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Because an intervention is required to control a patient's aggressive behavior, a critical incident debriefing takes place. Which topics should be the focus of the discussion? (Select all that apply.)
- A. Patient behavior associated with the incident
- B. Genetic factors associated with aggression
- C. Intervention techniques used by staff
- D. Effect of environmental factors
- E. Review of theories of aggression
Correct Answer: A,C,D
Rationale: The patient's behavior, the intervention techniques used, and the environment in which the incident occurred are important to establish realistic outcomes and effective nursing interventions. Discussing the views about the theoretical origins of aggression is less effective.
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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 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.
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?
- 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.
Correct Answer: B
Rationale: Periodic updates reduce anxiety and defuse anger. This strategy acknowledges the spouse's presence and concerns. The incorrect options are likely to increase anger because they imply that the anxiety is inappropriate.
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 nurse directs the intervention team who must take an aggressive patient to seclusion. Other patients were removed from the area. Before approaching the patient, the nurse should ensure that which actions are taken by staff? (Select all that apply.)
- A. Remove jewelry, glasses, and harmful items from the patient and staff members.
- B. Appoint a person to clear a path and open, close, or lock doors.
- C. Quickly approach the patient and grab the closest extremity.
- D. Select the person who will communicate with the patient.
- E. Move behind the patient to use the element of surprise.
Correct Answer: A,B,D
Rationale: Injury to staff members and to the patient should be prevented. Only one person should explain what will happen and direct the patient; this person might be the nurse or staff member who has a good relationship with the patient. A clear pathway is essential; those restraining a limb cannot use keys, move furniture, or open doors. The nurse is usually responsible for administering the medication once the patient is restrained. Each staff member should have an assigned limb rather than just grabbing the closest limb. This system could leave one or two limbs unrestrained. Approaching in full view of the patient reduces suspicion.