Question 1

A patient presents for an annual physical. As the nurse conducts the assessment, which statement will suggest the patient is experiencing workplace bullying?

Accepted Answer

3. Workplace bullying can be defined as deliberate, repeated mistreatment of a worker over time by another worker; it involves negative and aggressive behaviors such as harassment, social exclusion, or interference with job performance. The manager who does not invite the employee to team meetings, affecting the employee's annual review, is displaying workplace bullying. A manager who has not given a raise is not displaying workplace bullying. Managers who criticize work and who do not give positive feedback are not necessarily engaging in workplace bullying if the employee's annual performance review has either been positive or unchanged.

Question 2

The nurse is caring for a patient with a history of violent behaviors. Which nursing interventions are most likely to prevent the patient from responding with aggressive or violent behavior? Select all that apply.

Accepted Answer

1. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.
2. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.
3. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. While assessing the patient's family history is important, it is unlikely to reduce the patient's risk for aggressive or violent behavior. Avoiding intervention is not therapeutic. Early intervention in the continuum of aggressive behavior will help prevent further escalation of violent behaviors.

Question 3

A patient tells the nurse, "I have been waiting two hours to be discharged. What is the problem?" The patient is pacing the room and glaring at staff members. What is the nurse's best action to prevent patient aggression?

Accepted Answer

4. In most cases, aggressive behavior is a response to an unmet need, often combined with underlying anxiety and poor coping mechanisms. The patient is displaying cues to aggressive behavior by pacing the room and glaring at staff members. The nurse's best action is to acknowledge the patient's feelings and determine the status of the patient's discharge paperwork. This action will validate the patient's feelings and attempt to address the patient's unmet needs. Calling hospital security does not address the patient's needs, nor does asking the patient to remain seated without validating the patient's concerns. Acknowledging the patient's feelings is the correct intervention; however, the nurse should intervene early, not leave the patient alone in the room.

Question 4

The nurse manager is teaching the staff nurses in the emergency department about violence in health care settings. What information will the nurse include when teaching about hospital risk factors that increase risk of violence? Select all that apply.

Accepted Answer

2. Risk factors for aggression and violence in health care settings include characteristics of the services delivered, such as the frequent presence of distraught patients and family members; individuals having to wait for services to be delivered; and low staffing levels that may exacerbate waiting times for those having to wait for care. Census levels and characteristics of staff members do not increase the risk of violence in the health care setting.
4. Risk factors for aggression and violence in health care settings include characteristics of the services delivered, such as the frequent presence of distraught patients and family members; individuals having to wait for services to be delivered; and low staffing levels that may exacerbate waiting times for those having to wait for care. Census levels and characteristics of staff members do not increase the risk of violence in the health care setting.
5. Risk factors for aggression and violence in health care settings include characteristics of the services delivered, such as the frequent presence of distraught patients and family members; individuals having to wait for services to be delivered; and low staffing levels that may exacerbate waiting times for those having to wait for care. Census levels and characteristics of staff members do not increase the risk of violence in the health care setting.

Question 5

The nurse manager is providing education to staff regarding the prevention of workplace aggression. Which statement, made by a staff nurse, best displays that teaching has been effective?

Accepted Answer

2. Bullying refers to repeated events or a pattern of behavior involving abuse or misuse of power. Although bullying typically is thought of as occurring in school or among children, bullying can occur in both social groups as well as professional groups. Cyberbullying may occur in the hospital environment by use of social media to threaten or intimidate peers. Type IV aggression occurs if a staff member is injured by a perpetrator who has a relationship to the staff member, but not to the organization or hospital. Type I aggression may occur when the perpetrator does not have a direct relationship to the staff member.

Question 6

The nurse preceptor is caring for a patient who has a history of aggressive behavior. The novice nurse asks, "Why is the patient taking a cardiac medication if he does not have a heart condition?" What is the preceptor's best response?

Accepted Answer

4. The nurse must be aware of the neurobiology associated with aggression. Beta-adrenergic antagonists are used in the collaborative treatment of aggression as well as to treat cardiac conditions. Beta-adrenergic antagonists decrease norepinephrine levels, decreasing the risk of violence. Beta-adrenergic agonists and calcium channel blockers are not used in the collaborative treatment of aggressive behavior.

Question 7

The nurse is caring for a patient who is making obscene gestures to other staff members and is raising his voice in protest of an ordered test. What is the nurse's best action?

Accepted Answer

2. The key concept to managing aggressive behavior is to identify the behavior warning signals. The patient is displaying escalating aggression by making obscene gestures and raising his voice. Escalation of aggression most often occurs when the patient's basic needs are not being met. The most appropriate action by the nurse is to determine what basic patient needs are not being met, in order to stop the escalation of aggression. The patient is displaying symptoms of escalating aggression from anxiety; therefore, determining the level of anxiety is not the best action, as the nurse must act in order to prevent further escalation. Reviewing the patient chart does not help to prevent the patient from becoming aggressive. Contacting the health care provider is not the best action because the nurse must act independently and quickly in order to prevent the escalation of aggression.

Question 8

A nurse educator is teaching a group of staff nurses on environmental risk factors that may lead to violence in the psychiatric setting. Which response by the staff nurse demonstrates that teaching has been effective?

Accepted Answer

3. Environmental risk factors in the psychiatric setting include restrictions that infringe on individual freedoms, such as restricting visitors, locking doors, and taking away belongings (such as razors, electrical items, belts, and personal communication devices) to maintain safety. The other choices are appropriate nursing interventions; however, these pertain to unit-based routines and processes, not environmental risk factors.

Question 9

The nurse educator is presenting a review course on workplace safety and prevention of aggression. The nurse discusses the various types of workplace aggression. Which action will the nurse manager recommend for nurses to take to prevent type I aggression while at work?

Accepted Answer

4. Type I violence occurs when criminal intent or activity results in violence. In this type of violence, the perpetrator has no known relationship with the victim. Having a security guard escort the nurse to the nurse's vehicle will help to prevent this type of violence. Recognizing escalating anxiety in visitors and family members of patients is an appropriate intervention; however, this describes an intervention to prevent type II violence, not type I. Reporting threats from a peer or health care provider are appropriate interventions; however, these interventions best describe prevention against type III violence, not type I.

Question 10

The nurse educator is teaching an in-service on the recognition of patient aggression within the hospital. One of the nurse participants is asked to classify her patient's behavior to determine if the patient is at risk for aggression. Which patient does the nurse classify as displaying manifestations that may lead to aggression? Select all that apply.

Accepted Answer

1. Fear, anger, anxiety, and frustration are all factors that can lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.
2. Fear, anger, anxiety, and frustration are all factors that lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.
4. Fear, anger, anxiety, and frustration are all factors that lead to aggressive behavior. Sadness and apprehension are not factors that are associated with aggressive behavior.

Question 11

The nurse is researching violence in the community as part of a community health assessment. Using the broken windows theory, which factor will the nurse research?

Accepted Answer

4. According to the broken windows theory, when a neighborhood or area is run down and appears to be lacking engagement or investment by both community members and larger society, there will be a disproportionate amount of violence and crime, and further disorder will occur. While the other answer choices may be important to assess in a community with increased violence, these are not the primary causative factors of violence according to the broken windows theory.

Question 12

A nurse is conducting a community risk assessment of the relationship between mental health and violence in the community. Which components would it be important for the nurse to include in the assessment? Select all that apply.

Accepted Answer

1. The nurse must understand that the prevalence of aggression within the community will vary based on the sample and measures used. In order to provide a thorough and accurate assessment, the nurse must include a method to determine the prevalence of violence within the community, as well as the prevalence of mental disorders within the community. Additionally, the research process must also include a method to quantify the numbers of individuals within the community who have mental illness and are currently being treated for the condition, as well as those with mental illness who are not being treated for the condition. The research must include a sampling of the community itself, not individuals across various communities.
3. The nurse must understand that the prevalence of aggression within the community will vary based on the sample and measures used. In order to provide a thorough and accurate assessment, the nurse must include a method to determine the prevalence of violence within the community, as well as the prevalence of mental disorders within the community. Additionally, the research process must also include a method to quantify the numbers of individuals within the community who have mental illness and are currently being treated for the condition, as well as those with mental illness who are not being treated for the condition. The research must include a sampling of the community itself, not individuals across various communities.
4. The nurse must understand that the prevalence of aggression within the community will vary based on the sample and measures used. In order to provide a thorough and accurate assessment, the nurse must include a method to determine the prevalence of violence within the community, as well as the prevalence of mental disorders within the community. Additionally, the research process must also include a method to quantify the numbers of individuals within the community who have mental illness and are currently being treated for the condition, as well as those with mental illness who are not being treated for the condition. The research must include a sampling of the community itself, not individuals across various communities.
5. The nurse must understand that the prevalence of aggression within the community will vary based on the sample and measures used. In order to provide a thorough and accurate assessment, the nurse must include a method to determine the prevalence of violence within the community, as well as the prevalence of mental disorders within the community. Additionally, the research process must also include a method to quantify the numbers of individuals within the community who have mental illness and are currently being treated for the condition, as well as those with mental illness who are not being treated for the condition. The research must include a sampling of the community itself, not individuals across various communities.

Question 13

The nurse is conducting research on violence in the community for a community health assessment. Which socioeconomic factors will the nurse include in the research? Select all that apply.

Accepted Answer

1. Socioeconomic factors which may contribute to violence in the community include younger age, poverty, inequality, and substance use. Race itself is not a factor that contributes to violence; rather, it is inequality that contributes to violence.
3. Socioeconomic factors which may contribute to violence in the community include younger age, poverty, inequality, and substance use. Race itself is not a factor that contributes to violence; rather, it is inequality that contributes to violence.
4. Socioeconomic factors which may contribute to violence in the community include younger age, poverty, inequality, and substance use. Race itself is not a factor that contributes to violence; rather, it is inequality that contributes to violence.
5. Socioeconomic factors which may contribute to violence in the community include younger age, poverty, inequality, and substance use. Race itself is not a factor that contributes to violence; rather, it is inequality that contributes to violence.

Question 14

The staff nurses at a local psychiatric unit are participating in a skills refresher day. The nurse manager is presenting information for the staff regarding the different types of workplace aggression. What information will the nurse manager include in the teaching, when discussing prevention of the various types of workplace aggression?

Accepted Answer

2. Promoting and establishing interpersonal relationships may help to prevent type III aggression. Type III aggression occurs when the perpetrator has or had a formal employment relationship with the victim. By developing interpersonal relationships among employees, this type of aggression may be prevented. Installing metal detectors and improving outside lighting may best prevent type I aggression, which occurs when the perpetrator has no relationship to the victim. An example of a type I violent act is a nurse or staff member being attacked by a stranger in the hospital parking lot. Limiting the number of visitors and family members in the hospital may help to prevent type II aggression, which occurs when the perpetrator has a legitimate relationship with the business. An example of a type II violent act is an emergency department receptionist being attacked by a family member of a patient.

Question 15

The school nurse is a member of the school's student support team. The team is meeting with parents of one of the football players to discuss his increasingly aggressive behaviors. Which risk factors will the nurse be prepared to discuss? Select all that apply.

Accepted Answer

1. Risk factors for aggression may be described as either static or dynamic. Static risk factors are factors that do not change over time. Static risk factors for aggression include younger age and a history of head injury. Dynamic risk factors are factors that could potentially be changed. A dynamic risk factor for aggression is substance use. Ethnicity and parental occupation are not risk factors for aggression.
3. Risk factors for aggression may be described as either static or dynamic. Static risk factors are factors that do not change over time. Static risk factors for aggression include younger age and a history of head injury. Dynamic risk factors are factors that could potentially be changed. A dynamic risk factor for aggression is substance use. Ethnicity and parental occupation are not risk factors for aggression.
5. Risk factors for aggression may be described as either static or dynamic. Static risk factors are factors that do not change over time. Static risk factors for aggression include younger age and a history of head injury. Dynamic risk factors are factors that could potentially be changed. A dynamic risk factor for aggression is substance use. Ethnicity and parental occupation are not risk factors for aggression.

Question 16

The nurse manager is reviewing risk factors for workplace aggression during a monthly staff meeting. The nurse manager includes risk factors for aggression related to the psychiatric patient population. Which statement by the staff nurse indicates that teaching has been effective?

Accepted Answer

2. Risk factors for aggression related to the patient population include dementia, psychosis, mania, substance use or withdrawal, and personality disorders. Depression, somatic symptom disorder, and eating disorders do not present an increased risk for aggression related to the patient population.

Question 17

The nurse educator is teaching a review course to the staff nurses on the role of neurobiology in aggressive behavior. The nurse educator asks a staff nurse to identify the patient on the unit who is most at risk for aggression, based on neurobiology. Which statement by the staff nurse indicates that the teaching has been effective?

Accepted Answer

4. The patient with a history of a traumatic brain injury (TBI) is at greatest risk for aggressive behavior. In addition, the patient's younger age and male gender increases the risk for aggression. Chronic neuropathy, multiple sclerosis (MS), and chronic migraine headaches are not associated with an increased risk of aggression.

Question 18

The nurse is caring for a patient with aggressive behavior. The health care provider has ordered a selective serotonin reuptake inhibitor (SSRI). The nurse is providing patient education related to the medication when the patient asks, "Why is this being prescribed for me? I'm not depressed." What is the nurse's best response? Select all that apply.

Accepted Answer

1. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.
2. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.
4. Serotonin inhibits both impulsive and predatory aggression. Studies have shown that serotonin levels are decreased in some who have aggressive behavior. SSRIs prevent the reuptake of serotonin, increasing, not decreasing, the serum level of serotonin. SSRIs may minimize anxiety and impulsivity associated with aggression. SSRIs are not used at help patients improve coping skills, although patients whose symptoms improve as a result of pharmacotherapy may be better able to retain teaching and learn new coping skills.

Question 19

The nurse is working in the emergency department (ED) of a local hospital. Which response by a patient or family member would alert the nurse to the greatest risk for displaying aggression?

Accepted Answer

1. Emergency departments (ED) are susceptible to violence by patients, visitors, and family members. Factors that increase the risk for violence include treatment of conditions such as anxiety, long wait times, and painful procedures. The individual whose brother in a lot of pain is at greatest risk for displaying aggression. The spouse who is concerned about the patient's condition is not at an increased risk for aggression. The patient who is nervous or apprehensive about an upcoming surgical procedure is not at an increased risk for aggression.

Question 20

The nurse is conducting a health history on a newly admitted patient. The patient's wife tells the nurse, "Ever since my husband's head injury, he is easily agitated, cannot focus, and is impulsive." What is the best response from the nurse?

Accepted Answer

1. Damage to the prefrontal cortex of the brain may manifest as agitation, inability to focus, and impulsivity. Damage to the occipital lobe would likely manifest in alterations in visual perception. Damage to the parietal lobe would exhibit as alterations in visual-spatial coordination. Damage to the cerebellum would manifest in poor balance and decreased fine motor control.

Quiz 25: Aggression and Violence