Nokea
After working with a patient who has a history of violent behavior to identify possible clues that suggest that his behavior is escalating, the nurse and patient develop a plan for prevention. Which strategy would they be least likely to include?
- A. Counting to 10
- B. Taking slow deep breaths
- C. Turning up the music loud
- D. Taking a voluntary time out
Correct Answer: C
Rationale: Turning up the music loud could overstimulate the patient and escalate agitation, making it an ineffective prevention strategy. Counting to 10, deep breathing, and voluntary time-outs are calming techniques that help de-escalate potential violence.
You may also like to solve these questions
While interviewing a patient, a nurse asks, What do you do when you get angry? Which patient response would indicate to the nurse that the patient engages in anger suppression?
- A. I?ve been known to fly off the handle when I?m angry.
- B. People say I withdraw and pout about the problem.
- C. I usually approach the person directly to talk about it.
- D. I try to discuss how I?m feeling about it with a close friend.
Correct Answer: B
Rationale: Withdrawing and pouting indicate anger suppression, as the patient avoids expressing anger directly. Flying off the handle suggests explosive anger, while direct discussion or confiding in a friend indicates healthier anger expression.
The nurse is caring for a family whose older father with dementia is living in their home. The nurse has instructed the family about how to decrease the father?s agitation. The nurse determines that the son has understood the nurse?s instructions when he states which of the following?
- A. Restraints can help reduce my father?s agitation.
- B. I should place my father in the bedroom with me so I can watch him more closely.
- C. It?s important that he gets out shopping with me or my wife.
- D. If I simplify our home environment, my father may be less agitated.
Correct Answer: D
Rationale: Simplifying the home environment reduces sensory overload, which can decrease agitation in patients with dementia. Restraints can increase agitation, close monitoring in a bedroom may not address triggers, and shopping outings may overstimulate the patient.
The nurse is caring for an older adult patient who has no history of violence but is agitated and appears ready to strike out at a staff member. The nurse would assess the patient for which of the following?
- A. Panic disorder
- B. Epilepsy
- C. Bipolar disorder
- D. Sensory losses
Correct Answer: D
Rationale: Sensory losses, such as hearing or vision impairment, are common in older adults and can lead to agitation or perceived aggression due to frustration or miscommunication. Panic disorder, epilepsy, or bipolar disorder are less likely causes without additional symptoms or history.
A nursing instructor is teaching a class of nursing students about anger, aggression, and violence. Which statement by the instructor would be most appropriate to include?
- A. Anger, aggression, and violence are points along a continuum.
- B. The terms used to describe anger are very precise.
- C. Anger is a knee-jerk reaction to external events.
- D. Women experience anger as frequently as men do.
Correct Answer: A
Rationale: Anger, aggression, and violence exist along a continuum, where anger can escalate to aggression and potentially violence if not managed. The other statements are less accurate: anger terms are not always precise, anger is not solely a knee-jerk reaction, and gender frequency is not the focus.
A nurse is presenting an in-service program about aggression and violence to a group of newly hired nurses who will be working in an inpatient psychiatric facility. When describing characteristics that may predict the risk for violence and aggression in patients, which of the following would the nurse include? Select all that apply.
- A. Age
- B. Impulsivity
- C. Substance withdrawal
- D. Gender
- E. Suspiciousness
Correct Answer: A,B,C,D,E
Rationale: Age, impulsivity, substance withdrawal, gender, and suspiciousness are all predictors of violence risk. Younger age, male gender, impulsivity, withdrawal symptoms, and paranoia or suspiciousness increase the likelihood of aggressive behavior in psychiatric settings.