Chapter 20: Management of Anger, Aggression, and Violence

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Analyze

Integrated Process: Nursing Process

Objective: 7

Page and Header: 304, Physical Condition

1. A nurse is caring for an older client in a residential care facility who has a history of alcohol abuse. The client has been extremely irritable the entire day. When modifying the client’s plan of care, what would be an appropriate snack to offer the client to decrease the irritability?

A) Chocolate candy bar

B) Handful of raisins

C) Granola bar

D) Glass of milk

Page and Header: 303, Assessment for Aggression and Violence

2. Which part of the history for a client who has been admitted to an inpatient psychiatric unit would the nurse identify as the strongest indicator of risk for violence?

A) Panic disorder

B) Problematic anxiety

C) Somatoform disorder

D) Previous episodes of rage

Page and Header: 299, Assessment of Anger

3. An adult child brings a parent to the clinic and tells the nurse that the parent has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the parent expresses remorse for the outburst. The person says, “I’ve never seen my parent act this way.” Which question would be most appropriate for the nurse to ask next?

A) “Does your parent have a history of an anxiety disorder, such as panic disorder?”

B) “Has your parent exhibited previous problems expressing anger appropriately?”

C) “Has your parent suffered any traumatic injury to the brain recently?”

D) “Has your parent injured the back of the head or neck in the past week?”

Page and Header: 303, Impaired Communication

4. A nurse is caring for an older adult client in a nursing home who has no history of violence but is agitated and appears ready to strike out at a staff member. The nurse would assess the client for which condition?

A) Panic disorder

B) Epilepsy

C) Bipolar disorder

D) Sensory losses

Page and Header: 301, Aggression and Violence

5. A client has been admitted to the detoxification unit after binge drinking. The client is combative and exhibits altered thought processes even though the client is not currently intoxicated. Which nursing diagnosis would be the priority?

A) Risk for injury related to effects of alcohol abuse

B) Risk for self-mutilation related to alcohol withdrawal and altered thought processes

C) Risk for other-directed violence related to alcohol withdrawal

D) Risk for delayed development related to chronic effects of alcohol intoxication

Page and Header: 296, Key Concepts

6. A nurse working with a potentially violent client in a community clinic would implement what intervention to minimize personal risk?

A) Using protective devices

B) Staying close to a door

C) Keeping the door closed to ensure privacy

D) Wearing inexpensive jewelry to distract the client

Page and Header: 306, Reducing Stimulation

7. A nurse is caring for a family whose older parent diagnosed with dementia is living in their home. The nurse has instructed the family about how to decrease the parent’s agitation. The nurse determines that the child of the parent has understood the instructions when what statement is made?

A) “Restraints can help reduce my parent’s agitation.”

B) “I should place my parent in the bedroom with me so I can watch my parent more closely.”

C) “It’s important that my parent gets out shopping with me or my spouse.”

D) “If I simplify our home environment, my parent may be less agitated.”

Page and Header: 297, Table 20.1, Cultural Myths About Anger

8. A psychiatric–mental health nurse is teaching a class of colleagues about anger, aggression, and violence. Which statement by the nurse would be most appropriate to include?

A) “Anger, aggression, and violence are points along a continuum.”

B) “The terms used to describe anger are very precise.”

C) “Anger is a knee-jerk reaction to external events.”

D) “Women experience anger as frequently as men do.”

Page and Header: 296, Key Concepts

9. A group of nurses who are reviewing information about maladaptive anger demonstrate a need for additional study when they identify which physical condition as being linked to suppressed anger?

A) Coronary heart disease

B) Arthritis

C) Hypertension

D) Breast cancer

Page and Header: 298, The Expression of Anger

10. While interviewing a client, a nurse asks, “What do you do when you get angry?” Which client response would indicate to the nurse that the client engages in anger suppression?

A) “I’ve been known to fly off the handle when I’m angry.”

B) “People say I withdraw and pout about the problem.”

C) “I usually approach the person directly to talk about it.”

D) “I try to discuss how I’m feeling about it with a close friend.”

Page and Header: 298, The Expression of Anger

11. The plan of care for a client demonstrating frequent anger includes behavioral interventions. What would the nurse be likely to find?

A) Self-monitoring of cues

B) Anger management

C) Relaxation training

D) Response disruption

Page and Header: 305, Validating

12. While talking with a client who has been experiencing aggression and intense anger, a nurse identifies that the client feels isolated and anxious. Which statement by the nurse would be most appropriate?

A) “This must be scary for you.”

B) “Once you relax, things will improve.”

C) “I really understand how you feel.”

D) “If you calm down, I can help you.”

Page and Header: 306, Developing Prevention Strategies

13. After working with a client who has a history of violent behavior to identify possible clues that suggest the behavior is escalating, the nurse and client develop a plan for prevention. Which strategy would they be least likely to include?

A) Counting to 10

B) Taking slow deep breaths

C) Turning up the music loudly

D) Taking a voluntary time out

Page and Header: 309, Responding to Assault on Nurses

14. An advanced practice psychiatric nurse is preparing to conduct a support group for psychiatric–mental health nurses who have been assaulted by clients. What would the nurse need to keep in mind with this group?

A) Nurses experience a conflict between the role of caregiver and victim.

B) Nurses who are victims often go on to prosecute the client attackers.

C) Nurses actively express the feelings associated with client assaults.

D) Nurses as victims of client assaults rarely experience guilt or shame.

Page and Header: 302, General Aggression Model

15. After teaching a class about the general aggression model, a nurse determines that additional education is needed when the class identifies what as an interactive component of the model?

A) Cognition

B) Affect

C) Arousal

D) Rewards

Page and Header: 296, Key Concepts

16. A nurse is reading a journal article about anger and violence. Which would the nurse expect to see as being linked to excessive, outwardly directed anger?

A) Myocardial infarction

B) Hypertension

C) Arthritis

D) Chronic pain

Page and Header: 302, General Aggression Model

17. When assessing a client experiencing aggression, a nurse applies the general aggression model. What would the nurse assess as the person factors? Select all that apply.

A) Client’s personality traits

B) Insult initiating the behavior

C) Previous behavior patterns

D) Client’s shouting

E) Client’s attitude

F) Client’s gender

Page and Header: 303, Characteristics Predictive of Aggression and Violence

18. A nurse is presenting an in-service program about aggression and violence to a group of newly hired nurses who will be working in an inpatient psychiatric facility. When describing characteristics that may predict the risk for violence and aggression in clients, which of the following would the nurse include? Select all that apply.

A) Age

B) Impulsivity

C) Alcohol withdrawal

D) Gender

E) Suspiciousness

Page and Header: 304, Milieu and Environmental Factors, Box 20.4

19. A unit in an inpatient psychiatric facility is experiencing an increase in violence episodes by clients. A group of nurses working on this unit is developing a plan to address this issue. When developing this plan, which would the nurses address as the problem areas? Select all that apply.

A) Inconsistent unit activities

B) Medication power struggles

C) Empathetic staff response

D) Clearly set boundaries

E) Little client participation in treatment plan

Page and Header: 296, Key Concepts

20. When assessing a client’s anger, which would be important for a nurse to obtain? Select all that apply.

A) How the person expresses the anger

B) Problems at work resulting from the anger

C) Frequency of the anger episodes

D) Evidence of coping techniques

E) The intensity of the anger, outwardly or inwardly