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Which medication should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?
- A. Lithium
- B. Trazodone
- C. Olanzapine
- D. Valproic acid
Correct Answer: C
Rationale: Olanzapine is a short-acting antipsychotic drug that is useful in calming angry, aggressive patients regardless of their diagnosis. The other drugs listed require long-term use to reduce anger. Lithium is for patients with bipolar disorder. Trazodone is for patients with depression, insomnia, or chronic pain. Valproic acid is for patients with bipolar disorder or borderline personality disorder.
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Which scenario predicts the highest risk for directing violent behavior toward others?
- A. Major depressive disorder with delusions of worthlessness
- B. Obsessive-compulsive disorder; performing many rituals
- C. Paranoid delusions of being followed by a military attack team
- D. Completion of alcohol withdrawal and beginning a rehabilitation program
Correct Answer: C
Rationale: The correct answer illustrates the greatest disruption of ability to perceive reality accurately. People who feel persecuted may strike out against those believed to be persecutors. The patients identified in the distractors have better reality-testing ability.
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.
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 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 nurse directs the intervention team who must take an aggressive patient to seclusion. Other patients were removed from the area. Before approaching the patient, the nurse should ensure that which actions are taken by staff? (Select all that apply.)
- A. Remove jewelry, glasses, and harmful items from the patient and staff members.
- B. Appoint a person to clear a path and open, close, or lock doors.
- C. Quickly approach the patient and grab the closest extremity.
- D. Select the person who will communicate with the patient.
- E. Move behind the patient to use the element of surprise.
Correct Answer: A,B,D
Rationale: Injury to staff members and to the patient should be prevented. Only one person should explain what will happen and direct the patient; this person might be the nurse or staff member who has a good relationship with the patient. A clear pathway is essential; those restraining a limb cannot use keys, move furniture, or open doors. The nurse is usually responsible for administering the medication once the patient is restrained. Each staff member should have an assigned limb rather than just grabbing the closest limb. This system could leave one or two limbs unrestrained. Approaching in full view of the patient reduces suspicion.