1. A nurse is working with a client who has frequent angry outbursts. Which of the
following statements is most helpful when working with this client?
A) ìAnger is a normal feeling, and you can use it to solve problems.î
B) ìYou need to learn to suppress your angry feelings.î
C) ìYou can reduce your anger by hitting a punching bag.î
D) ìYou need to learn how to be less assertive in your communications.î
Ans: A
Feedback:
Anger can be a normal and healthy reaction when situations or circumstances are unfair
or unjust, personal rights are not respected, or realistic expectations are not met. If the
person can express his or her anger assertively, problem solving or conflict resolution is
possible. Anger becomes negative when the person denies it, suppresses it, or expresses
it inappropriately. A person may deny or suppress (i.e., hold in) angry feelings if he or
she is uncomfortable expressing anger. Catharsis can increase rather than alleviate angry
feelings. Effective methods of anger expression, such as using assertive communication,
to express anger should replace angry aggressive outbursts.
2. Which of the following statements about anger, hostility and aggression are accurate?
Select all that apply.
A) Anger is an emotional response to a real or perceived provocation.
B) Hostility stimulates the sympathetic nervous system.
C) Physical aggression involves harming other persons or property.
D) Anger, hostility, and physical aggression are normal human emotions.
E) Hostility is also referred to as verbal aggression.
F) Physical aggression often progresses to hostility.
Ans: A, C, E
Feedback:
Anger is an emotional response to a real or perceived provocation. Anger energizes the
body physically for self-defense, when needed, by activating the ìfight-or-flightî
response mechanism of the sympathetic nervous system. Hostility is different than
anger. Physical aggression is behavior in which a person attacks or injures another
person or that involves destruction of property. Hostility is also referred to as verbal
aggression. Anger is a normal human emotion. Hostility is an emotion that is expressed
through negative behavior. Physical aggression is behavior. Hostility may lead to
physical aggression.
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3. A married man expresses to the nurse that his wife’s frequent nagging angers him. The
nurse role-plays assertive communication techniques with the husband. Which of the
following indicates the husband understands how to use assertive techniques
effectively?
A) ìI really wish you would stop nagging me.î
B) ìYou are not perfect either.î
C) ìI feel unappreciated when you criticize me.î
D) ìAre you telling me you want me to change?î
Ans: C
Feedback:
The nurse can help clients express anger appropriately by serving as a model and by
role-playing assertive communication techniques. Assertive communication uses ìIî
statements that express feelings and are specific to the situation; for example, ìI feel
angry when you interrupt me,î or ìI am angry that you changed the work schedule
without talking to me.î Statements such as these allow appropriate expression of anger
and can lead to productive problem-solving discussions and reduced anger.
4. Which one of the following statements about anger is most accurate?
A) Anger is an abnormal human emotion that is always negative.
B) It is best to express anger by whatever means possible to minimize its
consequences.
C) Most men are socialized to suppress anger.
D) Anger awareness and expression are necessary for women’s growth and
development.
Ans: D
Feedback:
Women must recognize that anger awareness and expression are necessary for their
growth and development. Anger is a normal human emotion and is often perceived as a
negative feeling. However, anger becomes negative when denied, suppressed, or
expressed inappropriately. Anger that is expressed inappropriately can lead to hostility
and aggression. Catharsis can increase rather than alleviate angry feelings. Men are
often socialized to believe that it is acceptable to express anger, while women are often
socialized to maintain and enhance relationships with others and avoid expression of
emotions such as anger.
5. At which point in the stages of aggressive incidents is intervention least likely to be
effective in preventing physically aggressive behavior?
A) Triggering
B) Escalation
C) Crisis
D) Postcrisis
Ans: C
Feedback:
Interventions during the triggering and escalation phases are key to prevent physically
aggressive behavior. During the crisis phase, behavior escalation may lead to physical
aggression. During the postcrisis phase, the physically aggressive behavior has stopped
and the client returns to the level of functioning before the aggressive incident.
6. Anger management is likely to be included in the care of clients with which of the
following psychiatric diagnoses? Select all that apply.
A) Alzheimer’s dementia
B) Schizophrenia
C) Anorexia nervosa
D) Acute alcohol intoxication
E) Generalized anxiety disorder
Ans: A, B, D
Feedback:
Although most clients with psychiatric disorders are not aggressive, clients with a
variety of psychiatric diagnoses can exhibit angry, hostile, and aggressive behavior.
Clients with paranoid delusions may believe others are out to get them; believing they
are protecting themselves, they retaliate with hostility or aggression. Some clients have
auditory hallucinations that command them to hurt others. Aggressive behavior also is
seen in clients with dementia, delirium, head injuries, intoxication with alcohol or other
drugs, and antisocial and borderline personality disorders.
7. Which is most likely to be the subject of an aggressive attack from a client with mental
illness?
A) Other people
B) The client
C) Animals
D) Objects
Ans: B
Feedback:
Clients with psychiatric disorders are more likely to hurt themselves than other people.
8. Which psychiatric disorder makes a person most susceptible to anger attacks that do not
result in physical aggression?
A) Delusions
B) Depression
C) Dementia
D) Delirium
Ans: B
Feedback:
Some clients with depression have anger attacks that are sudden intense spells of anger
that typically occur in situation where the depressed person feels emotionally trapped.
Anger attacks involve verbal expressions of anger or rage but no physical aggression.
Persons with delusions, dementia, and delirium are most likely to become physically
aggressive.
9. A client is observed pacing the hall with clenched fists and swearing at others. The
nurse intervenes immediately to prevent the client from moving to which phase of the
aggressing cycle?
A) Triggering
B) Escalation
C) Crisis
D) Recovery
Ans: B
Feedback:
During escalation, the client’s responses represent escalating behaviors that indicate
movement toward a loss of control, including pale or flushed face, yelling, swearing,
agitated, threatening, demanding, clenched fists, threatening gestures, hostility, loss of
ability to solve the problem or think clearly. This phase is followed by the crisis phase.
During a period of emotional and physical crisis, the client loses control. Behaviors may
include loss of emotional and physical control, throwing objects, kicking, hitting,
spitting, biting, scratching, shrieking, screaming, and inability to communicate clearly.
10. The client’s son is yelling and is hitting his hand with a rolled up newspaper. Which
stage of aggression does the nurse identify that the client’s son is exhibiting?
A) Triggering
B) Escalation
C) Crisis
D) Recovery
Ans: B
Feedback:
During the escalation phase of aggression, a person may exhibit yelling and threatening,
clenched fist, threatening gestures. During the triggering phase of aggression, a person
may exhibit signs and symptoms and behaviors including restlessness, anxiety,
irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger.
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