Anger Management and Behavioral Interventions
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Questions and Answers

Which individuals are most at risk for displaying aggressive behavior? Select all that apply.

  • A young male who feels rejected by the social group. (correct)
  • A middle-aged adult who feels that concerns are going unheard. (correct)
  • An adolescent embarrassed in front of friends. (correct)
  • A young adult depressed after the death of a friend. (correct)
  • A patient who was discovered telling a lie.

A newly admitted male patient has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint?

  • If his behavior warrants restraints, someone will stay with him the entire time he's restrained.
  • I'll call the primary provider and get an as-needed (prn) seclusion/restraint order. (correct)
  • If he is restrained, be sure he is offered food and fluids regularly.
  • Remember that physical restraints are our last resort.

Which intervention(s) should the nurse implement when helping a patient who expresses anger in an inappropriate manner? Select all that apply.

  • Provide suggestions regarding acceptable ways of communicating anger. (correct)
  • Approach the patient in a calm, reassuring manner. (correct)
  • Allow any expression of anger as long as no one is hurt.
  • Warn the patient that being angry is not a healthy emotional state.
  • Set limits on the angry behavior that will be tolerated. (correct)

Which guidelines should direct nursing care when deescalating an angry patient? Select all that apply.

<p>Recognize the patient's need for increased personal space. (A), Behave calmly and respectfully. (B), Intervene as quickly as possible. (C), Identify the trigger for the anger. (D)</p> Signup and view all the answers

Which comorbid condition would result in cautious use of an SSRI for a patient with chronic aggression?

<p>Bipolar disorder (A)</p> Signup and view all the answers

Patrick is a widower with four daughters. He enjoyed a healthy relationship with each of them until they reached puberty. As the girls began to mature physically, he acted in an aggressive manner, often beating them without provocation. Patrick is most likely acting on:

<p>Frustration of unhealthy desire (A)</p> Signup and view all the answers

A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression?

<p>An obvious change in behavior is a risk factor for aggression. (D)</p> Signup and view all the answers

An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through:

<p>Brief, frequent, nonthreatening encounters (D)</p> Signup and view all the answers

A 24-hour observation is a good choice for restraint in which of the following patients?

<p>An inmate with suicidal ideation on hospice care (B)</p> Signup and view all the answers

Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are conditions that:

<p>Contraindicate restraint and seclusion. (B)</p> Signup and view all the answers

Which statement made by a new mother should be explored further by the nurse?

<p>I think the baby cries just to make me angry. (C)</p> Signup and view all the answers

Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply.

<p>Major depressive disorder (A), Low self-esteem (B), Posttraumatic stress disorder (D), Phobias (E)</p> Signup and view all the answers

What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver?

<p>The caregiver was neglected as a child. (C)</p> Signup and view all the answers

What safety-related responsibility does the nurse have in any situation of suspected abuse?

<p>Report suspected abuse to the proper authorities. (B)</p> Signup and view all the answers

The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply.

<p>A domestic violence shelter (A), A responsible friend or family member (B), An abuse hotline (C), The hospital emergency department (D), The police department (E)</p> Signup and view all the answers

Secondary effects of abuse often manifest as arrested development in children due to the fact that:

<p>Energy for development is diverted to coping (C)</p> Signup and view all the answers

The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and:

<p>Establish trust and rapport (C)</p> Signup and view all the answers

The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to:

<p>Their limited options. (D)</p> Signup and view all the answers

An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be:

<p>The perpetrator will recognize destructive patterns of behavior and learn alternate responses. (A)</p> Signup and view all the answers

Perpetrators of domestic violence tend to: Select all that apply.

<p>Have relatively poor social skills and have grown up with poor role models. (B), Prevent their mates from having relationships and activities outside the family. (C), Be controlling and willing to use force to maintain their power in relationships. (D), Believe they, if male, should be dominant and in charge in relationships. (E)</p> Signup and view all the answers

Which statement made by a sexually assaulted patient strongly suggests the drug gamma-hydroxybutyric acid (GHB) was involved in the attack?

<p>They tell me I was unconscious for 24 hours. (A)</p> Signup and view all the answers

Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority?

<p>Do you have any thoughts about harming yourself? (C)</p> Signup and view all the answers

Which statement is an accurate depiction of sexual assault?

<p>Most rapes occur in the home. (B)</p> Signup and view all the answers

Which signs and symptoms are associated with rape-trauma and rape-trauma response? Select all that apply.

<p>Amnesia for the event (A), Flashbacks (C), Outbursts of anger (D), Major depressive disorder (E)</p> Signup and view all the answers

Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime?

<p>American Indian (D)</p> Signup and view all the answers

The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction to trauma, resulting in which of the following?

<p>All of the above (D)</p> Signup and view all the answers

A young woman named Carly was raped after closing shift behind the restaurant where she works. Six months have passed and Carly has not been able to return to work, refuses to go out to eat, and feels that she has less value as a woman now that she has been raped. Carly's clinical presentation suggests:

<p>Avoidance (C)</p> Signup and view all the answers

Ron is a victim of assault and has revealed to his family and friends the fact that he was raped. The family reacts with horror and disgust, and the nurse caring for Ron recognizes that

<p>Ron's family will also need support. (D)</p> Signup and view all the answers

Perpetrators of sexual assault are often incarcerated but frequently do not undergo therapy. Samuel, convicted of rape and sentenced to 15 years in prison, has asked to see a therapist. The psychiatric nurse practitioner is surprised to learn of the request, as many perpetrators

<p>Do not acknowledge the need for change. (C)</p> Signup and view all the answers

You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response?

<p>I'm here to listen, and we can talk about your feelings. (B)</p> Signup and view all the answers

When caring for a patient recovering from an episode of opioid toxicity, the nurse determines that the patient has opioid use disorder based on which finding?

<p>Craving that results in drug-seeking behaviors (B)</p> Signup and view all the answers

A patient hospitalized with a fractured femur after an automobile accident develops nausea and vomiting, abdominal cramps, and restlessness. The nurse suspects that the patient is experiencing which reaction?

<p>Opioid withdrawal (A)</p> Signup and view all the answers

Which treatments will the nurse anticipate administering to a patient who has been admitted with alcohol toxicity? (Select all that apply.)

<p>Thiamine (A), Intravenous fluids (D), Intravenous glucose solution (E)</p> Signup and view all the answers

The nurse observes another nurse taking oral opioids from the medication room at the hospital. Which is the best action for the nurse who observes drug diversion to take?

<p>Report the finding to the nursing supervisor to enable the nurse's participation in a nondisciplinary program. (C)</p> Signup and view all the answers

A patient is to start disulfiram to help with alcohol use disorder. The nurse providing medication education about the drug will include which topics in the education plan? (Select all that apply.)

<p>Importance of taking the medication every day (A), That use of alcohol with disulfiram may cause nausea and vomiting and may even be fat (B), Common food and hygiene products that contain alcohol (C), That better results are experienced when a support group helps with treatment adherence (D), That disulfiram works by disrupting the metabolism of alcohol (F)</p> Signup and view all the answers

Flashcards

Aggressive behavior risk factors (adolescents)

Adolescents experiencing embarrassment among peers, feeling rejected by social groups, are potentially at risk for expressing aggression.

Aggressive behavior risk factors (adults)

Middle-aged adults feeling unheard or patients caught in dishonesty can display signs of aggressive behavior.

Restraint use in aggressive patients

Carefully consider using restraints as a last resort, involving continuous supervision, fluid/food provision, and a documented PRN order from the primary care provider.

Managing anger in patients

Approach with calm reassurance, offering ways to manage anger constructively (acceptable ways of expressing anger) and setting clear limits on unacceptable behavior.

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Anger de-escalation guidelines

Intervene calmly, identify the trigger, acknowledge patient needs, and offer space. Do NOT engage in power struggles or threats.

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SSRI use caution with…

Bipolar disorder requires careful consideration when prescribing SSRIs due to potential exacerbation of manic episodes.

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Aggressive behavior in puberty

Unhealthy desire, stress and frustration can manifest as aggression when parents struggle to adapt to the physical maturity of their children.

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Danger signs of aggression

Obvious and subtle changes in behavior are key danger signs for potential aggression. Assess for withdrawal or increased attention-seeking behaviors.

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Trust & violence prevention

Trust builds by creating frequent, nonthreatening interactions in an environment with violent individuals.

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24-hour observation

Suicidal ideation is a key reason for 24-hour observation; NOT generally a suitable approach for patients with other criteria.

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Conditions contraindicating restraint

Conditions like COPD, spinal injury, seizures, and pregnancy generally contraindicate restraint.

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Reasons for parental concern

New mothers expressing concerns about constant baby crying should be assessed to rule out potential underlying issues and concerns.

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Violence exposure in children

Children exposed to family violence frequently exhibit low self-esteem, phobias, and PTSD.

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Elder abuse risk

Caregiver neglect or lack of experience are major risk factors for elder abuse.

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Nurse's abuse reporting

Nurses have a legal and ethical responsibility to report suspected abuse.

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Safety plan for abuse victims

Abuse victims need access to emergency services (police, hotline), support networks (friends/family), crisis support shelters, and hospital emergencies.

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Coping and development in children

Children use coping mechanisms, as energy is diverted to dealing with abuse, potentially preventing proper emotional growth.

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Patient-centered interview

Establish trust and mutual understanding with the patient, listen without interruption, and focus on open-ended questions in interviews for abuse issues.

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Abuse victim's vulnerabilities

Children and older adults are especially vulnerable to abuse due to their dependence on others and limited options.

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Perpetrator therapy outcome

Perpetrators of abuse require recognizing their destructive behaviors and developing alternative coping/interaction methods.

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Domestic violence traits

Domestic abusers exhibit controlling behavior, often with poor social skills and a history of poor role models, and are often domineering and use force to exert control.

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GHB recognition

Signs like unresponsiveness and physical weakness but with some memory of the attack suggest GHB use.

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Sexual assault priority

Immediate priority is to assess for suicidal thoughts, which are a leading concern in sexual assault victims due to the psychological trauma.

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Disulfiram (Antabuse)

A medication used to help people with alcohol use disorder avoid relapse by causing unpleasant side effects if alcohol is consumed.

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Disulfiram Side Effects

When taken with alcohol, disulfiram (Antabuse) can cause nausea, vomiting, sweating, dizziness, headache, and facial flushing.

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Opioid Withdrawal Symptoms

Symptoms include dilated pupils, increased heart rate, anxiety, restlessness, muscle aches, and insomnia.

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Denial (Nursing Diagnosis)

A defense mechanism where individuals minimize or deny the seriousness of their substance use or gambling problems.

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Substance Use Disorder Intervention

It's essential to address the individual's denial and encourage them to seek help.

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Opioid Use Disorder Treatment

It often involves medication-assisted treatment, therapy, and support groups to manage withdrawal symptoms and cravings.

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Gambling Disorder Treatment

Involves therapy and support groups to help individuals understand and change their gambling behavior.

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Reward Pathways in the Brain

Gambling can activate these pathways, leading to feelings of pleasure and reinforcement.

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Signs of Substance Use Disorder in Staff

Behavioral changes, decreased productivity, mood swings, and absenteeism can be indicative of substance use.

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Peer Assistance Programs

These programs offer confidential support and resources for healthcare professionals struggling with substance use.

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Initial Intervention for Opioid Withdrawal

Prioritizing the management of withdrawal symptoms is crucial for a patient's successful recovery.

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Low-Stimulus environment for Recovery

Creating a calm and supportive environment can aid in the recovery process.

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Long-Term Treatment for Substance Use

It is recommended for optimal recovery outcomes, typically involving therapy and support groups.

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Acknowledging Gambling Problem

A crucial step for recovery is acknowledging the problem and its impact on oneself and others.

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Opioid Tolerance

The body requires increasingly higher doses of the drug to achieve the same euphoric effect.

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Distracted and Disengaged in Recovery

Can indicate resistance to change and lack of motivation to engage in the recovery process.

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Caffeine Overdose

Excessive caffeine intake can lead to symptoms such as anxiety, restlessness, insomnia, and even tremors.

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Alcohol Detoxification

A process of safely withdrawing from alcohol under medical supervision to prevent dangerous complications.

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Alcohol Withdrawal Syndrome

Symptoms include tremors, anxiety, sweating, insomnia, and seizures.

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Motivation in Recovery

Crucial factor for success - a desire to change and make a positive shift in life.

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Substance Use Disorder Risk Factors

Family history, trauma, mental health conditions, and social environment can influence someone's susceptibility to substance use.

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Treatment Outcomes for Substance Use

Depend on factors like individual motivation, access to support, and duration of treatment.

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Understanding Substance Use

It involves recognizing the physical, psychological, and social aspects of addiction.

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Support Groups for Recovery

Provide a safe and supportive environment for individuals to share their experiences and receive encouragement.

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Relapse Prevention Strategies

Techniques to identify and manage triggers, develop coping skills, and maintain healthy lifestyles

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Medication-Assisted Treatment

Using medications to manage withdrawal symptoms and cravings, aiding in reducing relapse risks.

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Behavioral Therapy

Focuses on identifying unhealthy behaviors and developing alternative coping mechanisms.

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Mental Health in Addiction

Mental health conditions often co-occur with substance use disorders, necessitating holistic treatment.

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Stigma Around Addiction

Negative perceptions and stereotypes that can hinder individuals from seeking help.

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Study Notes

Aggressive Behavior Risk Factors

  • Adolescent embarrassed in front of peers
  • Young male feeling rejected by social group
  • Young adult depressed after a friend's death
  • Middle-aged adult feeling unheard

Restraint Use Information

  • Nurse should inquire further if restraint is warranted, especially if the patient's behavior requires restraint throughout the entire time they are restrained.
  • Nurse should only utilize restraint as a last resort.
  • The patient should be given access to fluids and food regularly when restrained.

Anger Management Interventions

  • Approach the patient calmly and reassuringly.
  • Provide examples of acceptable ways to communicate anger.
  • Set limits on behaviors that will not be tolerated.
  • Allow anger expression as long as no one is harmed

De-escalating Angry Patients

  • Intervene quickly.
  • Identify the trigger for the anger.
  • Behave calmly and with respect.
  • Recognize the patient's need for more personal space.

Cautious SSRI Use

  • Bipolar disorder

Patrick's Aggressive Behavior

  • Frustration of unhealthy desires is most likely the cause of his aggressive behavior.

Recognizing Escalating Anger

  • Look for patients who are withdrawn and sitting alone.
  • Be aware of sudden changes and expressions of behaviors.

Preventing Escalation in Violent Environments

  • Develop trust through brief, frequent, and non-threatening interactions.

Restraint in Patients

  • Inmates with suicidal ideation in hospice care.

Nurse's Responsibility in Abuse Cases

  • Protect the patient from future abuse.
  • Report the suspected abuse to the proper authorities.
  • Arrange for counseling for the involved parties (especially the patient).

Effective Therapy for Perpetrators

  • Recognizing destructive patterns of behavior.
  • Learning alternate responses.
  • The perpetrator should not live with the family, and supervised contact is necessary while undergoing intensive inpatient therapy.

Perpetrators of Domestic Violence Tendencies

  • Poor social skills.
  • Belief that men should be dominant.
  • Forcefully control their partners regarding finances and relationship control
  • Preventing their partners from having relationships outside of the family unit.

Opioid Toxicity Recovery

  • Patient should exhibit withdrawal symptoms
  • Craving that results in drug seeking behaviors
  • Intravenous, rather than oral, use of the drug.
  • A patient's history of daily use of opioids.

Patient Hospitalized with Fractured Femur Possible Reactions

  • Opioid withdrawal
  • Alcohol toxicity
  • Flashbacks
  • Nicotine withdrawal

Alcohol Toxicity Treatment

  • Naloxone
  • Thiamine
  • Intravenous fluids

Drug Diversion

  • Report the finding to the superior nursing staff.

Disulfiram Education

  • Importance of taking the medication every day.
  • Support groups help with treatment adherence.
  • Common food and hygiene products containing alcohol.
  • Disulfiram treatment should be stopped 1 day before alcohol use.
  • Disulfiram disrupts the metabolism of alcohol
  • Disulfiram can cause nausea, vomiting, and possibly affect the patient.

Sexual Assault Assessment

  • Questions should focus on feelings of guilt and harm toward oneself.
  • Assessing if the patient has someone they trust and can stay with them.
  • Consider if the patient recognizes the person who assaulted them.
  • Consider if the patient wants law enforcement notified/involved.

Sexual Assault Signs and Symptoms

  • Outbursts of anger.
  • Major depressive disorder
  • Auditory hallucinations.
  • Flashbacks.
  • Amnesia of the event.

Sexual Assault Risk Factors

  • American Indian.
  • Black non-Hispanic

Stressors After Sexual Assault

  • Posttraumatic stress disorder
  • Anxiety
  • Depression
  • Reexperiencing.
  • Hyperalertness
  • Avoidance
  • Physical effects of assault
  • Family dynamics.

Patient with Sexual Assault History

  • Feelings of loss of worth.
  • Difficulty returning to work.
  • Difficulty returning to previous social activities.
  • Fear of the future.

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Description

This quiz covers essential risk factors associated with aggressive behavior and effective strategies for anger management. It aims to provide insights into the role of caregivers in de-escalating angry patients and the proper use of restraints. Test your knowledge on handling anger and supporting individuals in crisis situations.

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