Nokea
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?
- 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.
Correct Answer: C
Rationale: Patients whose personality style causes them to externalize blame see the source of their discomfort and anxiety as being outside themselves. They displace anger and are often unable to soothe themselves. The incorrect options are less likely to have a bearing on this behavior.
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Which behavior best demonstrates aggression?
- A. Stomping away from the nurses' station, darting to another room, and grabbing a snack from from another patient
- B. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing
- C. Telling the primary nurse, 'I felt angry when you said I could not have a second helping at lunch'
- D. Telling the medication nurse, 'I am not going to take that or any other medication you try to give me'
Correct Answer: A
Rationale: Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not feature violation of another's rights.
Which medication should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?
- A. Lithium
- B. Trazodone
- C. Olanzapine
- D. Valproic acid
Correct Answer: C
Rationale: Olanzapine is a short-acting antipsychotic drug that is useful in calming angry, aggressive patients regardless of their diagnosis. The other drugs listed require long-term use to reduce anger. Lithium is for patients with bipolar disorder. Trazodone is for patients with depression, insomnia, or chronic pain. Valproic acid is for patients with bipolar disorder or borderline personality disorder.
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?
- 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.'
Correct Answer: B
Rationale: A patient gains feelings of security if he or she sees that others are present to help with control. The nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that the intervention will be helpful. This positive approach assumes that the patient can act responsibly and will maintain control. Physical control measures should be used only as a last resort. The security guards are likely to intimidate the patient and increase feelings of vulnerability.
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.
A patient with a history of impulsively acting out anger by striking others. Which would be an appropriate plan for avoiding such incidents?
- 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.
Correct Answer: B
Rationale: Identifying trigger incidents allows the patient and nurse to plan interventions to reduce irritation and frustration that lead to acting out anger and to put more adaptive coping strategies eventually into practice. None of the other options allow for self-reflection and understanding of the causes of the aggressive behavior.