Misc
The nurse is caring for a patient with a history of violent behaviors. Which nursing interventions are most likely to prevent the patient from responding with aggressive or violent behavior? Select all that apply.
1. Address the patient's anxiety as needed.
2. Determine the patient's coping mechanisms.
3. Ensure the patient's needs are met in a timely manner.
4. Assess the patient's family history of violent behaviors.
5. Avoid intervention with the patient if he or she is displaying aggression.
Answer: 1, 2, 3
Explanation: 1. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.
2. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.
3. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.
The nurse preceptor is caring for a patient who has a history of aggressive behavior. The novice nurse asks, "Why is the patient taking a cardiac medication if he does not have a heart condition?" What is the preceptor's best response?
1. "Calcium channel blockers increase dopamine levels, decreasing the risk of violence."
2. "Calcium channel blockers decrease dopamine levels, decreasing the risk of violence."
3. "Beta-adrenergic agonists decrease norepinephrine levels, decreasing the risk of violence."
4. "Beta-adrenergic antagonists decrease norepinephrine levels, decreasing the risk of violence."
Answer: 4
Explanation: 4. The nurse must be aware of the neurobiology associated with aggression. Beta-adrenergic antagonists are used in the collaborative treatment of aggression as well as to treat cardiac conditions. Beta-adrenergic antagonists decrease norepinephrine levels, decreasing the risk of violence. Beta-adrenergic agonists and calcium channel blockers are not used in the collaborative treatment of aggressive behavior.
The nurse educator is presenting a review course on workplace safety and prevention of aggression. The nurse discusses the various types of workplace aggression. Which action will the nurse manager recommend for nurses to take to prevent type I aggression while at work?
1. Recognize escalating anxiety in visitors and family members of patients.
2. Report to the charge nurse when a health care provider gets angry at the nurse.
3. Report to the charge nurse any threats that a colleague or peer makes to the nurse.
4. Have a security guard escort the nurse outside if it is dark when the nurse leaves.
Answer: 4
Explanation: 4. Type I violence occurs when criminal intent or activity results in violence. In this type of violence, the perpetrator has no known relationship with the victim. Having a security guard escort the nurse to the nurse's vehicle will help to prevent this type of violence. Recognizing escalating anxiety in visitors and family members of patients is an appropriate intervention; however, this describes an intervention to prevent type II violence, not type I. Reporting threats from a peer or health care provider are appropriate interventions; however, these interventions best describe prevention against type III violence, not type I.
The nurse is observing several patients who are in the activity room of the inpatient psychiatric facility. The nurse notices that one of the patients begins to get upset, raising her voice, pacing the room, and standing with clenched fists. What is the nurse's priority action?
1. Reorient the patient to person, place, and time.
2. Remove other patients from the room to provide more space.
3. Call the health care provider to obtain an order for anti-anxiety medication.
4. Call security and promptly isolate the patient and apply physical restraints.
Answer: 2
Explanation: 2. The patient is displaying increased anxiety and aggression. Anxiety and agitation tend to escalate when there is an audience, so removing other patients to another area of the unit is a useful intervention. Removing other patients also provides safety for both the patient who is experiencing anxiety and for the other patients in the room. The patient is not displaying symptoms of altered level of consciousness or disorientation, so the primary nursing action is not to reorient the patient. Calling the health care provider for pharmacological intervention would be appropriate only after the nurse fails to achieve the desired outcome using less restrictive independent interventions. Applying physical restraints is a last resort that would not be used as a primary intervention.
The nurse assesses a patient and finds several old and fresh bruises in the abdominal area, as well as signs of malnutrition. What is the most appropriate question for the nurse to ask?
1. "Are you dieting?"
2. "Has someone been hurting you?"
3. "Do you have an alcohol problem?"
4. "Have you had any falls lately?"
Answer: 2
Explanation: 2. When the nurse suspects abuse, it is important to ask direct questions, such as asking if the patient has been hurt by someone. Asking if the patient is dieting or has fallen implies that the nurse has made assumptions about the cause of the injuries. The question about an alcohol problem carries with it a suggestion that the patient is to blame for the injuries.
A patient tells the nurse, "I have been waiting two hours to be discharged. What is the problem?" The patient is pacing the room and glaring at staff members. What is the nurse's best action to prevent patient aggression?
1. Call hospital security to be prepared if the patient becomes aggressive.
2. Ask the patient to remain seated and retrieve the patient's discharge paperwork.
3. Acknowledge the patient's feelings and leave the room in order to avoid confrontation.
4. Acknowledge the patient's feelings and determine the status of the patient's discharge paperwork.
Answer: 4
Explanation: 4. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. The patient is displaying cues to aggressive behavior by pacing the room and glaring at staff members. The nurse's best action is to acknowledge the patient's feelings and determine the status of the patient's discharge paperwork. This action will validate the patient's feelings and attempt to address the patient's unmet needs. Calling hospital security does not address the patient's needs, nor does asking the patient to remain seated without validating the patient's concerns. Acknowledging the patient's feelings is the correct intervention; however, the nurse should intervene early, not leave the patient alone in the room.
The nurse educator is teaching a review course to the staff nurses on the role of neurobiology in aggressive behavior. The nurse educator asks a staff nurse to identify the patient on the unit who is most at risk for aggression, based on neurobiology. Which statement by the staff nurse indicates that the teaching has been effective?
1. "A 73-year-old female with a history of chronic neuropathy."
2. "A 42-year-old female with a history of multiple sclerosis (MS)."
3. "A 55-year-old male with a history of chronic migraine headaches."
4. "A 32-year-old male with a history of a traumatic brain injury (TBI)."
Answer: 4
Explanation: 4. The patient with a history of a traumatic brain injury (TBI) is at greatest risk for aggressive behavior. In addition, the patient's younger age and male gender increases the risk for aggression. Chronic neuropathy, multiple sclerosis (MS), and chronic migraine headaches are not associated with an increased risk of aggression.
The nurse manager is reviewing risk factors for workplace aggression during a monthly staff meeting. The nurse manager includes risk factors for aggression related to the psychiatric patient population. Which statement by the staff nurse indicates that teaching has been effective?
1. "Patients who are being treated for depression have an increased risk for aggression."
2. "Patients who have been diagnosed with dementia have an increased risk for aggression."
3. "Patients who are receiving group therapy for somatic symptom disorders have an increased risk for aggression."
4. "Patients who are receiving cognitive-behavioral therapy for eating disorders have an increased risk for aggression."
Answer: 2
Explanation: 2. Risk factors for aggression related to the patient population include dementia, psychosis, mania, substance use or withdrawal, and personality disorders. Depression, somatic symptom disorder, and eating disorders do not present an increased risk for aggression related to the patient population.
The nurse educator is providing education to the staff nurses regarding the use of seclusion in the psychiatric setting. The educator asks the nurses to describe patients who would best benefit from seclusion. Which statements by the nurses would indicate that teaching has been effective? Select all that apply.
1. "The patient who throws a book on the ground in frustration."
2. "The patient who is loud and disrupting the milieu of the unit."
3. "The patient who attempts to cut herself with an object found on the unit."
4. "The patient who hits another patient in the face during a therapy session."
5. "The patient who is confused and disoriented with altered thought processes."
Answer: 3, 4
Explanation: 3. Seclusion is an intervention that may be used in the inpatient psychiatric setting to protect a patient who is a danger to self or to protect others from injury when imminent risk is present. The patient who attempts to cut herself and the patient who hits another patient are patients who would benefit from seclusion. The patient who throws a book on the ground and the patient who is loud and disruptive are not displaying a physical threat to self or others. Rather, these patients are displaying escalating anxiety and would benefit from therapeutic communication interventions, not seclusion. The patient with altered thought processes would benefit from reorientation, not seclusion.
4. Seclusion is an intervention that may be used in the inpatient psychiatric setting to protect a patient who is a danger to self or to protect others from injury when imminent risk is present. The patient who attempts to cut herself and the patient who hits another patient are patients who would benefit from seclusion. The patient who throws a book on the ground and the patient who is loud and disruptive are not displaying a physical threat to self or others. Rather, these patients are displaying escalating anxiety and would benefit from therapeutic communication interventions, not seclusion. The patient with altered thought processes would benefit from reorientation, not seclusion.
Which statements by the patient indicate the patient may be experiencing intimate partner violence (IPV)? Select all that apply.
1. "My partner uses our children as messengers."
2. "My partner humiliates me in front of our friends."
3. "My partner gets upset at me for spending too much money."
4. "My partner will not allow my family to visit, and I cannot visit any of my friends."
5. "My partner gives me a weekly allowance and does not allow me to access our bank account."
Answer: 1, 2, 4, 5
Explanation: 1. Most often, the behaviors associated with IPV relate to dynamics of power and control over a partner or significant other. Using the couple's children as messengers, humiliating the patient, isolating the patient, and taking away economic freedoms are all examples of IPV. A partner who is upset at the other partner for spending too much money is not exhibiting signs of IPV.
2. Most often, the behaviors associated with IPV relate to dynamics of power and control over a partner or significant other. Using the couple's children as messengers, humiliating the patient, isolating the patient, and taking away economic freedoms are all examples of IPV. A partner who is upset at the other partner for spending too much money is not exhibiting signs of IPV.
4. Most often, the behaviors associated with IPV relate to dynamics of power and control over a partner or significant other. Using the couple's children as messengers, humiliating the patient, isolating the patient, and taking away economic freedoms are all examples of IPV. A partner who is upset at the other partner for spending too much money is not exhibiting signs of IPV.
5. Most often, the behaviors associated with IPV relate to dynamics of power and control over a partner or significant other. Using the couple's children as messengers, humiliating the patient, isolating the patient, and taking away economic freedoms are all examples of IPV. A partner who is upset at the other partner for spending too much money is not exhibiting signs of IPV.
The nurse educator is teaching an in-service on the recognition of patient aggression within the hospital. One of the nurse participants is asked to classify her patient's behavior to determine if the patient is at risk for aggression. Which patient does the nurse classify as displaying manifestations that may lead to aggression? Select all that apply.
1. 47-year-old female who appears fearful and angry
2. 20-year-old male who is experiencing acute anxiety
3. 25-year-old female who is experiencing sadness regarding a death in the family
4. 75-year-old male who is expressing frustration due to a delay in hospital discharge
5. 36-year-old male who has expressed apprehension regarding his upcoming medical procedure
Answer: 1, 2, 4
Explanation: 1. Fear, anger, anxiety, and frustration are all factors that can lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.
2. Fear, anger, anxiety, and frustration are all factors that lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.
4. Fear, anger, anxiety, and frustration are all factors that lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.
The nurse is caring for a patient with aggressive behavior. The health care provider has ordered a selective serotonin reuptake inhibitor (SSRI). The nurse is providing patient education related to the medication when the patient asks, "Why is this being prescribed for me? I'm not depressed." What is the nurse's best response? Select all that apply.
1. "SSRIs are sometimes used to minimize anxiety."
2. "SSRIs are sometimes used to minimize impulsivity."
3. "SSRIs are sometimes used to improve coping skills."
4. "SSRIs increase serotonin levels, decreasing aggression."
5. "SSRIs decrease serotonin levels, decreasing aggression."
Answer: 1, 2, 4
Explanation: 1. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.
2. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.
4. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.
The nurse is working in the emergency department (ED) of a local hospital. Which response by a patient or family member would alert the nurse to the greatest risk for displaying aggression?
1. "My brother is in a lot of pain and can't get comfortable."
2. "I am worried about my husband's condition after his heart attack."
3. "I am nervous about the upcoming surgery to repair my broken arm."
4. "My mother is very short of breath but the medication seems to be helping."
Answer: 1
Explanation: 1. Emergency departments (ED) are susceptible to violence by patients, visitors, and family members. Factors that increase the risk for violence include treatment of conditions such as anxiety, long wait times, and painful procedures. The individual whose brother in a lot of pain is at greatest risk for displaying aggression. The spouse who is concerned about the patient's condition is not at an increased risk for aggression. The patient who is nervous or apprehensive about an upcoming surgical procedure is not at an increased risk for aggression.
The parent of a patient in physical restraints asks the nurse, "Why is my son tied down? He wouldn't hurt anyone." What is the nurse's best response?
1. "The restraints are placed to control his behavior."
2. "The restraints are placed to prevent harm to him and others."
3. "The restraints are placed because he was angry to the staff."
4. "The restraints are placed to keep him from falling off the bed."
Answer: 2
Explanation: 2. The nurse's best response is to tell the parent that the patient is in restraints to prevent the patient from harming himself or others. Restraints are not used simply because a patient was angry or to control behavior. All other less-invasive measures must be used prior to placing restraints and the patient must be a threat to self or others. Also, restraints are not used solely to keep a person from falling off the bed.
The community health nurse is teaching a class to a group of college women at the local community college. The nurse's teaching is focused on the risk factors of interpersonal violence (IPV) and rape. Which statement by the college student indicates that the nurse's teaching has been effective?
1. "Interpersonal violence is typically committed by men only."
2. "Interpersonal violence is typically committed by young individuals."
3. "Interpersonal violence is usually related to dynamics of power and control."
4. "Interpersonal violence is usually related to the concepts of self-esteem and self-worth."
Answer: 3
Explanation: 3. IPV, or domestic violence, involves aggressive behavior of many types between individuals in an intimate or dating relationship. IPV is usually related to dynamics of power and control, not self-esteem and self-worth. While IPV most often refers to violence toward women by men; however, women may engage in an equal amount of violence toward men, although the results of male partner violence are stronger and more severe. IPV may occur at any age.
The nurse is caring for a patient who is making obscene gestures to other staff members and is raising his voice in protest of an ordered test. What is the nurse's best action?
1. Determine the patient's level of anxiety.
2. Determine what basic patient needs are not being met.
3. Review the patient's chart for previous violent episodes.
4. Contact the health care provider regarding the patient's actions.
Answer: 2
Explanation: 2. The key concept to managing aggressive behavior is to identify the behavior warning signals. The patient is displaying escalating aggression by making obscene gestures and raising his voice. Escalation of aggression most often occurs when the patient's basic needs are not being met. The most appropriate action by the nurse is to determine what basic patient needs are not being met, in order to stop the escalation of aggression. The patient is displaying symptoms of escalating aggression from anxiety; therefore, determining the level of anxiety is not the best action, as the nurse must act in order to prevent further escalation. Reviewing the patient chart does not help to prevent the patient from becoming aggressive. Contacting the health care provider is not the best action because the nurse must act independently and quickly in order to prevent the escalation of aggression.
The nurse is researching violence in the community as part of a community health assessment. Using the broken windows theory, which factor will the nurse research?
1. Level of finances of the community members
2. Level of parental guidance in the community members
3. Level of education in both the community members and the larger society
4. Level of engagement by both the community members and the larger society
Answer: 4
Explanation: 4. According to the broken windows theory, when a neighborhood or area is run down and appears to be lacking engagement or investment by both community members and larger society, there will be a disproportionate amount of violence and crime, and further disorder will occur. While the other answer choices may be important to assess in a community with increased violence, these are not the primary causative factors of violence according to the broken windows theory.
The nurse is caring for a patient with acute anxiety. What interventions are most beneficial for preventing escalation of anxiety to aggression? Select all that apply.
1. Provide needed food and drink.
2. Assist the patient without delay.
3. Show a calm, positive, friendly demeanor.
4. Express sympathy and concern for the patient.
5. Decrease environmental stimuli.
Answer: 1, 2, 3, 5
Explanation: 1. Interventions that are most beneficial for the prevention of aggression in a patient who is experiencing anxiety include assisting the patient without delay, providing needed food and drink, showing a calm and positive demeanor, and decreasing environmental stimuli. The nurse should express compassion, not sympathy, when caring for this patient.
2. Interventions that are most beneficial for the prevention of aggression in a patient who is experiencing anxiety include assisting the patient without delay, providing needed food and drink, showing a calm and positive demeanor, and decreasing environmental stimuli. The nurse should express compassion, not sympathy, when caring for this patient.
3. Interventions that are most beneficial for the prevention of aggression in a patient who is experiencing anxiety include assisting the patient without delay, providing needed food and drink, showing a calm and positive demeanor, and decreasing environmental stimuli. The nurse should express compassion, not sympathy, when caring for this patient.
5. Interventions that are most beneficial for the prevention of aggression in a patient who is experiencing anxiety include assisting the patient without delay, providing needed food and drink, showing a calm and positive demeanor, and decreasing environmental stimuli. The nurse should express compassion, not sympathy, when caring for this patient.
The nursing staff cared for a patient who was aggressive and violent toward one of the nurses. What is the nurse manager's best immediate response?
1. Schedule a debriefing for all staff involved.
2. Schedule a staff meeting for all staff involved.
3. Schedule an educational session for all staff involved.
4. Schedule a medical record review with all staff involved.
Answer: 1
Explanation: 1. Work settings should address the need for staff to debrief after difficult interactions and interventions. Staff meetings and educational sessions do not necessarily address the need to debrief. A medical record review may be appropriate for all the staff after an encounter with a patient who is aggressive and angry; however, this is not the best immediate response from the nurse manager.
The nurse is caring for a patient who is a victim of interpersonal violence (IPV). What is the nurse's first priority?
1. Assist the patient to devise a safety or escape plan.
2. Encourage the patient to take charge of the situation.
3. Make it clear to the patient that the partner needs to see a therapist.
4. Offer to contact outpatient services if the patient promises not to return home after discharge.
Answer: 1
Explanation: 1. A victim of intimate partner violence should have a safety plan. This is the highest priority because the patient's physical and/or mental health is in danger. The nurse should not assume that the patient will be able to control the partner, and suggesting that the patient tell the abusive partner to see a therapist could escalate the abuse. Encouraging a patient to take charge is a very general suggestion. The patient needs specific tools to develop a safety plan. It may not be safe or feasible for the patient to leave home right away, and resources should not be withheld if a patient is unable to promise to leave home.
The nurse is conducting a health history on a newly admitted patient. The patient's wife tells the nurse, "Ever since my husband's head injury, he is easily agitated, cannot focus, and is impulsive." What is the best response from the nurse?
1. "Your husband's injuries may have damaged the prefrontal cortex of the brain, causing these symptoms."
2. "Your husband's injuries may have damaged the occipital lobe of the brain, causing these symptoms."
3. "Your husband's injuries may have damaged the parietal lobe of the brain, causing these symptoms."
4. "Your husband's injuries may have damaged the cerebellum of the brain, causing these symptoms."
Answer: 1
Explanation: 1. Damage to the prefrontal cortex of the brain may manifest as agitation, inability to focus, and impulsivity. Damage to the occipital lobe would likely manifest in alterations in visual perception. Damage to the parietal lobe would exhibit as alterations in visual-spatial coordination. Damage to the cerebellum would manifest in poor balance and decreased fine motor control.
A patient presents for an annual physical. As the nurse conducts the assessment, which statement will suggest the patient is experiencing workplace bullying?
1. "My manager has not given me a raise in over 10 years."
2. "My manager criticizes my work all the time, despite the fact that my annual performance review is always positive."
3. "My manager does not invite me to team meetings and I miss out on important information, affecting my annual performance review."
4. "My manager does not provide any positive feedback on my work at all and my annual performance review remains unchanged."
Answer: 3
Explanation: 3. Workplace bullying can be defined as deliberate, repeated mistreatment of a worker over time by another worker; it involves negative and aggressive behaviors such as harassment, social exclusion, or interference with job performance. The manager who does not invite the employee to team meetings, affecting the employee's annual review, is displaying workplace bullying. A manager who has not given a raise is not displaying workplace bullying. Managers who criticize work and who do not give positive feedback are not necessarily engaging in workplace bullying if the employee's annual performance review has either been positive or unchanged.
The nurse is caring for a patient who appears anxious and is pacing the room and clenching his fists. What action best demonstrates the core concept of effective intervention for this patient?
1. Administering a medication to the patient
2. Deciding to promptly isolate the patient from others
3. Assessing the patient's perception of his level of anxiety
4. Demonstrating therapeutic communication with the patient
Answer: 4
Explanation: 4. The patient in the scenario is displaying escalating anxiety, which may lead to aggression and violence. Interventions for a patient who is displaying anxiety, frustration, anger, and aggression are based on the core principle of therapeutic communication. Pharmacological therapy may be used in the treatment of this patient; however, this is not the core concept of effective intervention for this patient. While prompt decision-making is appropriate for this patient, isolating the patient is not and does not represent the core concept of effective intervention for this patient. While it may be appropriate to assess the patient's perception of his level of anxiety, this does not represent the core concept of effective intervention for this patient.
The emergency department nurse educator is providing an in-service to the nursing staff on recognizing the signs and symptoms of interpersonal violence (IPV) and rape. Which assessment finding will the educator include in the teaching?
1. Sores around the mouth, brittle hair
2. Multiple bruises, abrasions at various stages of healing
3. Acting-out behaviors, disobedience, trouble with the law
4. Poor eye contact, depressed mood, unwillingness to give history data
Answer: 2
Explanation: 2. Physical abuse is the non-accidental use of physical force that results in bodily injury, pain, or impairment. Multiple bruises and abrasions at various levels of healing are signs that the patient may have been subjected to physical abuse. Acting-out behaviors are more consistent with antisocial personality disorder. Poor eye contact, depressed mood, and withdrawal behaviors are more consistent with a diagnosis of depression. Sores around the mouth and brittle hair may indicate an eating disorder.
The nurse is caring for a patient whom the nurse suspects is a victim of intimate partner violence (IPV). What screening question made by the nurse is most appropriate?
1. "Can you tell me how you got your injuries?"
2. "Can you tell me if it is safe for you to go home?"
3. "Can you tell me what you know about intimate partner violence?"
4. "Can you tell me what your spouse was doing when you sustained your injuries?"
Answer: 2
Explanation: 2. Screening is one way that nurses can help to provide information and resources to a person who may be suffering IPV. The most appropriate way to screen for IPV is the use of direct questions about the violence. The most appropriate question is, "Is it safe for you to go home?" All the other questions are not as direct, and they do not get at the priority nursing action, which is to assess the safety of the patient.