ELITE COMPREHENSIVE
VARCAROLIS -CHPT 27 ANGER, AGGRESSION, AND
VIOLENCE IN PSYCHIATRIC–MENTAL HEALTH
NURSING
Comprehensive Pathophysiology, Risk Assessment,
De-Escalation
• HESI High-Yield Master Exam Review (Advanced
Level)
Spring Semester Examination May
2026
You are caring for Malcolm, an 83 y/o African American patient with Alzheimer's
disease. Malcolm exhibits agitated behavior at times, especially when he feels he is
missing work, and he sometimes attempts to leave the unit to " get to the school where I
teach. " which of the following interventions is appropriate for de-escalating Malcolm's
agitation.
A. Medicate Malcolm with PRN medication at regular intervals to prevent agitation
B. Repeatedly explain to Malcolm that he is retired and no longer teaches as the
repetition will reinforce the patient's orientation
C . Use validation therapy and ask Malcolm about the school and his job
1|Page
,D. Reduce stimulation In the environment by having Malcolm sit by himself in his room
until the agitation passes
• C . Use validation therapy and ask Malcolm about the school and his
job
Ian makes the following statements to you while admitting him. Which statement
indicates and increased likelihood of violent behavior?
A. "When I get mad, I want to be left alone"
B. "Last time I was in here I ended up in seclusion for punching my roommate
C. "My old man was meek and mild, and I've always said I'm not going to be like him"
D. "My girlfriend says I yell way too much, and she's threatened to leave me."
• B. "Last time I was in here I ended up in seclusion for punching my
roommate
You respond to a loud, angry voice coming from the day room, where you find Alex is
pacing and shouting that he isn't "going to take his (expletive) anymore." which of the
following responses is likely to be helpful in de-escalating Alex? Select all that apply
A. Remain calm, quiet, and in control
B. Tell Alex that his actions are unacceptable and that he must go to his room
C. Match Alex's volume so that he is able to hear over his own shouting
D. Ask Alex if he can tell you what is upsetting him so you may be able to help
E. Sand close to Alex so you can intervene physically if needed to protect others
F. Tell Alex that he could be placed in seclusion if he cannot control himself so that the
patient is aware of the negative consequences
Remain calm, quiet, and in control
2|Page
, • D. Ask Alex if he can tell you what is upsetting him so you may be
able to help
Andie is a patient anxiously waiting her turn to speak with you. As you are very busy,
you ask Andie if she can wait a few minutes so that you can finish your task.
Unfortunately the task takes longer than anticipated and you are delayed getting back to
Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak
with you. Which response is most likely to be therapeutic at this time?
A. "you are angry that I didn't speak with you when I promised I would"
B. "I'm sorry for being late, but screaming at me is not the best way to handle it."
C. "You are too angry to talk right now. I'll come back in 20 minutes and we can try
again."
D. "Why are you angry? I told you I was busy and would get to you as soon as I could."
• "you are angry that I didn't speak with you when I promised I would"
Which statement about violence and nursing is accurate?
A. Unless working in psychiatric mental health settings, nurses are unlikely to
experience patient violence
B. To date, no legislation exists that addresses workplace violence against nurses
C. Emergency, psychiatric, and step-down units have the highest rates of violence
towards staff
D. Violence primarily affects inexperienced or unskilled staff who cannot calm their
patients
• C. Emergency, psychiatric, and step-down units have the highest
rates of violence towards staff
3|Page
VARCAROLIS -CHPT 27 ANGER, AGGRESSION, AND
VIOLENCE IN PSYCHIATRIC–MENTAL HEALTH
NURSING
Comprehensive Pathophysiology, Risk Assessment,
De-Escalation
• HESI High-Yield Master Exam Review (Advanced
Level)
Spring Semester Examination May
2026
You are caring for Malcolm, an 83 y/o African American patient with Alzheimer's
disease. Malcolm exhibits agitated behavior at times, especially when he feels he is
missing work, and he sometimes attempts to leave the unit to " get to the school where I
teach. " which of the following interventions is appropriate for de-escalating Malcolm's
agitation.
A. Medicate Malcolm with PRN medication at regular intervals to prevent agitation
B. Repeatedly explain to Malcolm that he is retired and no longer teaches as the
repetition will reinforce the patient's orientation
C . Use validation therapy and ask Malcolm about the school and his job
1|Page
,D. Reduce stimulation In the environment by having Malcolm sit by himself in his room
until the agitation passes
• C . Use validation therapy and ask Malcolm about the school and his
job
Ian makes the following statements to you while admitting him. Which statement
indicates and increased likelihood of violent behavior?
A. "When I get mad, I want to be left alone"
B. "Last time I was in here I ended up in seclusion for punching my roommate
C. "My old man was meek and mild, and I've always said I'm not going to be like him"
D. "My girlfriend says I yell way too much, and she's threatened to leave me."
• B. "Last time I was in here I ended up in seclusion for punching my
roommate
You respond to a loud, angry voice coming from the day room, where you find Alex is
pacing and shouting that he isn't "going to take his (expletive) anymore." which of the
following responses is likely to be helpful in de-escalating Alex? Select all that apply
A. Remain calm, quiet, and in control
B. Tell Alex that his actions are unacceptable and that he must go to his room
C. Match Alex's volume so that he is able to hear over his own shouting
D. Ask Alex if he can tell you what is upsetting him so you may be able to help
E. Sand close to Alex so you can intervene physically if needed to protect others
F. Tell Alex that he could be placed in seclusion if he cannot control himself so that the
patient is aware of the negative consequences
Remain calm, quiet, and in control
2|Page
, • D. Ask Alex if he can tell you what is upsetting him so you may be
able to help
Andie is a patient anxiously waiting her turn to speak with you. As you are very busy,
you ask Andie if she can wait a few minutes so that you can finish your task.
Unfortunately the task takes longer than anticipated and you are delayed getting back to
Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak
with you. Which response is most likely to be therapeutic at this time?
A. "you are angry that I didn't speak with you when I promised I would"
B. "I'm sorry for being late, but screaming at me is not the best way to handle it."
C. "You are too angry to talk right now. I'll come back in 20 minutes and we can try
again."
D. "Why are you angry? I told you I was busy and would get to you as soon as I could."
• "you are angry that I didn't speak with you when I promised I would"
Which statement about violence and nursing is accurate?
A. Unless working in psychiatric mental health settings, nurses are unlikely to
experience patient violence
B. To date, no legislation exists that addresses workplace violence against nurses
C. Emergency, psychiatric, and step-down units have the highest rates of violence
towards staff
D. Violence primarily affects inexperienced or unskilled staff who cannot calm their
patients
• C. Emergency, psychiatric, and step-down units have the highest
rates of violence towards staff
3|Page
