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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.
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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.
A patient with burn injuries has demonstrated good coping skills for several weeks. Today, a new nurse is poorly organized and does not follow the patient's usual schedule. By mid-afternoon, the patient is angry and loudly complains to the nurse manager. Which is the nurse manager's best response?
- A. Explain the reasons for the disorganization and take over the patient's care for the rest of the shift.
- B. Acknowledge and validate the patient's distress and ask, 'What would you like to have happen?'
- C. Apologize and explain that the patient will have to accept the situation for the rest of the shift.
- D. Ask the patient to control the anger and explain that allowances must be made for new staff members.
Correct Answer: B
Rationale: When a patient with good coping skills is angry and overwhelmed, the goal is to reestablish a means of dealing with the situation. The nurse should solve the problem with the patient's input by acknowledging the patient's feelings, validating them as understandable, apologizing if necessary, and then seeking an acceptable solution. Often patients can tell the nurse what they would like to have happen as a reasonable first step.
Which behaviors are most consistent with the clinical picture of a patient who is becoming increasingly aggressive? (Select all that apply.)
- A. Pacing
- B. Crying
- C. Withdrawn affect
- D. Rigid posture with clenched jaw
- E. Staring with narrowed eyes into the eyes of another
Correct Answer: A,D,E
Rationale: Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently. The other behaviors are consistent with the increased risk for other-directed violence.
A new patient immediately requires seclusion on admission. The assessment is incomplete, and the health care provider has not examined the patient. Immediately after safely secluding the patient, which action has priority?
- A. Provide an opportunity for the patient to go to the bathroom.
- B. Notify the health care provider and obtain a seclusion order.
- C. Notify the hospital risk manager.
- D. Debrief the staff.
Correct Answer: B
Rationale: Emergency seclusion can be affected by a credentialed nurse but must be followed by securing a medical order within the period specified by the state and agency. The incorrect options are not immediately necessary from a legal standpoint.