CHAPTER 27: ANGER, AGGRESSION, AND VIOLENCE {Varcarolis’ Foundations of Psychiatric-Mental Health Nursing: 8th Edition}

C HAPTER 27: A NGER , A GGRESSION , AND
V IOLENCE
Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: 8th Edition




MULTIPLE CHOICE


1. An emergency code was called after a patient pulled a knife from a pocket
and threatened, I will kill anyone who tries to get near me. The patient
was safel y disarmed and placed in seclusion. Justification for use of
seclusion was that the patient:
a. was threatening to others.
b. was experiencing psychosis.
c. presented an undeniable escape risk.
d. presented a clear and present danger to others.



ANS: D



The patients threat to kill self or others with the knife he possessed
constituted a clear and pre sent danger to self and others. The
distracters are not sufficient reasons for seclusion.



PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 510 TOP: Nursing Process: Planning MSC:
Client Needs: Safe, Effective Care Environment



2. A patient sat in silence for 20 minutes after a therapy appointment,
appearing tense and vigilant. The patient abruptl y stood, paced back and

, forth, clenched and unclenched fists, and then stopped and stared in the
face of a staff member. The patient is:
a. demonstrating withdrawal.
b. working though angry feelings.
c. attempting to use relaxation strategies.
d. exhibiting clues to potential aggression.



ANS: D



The description of the patients behavior shows the classic signs of
someone whose potential for aggression is increasing .



PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 506 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y



3. A patient with multi -infarct dementia lashes out and kicks at people who
walk past in the hall of a skilled nursing facilit y. Intervention by the nurse
should begin by:
a. gentl y touching the patients arm.
b. asking the patient, What do you need?
c. saying to the patient, This is a safe place.
d. directing the patient to cease the behavior.



ANS: C



Striking out usuall y signals fear or that the patient perceives the
environment to be out of control. Getting the patients attention is
fundamental to intervention. The nurse should make eye contact and
assure the patient of safet y. Once the nurse has the patients attention,

, gentl y touching the patient, asking what he or she needs, or directing
the patient to discontinue the behavior may be appropriate.



PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 516
TOP: Nursing Process: Implementation MSC: Client
Needs: Psychosocial Integrit y



4. A cognitivel y impaired patient has been a widow for 30 years. This patient
franticall y tries to leave the facilit y, sayi ng, I have to go home to cook
dinner before m y husband arrives from work. To intervene with validation
therapy, the nurse will 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 husbands dinner?
d. Your husband gets angry if you do not have dinner ready on time?



ANS: C



Validation therapy meets the patient where she o r he is at the moment
and acknowledges the patients wishes. Validation does not seek to
redirect, reorient, or probe. The distracters do not validate the patients
feelings.



PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 516 TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity



5. A patient with a history of anger and impulsivit y was hospitalized after an
accident resulting in injuries. When in pain, the patient loudl y scolded