Aggression

Aggression items hand you a scenario and ask what to do first or which sign is the earliest warning. The tell is rising agitation in the stem — loud speech, demanding behavior — and the credited answer is almost always a verbal de-escalation move while the patient is still in the anxiety or defensive stage, before the acting-out (crisis) stage, when de-escalation rarely works. Choose the response that maintains safety without provoking: stay beyond arm’s reach, keep an exit accessible, never block the doorway, and let one calm staff member be the sole communicator. PRN medication is offered, not forced; restraint for violent behavior needs a provider order and continuous monitoring.

The classic trap is jumping straight to restraint or grouping aggressive patients together. Distinguish aggression (a safety/behavior threat) from crisis (an internal collapse of coping) and boundary issues (which threaten therapeutic focus, not physical safety). When a command hallucination drives the aggression, assess what the voices are saying — content guides the safety plan. Memory hook: de-escalate before you medicate, medicate before you restrain.