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Which behavior best demonstrates aggression?
- A. Stomping away from the nurses' station, darting to another room, and grabbing a snack from from another patient
- B. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing
- C. Telling the primary nurse, 'I felt angry when you said I could not have a second helping at lunch'
- D. Telling the medication nurse, 'I am not going to take that or any other medication you try to give me'
Correct Answer: A
Rationale: Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not feature violation of another's rights.
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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.
A patient with severe physical injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the patient screams, 'Don't touch me! You are so stupid. You will make it worse!' Which intervention uses a cognitive technique to help this patient?
- A. Discontinue the dressing change without comments and leave the room.
- B. Stop the dressing change, saying, 'Perhaps you would like to change your own dressing.'
- C. Continue the dressing change, saying, 'Do you know this dressing change is needed so your wound will not get infected?'
- D. Continue the dressing change, saying, 'Unfortunately, you have no choice. Your doctor ordered this dressing change.'
Correct Answer: C
Rationale: Anger is cognitively driven. The correct answer helps the patient test his cognitions and may help lower his anger. The incorrect options will escalate the patient's anger by belittling or escalating the patient's sense of powerlessness.
A patient with a history of anger and impulsivity is hospitalized after an accident resulting in injuries. When in pain, the patient loudly scolds the nurse for 'not knowing enough to give me pain medicine when I need it.' Which intervention would best address this problem?
- A. Tell the patient to notify the nurse 30 minutes before the pain returns so the medication can be prepared.
- B. Urge the health care provider to change the prescription for pain medication from as needed to a regular schedule.
- C. Tell the patient that verbal assaults on nurses will not shorten the wait for pain medication.
- D. Have the clinical nurse leader request a psychiatric consultation.
Correct Answer: B
Rationale: Scheduling the medication at specific intervals will help the patient anticipate when the medication can be given. Receiving the medication promptly on schedule, rather than expecting nurses to anticipate the pain level, should reduce anxiety and anger. The patient cannot predict the onset of pain before it occurs.
Which is an effective nursing intervention to assist an angry patient to learn to manage anger without violence?
- A. Help the patient identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking.
- B. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present.
- C. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings.
- D. Administer an antipsychotic or antianxiety medication when the patient feels angry.
Correct Answer: A
Rationale: Anger has a strong cognitive component; therefore, using cognition to manage anger is logical. The incorrect options do nothing to help the patient learn anger management.
A patient is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say what?
- A. What is going on?'
- B. Quiet down immediately. You are scaring others.'
- C. I'd like to talk with you about how you're feeling right now.'
- D. You must go to your room and try to get control of yourself.'
Correct Answer: C
Rationale: Intervention should begin with an analysis of the patient and situation. With the correct response, the nurse is attempting to hear the patient's feelings and concerns, which leads to the next step of planning an intervention. The incorrect responses are authoritarian, creating a power struggle between the patient and nurse.