Nokea
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- C. Withdrawn affect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Rationale: Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently.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.
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An adult patient assaulted another patient and was restrained. One hour later, which statement by this restrained patient necessitates the nurse's immediate attention?
- A. I hate all of you!'
- B. My fingers are tingly.'
- C. You wait until I tell my lawyer.'
- D. It was not my fault. The other patient started it.'
Correct Answer: B
Rationale: The correct response indicates impaired circulation and necessitates the nurse's immediate attention. The incorrect responses indicate that the patient has continued aggressiveness and agitation.
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 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.
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 cognitively impaired patient has been a widow for 30 years. This patient is frantically trying to leave the unit, saying, 'I have to go home to cook dinner before my husband arrives from work.' To intervene with validation therapy, what should the nurse first say?
- A. You must come away from the door.'
- B. You have been a widow for many years.'
- C. You want to go home to prepare your husband's dinner?'
- D. Was your husband angry if you did not have dinner ready on time?'
Correct Answer: C
Rationale: Validation therapy meets the patient 'where she or he is at the moment' and acknowledges the patient's wishes. Validation does not seek to redirect, reorient, or probe. The incorrect options do not validate the patient's feelings.