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A nurse obtains data about a client. Which assessment data best supports the suspicion that a client possesses what is medically referred to as trait anger?
A. History of arrests for assault and battery
B. Reports “being bullied by both my father and my older brothers”
C. Statements about being “quick tempered most of my life”
D. Several knuckles are bruised and scratched
Answer: C
Rationale: Trait anger is often referred to as a general biologic leaning toward a volatile personality that may be described by the person as “quick-temper,” a feeling of becoming “hot” or feeling one's heart rate accelerate, or behavior that reflects a quick response of irritation and fury. The individual with this type of personality typically has a habitual response to frustrating circumstances that trigger a negative social outcome. While the other options can be associated with the display of anger, they are not as conclusive as a history of anger-related behaviors.
Assessment reveals a client with a history of anger management issues Which statement would lead the nurse to identify the origin for the client’s anger and resentment?
A. “Dad always said anger was a good thing when we needed to defend ourselves.”
B. “In my culture, you have a duty to get angry and to stand up for yourself.”
C. “The way I see it is that I was wronged and had a right to get angry.”
D. “Sometimes the only thing that solves the problem is to get angry.”
Answer: C
Rationale: Both anger and resentment originate in our mental perception of a situation. This perception usually includes feelings of being wronged, ignored, cheated, or abused in some way. The remaining options are expressing more socially accepted reasons for the display of anger.
While leading a group session, a member reacts with an angry verbal outburst. Which response by the nurse would be appropriate?
A. “It is disrespectful to be verbally aggressive with the members of the group, and I'm certain you would not want to act in such a manner.”
B. “I acknowledge the pain you feel and your need to be heard, but I cannot let you manipulate and control the group with your anger.”
C. “I want you to leave the group now and think about how your behavior is having a negative impact on the group and on you as well.”
D. “The group does not deserve to experience your anger and aggressive behavior; you may stay only if you respond in a more acceptable manner.”
Answer: B
Rationale: Getting angry is a way of using manipulation to cause an emotional reaction in another in order to get them to act in accordance with one's thinking. This response is conveyed in one's behavior as an attempt to resolve the mental hurt one feels. Many of these mental hurts are formed during the vulnerable defenseless years of childhood and the baggage is carried over a lifetime. While it is appropriate to identify the behavior as being disrespectful, doing so doesn't reflect an understanding of the causes of the behavior. It would not be therapeutic to require the individual to leave the group, especially without guidance in reflecting the impact of the behavior or in the identification of acceptable behavior.
While interviewing a 14-year-old, the nurse suspects that the client may be a victim of bullying? Which client statement would support the nurse’s suspicions?
A. “Yes, I skip school a lot but that's no big deal.”
B. “I can't seem to make friends at this new school.”
C. “No, I don't do social networking very much.”
D. “Some kids at my school can be really mean sometimes.”
Answer: D
Rationale: Bullying involves repeated threats and taunting hurtful abuse by a person who seems stronger than the person being targeted. It is a frightening experience for the victim and can be physical, verbal, or social. It can involve physically hitting, pushing, teasing, or destroying property belonging to the targeted individual. While absenteeism can be a red flag, bullying is not the only reason a child may resist going to school. Not all bullying involves social media networking. Making new friends can be difficult for many reasons that do not involve bullying.
An individual has shared that they “are suicidal and have a plan to implement it soon.” Which question would be most important for the nurse to ask first?
A. “How long have you had this plan to harm yourself?”
B. “Have you ever tried to harm yourself in the past?”
C. “Where did you get this plan to harm yourself?”
D. “How do you plan to harm yourself?”
Answer: D
Rationale: A risk assessment should be done on the first contact with the person and it is important that this assessment determines the lethality and immediacy of the crisis, in this case, the suicide attempt. While the remaining options provide important information, the priorities are to determine how likely it is that the individual's plan would prove to be life-threatening, if the individual can implement the plan, and when the plan is to be acted upon.
A mental health nurse is conducting a class for client about how to recognize triggers for their anger responses. The nurse is conducting this class based on which rationale?
A. Recognition helps refocus from physical anger to less violent verbal aggression
B. Knowing the triggers helps clients direct their anger away from people and animals
C. This knowledge helps provide the opportunity to gain control of their anger
D. Identifying triggers allows them to better control them
Answer: C
Rationale: Recognizing the origin of the emotional response of anger can identify triggers that allow people to be in touch with why they respond as they do. This awareness gives people the opportunity to assume control of the anger before they succumb to its fury. Transferring from one form of aggression to another or from one target to another is not the purpose of trigger identification. It is not always reasonable to expect to control triggers but rather to manage one's response to those triggers.
Assessment reveals that a female client has experienced physical abuse by their spouse. The nurse would most likely observe which response in the client related to the spouse's remorseful promise that “it will never happen again”?
A. Feelings of guilt with acceptance of blame for the abuse
B. Reactions to the spouse with similar physical violence
C. Retreat from the abuser by leaving the home
D. Notification of the police that the abuse occurred
Answer: A
Rationale: Once major physical and emotional harm or battering has been done to the victim, the batterer or abusive partner usually tries to offer some type of gift or loving gestures of remorse and promises that it will not happen again. Ironically, this presumed sorrow sets the victim up for the next step of abuse in which the perpetrator justifies the behavior by projecting the blame to the victim. The victim feels guilty and accepts the blame. The other options are not the usual response at this point in the cycle of violence and abuse.
A nurse is working with a female client who has just left an abusive partner. Based on assessment of the client’s needs, the nurse would initially focus on which area as the priority?
A. Arranging for the client to attend a therapy group dealing with intimate partner abuse
B. Assuring the client that they are not to blame for the abusive situation that exists
C. Working with the client to identify a safe place to live
D. Recognizing the effects such abuse has on a client
Answer: C
Rationale: It is important that the initial intervention in this situation involves providing a safe environment and then counseling to help build a sense of power, self-worth, and support for the abused victim. The victim is usually in greatest danger right after the separation occurs as the batterer is flooded with a surge of anger and blame. The other options are appropriate needs but safety is, without question, the most important initially.
A nurse is working with a client who recently experienced the loss of a spouse. The nurse determines that the client has the skills to cope with the emotional crisis associated with this loss based on which statement?
A. “It is so difficult; I can remember what it was like losing my father.”
B. “Death is something everyone has to deal with at one time or another.”
C. “I'll do anything to make this sadness go away.”
D. “I believe I will see him in another life.”
Answer: A
Rationale: The fact that the client has experienced a crisis in the past and coped with it effectively is a strong indicator that the client has the needed skills to cope again. While it is true that death is a universally experienced crisis, recognizing that is no indication of how the client will cope with it. Most individuals are willing to accept help during a crisis but that willingness doesn't assure a successful coping experience. Having a faith in the afterlife is a comfort for some but it doesn't ensure successful coping with the loss.
While talking with a teenager, the teenager says, “I just want to die.” Which intervention would be the nurse's priority?
A. Call the teen's parents so they can be aware of the seriousness of the situation.
B. Stay with the teen and demonstrate calm, caring concern for the situation.
C. Assure the teen that “things are not as bad as they seem right now.”
D. Assess the teen for risk factors that triggered these suicidal thoughts.
Answer: B
Rationale: It is important that interventions focus on the immediate danger to and safety of the individual. The person in an acute crisis situation should never be left alone. Assessing the client and notifying parents, if appropriate, can be accomplished once the teen's safety is being managed. Minimizing the client's feelings is not appropriate and should not be done.
After teaching a client about anger, a nurse determines that the teaching was successful based on which client statement?
A. “I know it's natural to be angry but I can't keep hurting my children like I do.”
B. “Everyone gets angry but I get really angry.”
C. “My family has learned to stay away from me when I get angry.”
D. “I can't remember a time when I wasn't angry; my dad was that way too.”
Answer: A
Rationale: In one sense, anger is a natural adaptive response needed for survival in the face of a threat or danger. In most instances, however, the reaction may be directed at a specific person or, in a generalized sense, toward a group and even society itself. These concepts are reflected in the statement about anger being natural along with the realization that the anger causes hurt. The remaining options demonstrate insight into the personal display of anger or how such displays have been adaptive too, but they do not indicate understanding of the process itself.
Which behavior exemplifies how suppressed anger is often displayed in situations where a parent directed physical abuse toward a child, who is now an adult?
A. Adult child interacts with the abusive parent only when it is unavoidable.
B. Abusive parent repeatedly claims the physical contact was discipline not abuse.
C. Adult child bans both sets of grandparents from having contact with the grandchildren.
D. Abusive parent maintains that the physical abuse was imagined and not real.
Answer: C
Rationale: Often, perceptions of anger are formed during the vulnerable years of childhood and the perceptions carry over throughout one’s lifetime. Suppressed over time, the hurt turns to resentment and often erupts in a destructive means of resolution such as denying contact between the grandchildren and even an uninvolved grandparent. Avoiding contact is an example of suppression while the other options are demonstrations of denial on the part of the abusive parent.
The nurse is reviewing the history of a 10-year-old child who repeatedly has been abused physically by both parents. As a result, the child behaves aggressively when faced with frustrations or disappointments. When assisting with planning the care for this child, which nursing intervention would likely have the greatest impact on modifying the child’s behaviors?
A. Providing age-appropriate consequences when the child behaves aggressively
B. Role modeling coping skills to appropriately manage frustration and disappointment
C. Clearly defining the behaviors expected of the child regarding respect and anger control
D. Minimizing the number of frustrating situations the child will likely experience
Answer: B
Rationale: Although inappropriate, violence and abusive behaviors are often learned responses in an environment where this is the norm. Growing up, the child learns to deal with frustration and disappointment by repeating patterns modeled by the family members. Since the conditioned response may be reactive and automatic, actions may precede any effort to dissolve the intensity of the emotion, or to resolve the situation through problem-solving. Role modeling coping skills to manage frustration and disappointment would be most effective. Minimizing frustrations is neither realistic nor therapeutic since frustrations are a part of daily living.
A nurse is attending a seminar on childhood bullying. The nurse demonstrates understanding of the information when the nurse identifies which statement as reflecting the most serious long-term psychosocial outcome of childhood bullying?
A. Financial difficulty resulting from the decision to drop out of school
B. Conscious adoption of bullying behaviors to boost self-esteem
C. Participation in criminal behavior to deal with suppressed anger
D. Serious problems with developing and maintaining healthy relationships
Answer: D
Rationale: The problems experienced by these individuals as a result of the psychological abuse may extend into adulthood with serious dysfunction in the individual's ability to function both in relationships and society in general. The financial limitations are physical, not psychosocial, in nature. As with all the options, the situations may occur but they are not as serious or as prevalent as the effect distrust has on interpersonal relationships.
A nurse is interviewing an older adult client. During the conversation, the client tells the nurse, “I really want to die. I have nothing to live for anymore.” Which response by the nurse would be most therapeutic?
A. “What are you feeling that makes you say this?”
B. “I will stay with you and not leave you alone.”
C. “How exactly do you want to end your life?”
D. “You’ll be safe once I remove any objects you could harm yourself with.”
Answer: B
Rationale: It is important that the nurse’s response and interventions focus on the immediate danger to and safety of the individual. The person in an acute crisis situation should never be left alone. A rapport should be established that conveys a calm and caring attitude or genuine concern for the life and story. The other responses do not address the client’s immediate safety needs. Asking about the client’s feelings and determining the “how” would be appropriate later on to evaluate the seriousness of the suicidal thoughts. Although removing harmful objects would promote safety, the priority is not to leave the client alone.
A nurse is gathering data about a client’s potential for risk for intimate partner violence. When reviewing the client's history, which information would the nurse identify as being important? Select all that apply.
A. Has a history of drug abuse.
B. Made the statement, “Women need to stay home and raise the children.”
C. Has been arrested for intentionally breaking the neighbor's windows.
D. Stated, “My dad beat us with a belt when we didn't obey him.”
E. Reported coaching a children's elementary school soccer team.
Answer: A, B, C, D
Rationale: Factors that indicate the potential or warning signs for violence in people include drug or alcohol abuse, degrading attitude toward women, has a history of vandalism, and a family history of violence. While extreme competitiveness is a potential risk factor, coaching a soccer team by itself is not a risk factor.
A nurse is providing care to a client with suicidal ideation and the client’s partner. Which statement(s) made by the partner support the nurse's belief that the partner understands the concept of crisis prevention? Select all that apply.
A. “My partner really doesn't want to hurt themself, but they want the emotional pain to stop.”
B. “I'll do whatever it takes to make my partner understand that they are loved and cared for.”
C. “All the medications in the home are locked up in a safe cabinet and only I have the key.”
D. “When my partner begins to give away favorite books, my partner he at great risk for self- harm.”
E. ”We don't have any firearms in the house and none of our friends have access to any.”
Answer: C, E
Rationale: Individuals who indicate that they are thinking about or wanting to kill themselves need help. A basic concept of crisis prevention is to realize that attention must be focused on their immediate safety. By removing any unsupervised access to prescription or OTC medications and eliminating access to firearms or other potential suicide tools, the client will be denied a possible means of acting on their ideations. While it is helpful that the members of the support system understand the depth of the individual's emotional pain and willingness to act on their plan as well as wish to demonstrate caring, these understandings don't directly impact the prevention of the crisis behavior that is associated with suicide.
A nurse is working as part of a team assisting a client with handling anger. Which statement by the nurse demonstrates an understanding of constructive methods of handling anger? Select all that apply.
A. “Is what they are doing really worth getting so angry about?”
B. “Have you ever tried going for a run when you find yourself getting angry?”
C. “It often helps to plan 'quiet alone time' for short periods during the day.”
D. “It's not a good idea to allow yourself to show it when something makes you angry.”
E. “When you find yourself getting angry, come find me and we can talk.”
Answer: A, B, C, E
Rationale: Putting the situation in perspective with restructured thinking can help the person from overdramatizing the facts. In order to control the emotion, one must also take steps to decrease the body response. One way to manage the anger is to engage in some form of physical activity such as walking, jogging, or playing tennis. People who know their temperament is easily irritated may want to plan a “time-out” period each day for exercise and meditation. Separating oneself from the situation allows the mind time to reflect and think about the cause of the feelings. Talking with someone who will listen is also a positive means of reducing the intensity of emotions. Assertion, the standing up for one's beliefs or rights is a healthy demonstration of anger but one must realize this has to be done in a reasonable manner.
A nurse is collecting data about a newly admitted client. Which information would the nurse interpret as possible risk factor(s) for violence? Select all that apply.
A. Acknowledges a history of drug and alcohol abuse
B. Admits to resorting to manipulation when unable to get the cooperation of others
C. States “things are fine when people just do like I say”
D. Overheard stating “People just like me and so they do what I want”
E. Reports a need to “always win” when competing with peers
Answer: A, C, E
Rationale: The factors that indicate the potential or warning signs for violence in people include history of alcohol and/or drug abuse and rationalization of the need for violence and extreme competitiveness. Neither manipulative behavior nor a sense of social acceptance is a potential warning sign of violence.
A nurse has assisted a client who has experienced a crisis. The nurse determines that the client understand crisis intervention based on which client statement(s)? Select all that apply.
A. “I start deep breathing techniques when I first start getting panicky about speaking in public.”
B. “I get really nervous when I have to speak in front of several people, especially in public places.”
C. “I know that I can speak in public if I can manage the nervousness I feel.”
D. “I won't speak in public unless I know at least one person in the audience.”
E. “If I have to speak in public, I'll remember to focus on making sure that I stay in control.”
Answer: A, B, C, E
Rationale: The goal of crisis intervention is to reduce the anxiety to a level that will allow the client to look at the situation more realistically toward a resolution. Early intervention in assisting the individual to manage the current situation promotes the best chance for a positive outcome. Once the anxiety level is reduced to a tolerable level, the individual can be assisted in defining the problem, determining available support, and setting realistic goals for resolution of the issue. Not speaking in public unless the person knows at least one person is unrealistic.