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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?
- 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.
Correct Answer: B
Rationale: The patient's threat to kill self or others with the knife he possesses constitutes a clear and present danger to self and others. The distractors are not sufficient reasons for seclusion.
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Which central nervous system structures are most associated with anger and aggression? (Select all that apply.)
- A. Amygdala
- B. Cerebellum
- C. Basal ganglia
- D. Temporal lobe
- E. Parietal lobe
Correct Answer: A,D
Rationale: The amygdala mediates anger experiences and helps a person judge an event as either rewarding or aversive. The temporal lobe, which is part of the limbic system, also plays a role in aggressive behavior. The cerebellum manages equilibrium, muscle tone, and movement. The basal ganglia are involved in movement. The parietal lobe is involved in interpreting sensations.
A patient with a history of command hallucinations approaches the nurse, yelling obscenities. The patient mumbles and then walks away. The nurse follows. Which nursing actions are most likely to be effective in de-escalating this scenario? (Select all that apply.)
- A. State the expectation that the patient will stay in control.
- B. State that the patient cannot be understood when mumbling.
- C. Tell the patient, 'You are behaving inappropriately.'
- D. Offer to provide the patient with medication to help.
- E. Speak in a firm but calm, caring voice.
Correct Answer: A,D,E
Rationale: Stating the expectation that the patient will maintain control of behavior reinforces positive, healthy behavior, and avoids challenging the patient. Offering an as-needed medication provides support for the patient trying to maintain control. A firm but calm voice will likely comfort and calm the patient. Belittling remarks may lead to aggression. Criticism will probably prompt the patient to begin shouting.
Which behaviors are most consistent with the clinical picture of a patient who is becoming increasingly aggressive? (Select all that apply.)
- A. Pacing
- B. Crying
- C. Withdrawn affect
- D. Rigid posture with clenched jaw
- E. Staring with narrowed eyes into the eyes of another
Correct Answer: A,D,E
Rationale: Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently. The other behaviors are consistent with the increased risk for other-directed violence.
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?
- A. Childhood trauma
- B. Family involvement
- C. Academic problems
- D. Daily substance abuse
Correct Answer: D
Rationale: The nurse should suspect compromised coping skills in a patient with daily substance abuse. He or she is often anxious, may be concerned about inadequate pain relief, and may have a personality style that externalizes blame. The incorrect options do not signal as high a degree of risk as substance abuse.
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?
- A. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
- B. Crowding in skilled care facilities increases individual tendencies toward violence.
- C. The patient interpreted the health care worker's behavior as potentially harmful.
- D. This patient learned violent behavior by watching other patients act out.
Correct Answer: C
Rationale: Confused patients are not always able to evaluate accurately the actions of others. This patient behaved as though provoked by the intrusive actions of the staff member.