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Essentials of Psychiatric Mental Health Nursing Chapters 1
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Essentials of Psychiatric Mental Health Nursing Chapters 1
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Essentials of Psychiatric Mental HealthNursing Chapters 1-24 Questions and
Correct Answers
1. Which behavior best demonstrates aggression?
a. Stomping away from the nurses' station, going to the day room, and grabbing a pool cue from a
patient standing by the pool table.
b. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing.
c. Telling the primary nurse, "I felt angry when you said I could not have a second helping at lunch."
d. Telling the medication nurse, "I am not going to take that or any other medication you try to give me."
- correct answers:ANS: A
Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or
verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not
feature violation of another's rights.
2. Which scenario predicts the highest risk for directing violent behavior toward others?
a. Major depression with delusions of worthlessness
b. Obsessive-compulsive disorder; performing many rituals
c. Paranoid delusions of being followed by alien monsters
d. Completing alcohol withdrawal and beginning a rehabilitation program - correct answers:ANS: C
The correct answer illustrates the greatest disruption of ability to perceive reality accurately. People who
feel persecuted may strike out against those believed to be persecutors. The patients identified in the
distracters have better reality-testing ability.
3. A patient is hospitalized after an arrest for breaking windows in the home of a former domestic
partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for
disorderly conduct. Which nursing diagnosis has priority?
a. Risk for injury
b. Posttrauma response
c. Disturbed thought processes
,d. Risk for other-directed violence - correct answers:ANS: D
The defining characteristics for Risk for other-directed violence include a history of being abused as a
child, having committed other violent acts, and demonstrating poor impulse control. The defining
characteristics for the other diagnoses are not present in this scenario.
4. A confused older adult patient in a skilled care facility is in bed sleeping. The nurse enters the room
quietly and touches the bed to see if it is wet. The patient awakens and hits the nurse in the face. Which
statement best explains the patient's action?
a. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
b. Crowding in skilled care facilities increases individual tendencies toward violence.
c. The patient interpreted the health care worker's behavior as potentially harmful.
d. This patient learned violent behavior by watching other patients act out. - correct answers:ANS: C
Confused patients are not always able to evaluate accurately the actions of others. This patient behaved
as though provoked by the intrusive actions of the staff member.
5. A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention
for the nurse would be to address the patient by name and say:
a. "Hey, what's going on?"
b. "Please quiet down immediately."
c. "I'd like to talk with you about how you're feeling right now."
d. "You must go to your room and try to get control of yourself." - correct answers:ANS: C
Intervention should begin with an analysis of the patient and situation. With this response, the nurse is
attempting to hear the patient's feelings and concerns, which leads to the next step of planning an
intervention.
6. A patient was responding to auditory hallucinations earlier in the morning. The patient approaches
the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse follows
the patient into the day room, the nurse should:
a. make sure adequate physical space exists between the nurse and the patient.
b. move into a position that allows the patient to be close to the door.
c. maintain one arm's length distance from the patient.
d. sit down in a chair near the patient. - correct answers:ANS: A
,Making sure space is present between the nurse and the patient avoids invading the patient's personal
space. Personal space needs increase when a patient feels anxious and threatened. Allowing the patient
to block the nurse's exit from the room is not wise. Closeness may be threatening to the patient and
provoke aggression. Sitting is inadvisable until further assessment suggests the patient's aggression is
abating. One arm's length is inadequate space.
7. An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming
increasingly more aggressive. The patient is in the day room. The nurse should enter the day room:
a. and say, "Would you like to come to your room and take some medication your doctor prescribed for
you?"
b. accompanied by three staff members and say, "Please come to your room so I can give you some
medication that will help you feel more comfortable."
c. and place the patient in a basket-hold and then say, "I am going to take you to your room to give you
an injection of medication to calm you."
d. accompanied by a male nursing assistant and tell the patient, "You can come to your room willingly so
I can give you this medication, or the aide and I will take you there." - correct answers:ANS: B
A patient gains feelings of security if he or she sees that others are present to help with control. The
nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that
the intervention will be helpful. This positive approach assumes that the patient can act responsibly and
will maintain control. Physical control measures should be used only as a last resort.
8. After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the
incident. The nurse says, "I dread facing potentially violent patients." Which response would be the most
urgent reason for this nurse to seek supervision?
a. Startle reactions
b. Difficulty sleeping
c. Wish for revenge
d. Preoccupation with the incident - correct answers:ANS: C
The desire for revenge signals an urgent need for professional supervision to work through anger and
counter the aggressive feelings. The distracters are normal in a person who has been assaulted. Nurses
are usually relieved with crisis intervention and follow-up designed to give support, help the individual
regain a sense of control, and make sense of the event.
9. The staff development coordinator plans to teach the use of physical management techniques when
patients become assaultive. Which topic should be emphasized?
, a. Practice and teamwork
b. Spontaneity and surprise
c. Caution and superior size
d. Diversion and physical outlets - correct answers:ANS: A
Intervention techniques are learned behaviors that must be practiced to be used in a smooth, organized
fashion. Every member of the intervention team should be assigned a specific task to carry out before
beginning the intervention. The other options are useless if the staff does not know how to use physical
techniques and how to apply them in an organized fashion.
10. An adult patient assaults another patient and is restrained. One hour later, which statement by this
restrained patient necessitates the nurse's immediate attention?
a. "I hate all of you!"
b. "My fingers are tingly."
c. "You wait until I tell my lawyer."
d. "It was not my fault. The other patient started it." - correct answers:ANS: B
The correct response indicates impaired circulation and necessitates the nurse's immediate attention.
The incorrect responses indicate that the patient has continued aggressiveness and agitation.
11. Which is an effective nursing intervention to assist an angry patient to learn to manage anger
without violence?
a. Help the patient identify a thought that increases anger, find proof for or against the belief, and
substitute reality-based thinking.
b. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether
or not violence is present.
c. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry
feelings.
d. Administer an antipsychotic or antianxiety medication. - correct answers:ANS: A
Anger has a strong cognitive component; therefore using cognition to manage anger is logical. The
incorrect options do nothing to help the patient learn anger management.
12. Which assessment finding presents the greatest risk for violent behavior? A patient who:
a. is severely agoraphobic.
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