid (Depakene)

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Question 20

Multiple Choice

An emergency department nurse realizes that the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should the nurse use to prevent escalation of anger?

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Explain that the patient's condition is not life threatening.

Periodically provide an update and progress report on the patient.

Explain that all patients are treated in order, based on their medical needs.

Suggest that the spouse return home until the patient's treatment is completed.

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