The nurse is caring for several clients on the behavioral health unit. Which client will be assessed as demonstrating aggression?

A client who bursts into tears, leaves the group meeting, and sits on the bed hugging a pillow and sobbing

A client who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from another client standing at the pool table

A client who tells the primary nurse "When you told me that I could not have a pass. I felt angry."

A client who tells the medication nurse, "I am not going to take that, or any other, medication."

The correct answer is B. A client who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from another client standing at the pool table.

Answer and Explanation

The Correct Answer is B

Aggression is a behavior characterized by hostility, anger, or violent actions toward others or objects. In the scenario described in option B, the client demonstrates aggressive behavior by stomping away from the nurses' station and grabbing a pool cue from another client. This behavior indicates hostility and potential violence towards others, which is a clear example of aggression.

Options A, C, and D do not describe aggressive behavior. Option A describes a client expressing sadness and seeking comfort by hugging a pillow and sobbing. Option C describes a client expressing anger verbally but not exhibiting aggression. Option D describes a client refusing to take medication, which may not necessarily involve aggressive behavior.

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Correct Answer is A

Explanation

The safety of both the client and others is the top priority in this situation. The client's aggressive behavior poses a significant risk, and immediate action is necessary. Calling for an emergency response from trained personnel, such as security or other staff members experienced in handling aggressive behavior, can help ensure the situation is properly managed and de-escalated in a safe manner.

Option B may not be appropriate in this situation, as trying to engage the client in verbal expression of anger while they are in an agitated and aggressive state can potentially escalate the situation further.

Option C is not recommended, as approaching the client in a confrontational manner may further escalate their anger and aggression.

Option D, while it may be beneficial in a different context and when the client is in a more stable state, is not appropriate when the client is actively engaged in aggressive behavior. The focus at this moment should be on ensuring the immediate safety of everyone involved.

A. The nurse informs the client that the behavior will not be tolerated and will be addressed by the psychiatrist. B. The nurse throws the medication in the trash and documents the client refuses the medication. C. The nurse pushes the client, and the client falls to the floor and sustains a nosebleed. D. The nurse goes to the client's room and applies restraints, then forces the medication in the client's mouth.

Correct Answer is D

Explanation

Falsely imprisoning a client involves restricting their freedom and movement against their will without proper legal authority or justification. Option D demonstrates false imprisonment because the nurse applies restraints to restrict the client's movement and then forces the medication into the client's mouth, essentially depriving the client of their right to refuse treatment.

Options A, B, and C are not examples of false imprisonment:

A. The nurse informing the client that the behavior will not be tolerated and will be addressed by the psychiatrist is a response to the client's inappropriate behavior. It does not involve restricting the client's freedom or movement.

B. The nurse throwing the medication in the trash and documenting the client's refusal is an appropriate response to the client's refusal of medication. It respects the client's right to refuse treatment.

C. The nurse pushing the client and causing them to fall to the floor, resulting in a nosebleed, is an example of physical assault and battery, not false imprisonment. It is an inappropriate and harmful action by the nurse.

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The nurse is caring for several clients on the behavioral health unit. Which client will be assessed as demonstrating aggression?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. Which is the most appropriate action by the nurse?

Correct Answer is A

Explanation

A client is informed by the nurse that they must take their medication, and the client kicks the nurse and runs to their room. Which action by the nurse demonstrates that the nurse falsely imprisons the client?

Correct Answer is D

Explanation

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