Chapter 28: Preventing and Managing Aggressive Behavior

Chapter 28: Preventing and Managing Aggressive Behavior

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. An adolescent patient says to a nurse, “I’m so glad you’ve come in. The nurse manager ordered me to stay in my room until dinner just because I got into another fight!” An appropriate response from the nurse would be:

a.	“You’re not going to split me from the nurse manager. Please go back in your room until your time-out is finished.”
b.	“I’m wondering why you’ve left your room, then. Please return to your room until your time-out is completed. I will talk with you after that.”
c.	“I’m sorry to hear that you are being punished. Please return to your room immediately. We can talk about this when your time-out is over.”
d.	“It sounds as if you haven’t had a very good day. Return to your room, and complete your time-out. I will speak with you after dinner.”

 

 

ANS:  D

Firm but empathetic limit setting is required in this situation. The patient is splitting, and the nurse needs to set limits and support the consequence that has been administered. By reflecting the patient’s psychic distress and providing clear instructions about the behavior that is expected (along with a time limit for that behavior), the nurse is assisting the patient in problem solving more adaptively. In addition, the nurse provides a reward or positive regard when offering a specific time to meet with the patient that occurs after the consequence has been accepted. Although the remaining options also provide similar feedback, they do not provide specific times that the patient can concretely conceptualize. Mutuality and respect for all patients are required from the therapeutic professional nurse, especially for those patients with impulse-control problems; they may try to enter into a regressive struggle with the nurse, who is trying to set limits on behavior.

 

DIF:    Cognitive Level: Analysis                REF:   Text Page: 583

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

2. A nurse is facilitating a social skills group on the inpatient unit for nursing assistants. Which comment would the nurse identify as assertive?

a.	“I enjoy my work. I do all my own work, and so I seldom have time to help others. I would if I had the time.”
b.	“I love my work. I try to help others whenever they ask because on our unit it’s certainly a team effort.”
c.	“I enjoy my work. I always try to be helpful, but I am careful not to help those who aren’t willing to help others.”
d.	“I enjoy my work. I help others after I have spent sufficient time with my patients and feel my assistance is needed.”

 

 

ANS:  D

Assertive behavior involves communicating clearly and directly with others. If the assertive individual is conveying negative feelings, thoughts, or issues of concern, the positive aspects are noted in balance with the negative information, and the individual takes responsibility to state what he or she would like to have done differently or changed. Assertiveness also involves accepting positive and negative input and is used for the purposes of expressing one’s feelings, wishes, or desires, but not necessarily as a means of getting one’s way or winning. Nursing staff members who are unable to demonstrate appropriate assertive behavior and communications will be unsuccessful role models for their patients.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 574

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Psychosocial Integrity

 

3. A newly licensed nurse tells a nurse manager, “I’d like you to stop referring to me as ‘the smart new degree nurse.’” The nurse manager replies, “I was only teasing. You are being overly sensitive.” Which statement accurately evaluates the newly licensed nurse’s comment to the nurse manager?

a.	The nurse is appropriately assertive, but now the nurse manager will likely belittle the nurse even more.
b.	The nurse is behaving aggressively because of the newness of being a graduate licensed nurse and owes the nurse manager an apology.
c.	The nurse is assertive, and responding that the nurse does not regard the nurse manager’s comments as “teasing” would be an effective follow-up communication.
d.	The nurse is overly sensitive and ought to have ignored the nurse manager’s teasing until it was extinguished. Now the nurse manager will be more sarcastic than ever.

 

 

ANS:  C

In the above communication, a request is made that describes what the newly licensed nurse would like the charge nurse to do (i.e., stop calling the nurse “the smart new degree nurse”). This communication is clear and concise and describes the behavior that the nurse wants to stop. The remaining options fail to demonstrate effective use of appropriate assertiveness.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 574

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Psychosocial Integrity

 

4. One morning, the nurse manager asks a nurse to work overtime for the fourth week in a row, saying “I know you’ve done a lot of overtime, but I’m in a bind. Can you help me out?” The nurse had planned to attend a child’s recital that evening. Which would be the most appropriate assertive response the nurse could give?

a.	“I cannot work tonight. I’m sure you will agree I’ve worked more than my share of overtime.”
b.	“This isn’t a good time for me to help you. It’s my child’s recital and the family has plans.”
c.	“Well, my child’s recital is tonight. If I work for you this evening you’d have to give me three weekends off on this schedule.”
d.	“For goodness sake! Am I the only one working for you? Get someone else. You are not going to take advantage of me anymore!”

 

 

ANS:  B

The most therapeutic communication is the one that communicates clearly what the nurse is able to do or, in this case, not to do. Assertive people are not afraid to ask for what they want or need.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 574

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity