Varcarolis: Chapter 27 - Anger and Aggression

Questions and Answers

Which intervention is appropriate for de-escalating Malcolm's agitation?

Use validation therapy and ask Malcolm about the school and his job (correct)

Medicate Malcolm with PRN medication at regular intervals to prevent agitation

Reduce stimulation in the environment by having Malcolm sit by himself in his room until the agitation passes

Repeatedly explain to Malcolm that he is retired and no longer teaches as the repetition will reinforce the patient's orientation

Which statement indicates an increased likelihood of violent behavior by Ian?

My old man was meek and mild, and I've always said I'm not going to be like him

When I get mad, I want to be left alone

My girlfriend says I yell way too much, and she's threatened to leave me.

Last time I was in here I ended up in seclusion for punching my roommate (correct)

Which responses are likely to be helpful in de-escalating Alex?

Tell Alex that his actions are unacceptable and that he must go to his room

Ask Alex if he can tell you what is upsetting him so you may be able to help (correct)

Tell Alex that he could be placed in seclusion if he cannot control himself

Remain calm, quiet, and in control (correct)

Stand close to Alex so you can intervene physically if needed to protect others

Match Alex's volume so that he is able to hear over his own shouting

Which response is most likely to be therapeutic when Andie accuses you of lying?

You are angry that I didn't speak with you when I promised I would Signup and view all the answers

Which statement about violence and nursing is accurate?

Emergency, psychiatric, and step-down units have the highest rates of violence towards staff Signup and view all the answers

How can anger be best defined?

A normal response to a perceived threat Signup and view all the answers

The factor most likely to contribute to a client's escalating anger is?

A staff member telling him that he is inappropriate Signup and view all the answers

Which assessment finding is the best predictor of violence in a newly admitted client?

A recent assault on a drinking companion Signup and view all the answers

Which nursing diagnosis is the priority when planning care for a client displaying anger and aggression?

Risk for other-directed violence Signup and view all the answers

Which neurotransmitter imbalance is related to impulsive aggression?

Low levels of serotonin Signup and view all the answers

When working with an angry client, it is best to?

Help the client reframe the anger-producing situation Signup and view all the answers

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of?

Vulnerability Signup and view all the answers

Which would be the most appropriate response by a nurse to help a client demonstrating escalating anger?

Walk the client to his room and help him practice stress-reduction techniques Signup and view all the answers

The more a nurse's intervention is prompted by emotion, the less likely it is to be?

Therapeutic Signup and view all the answers

The most restrictive method for dealing with an aggressive client who is out of control is?

Seclusion Signup and view all the answers

The client at highest risk for violence directed at others is one who?

Has delusions of persecution Signup and view all the answers

A client experiencing manic hyperactivity stands up, glares challengingly at clients and staff, and shouts, 'This food is garbage! I'll fight anyone who says it's not!' The nurse's most relevant assessment is that the client?

Has a high potential for other-directed violence Signup and view all the answers

Which intervention strategy should be avoided by staff working with a client who is shouting and flailing his arms?

Defusing the situation by laughing or making a joke of the challenge Signup and view all the answers

An adolescent male is swearing and shouting at his physician, who refused to give him a pass to leave the unit. This behavior?

Is a major indicator that the client may become physically aggressive Signup and view all the answers

A client waiting to see the physician is pacing and looking both angry and tense. When it's determined that the client won't be seen for another 30 minutes, what should the nurse address with the client?

Explaining to the client what caused the back-up and suggesting that he has time to go to the coffee shop Signup and view all the answers

An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior?

When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control Signup and view all the answers

A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. The nurse best demonstrates the ability to help the client deescalate by?

Moving to the rear of the staff group Signup and view all the answers

A client has a history of demonstrating aggression physically. An appropriate short-term goal to help the client manage this anger is?

Identify situations that precipitate hostility Signup and view all the answers

When a client diagnosed with a cognitive deficit experiences a catastrophic reaction, the priority intervention is to?

Smile and call the client by name Signup and view all the answers

A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include?

Providing for nutrition and hydration Signup and view all the answers

Peter, a 21-year-old patient, asks you, 'What's wrong with my brain that I have such a problem with aggression?' Your response is based on the knowledge that?

The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression Signup and view all the answers

One older concept that is being used currently that may help in violence reduction in patients is?

Trauma-informed care Signup and view all the answers

Which of the following statements to Matt may help prevent escalation and/or violence? (Select all that apply)

You appear upset. Can I help you with anything? Signup and view all the answers

To deal with Katy's situation and prevent further escalation, your best response would be?

Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room? Signup and view all the answers

When you approach Katy, what considerations should you take? (Select all that apply)

Have other staff as backup, and stand far enough away to avoid injury. Signup and view all the answers

Which of the following statements made by a client is an example of aggressive communication?

You'd better listen to me. Signup and view all the answers

Which action should the nurse take when caring for a client who is speaking in a loud voice with clenched fists?

Request that other staff members remain close by. Signup and view all the answers

Which findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply)

Facial grimacing Signup and view all the answers

What is the priority nursing action when a client throws a chair in the day room?

Move the client away from others. Signup and view all the answers

Which of the following is a therapeutic response by the nurse to a client who is screaming?

Stop screaming, and walk with me outside. Signup and view all the 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. Signup and view all the answers

Which statement by the nurse demonstrates the need for more information about the use of restraint?

I'll call the primary provider and get an as needed (prn) seclusion/restraint order. Signup and view all the answers

Which interventions should the nurse implement when helping a patient express anger in an inappropriate manner? (Select all that apply)

Approach the patient in a calm, reassuring manner. Signup and view all the answers

Which guidelines should direct nursing care when de-escalating an angry patient? (Select all that apply)

Recognize the patient's need for increased personal space. Signup and view all the answers

Which comorbid condition would result in cautious use of selective serotonin reuptake inhibitors for a patient with chronic aggression?

Bipolar disorder Signup and view all the answers

John Patrick is most likely acting on?

Frustration of unhealthy desire Signup and view all the answers

Which statement indicates that Darryl understands danger signs in regard to aggression?

An obvious change in behavior is a risk factor for aggression. 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?

Brief, frequent, nonthreatening encounters Signup and view all the answers

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

An inmate with suicidal ideation on hospice care Signup and view all the answers

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

Contraindicate restraint and seclusion. Signup and view all the answers

Study Notes

Agitation and De-escalation Strategies

Validation therapy is effective for de-escalating agitation in patients with cognitive impairments, such as asking about their past professions.
Maintaining a calm demeanor and asking open-ended questions can help de-escalate angry patients.
In high-stress interactions, nurses should avoid punitive or accusatory statements that could escalate anger.

Violence Indicators

Previous violent behavior, as indicated by an incident such as assault or seclusion for aggression, significantly predicts future violent actions.
High-risk settings for violence include emergency and psychiatric units, where staff are more frequently targeted.
Signs of escalating anger can include shouting, pacing, or challenging behaviors, signaling potential violence.

Nursing Diagnoses and Assessments

Prioritize the nursing diagnosis of "Risk for other-directed violence" in patients exhibiting significant anger.
Identification of triggers for hostility is crucial for developing effective coping strategies in aggressive clients.
Assessment of a client's history, such as past violent behavior or family history of mood disorders, can guide interventions.

Neurotransmitters and Anger Management

Low levels of serotonin are linked to impulsive aggression, highlighting the role of neurotransmitter imbalances in anger.
Therapeutic interventions should aim to help clients reframe anger-producing situations to promote coping instead of aggressive responses.

Therapeutic Responses and Techniques

When responding to anger, acknowledging the client's feelings and providing an empathetic statement can foster therapeutic communication.
Encouraging clients to practice stress-reduction techniques like deep breathing can effectively mitigate escalating aggression.
Avoiding humor in tense situations is crucial as it may be perceived as ridicule rather than support.

Environmental and Situational Considerations

Trauma-informed care addresses the histories of violence and trauma in patients, promoting understanding and reducing aggression.
Simple, clear communication about delays or frustrations can alleviate tensions in clients waiting for care.

Management of Aggressive Behavior

Seclusion is the most restrictive intervention for managing aggressive behavior, ensuring safety for both the patient and staff.
Regular observation and provision of basic needs are essential for clients placed in seclusion to prevent further agitation.

Interpersonal Dynamics

Engaging with angry clients in a non-confrontational manner and offering help can prevent situations from escalating to violence.
Providing a choice in how to manage emotions, such as a quiet space or discussing feelings, can empower the client, reducing the likelihood of aggressive outbursts.

Key Takeaways

Anger is a normal response to perceived threats and should be handled with techniques that validate feelings and promote constructive coping.
Understanding the underlying factors contributing to anger and aggression, including neurological influences, can enhance nursing interventions.
Fostering an environment of calm and control while recognizing and addressing client emotions can lead to better outcomes in managing anger and preventing violence.### Seclusion and Restraint Considerations
Premature use of seclusion and restraint can often be avoided by employing the least restrictive interventions.
The nursing process emphasizes analysis and planning when determining the best course of action.
Safety in handling aggressive situations requires assessing the potential for conflict and employing preventive measures.

Approaching an Aggressive Patient

Enlist backup staff and maintain a safe distance during initial interactions to prevent injury.
Non-threatening approaches avoid escalating the patient's behavior while addressing their immediate needs.

Aggressive Communication in Group Therapy

Aggressive communication is exemplified by demands or ultimatums, such as "You'd better listen to me."

Managing Clients Exhibiting Aggression

Request that other staff members remain nearby when a client is demonstrating aggression to enhance safety.
Monitor signs indicating a preassaultive stage, including defensive responses, facial grimacing, and agitation.

Prioritizing Patient Safety

In situations where a client is exhibiting violent behavior (e.g., throwing furniture), the priority is to move the client away from others to ensure safety.

Therapeutic Responses to Anger

A direct approach, such as asking the client to stop screaming and walk outside, is a therapeutic response that aims to de-escalate the situation.

Risk Factors for Aggressive Behavior

Adolescents embarrassed in social settings, young adults feeling rejected, and middle-aged adults feeling unheard are more susceptible to aggression.

Restraint Guidelines and Protocol

Appropriate use of restraints requires knowledge of legal and ethical considerations, with a focus on the last-resort approach.
Orders for restraints must be obtained from a primary provider based on assessed behavior.

Interventions for Expressing Anger

Calmly address the patient, suggest appropriate communication methods, and set clear behavioral limits on expressing anger.

De-escalation Guidelines

Quick intervention, identifying triggers, maintaining calm and respectful behavior, and recognizing the need for personal space are key in de-escalating anger in patients.

Medication Considerations

Caution is advised when prescribing selective serotonin reuptake inhibitors for patients with chronic aggression, particularly those with bipolar disorder.

Factors Influencing Aggression

Behavioral changes, especially abrupt ones, are significant indicators of potential aggression.
Building trust through consistent, non-threatening interactions can effectively mitigate violence in high-risk environments.

Observation Needs for High-Risk Patients

Continuous observation is crucial for patients at risk, such as inmates with suicidal ideation.

Conditions Affecting Restraint Decisions

Certain medical conditions, including COPD and pregnancy, contraindicate the use of restraint and seclusion, highlighting the need for alternative interventions.

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Description

Explore the complexities of anger, aggression, and violence in nursing care through this quiz based on Varcarolis' Chapter 27. You'll analyze case scenarios and appropriate interventions for managing agitation in patients, particularly those with Alzheimer's disease. Test your understanding of effective strategies for de-escalation in challenging situations.