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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.
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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.
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.
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 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.
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.