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a. Teach the patient to use coping strategies such as deep breathing and progressive relaxation to reduce the pain.

b. Talk with the health care provider about changing the pain medication from prn to patient-controlled analgesia.

c. Tell the patient that verbal assaults on nurses will not shorten the wait for analgesic medication. d. Talk with the patient about the risks of dependency associated with overuse of analgesic medication.

ANS: B

Use of patient-controlled analgesia will help the patient manage the pain. This intervention will help reduce the patient’s anxiety and anger. Dependency is not an important concern related to acute pain.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 27-3, 25 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. Teach the patient about herbal preparations that reduce anger. b. Help the patient identify incidents that trigger impulsive anger. c. Explain that restraint and seclusion will be used if violence occurs. d. Offer one-on-one supervision to help the patient maintain control.

18. A patient has a history of impulsively acting-out anger by striking others. Select the most appropriate intervention for avoiding similar incidents.

ANS: B

Identification of trigger incidents allows the patient and nurse to plan interventions to reduce irritation and frustration, which lead to acting-out anger, and eventually to put into practice more adaptive coping strategies.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 27-8, 12, 17, 29 (Vignette) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. Stop the dressing change and say, “I will leave the supplies so that you can change your own dressing.” b. Continue the dressing change and say, “This dressing change is necessary because you were careless with fire.” c. Discontinue the dressing change, tell the patient, “I will return when you gain control of yourself,” and leave the room. d. Continue the dressing change and say, “Dressing changes are needed to prevent infection. What are your ideas about how to make it less painful?”

19. A patient with severe burn injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the patient screams, “Don’t touch me! You are so stupid. You will make it worse!” Which action by the nurse will best help to diffuse the patient’s anger?

ANS: D

The nurse should not respond personally to the patient’s comments. The correct answer objectively gives the patient information that may lead to lowering his anger and engages the patient in problem solving. The incorrect options will escalate the patient’s anger by belittling or escalating the patient’s sense of powerlessness. Dressing changes are needed for the patient’s physiological integrity; therefore, the nurse should not abandon the responsibility to perform them.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 27-14, 15, 23 to 26 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Lithium b. Trazodone c. Olanzapine d. Valproic acid

20. Which medication from the medication administration record should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention?

ANS: C

Olanzapine is a short-acting antipsychotic useful in calming angry, aggressive patients regardless of diagnosis. The other drugs listed require long-term use to reduce anger. Lithium is for bipolar patients. Trazodone is commonly prescribed for patients experiencing depression, insomnia, or chronic pain. Valproic acid is for bipolar or borderline patients.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 27-17, 44 (Table 27- 2)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Implementation a. Offer the waiting spouse a cup of coffee. b. Explain that the patient’s condition is not life threatening. c. Periodically provide an update and progress report on the patient. d. Suggest that the spouse return home until the patient’s treatment is complete.

21. An emergency department nurse realizes that the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should the nurse use to prevent further escalation of the spouse’s anger?

ANS: C

Periodic updates reduce anxiety and defuse anger. This strategy acknowledges the spouse’s presence and concern. A cup of coffee is a nice gesture, but it does not address the spouse’s feelings. The other incorrect options would be likely to increase anger because they imply that the anxiety is inappropriate.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 27-14, 15

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

22. Which information from a patient’s record would indicate marginal coping skills and the need for careful assessment of the risk for violence? A history of a. academic problems. b. family involvement. c. childhood trauma. d. substance abuse.

ANS: D