NSG 3450 Exam 4 advanced
competence test
An emotional response to frustration of desires, threat to one's needs (emotional or physical),
or a challenge. - answer ✔✔-Anger
Action or behavior that results in verbal or physical attack. It is not okay to be aggressive. -
answer ✔✔-Aggression
Psychiatric units, geriatric units, and intensive care units, Emergency Room. - answer ✔✔-Which
units see the most violence from patients?
Hypertension and cardiovascular disease including myocardial infarctions and ischemic strokes. -
answer ✔✔-Risk Factors for Anger, Aggression, and Violence.
Individuals with PTSD and substances abuse have issues with aggression. Individuals with
bipolar disorder have difficulty with anger and aggression during remission. It coexists in
individuals with depression, anxiety, psychosis, and personality disorders. - answer ✔✔-
Comorbidity for anger, aggression, and violence
Brain tumors, Alzheimers, disease, temporal lobe epilepsy, and traumatic injury to certain parts
of the brain result in changes to personality that could include increased violence. - answer
✔✔-Etiology: Neurobiological factors to anger, aggression, and violence
,The limbic system which is located beneath the cerebrum on both sides of the thalamus. It is
responsible for combining higher mental functions and primitive emotions into one system,
learning, and the formation of memories. - answer ✔✔-Which area of the brain is associated
with aggression?
The amygdala! it helps evaluate the emotional content of experiences. It helps the brain to
recognize potential threats and whether to activate the fight or flight response. - answer ✔✔-
What is the emotional center of the brain?
The prefrontal cortex is the area of the brain that is responsible for executive functions.
Executive functions allows us to distinguish between good and bad, consequences of actions,
goal-directed behaviors, and suppressing socially unacceptable activities. - answer ✔✔-Which
cortex is an important role in aggressive behavior?
Serotonin can both inhibit and stimulate aggressive behavior, depending on the part of the
brain being measured.
Dopamine's impact on reward-seeking behaviors may increase aggression. Serotonin and
dopamine can sometimes enhance aggression and sometimes reduce impulsivity that leads to
aggression. GABA the main inhibitory neurotransmitter may reduce aggressiveness, its absence
may increase impulsivity and aggressive responses. - answer ✔✔-Which neurotransmitters play
a role in anger and aggression?
Is a learned response to environmental stimuli. - answer ✔✔-Anger Behavioral Theory
Researchers demonstrated that children learn aggression by observing and imitating behaviors
of others, especially if that that behavior is rewarded. - answer ✔✔-Anger Social Learning
Theory
Hyperactivity: most important predictor of imminent violence (pacing or restlessness). Increase
anxiety and tension, clenched jaw or fist, rigid posture, fixed or tense facial expression,
mumbling to self (patient may have shortness of breath, sweating, and rapid pulse). Verbal
abuse: profanity, argumentativeness. Loud voice, change of pitch, or very soft voice, forcing
,others to strain to hear. Stone silence. Intense eye contact or avoidance of eye contact. Recent
acts of violence, including property violence. Alcohol or drug intoxication. Possession of a
weapon or object that may be used as a weapon (fork or knife). Isolation that is
uncharacteristic. Milieu characteristics conducive to violence: Overcrowding, staff inexperience,
provocative or controlling staff, poor limit setting, arbitrary revocation of privileges. - answer
✔✔-Predictors of Violence (Signs and Symptoms)
Patient will exhibit increased demands, irritability, frowning, redness in the face, pacing,
twisting of the hands, or clenching and unclenching of the fists are all signs of irritation. Speech
may either be increased in rate and volume or may be slowed, pointed, and quite. - answer
✔✔-General Assessment for a patient experiencing anger.
It is based on the notion that disruptive patients often have histories that include violence and
victimizations. This care focuses on the patients past experiences of violence or trauma and on
the role these experiences currently play in their lives. - answer ✔✔-Trauma-informed Care
A history of violence is the single best predictor of future violence. Patients who are delusional,
hyperactive, impulsive or predisposed to irritability are at higher risk for violence. Major factors
associated with violence can be assessed with these questions (Does the pt have a wish or
intent to harm?, Does the pt have plan?, Does the patient have demographic risk factors: male,
aged 14-24, low socioeconomic status, inadequate support system, and prison time). Aggression
by patient occurs most often in the context of limit-setting by the nurse. History of limited
coping skills, including lack of assertiveness or use of intimidation, indicates a higher risk of
using violence. - answer ✔✔-Anger and Aggression Assessment Guidelines
Risk for other-directed violence, Risk for self-directed violence, Ineffective coping, Stress
overload. - answer ✔✔-Nursing Diagnoses for Anger, Aggression, and Violence
Identifies when angry, identifies alternatives to aggression, refrains from verbal outbursts,
avoids violating others personal space, maintains self-control. Expresses feelings, verbalizes
suicidal ideas, refrains from suicide attempts, plans for the future. Identifies ineffective and
effective coping, uses support system, uses new coping strategies, engages in personal actions
to manage stressors effectively. - answer ✔✔-Outcomes for aggression
, Maintain the patients self-esteem and dignity. Maintain calmness (you and pt). Assess the pt
and the situation. Identify stressors and stress indicators. Respond as early as possible. Use a
calm clear tone of voice. Invest time, remain honest. Determine what the patient considers to
be needed, identify goals. Avoid invading personal space, in time of high anxiety, personal space
increases. Avoid arguing, use several clear options, use genuineness and empathy, be assertive
(NOT AGGRESSIVE) do not take chances maintain personal safety. - answer ✔✔-Deescalation
Techniques
Antianxiety Agents (Benzodiazepines): Lorazepam (Ativan), Alprazolam (Xanax), Diazepam
(Valium)
First Generation Antipsychotics: Haloperidol (Haldol), Perphenazine, Chlorpromazine
(Thorazine), Loxapine (Adasuve).
Second Generation Antipsychotics: Risperidone (Risperdal), Olanzapine (Zyprexa, Zydis),
Ziprasidone (Geodon)
Combinations: Haloperidol (Haldol) - answer ✔✔-Drug used for acute management of violent
behavior.
SSIR's: for the population that is depressed, anxiety, personality disorder, dementia, and
intellectual disability
Lithium: for the population that is intellectual disability, conduct disorder, antisocial personality,
bipolar disorder, and prison inmates.
Anticonvulsants : Schizophrenia, prison inmates, antisocial/ borderline personality, conduct
disorders, and bipolar disorders
Gabapentin: patients with co-existing anxiety disorder and personality disorder.
Benzodiazepines: should have underlying component of anxiety.
Second-generation antipsychotics: Schizophrenia, psychosis, and mania.
Beta-blockers: organic brain disease, brain injury, dementia, intellectual disability.
Psychostimulants: ADD/ADHD in children and adults. - answer ✔✔-Drugs used for long-term
management of chronic aggression
competence test
An emotional response to frustration of desires, threat to one's needs (emotional or physical),
or a challenge. - answer ✔✔-Anger
Action or behavior that results in verbal or physical attack. It is not okay to be aggressive. -
answer ✔✔-Aggression
Psychiatric units, geriatric units, and intensive care units, Emergency Room. - answer ✔✔-Which
units see the most violence from patients?
Hypertension and cardiovascular disease including myocardial infarctions and ischemic strokes. -
answer ✔✔-Risk Factors for Anger, Aggression, and Violence.
Individuals with PTSD and substances abuse have issues with aggression. Individuals with
bipolar disorder have difficulty with anger and aggression during remission. It coexists in
individuals with depression, anxiety, psychosis, and personality disorders. - answer ✔✔-
Comorbidity for anger, aggression, and violence
Brain tumors, Alzheimers, disease, temporal lobe epilepsy, and traumatic injury to certain parts
of the brain result in changes to personality that could include increased violence. - answer
✔✔-Etiology: Neurobiological factors to anger, aggression, and violence
,The limbic system which is located beneath the cerebrum on both sides of the thalamus. It is
responsible for combining higher mental functions and primitive emotions into one system,
learning, and the formation of memories. - answer ✔✔-Which area of the brain is associated
with aggression?
The amygdala! it helps evaluate the emotional content of experiences. It helps the brain to
recognize potential threats and whether to activate the fight or flight response. - answer ✔✔-
What is the emotional center of the brain?
The prefrontal cortex is the area of the brain that is responsible for executive functions.
Executive functions allows us to distinguish between good and bad, consequences of actions,
goal-directed behaviors, and suppressing socially unacceptable activities. - answer ✔✔-Which
cortex is an important role in aggressive behavior?
Serotonin can both inhibit and stimulate aggressive behavior, depending on the part of the
brain being measured.
Dopamine's impact on reward-seeking behaviors may increase aggression. Serotonin and
dopamine can sometimes enhance aggression and sometimes reduce impulsivity that leads to
aggression. GABA the main inhibitory neurotransmitter may reduce aggressiveness, its absence
may increase impulsivity and aggressive responses. - answer ✔✔-Which neurotransmitters play
a role in anger and aggression?
Is a learned response to environmental stimuli. - answer ✔✔-Anger Behavioral Theory
Researchers demonstrated that children learn aggression by observing and imitating behaviors
of others, especially if that that behavior is rewarded. - answer ✔✔-Anger Social Learning
Theory
Hyperactivity: most important predictor of imminent violence (pacing or restlessness). Increase
anxiety and tension, clenched jaw or fist, rigid posture, fixed or tense facial expression,
mumbling to self (patient may have shortness of breath, sweating, and rapid pulse). Verbal
abuse: profanity, argumentativeness. Loud voice, change of pitch, or very soft voice, forcing
,others to strain to hear. Stone silence. Intense eye contact or avoidance of eye contact. Recent
acts of violence, including property violence. Alcohol or drug intoxication. Possession of a
weapon or object that may be used as a weapon (fork or knife). Isolation that is
uncharacteristic. Milieu characteristics conducive to violence: Overcrowding, staff inexperience,
provocative or controlling staff, poor limit setting, arbitrary revocation of privileges. - answer
✔✔-Predictors of Violence (Signs and Symptoms)
Patient will exhibit increased demands, irritability, frowning, redness in the face, pacing,
twisting of the hands, or clenching and unclenching of the fists are all signs of irritation. Speech
may either be increased in rate and volume or may be slowed, pointed, and quite. - answer
✔✔-General Assessment for a patient experiencing anger.
It is based on the notion that disruptive patients often have histories that include violence and
victimizations. This care focuses on the patients past experiences of violence or trauma and on
the role these experiences currently play in their lives. - answer ✔✔-Trauma-informed Care
A history of violence is the single best predictor of future violence. Patients who are delusional,
hyperactive, impulsive or predisposed to irritability are at higher risk for violence. Major factors
associated with violence can be assessed with these questions (Does the pt have a wish or
intent to harm?, Does the pt have plan?, Does the patient have demographic risk factors: male,
aged 14-24, low socioeconomic status, inadequate support system, and prison time). Aggression
by patient occurs most often in the context of limit-setting by the nurse. History of limited
coping skills, including lack of assertiveness or use of intimidation, indicates a higher risk of
using violence. - answer ✔✔-Anger and Aggression Assessment Guidelines
Risk for other-directed violence, Risk for self-directed violence, Ineffective coping, Stress
overload. - answer ✔✔-Nursing Diagnoses for Anger, Aggression, and Violence
Identifies when angry, identifies alternatives to aggression, refrains from verbal outbursts,
avoids violating others personal space, maintains self-control. Expresses feelings, verbalizes
suicidal ideas, refrains from suicide attempts, plans for the future. Identifies ineffective and
effective coping, uses support system, uses new coping strategies, engages in personal actions
to manage stressors effectively. - answer ✔✔-Outcomes for aggression
, Maintain the patients self-esteem and dignity. Maintain calmness (you and pt). Assess the pt
and the situation. Identify stressors and stress indicators. Respond as early as possible. Use a
calm clear tone of voice. Invest time, remain honest. Determine what the patient considers to
be needed, identify goals. Avoid invading personal space, in time of high anxiety, personal space
increases. Avoid arguing, use several clear options, use genuineness and empathy, be assertive
(NOT AGGRESSIVE) do not take chances maintain personal safety. - answer ✔✔-Deescalation
Techniques
Antianxiety Agents (Benzodiazepines): Lorazepam (Ativan), Alprazolam (Xanax), Diazepam
(Valium)
First Generation Antipsychotics: Haloperidol (Haldol), Perphenazine, Chlorpromazine
(Thorazine), Loxapine (Adasuve).
Second Generation Antipsychotics: Risperidone (Risperdal), Olanzapine (Zyprexa, Zydis),
Ziprasidone (Geodon)
Combinations: Haloperidol (Haldol) - answer ✔✔-Drug used for acute management of violent
behavior.
SSIR's: for the population that is depressed, anxiety, personality disorder, dementia, and
intellectual disability
Lithium: for the population that is intellectual disability, conduct disorder, antisocial personality,
bipolar disorder, and prison inmates.
Anticonvulsants : Schizophrenia, prison inmates, antisocial/ borderline personality, conduct
disorders, and bipolar disorders
Gabapentin: patients with co-existing anxiety disorder and personality disorder.
Benzodiazepines: should have underlying component of anxiety.
Second-generation antipsychotics: Schizophrenia, psychosis, and mania.
Beta-blockers: organic brain disease, brain injury, dementia, intellectual disability.
Psychostimulants: ADD/ADHD in children and adults. - answer ✔✔-Drugs used for long-term
management of chronic aggression
