TUTORPAPER
ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING / CONCEPTS
OF CARE IN EVIDENCE-BASED PRACTICE 8TH EDITION
1. Which behavior best demonstrates aggression?
- a. **Stomping away from the nurses' station, going to the day room, and grabbing a pool cue from a
patient standing by the pool table.**
- 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."
2. Which scenario predicts the highest risk for directing violent behavior toward others?
- a. Major depression with delusions of worthlessness
- b. Obsessive-compulsive disorder; performing many rituals
- c. **Paranoid delusions of being followed by alien monsters**
- d. Completing alcohol withdrawal and beginning a rehabilitation program
3. A patient is hospitalized after an arrest for breaking windows in the home of a former domestic
partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest
for disorderly conduct. Which nursing diagnosis has priority?
- a. Risk for injury
- b. Posttrauma response
- c. Disturbed thought processes
- d. **Risk for other-directed violence**
4. A confused older adult patient in a skilled care facility is in bed sleeping. The nurse enters the room
quietly and touches the bed to see if it is wet. The patient awakens and hits the nurse in the face. Which
statement best explains the patient's action?
- a. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
- b. Crowding in skilled care facilities increases individual tendencies toward violence.
- c. **The patient interpreted the health care worker's behavior as potentially harmful.**
- d. This patient learned violent behavior by watching other patients act out.
5. A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial
intervention for the nurse would be to address the patient by name and say:
- a. "Hey, what's going on?"
- b. "Please quiet down immediately."
- 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."
,TUTORPAPER
6. A patient was responding to auditory hallucinations earlier in the morning. The patient approaches
the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse follows
the patient into the day room, the nurse should:
- a. **Make sure adequate physical space exists between the nurse and the patient.**
- b. Move into a position that allows the patient to be close to the door.
- c. Maintain one arm's length distance from the patient.
- d. Sit down in a chair near the patient.
7. An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming
increasingly more aggressive. The patient is in the day room. The nurse should enter the day room:
- a. and say, "Would you like to come to your room and take some medication your doctor prescribed
for you?"
- b. **Accompanied by three staff members and say, "Please come to your room so I can give you
some medication that will help you feel more comfortable."**
- c. and place the patient in a basket-hold and then say, "I am going to take you to your room to give
you an injection of medication to calm you."
- d. Accompanied by a male nursing assistant and tell the patient, "You can come to your room
willingly so I can give you this medication, or the aide and I will take you there."
8. After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with
the incident. The nurse says, "I dread facing potentially violent patients." Which response would be the
most urgent reason for this nurse to seek supervision?
- a. Startle reactions
- b. Difficulty sleeping
- c. **Wish for revenge**
- d. Preoccupation with the incident
9. The staff development coordinator plans to teach the 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
10. An adult patient assaults another patient and is 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."
,TUTORPAPER
11. 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.
12. Which assessment finding presents the greatest risk for violent behavior? A patient who:
- a. is severely agoraphobic.
- b. **has a history of spousal abuse.**
- c. demonstrates bizarre somatic delusions.
- d. verbalizes hopelessness and powerlessness.
13. A patient being admitted suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone
who tries to get near me." An emergency code is called. The patient is safely disarmed and placed in
seclusion. Justification for the use of seclusion is that the patient:
- a. evidences a thought disorder, rendering rational discussion ineffective.
- b. **presents a clear and present danger to others.**
- c. presents a clear escape risk.
- d. is psychotic.
14. A patient sits in silence for 20 minutes after a therapy appointment, appearing tense and vigilant.
The patient abruptly stands and paces back and forth, clenching and unclenching fists, and then stops
and stares in the face of a staff member. The patient is:
- a. demonstrating withdrawal.
- b. working through angry feelings.
- c. attempting to use relaxation strategies.
- d. **exhibiting clues to potential aggression.**
15. 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, the nurse should 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?"
, TUTORPAPER
16. 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 nursing staff for "not knowing enough to give me pain
medicine when I need it." Which nursing intervention would best address this problem?
- a. Tell the patient to notify nursing staff 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.
17. A patient has a history of impulsively acting out anger by striking others. Which would be an
appropriate plan for avoiding such incidents?
a. Explain that restraint and seclusion will be used if violence occurs.
b. Help the patient identify incidents that trigger impulsive acting out.
c. Offer one-on-one supervision to help the patient maintain control.
d. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety.
CORRECT ANSWER - ANS: B
Identifying trigger incidents allows the patient and nurse to plan interventions to reduce irritation and
frustration that lead to acting out anger and to put more adaptive coping strategies eventually into
practice.
18. A patient with severe 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 the patient?
a. Wordlessly discontinue the dressing change, and then 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 in this because your doctor
ordered this dressing change."
CORRECT ANSWER - ANS: C
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.
19. 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 (Eskalith)
ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING / CONCEPTS
OF CARE IN EVIDENCE-BASED PRACTICE 8TH EDITION
1. Which behavior best demonstrates aggression?
- a. **Stomping away from the nurses' station, going to the day room, and grabbing a pool cue from a
patient standing by the pool table.**
- 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."
2. Which scenario predicts the highest risk for directing violent behavior toward others?
- a. Major depression with delusions of worthlessness
- b. Obsessive-compulsive disorder; performing many rituals
- c. **Paranoid delusions of being followed by alien monsters**
- d. Completing alcohol withdrawal and beginning a rehabilitation program
3. A patient is hospitalized after an arrest for breaking windows in the home of a former domestic
partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest
for disorderly conduct. Which nursing diagnosis has priority?
- a. Risk for injury
- b. Posttrauma response
- c. Disturbed thought processes
- d. **Risk for other-directed violence**
4. A confused older adult patient in a skilled care facility is in bed sleeping. The nurse enters the room
quietly and touches the bed to see if it is wet. The patient awakens and hits the nurse in the face. Which
statement best explains the patient's action?
- a. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
- b. Crowding in skilled care facilities increases individual tendencies toward violence.
- c. **The patient interpreted the health care worker's behavior as potentially harmful.**
- d. This patient learned violent behavior by watching other patients act out.
5. A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial
intervention for the nurse would be to address the patient by name and say:
- a. "Hey, what's going on?"
- b. "Please quiet down immediately."
- 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."
,TUTORPAPER
6. A patient was responding to auditory hallucinations earlier in the morning. The patient approaches
the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse follows
the patient into the day room, the nurse should:
- a. **Make sure adequate physical space exists between the nurse and the patient.**
- b. Move into a position that allows the patient to be close to the door.
- c. Maintain one arm's length distance from the patient.
- d. Sit down in a chair near the patient.
7. An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming
increasingly more aggressive. The patient is in the day room. The nurse should enter the day room:
- a. and say, "Would you like to come to your room and take some medication your doctor prescribed
for you?"
- b. **Accompanied by three staff members and say, "Please come to your room so I can give you
some medication that will help you feel more comfortable."**
- c. and place the patient in a basket-hold and then say, "I am going to take you to your room to give
you an injection of medication to calm you."
- d. Accompanied by a male nursing assistant and tell the patient, "You can come to your room
willingly so I can give you this medication, or the aide and I will take you there."
8. After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with
the incident. The nurse says, "I dread facing potentially violent patients." Which response would be the
most urgent reason for this nurse to seek supervision?
- a. Startle reactions
- b. Difficulty sleeping
- c. **Wish for revenge**
- d. Preoccupation with the incident
9. The staff development coordinator plans to teach the 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
10. An adult patient assaults another patient and is 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."
,TUTORPAPER
11. 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.
12. Which assessment finding presents the greatest risk for violent behavior? A patient who:
- a. is severely agoraphobic.
- b. **has a history of spousal abuse.**
- c. demonstrates bizarre somatic delusions.
- d. verbalizes hopelessness and powerlessness.
13. A patient being admitted suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone
who tries to get near me." An emergency code is called. The patient is safely disarmed and placed in
seclusion. Justification for the use of seclusion is that the patient:
- a. evidences a thought disorder, rendering rational discussion ineffective.
- b. **presents a clear and present danger to others.**
- c. presents a clear escape risk.
- d. is psychotic.
14. A patient sits in silence for 20 minutes after a therapy appointment, appearing tense and vigilant.
The patient abruptly stands and paces back and forth, clenching and unclenching fists, and then stops
and stares in the face of a staff member. The patient is:
- a. demonstrating withdrawal.
- b. working through angry feelings.
- c. attempting to use relaxation strategies.
- d. **exhibiting clues to potential aggression.**
15. 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, the nurse should 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?"
, TUTORPAPER
16. 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 nursing staff for "not knowing enough to give me pain
medicine when I need it." Which nursing intervention would best address this problem?
- a. Tell the patient to notify nursing staff 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.
17. A patient has a history of impulsively acting out anger by striking others. Which would be an
appropriate plan for avoiding such incidents?
a. Explain that restraint and seclusion will be used if violence occurs.
b. Help the patient identify incidents that trigger impulsive acting out.
c. Offer one-on-one supervision to help the patient maintain control.
d. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety.
CORRECT ANSWER - ANS: B
Identifying trigger incidents allows the patient and nurse to plan interventions to reduce irritation and
frustration that lead to acting out anger and to put more adaptive coping strategies eventually into
practice.
18. A patient with severe 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 the patient?
a. Wordlessly discontinue the dressing change, and then 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 in this because your doctor
ordered this dressing change."
CORRECT ANSWER - ANS: C
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.
19. 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 (Eskalith)
