Chapter 25: Anger and Aggression Nursing School Test Banks

Chapter 25: Anger and Aggression
Test Bank

MULTIPLE CHOICE

1. The use of inappropriate, harmful, or destructive behaviors to express current or past emotions is defined as:
a. Anger
b. Assault
c. Acting out
d. Aggression
ANS: C
Acting out is the use of inappropriate, detrimental, or destructive behaviors to express current or past emotions. Anger is a normal emotional response in certain situations; assault is a threat for bodily injury; and aggression is a forceful attitude or action.

DIF: Cognitive Level: Knowledge REF: p. 285 OBJ: 1
TOP: Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. Toddlers often express their anger through:
a. Crying
b. Manipulation
c. Temper tantrums
d. Direct aggression
ANS: C
Toddlers engage in temper tantrums when they learn to focus their aggression on what they believe is responsible for their anger.

DIF: Cognitive Level: Knowledge REF: p. 286 OBJ: 2
TOP: Aggression throughout the Life Cycle
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

3. In the assault cycle, people are unable to listen to reason, follow directions, or engage in mental exercises during the stage of:
a. Crisis
b. Trigger
c. Recovery
d. Escalation
ANS: A
Assault is an aggressive behavior that violates anothers person or property. Crisis describes the behaviors in the question. Trigger refers to the phase when a stress-producing event occurs; recovery is described as the cooling-down period of the assault cycle; and escalation is characterized by a behavioral response that is approaching loss of control.

DIF: Cognitive Level: Comprehension REF: p. 288 OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. Crisis interventions are very successful if begun early in the assault cycle, in the ____ stage.
a. Crisis
b. Trigger
c. Depression
d. Escalation
ANS: B
Crisis intervention works best in this stage because coping mechanisms can be implemented that are effective rather than allowing behavior to continue to the next phase of escalation.

DIF: Cognitive Level: Knowledge REF: p. 288 OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

5. Persons who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings are given the diagnosis of ____ disorder.
a. Conduct
b. Adjustment
c. Impulse-control
d. Oppositional defiant
ANS: A
These are characteristics of conduct disorders. Adjustment disorders are characterized by a psychological response from an identifiable stressor or group of stressors that causes significant emotional or behavioral symptoms that do not meet criteria for more specific disorders; impulse-control disorders are characterized by a failure to resist impulses or temptations that are harmful to the person or to others; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.

DIF: Cognitive Level: Comprehension REF: p. 289 OBJ: 6
TOP: Aggressive Behavioral Disorders of Childhood
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

6. Emotional or behavioral problems that develop in response to an identifiable source and last no longer than 6 months are called ____ disorders.
a. Conduct
b. Adjustment
c. Impulse-control
d. Oppositional defiant
ANS: B
This is the criterion for adjustment disorders. Conduct disorders are characterized by individuals who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings; impulse-control disorders are characterized by failure to resist an impulse, drive, or temptation; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.

DIF: Cognitive Level: Knowledge REF: p. 289 OBJ: 6
TOP: Adjustment Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. Level one interventions for potentially assaultive clients should be practiced as:
a. Therapy
b. Control methods
c. Assessment measures
d. Preventive measures
ANS: D
Level one interventions focus on the prevention of violence.

DIF: Cognitive Level: Knowledge REF: p. 290 OBJ: 8
TOP: Level One Interventions KEY: Nursing Process Step: Planning
MSC: Client Needs: Safe and Effective Care Environment

8. Interventions for assaultive clients that focus on protecting the client and others from potential harm are level ____ interventions.
a. One
b. Two
c. Three
d. Four
ANS: B
Level two interventions focus on protecting the client and others from potential harm. Level one interventions focus on preventing violence, and level three is the last level of interventions that are implemented for clients whose behaviors reflect a loss of control.

DIF: Cognitive Level: Knowledge REF: p. 291 OBJ: 8
TOP: Level Two Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

9. Restrained clients must be monitored and their condition documented at least every ____ minutes.
a. 15
b. 30
c. 60
d. 90
ANS: A
The use of restraints is governed by federal and state laws, institutional policies, and special procedures.

DIF: Cognitive Level: Knowledge REF: p. 291 OBJ: 8
TOP: Level Three Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

10. As long as the client is limiting her behaviors to verbal assaults and harmless physical movements:
a. She is placed in seclusion.
b. The acting out may continue.
c. The caregiver is prepared to apply restraints.
d. She is reminded of the inappropriateness of her behavior.
ANS: B
Allow clients to act out as long as they limit their behaviors to verbal assaults and harmless physical movements. However, it is important for the caregiver to maintain control of the situation and set limits on the clients behavior.

DIF: Cognitive Level: Application REF: p. 291 OBJ: 8
TOP: Level Two Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

11. Interventions that help caregivers the most in coping with their own anger focus on:
a. Learning to effectively interact with clients
b. Assessing which stressors and coping skills are being used
c. Learning to effectively control feelings of anger
d. Establishing a trusting therapeutic relationship via clear communications
ANS: C
Although all these interventions are necessary when one is dealing with clients, this intervention allows caregivers to be most effective in caring for individuals who express emotions of anger.

DIF: Cognitive Level: Application REF: p. 293 OBJ: 9
TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

12. Which situation would most negatively affect a female client with a diagnosis of adjustment disorder?
a. Marrying her partner she has lived with for 5 years
b. Beginning college after graduating from high school 12 years ago
c. Being promoted in the company at which she has worked for the past 10 years
d. Meeting with a friend with whom she keeps in contact but has not seen for 8 years
ANS: B
Individuals with adjustment disorders have the greatest difficulty in adapting to new situations. Therefore, beginning college has the most stress potential because it has no familiar aspect to it, as the other options do.

DIF: Cognitive Level: Analysis REF: p. 289 OBJ: 6
TOP: Adjustment Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

13. A married couple is seeking counseling for domestic abuse issues. The husband states that he cant control his anger when his wife constantly nags at him. In the assault cycle, the wifes behavior in this situation is the stage known as:
a. Recovery
b. Crisis
c. Escalation
d. Trigger
ANS: D
The nagging is the trigger to the assault in this situation. The trigger stage should not be confused as being a justified reason for an assault to occur.

DIF: Cognitive Level: Application REF: p. 288 OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. A male client is being seen for anger management issues following an incident in which he was late for work, became angry at the driver in front of him for not driving faster, and intentionally ran into the car at a stop sign. This client is displaying actions most typical of:
a. Intermittent explosive disorder
b. Passive aggressive behavior
c. Oppositional defiant disorder
d. Adjustment disorder with anxiety
ANS: A
The main characteristic of intermittent explosive disorder is the failure to resist aggressive impulses that result in assault of another individual or property. Passive aggressive behavior, oppositional defiant disorder, and adjustment disorder with anxiety do not result in injury or harm to persons or property.

DIF: Cognitive Level: Application REF: p. 289 OBJ: 6
TOP: Impulse-Control Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. An intramuscular injection of an antianxiety agent is administered to a client who has become violent toward the staff in the emergency room. This is an example of what level of therapeutic intervention?
a. One
b. Two
c. Three
d. Four
ANS: C
Level three interventions also include seclusion and restraints and are used only for clients who are out of control. Level one is the prevention stage of interventions, and level two is focused on protection of the client and others from potential harm. Level four does not exist.

DIF: Cognitive Level: Application REF: p. 292 OBJ: 8
TOP: Level Three Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

16. Which of the following persons is exhibiting passive aggression?
a. The woman who willingly volunteers to help out at her childs school play
b. The woman who says no when asked to go to a charity event
c. The woman who asks a coworker to cover her shift
d. The woman who agrees to cover a coworkers shift and complains to customers that she is supposed to be home
ANS: D
A person demonstrating passive aggressive actions expresses anger in indirect ways. Instead of declining to cover the shift, the person complains to others. The other examples do not demonstrate this indirect anger.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 1
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

17. Children in preadolescence have started to channel aggression through which positive activity?
a. Fights in schoolyards
b. Organized sports
c. Joining gangs
d. Verbal abuse
ANS: B
By preadolescence, most children stop hitting and learn to channel their aggression into physical activities, such as competitive sports or physical conditioning. Fighting, gangs, and verbal abuse are not positive activities.

DIF: Cognitive Level: Application REF: p. 287 OBJ: 1
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

18. A 15-year-old female is seen in the clinic for episodes of cutting herself since her parents divorced six 6 months ago. Which nursing diagnosis is a priority for this client?
a. Behavior, risk-prone health
b. Spiritual distress
c. Social interaction, impaired
d. Family processes, interrupted
ANS: A
The client is demonstrating anger turned inward demonstrated by self-mutilation. The priority would be to prevent the client from further harming herself. Dealing with spiritual distress, impaired social interaction, and interrupted family processes are accomplished after this.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 1
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

19. A man who hit his wife yesterday causing her to fall and break her arm has called out of work today to take care of her and buy her flowers. He repeatedly tells her how horrible he feels and promises this will never happen again. What stage of the assault is he demonstrating?
a. Trigger stage
b. Escalation stage
c. Recovery stage
d. Depression stage
ANS: D
The depression stage involves a period of guilt and attempts to reconcile (make up) with others. Aggressors are aware of the assault and genuinely feel bad about it. They may apologize frequently, or provide loving care for the victim. The trigger stage occurs prior to the assault when the stress-producing event occurs. Escalation stage is when actions move closer to a loss of control and the recovery stage occurs after the violence and injuries are assessed.

DIF: Cognitive Level: Application REF: p. 288 OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

MULTIPLE RESPONSE

20. Which mental health problems are categorized as anger control disorders? (Select all that apply.)
a. Conversion disorder
b. Conduct disorder
c. Dissociative disorder
d. Impulse-control disorder
e. Dysthymic disorder
f. Adjustment disorder
g. Oppositional defiant disorder
ANS: B, D, F, G
Conduct disorder, impulse-control disorder, adjustment disorder, and oppositional defiant disorder are all examples of anger control disorders.

DIF: Cognitive Level: Comprehension REF: p. 288 OBJ: 6
TOP: Anger Control Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. During the psychosocial portion of the assessment of a client with anger, aggression, or violent behavior issues, the nurse will assess which of the following? (Select all that apply.)
a. Coping skills
b. General appearance
c. Value and belief systems
d. Cultural, spiritual, and occupational interests
e. Potential for engaging in inappropriate behavior
ANS: A, C, D
Assessing coping skills, whether the client has a value and beliefs system, and cultural, spiritual, and occupational interests are components of the psychosocial portion of the assessment. Potential for engaging in inappropriate behavior and general appearance occur during the initial portion of the assessment and during the mental status assessment, respectively.

DIF: Cognitive Level: Knowledge REF: p. 290 OBJ: 7
TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Which of the following psychosocial nursing diagnoses are related to anger and aggression? (Select all that apply.)
a. Anxiety
b. Violence, risk for other-directed
c. Hopelessness
d. Violence, risk for self-directed
e. Coping ineffective, individual
f. Fear
ANS: A, C, E, F
Anxiety, hopelessness, ineffective coping, and fear are all potential nursing diagnoses related to anger and aggression. Violence, risk for other-directed and violence, risk for self-directed are diagnoses in the physical realm.

DIF: Cognitive Level: Knowledge REF: p. 290 OBJ: 7
TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. __________ is a forceful attitude or action that does not take into consideration others feelings or needs and may be expressed verbally, physically, or symbolically.

ANS:
Aggression
Aggressive behaviors usually are a result of anger.

DIF: Cognitive Level: Knowledge REF: p. 284 OBJ: 1
TOP: Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

24. __________ typically express anger and/or aggression with temper tantrums.

ANS:
Toddlers
This is typical of the toddler years. Anger and aggression are expressed in some form from infancy until death.

DIF: Cognitive Level: Knowledge REF: p. 286 OBJ: 2
TOP: Aggression throughout the Life Cycle
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

25. The __________ theory explains aggression and violence as being caused by physical or chemical differences among people.

ANS:
biological
In addition to the biological theory, the psychosocial theory and the sociocultural theory attempt to explain the causes of anger and aggression.

DIF: Cognitive Level: Knowledge REF: p. 287 OBJ: 4
TOP: Theories of Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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