Question: 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. When entering the day room what response should the nurse make?
Answer Choices: a. States, “Would you like to come to your room and take some medication your doctor prescribed for you?” b. Accompanied by three staff members and states, “Please come to your room so I can give you some medication that will help you feel more comfortable.” c. Initiates process to place the patient in a basket-hold and then state, “I am going to take you to your room to give you an injection of medication to calm you.” d. 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.”
Answer: b. Accompanied by three staff members and states, “Please come to your room so I can give you some medication that will help you feel more comfortable.”
Question: 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. They make me so angry” Which response would be the most urgent reason for this nurse to seek supervision?
Answer Choices: a. Startle reactions b. Difficulty sleeping c. Expression of anger d. Preoccupation with the incident
Answer: c. Expression of anger
Question: The staff development coordinator plans to teach use of physical management techniques when patients become assaultive. Which topic should be emphasized?
Answer Choices: a. Practice and teamwork b. Spontaneity and surprise c. Caution and superior size d. Diversion and physical outlets
Answer: a. Practice and teamwork
Question: An adult patient assaulted another patient and was restrained. One hour later, which statement by this restrained patient necessitates the nurse’s immediate attention?
Answer Choices: a. “I hate all of you!” b. “My fingers are tingly.” c. “You wait until I tell my lawyer.” d. “It was not my fault. The other patient started it.”
Answer: b. “My fingers are tingly.”
Question: Which is an effective nursing intervention to assist an angry patient to learn to manage anger without violence?
Answer Choices: a. Help the patient identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking. b. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present. c. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings. d. Administer an antipsychotic or antianxiety medication when the patient feels angry.
Answer: a. Help the patient identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking.
Question: Which assessment finding presents the greatest risk for violent behavior?
Answer Choices: a. Severe agoraphobic b. A history of intimate partner violence c. Reports of bizarre somatic delusions d. Verbalization of hopelessness and powerlessness
Answer: b. A history of intimate partner violence
Question: 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. What is the justification for the use of seclusion?
Answer Choices: a. Patient demonstrates a thought disorder, rendering rational discussion ineffective. b. Patient’s actions present a clear and present danger to others. c. Patient demonstrates an apparent and plausible escape risk. d. Patient’s actions display features of psychotic thinking.
Answer: b. Patient’s actions present a clear and present danger to others.
Question: 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. What is the likely conclusion regarding the patient’s behavior?
Answer Choices: a. Patient is demonstrating withdrawal behaviors. b. Patient is trying to work through angry feelings. c. Patient is attempting to use relaxation strategies. d. Patient is exhibiting clues to potential aggression.
Answer: d. Patient is exhibiting clues to potential aggression.
Question: 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, what should the nurse first say?
Answer Choices: a. “You must come away from the door.” b. “You have been a widow for many years.” c. “You want to go home to prepare your husband’s dinner?” d. “Was your husband angry if you did not have dinner ready on time?”
Answer: c. “You want to go home to prepare your husband’s dinner?”
Question: 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?
Answer Choices: a. Tell the patient to notify the nurse 30 minutes before the pain returns so the medication can be prepared. b. Urge the health care provider to change the prescription for pain medication from as needed to a regular schedule. c. Tell the patient that verbal assaults on nurses will not shorten the wait for pain medication. d. Have the clinical nurse leader request a psychiatric consultation.
Answer: b. Urge the health care provider to change the prescription for pain medication from as needed to a regular schedule.
Question: A patient has a history of impulsively injuring others by striking others. Which would be an appropriate plan for avoiding such incidents?
Answer Choices: a. Explain that restraint and seclusion will be used if violence occurs. b. Help the patient identify incidents that trigger impulsive acting out. c. Offer one-on-one supervision to help the patient maintain control. d. Administer lorazepam every 4 hours to reduce the patient’s anxiety.
Answer: b. Help the patient identify incidents that trigger impulsive acting out.
Question: 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?
Answer Choices: a. Discontinue the dressing change without comments and leave the room. b. Stop the dressing change, saying, “Perhaps you would like to change your own dressing.” c. Continue the dressing change, saying, “Do you know this dressing change is needed so your wound will not get infected?” d. Continue the dressing change, saying, “Unfortunately, you have no choice. Your doctor ordered this dressing change.”
Answer: c. Continue the dressing change, saying, “Do you know this dressing change is needed so your wound will not get infected?”
Question: Which medication should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?
Answer Choices: a. Lithium b. Trazodone c. Olanzapine d. Valproic acid
Answer: c. Olanzapine
Question: 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?
Answer Choices: a. Explain that the patient’s condition is not life threatening. b. Periodically provide an update and progress report on the patient. c. Explain that all patients are treated in order, based on their medical needs. d. Suggest that the spouse return home until the patient’s treatment is completed.
Answer: b. Periodically provide an update and progress report on the patient.
Question: Confirmation of a history of what scenario from a patient’s record indicates compromised coping skills and the need for careful assessment of the risk for violence?
Answer Choices: a. Childhood trauma b. Family involvement c. Academic problems d. Daily substance abuse
Answer: a. Childhood trauma
Question: A patient diagnosed with pneumonia has been hospitalized for 4 days. Family members describe the patient as “a difficult person who finds fault with everyone.” The patient verbally abuses nurses for providing poor care. What is the most likely explanation for this behavior?
Answer Choices: a. Poor child-rearing that did not teach respect for others. b. Automatic thinking, leading to cognitive distortion. c. Personality style that externalizes problems. d. Delusions that others wish to deliver harm.
Answer: c. Personality style that externalizes problems.
Question: A patient with burn injuries has demonstrated good coping skills for several weeks. Today, a new nurse is poorly organized and does not follow the patient’s usual schedule. By mid-afternoon, the patient is irritable and loudly criticizes the nurse manager. Which is the best response?
Answer Choices: a. Explain the reasons for the disorganization and take over the patient’s care for the rest of the shift. b. Acknowledge and validate the patient’s distress and ask, “What would you like to have happen?” c. Apologize and explain that the patient will have to accept the situation for the rest of the shift. d. Ask the patient to control the anger and explain that allowances must be made for new staff members.
Answer: b. Acknowledge and validate the patient’s distress and ask, “What would you like to have happen?”
Question: When a patient’s aggression quickly escalates, which principle applies to the selection of nursing interventions?
Answer Choices: a. Staff members should match the patient’s affective level and tone of voice. b. Ask the patient what intervention would be most helpful. c. Immediately use physical containment measures. d. Begin with the least restrictive measure possible.
Answer: d. Begin with the least restrictive measure possible.