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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?
- A. Startle reactions
- B. Difficulty sleeping
- C. Expression of anger
- D. Preoccupation with the incident
Correct Answer: C
Rationale: The expression of patient-focused anger signals an urgent need for professional supervision to work through anger and counter the aggressive feelings. The distractors are normal in a person who has been assaulted. Nurses are usually relieved with crisis intervention and follow-up designed to give support, help the individual regain a sense of control, and make sense of the event.
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A patient is hospitalized after an arrest for breaking windows in the home of a former intimate partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority?
- A. Risk for injury
- B. Post-trauma response
- C. Disturbed thought processes
- D. Risk for other-directed violence
Correct Answer: D
Rationale: The defining characteristics for risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. The defining characteristics for the other diagnoses are not present in this scenario.
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 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.
When a patient's aggression quickly escalates, which principle applies to the selection of nursing interventions?
- 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.
Correct Answer: D
Rationale: Standards of care require that staff members use the least restrictive measure possible. This becomes the guiding principle for intervention. Physical containment is seldom the least restrictive measure. Asking the out-of-control patient what to do is rarely helpful. It may be an effective strategy during the pre-assaultive phase but is less effective during escalation.
The staff development coordinator plans to teach use of physical management techniques when patients become assaultive. Which topic should be emphasized?
- A. Practice and teamwork
- B. Spontaneity and surprise
- C. Caution and superior size
- D. Diversion and physical outlets
Correct Answer: A
Rationale: Intervention techniques are learned behaviors that must be practiced to be used in a smooth, organized fashion. Every member of the intervention team should be assigned a specific task to carry out before beginning the intervention. The other options are useless if the staff does not know how to use physical techniques and how to apply them in an organized fashion.