Nokea
The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid?
- A. Anticipating that a loss of control is possible and planning accordingly
- B. Explaining the consequences the client will face if control is lost
- C. Interviewing the client with another staff member present
- D. Responding to verbal threats by terminating the interview and obtaining assistance
Correct Answer: B
Rationale: Explaining consequences may provoke hostility, unlike proactive safety measures like anticipating loss of control or having support, which are appropriate.
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After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive?
- A. If you still need to work on your problem-solving skills
- B. I will not allow you to get that angry again.
- C. If you should not have let your anger buildup like you did
- D. What could you have done when you first started to feel angry?
Correct Answer: D
Rationale: Encouraging reflection on early anger management in the postcrisis phase supports learning, unlike lecturing or blaming the client.
Anger management is likely to be included in the care of clients with which of the following psychiatric diagnoses?
- A. Alzheimer's dementia
- B. Schizophrenia
- C. Anorexia nervosa
- D. Acute alcohol intoxication
- E. Generalized anxiety disorder
Correct Answer: A,B,D
Rationale: Clients with Alzheimer's dementia, schizophrenia, or acute alcohol intoxication may exhibit aggression due to cognitive impairments or delusions, requiring anger management, unlike anorexia or anxiety.
A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately to prevent the client from moving to which phase of the aggression cycle?
- A. Triggering
- B. Escalation
- C. Crisis
- D. Recovery
Correct Answer: B
Rationale: The client's behaviors (pacing, clenched fists, swearing) indicate the escalation phase, and intervention aims to prevent progression to the crisis phase of physical aggression.
Which of the following interventions are most effective in managing the environment to reduce or eliminate aggressive behavior?
- A. Planning group activities such as playing games
- B. Scheduling one-to-one interactions with the client
- C. Providing structure and consistency in the unit
- D. Avoiding discussions among clients on the unit
- E. Discouraging clients from negotiating solutions
Correct Answer: A,B,C
Rationale: Group activities, one-to-one interactions, and consistent structure foster a calm environment and reduce aggression, unlike avoiding discussions or negotiation.
A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints. Which statement should the nurse make to explain the use of restraints to the client?
- A. The length of time you'll be in restraints is undetermined.
- B. The staff will monitor your behavior closely.
- C. This is what happens when you lose control.
- D. This is a means of keeping you and others safe.
Correct Answer: D
Rationale: Explaining restraints as a safety measure clarifies their purpose without implying punishment, unlike vague or punitive statements.