EAQ - Ch21: Impulse Control Disorders
The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. The child deals with any frustration by bullying and hitting and seldom shows any remorse for his or her actions. The nurse who gathers this data will note that the child's behaviors are most consistent with the Diagnostic and Statistical Manual of Mental Disorders DSM-5 diagnosis of Social phobia Conduct disorder Oppositional defiant disorder Attention deficit hyperactivity disorder
Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type. p. 397
The nurse is interviewing the family of a patient with a history of oppositional defiant disorder and notes that the patient blames coworkers and family for his own behavior and states that he is better than the rest of them. What nursing diagnosis does this reflect? Risk for suicide Defensive coping Impaired parenting Risk for other-directed violence
Defensive coping Defensive coping mechanisms are observed when a patient blames others for his own behavior, shows grandiosity, or has a hostile laugh. Risk for other-directed violence is when a patient has a rigid posture, clenches fist and jaws, paces, or often fights. A nursing diagnosis of risk for suicide is appropriate when a patient has a history of suicide attempts, aggression and impulsivity, or conflicting relationships. Impaired parenting includes rejection of or hostility toward a child and a disturbed relationship between parents or caregivers and the child. p. 401, Table 21.2
Which characteristic in a child serves to support the diagnosis of oppositional defiant disorder? Deliberately agitating family members Vindictive responses to imagined personal wrongs Manipulation is regularly used to achieve personal goals Cannot assume responsibility when proven responsible for failures Seldom shows anger but rather is passive-aggressive when frustrated
Deliberately agitating family members Vindictive responses to imagined personal wrongs Cannot assume responsibility when proven responsible for failures Primarily a childhood disorder, oppositional defiant disorder is a repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. Aggressiveness rather than manipulation is characteristic of this disorder. pp. 393-394
Ariel Castro was convicted in 2013 of kidnapping, raping, and torturing three women for over 10 years. At his sentencing hearing he said, "We had a lot of harmony going on in that home." Which sentiment is most evident in his comment? Guilt Denial Remorse Empathy
Denial The comment evidences denial of the pain endured by his victims. It shows a lack of empathy. Empathy involves having concerns for the feelings of others. There is no evidence of feelings of guilt or remorse in this comment, although he later apologized to his victims and asked for forgiveness. p. 402
A patient diagnosed with conduct disorder craves Excitement without concern for possible negative outcomes Control of situations and constantly strategizes for such power Friendship but from those older than him- or herself Material possessions, but lacks focus and direction
Excitement without concern for possible negative outcomes People with conduct disorder crave excitement and do not worry as much about consequences as other people do. p. 397
A nurse is assessing a patient with conduct disorder. Which assessment findings would indicate suicidal risk in the patient? Fine coping skills Feelings of despair Impulsive behavior Past suicide attempts Improved decision making
Feelings of despair Impulsive behavior Past suicide attempts Feelings of despair, hopelessness, or changes in energy levels increase the risk of suicide. Impulsive behavior or poor judgment increases the patient's risk of suicidal behavior. A history of suicidal attempts increases the patient's chances of repeating suicidal behavior. Fine coping skills show better adaptability, whereas patients with decreased coping skills are at an increased risk of suicide. Improved decision making shows positive performance; decreased decision-making ability indicates low self-esteem and an increased risk of suicide. pp. 399-400
Which behaviors in an adolescent support the diagnosis of conduct disorder? Has a history of school truancy Is sexually suggestive and aggressive Physically and verbally bullies classmates regularly Demonstrates signs of depression with suicidal tendencies Has a juvenile arrest record for stealing on three separate occasions
Has a history of school truancy Is sexually suggestive and aggressive Physically and verbally bullies classmates regularly Has a juvenile arrest record for stealing on three separate occasions Rationale: Conduct disorder is a persistent pattern of behavior that includes initiating physical fights and bullying others. The adolescent may steal or use a weapon to intimidate or hurt others. Coercion into activity against the will of others, including sexual activity, is characteristic of this disorder. The people affected by this disorder may have normal intelligence, but they tend to skip class or disrupt school so much that they fall behind and may be expelled or drop out. Neither depression nor suicidal tendencies are associated with this disorder. p. 397
The nurse is teaching the family of a patient with intermittent explosive disorder. What conditions may be associated with intermittent explosive disorder? Hypertension Diabetes Depression Anxiety disorders Attention deficit hyperactivity disorder
Hypertension Diabetes Anxiety disorders Intermittent explosive disorder can lead to hypertension, diabetes, and anxiety disorders. This is probably because the patient is under a lot of stress and in an agitated state for a prolonged period. Depression is a comorbid condition, as is kleptomania. Attention deficit hyperactivity disorder is a predisposing factor in child- and adolescent-onset conduct disorder that is seen in children. Intermittent explosive disorder is an adult-onset disorder. p. 395
When treating impulse control disorders, psychodynamic psychotherapy is directed toward Mastering relaxation techniques Identifying the triggers of the rage Teaching the patient self-distracting techniques Helping the patient replace the rage with acceptable alternative feelings
Identifying the triggers of the rage Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help the patient to develop better ways to think about and control his or her behavior. p. 403
The nurse is caring for a patient with an impulse disorder who is undergoing multisystemic therapy. How would the patient demonstrate improvement due to this therapy? Improvement in uncovering underlying feelings Improvement in recognizing the impulse to explode Improvement in functioning of the child within the family Improvement in school performance Improvement in distress tolerance
Improvement in functioning of the child within the family Improvement in school performance Multisystemic therapy is an evidence-based approach. Implementation of this therapy shows improvement in family functioning, school performance, and peer relationships. Psychodynamic psychotherapy helps the patient to uncover underlying feelings and reasons behind rage or anger. Cognitive therapy teaches patients to recognize the onset of the impulse to explode or act aggressively and to identify circumstances or triggers that are associated with the onset. Dialectical behavioral therapy improves mindfulness, emotional regulation, distress tolerance, and personal effectiveness. p. 403
The primary characteristic that separates intermittent explosive disorder (IED) from oppositional defiance is that IED Is diagnosed in individuals 18 years of age or older Has very specific, predictable triggers Rarely involves physical self-harm Seldom results in remorse for the aggressive behavior
Is diagnosed in individuals 18 years of age or older Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The aggression can be verbal or physical and targeted toward other people, animals, property, or even themselves. p. 399, Table 21.1
Which statements are true regarding childhood-onset conduct disorder? It is more commonly diagnosed in males. It is characterized by feelings of remorse and regret. It is usually diagnosed in late teen years. It is characterized by disregard for the rights of others. It allows patients to rationalize their aggressive behaviors. It is usually outgrown by early adulthood.
It is more commonly diagnosed in males. It is characterized by disregard for the rights of others. It allows patients to rationalize their aggressive behaviors. Rationale: Childhood-onset conduct disorder is more common in male patients and is seen before the age of 10 years. Hallmarks include disregard for the rights of others, physical aggression, poor peer relationships, and lack of feelings of guilt or remorse. Conduct disorder is not usually outgrown by early childhood. p. 397
A nurse is assessing an adolescent boy from an upper-class family. He has an irresistible desire to steal objects from others' bags. What does the nurse diagnose this condition as? Defiance Pyromania Callousness Kleptomania
Kleptomania Kleptomania is characterized by an uncontrolled desire to steal objects and failing to resist the urge. The urge does not have to be related to actual need. Defiance in oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Pyromania is the uncontrolled desire to deliberately set fire and experiencing pleasure by doing so. Callousness is a lack of sensitivity and empathy for others. p. 399
Which technique for managing disruptive behaviors is most analogous to assertiveness? Limit setting Restructuring Planned ignoring Positive feedback
Limit setting Limit setting involves giving direction, stating an expectation, or telling a patient what is required. Limit setting is firm, calm, and direct, without judgment or anger. Assertive communication uses similar principles, including defining a situation, followed by stating a desired behavior or expectation and consequences. Restructuring refers to changing an activity in a way that will decrease the stimulation or frustration. Planned ignoring refers to intentional disregard of an attention seeking behavior. Positive feedback refers to providing emotional support and positive feedback for a desired behavior. p. 402, Box 21.1
The nurse is educating a community of parents about psychological and environmental factors that may lead to conduct disorder. What psychological and environmental factors that can lead to conduct disorder should the nurse include in the teaching? Low self-esteem Low intelligence Violence in the family Chaotic and negligent parenting Conflict in marriage Remorseful nature
Low self-esteem Low intelligence Chaotic and negligent parenting Conflict in marriage Patients with conduct disorder have low self-esteem and low intelligence (immature coping and problem-solving abilities). These patients tend to cover and compensate for these abnormalities with impulsive behavior. People who are brought up in chaotic and negligent conditions develop poor emotional responses. Conflict in marriage is associated with emotion and attachment that may lead to conduct disorder. Intermittent explosive disorder is associated with conflict and violence in the family of origin. Exposure to family violence at an early age makes it likely that the behavior will be repeated as the child matures. Delayed consequences of aggressive behavior in patients with intermittent explosive disorder are feelings of remorse, regret, and embarrassment. p. 398
A nurse is assessing a child who exhibits disruptive behavior at home and school. Which intervention does the nurse advise to the parents when the child throws furniture at home? Criticize the child for the disruptive behavior Use firm, consistent punishment for this behavior Ignore the child's actions and behavior Make the child replace the disturbed furniture
Make the child replace the disturbed furniture Making the child replace the disturbed furniture is simple restitution for correcting the behavior by bringing the environment back to its original state. Criticizing the child for disruptive behavior can increase chances of aggression and violence. Firm punishment may not be effective for a disruptive child as it may further frustrate the child and caregivers. Ignoring the child's behavior may have a negative impact and increase the chances of aggression. p. 402, Box 21.1
Which characteristic supports the diagnosis of intermittent explosive disorder? Man who is 19 years old Often demonstrates anger by shouting Demonstrates poor intellectual abilities Has a history of damaging the property of others Displays of aggressive behaviors began abruptly at age 14
Man who is 19 years old Often demonstrates anger by shouting Has a history of damaging the property of others Rationale: Characteristics of intermittent explosive disorder include being 19 years of age (diagnosed at age 18); onset is often abrupt; 7.3% more men than women are affected; and impulsive and unwarranted emotional outbursts, violence, and destruction of property are common. Poor cognitive abilities are not associated with this disorder. p. 399, Table 21.1
The nurse is providing information about dialectical behavioral therapy to the parents of a patient with conduct disorder. Which skills are taught in this therapy? Mindfulness Emotional Regulation Role-playing Uncovering underlying feelings Distress tolerance Personal effectiveness
Mindfulness Emotional Regulation Distress tolerance Personal effectiveness Rationale: Dialectical behavioral therapy is a specific kind of cognitive-behavioral treatment that focuses on impulse control. Skills taught include mindfulness, emotional regulation, distress tolerance, and personal effectiveness. Cognitive-behavioral treatment teaches patients to recognize the onset of the impulse to explode or act aggressively, to identify circumstances or triggers that are associated with the onset, and to develop methods to prevent the maladaptive behaviors from occurring. Role-playing is a counseling technique in which the nurse and the patient or a group of patients act out a specified script or role to enhance their understanding of that role, learn and practice new behaviors or skills, and practice specific situations. Psychodynamic psychotherapy helps the patient to uncover underlying feelings and reasons behind rage or anger. This may help patients to develop better ways to think about and control their behavior. p. 403
A mother tells the nurse that her child often deliberately annoys others and blames others for misbehavior by saying, "They made me do it." What disorder is the child likely to have? Pyromania Kleptomania Oppositional defiant disorder Intermittent explosive disorder
Oppositional defiant disorder A person with oppositional defiant disorder has a pattern of annoying people and blaming others for his or her behavior. When blaming others, a child may use sentences such as, "They made me do it" or "It's not my fault." Patients with intermittent explosive disorder have aggressive behavior, a delayed consequence of which is remorsefulness. A patient with pyromania often deliberately sets fires and experiences pleasure from it. Kleptomania is a repeated failure to resist urges to steal objects. pp. 393-394
Which statement concerning impulse control disorders is true? Oppositional defiant disorder is one such illness. Obsessive compulsive disorder is one such illness. Early diagnosis and treatment is vital to future behaviors. The associated behaviors can lead to problems with the law. A common misconception is that the behaviors are a result of poor parenting.
Oppositional defiant disorder is one such illness. Early diagnosis and treatment is vital to future behaviors. The associated behaviors can lead to problems with the law. A common misconception is that the behaviors are a result of poor parenting. The development of a psychiatric illness can be devastating to a person and his or her family. People with impulse control disorders may look like people whose parents cannot control them or people who simply do not choose to control their behavior. They are impulsive and exhibit aggressive behaviors and emotions that can have severe criminal consequences as well as long-lasting negative personal impact. Recognizing and treating a person with one of the disorders while he or she is young can prevent further problems and avoid interactions with the criminal justice system. While oppositional defiant disorder is considered under the umbrella of these disorders, obsessive compulsive disorder is not. p. 393
A nurse is assessing a group of children with oppositional defiant disorder. Which predisposing factors does the nurse identify with this disorder? Parental rejection Good family support Sociable child behaviors Harsh discipline at home Attention deficit hyperactivity disorder
Parental rejection Harsh discipline at home Attention deficit hyperactivity disorder Parental rejection can have an impact on the child's environment and behavior, predisposing him or her to oppositional defiant disorder. Harsh discipline at home with inconsistent parenting can lead to oppositional defiant disorder. Attention deficit hyperactivity disorder predisposes the child to rebelliousness and behavior problems like oppositional defiant disorder. Good family support can provide a healthy environment to promote child development. Sociable child behaviors promote healthy child development, while oppositional child behaviors increase the chance of oppositional defiant disorder. p. 398
The nurse is assessing a patient with impulse disorder for suicidal tendencies. What suicidal predictors does the nurse assess for in the patient? Past suicidal attempts Family history of suicide attempt Hostile laughter Clenching of fists and jaws Feeling of hopelessness Drug or alcohol use
Past suicidal attempts Family history of suicide attempt Feeling of hopelessness Drug or alcohol use Rationale: Past suicide attempt is the number one predictor of suicide attempt. Impulsivity and aggression in such patients increases the possibility of future suicide attempts. Patients with a family or close friend who committed or attempted suicide may show suicidal tendencies. A feeling of hopelessness also leads to suicidal behavior. Drug abuse and alcohol consumption also increase tendency toward suicide. Hostile laughter shows a patient's ineffective coping skills. Clenched fists and jaws are the predictors of a risk of other-directed violence. pp. 399-400
The nurse is preparing to set goals for a 10-year-old diagnosed with an impulse control disorder. To best ensure the expected therapeutic outcomes, the nurse includes goals that are Simple and easily defined Family centered and long term in nature Patient centered and include the patient's input Age appropriate and achievable in a short period
Patient centered and include the patient's input Whenever possible, outcomes should be patient centered and agreed on by both the nurse and the patient or the patient's designee. Although goals that are age appropriate, achievable in a short period, simple, easily defined, family centered, and long term in nature should be considered when possible, the primary factor that should be considered is that the goals be patient centered and made with patient input because that will have a positive effect on the patient's compliance. p. 401
An adult patient is being treated for conduct disorder. The nurse observes that the patient becomes violent and starts to hurt himself and others. What management technique is used as a last resort? Counseling Role-playing Physical restraint Planned ignoring
Physical restraint Physical restraint is the last resort when adult patients with conduct or impulse disorder become violent. Counseling is used to maintain adaptive behavior, to provide positive reinforcement, and to provide skills for coping. Role-playing techniques improve new behavior skills and allow patients to practice specific situations where they are placed in a role and have to act out their responses in a given situation. Planned ignoring is used when a patient shows attention-seeking behavior. Counseling, role-playing, and planned ignoring are techniques that are implemented when a patient is nonviolent. pp. 402, 404, Box 21.1
A nurse is teaching a group of teachers about managing oppositional behaviors in children. Which technique should the nurse suggest when a child shows disruptive behavior to seek attention? Use of criticism Planned ignoring Physical restraints Immediate attention
Planned ignoring Planned ignoring and additional positive reinforcement for on-task actions can be helpful. Criticism can increase the chances of aggressive behavior and violence. Physical restraints may be used to protect the child from acting out impulses or hurting self or others. Receiving immediate attention would accomplish the child's objective and may increase the behavior in the future. p. 402, Box 21.1
Which statement is true regarding the relationship between parenting and behavioral problems in a child? Mothers exert greater influence on their children's behavior than do fathers. Poor parenting does not necessarily result in behavioral problems. Single-parent homes are a risk factor for the development of behavioral problems. The absence of a father figure contributes significantly to dysfunctional behavior.
Poor parenting does not necessarily result in behavioral problems. External factors in the environment can either support or put stress on children and adolescents and shape their development. Supportive families help children with behavior problems do better, and children without supportive families may have a harder time. Bad parenting does not necessarily cause behavior problems; however, a supportive family or environment can help improve a child's future outcome. Mothers exerting greater influence on their children's behavior than do fathers, single-parent homes being a risk factor for the development of behavioral problems, and the absence of a father figure contributing significantly to dysfunctional behavior are not supported by any current research. p. 394
The nurse is caring for a patient with conduct disorder. What psychosocial interventions may be needed for this patient? Provide a climate of safety. Set limits and expectations. Prescribe antipsychotic medicines. Provide structure and boundaries. Use a physical restraint.
Provide a climate of safety. Set limits and expectations Provide structure and boundaries. Providing a climate of safety to the patient and others, setting limits and expectations for patients, and providing structure and boundaries are the general psychosocial interventions used to manage patients with conduct disorder because these interventions are aimed at correcting faulty personality (ego and superego). Antipsychotic medicines are a pharmacological intervention used for their calming effects. Physical restraint is the last resort of management of a patient with conduct or impulse disorder when he or she becomes violent. It is not a type of psychosocial intervention. p. 402
A nurse is teaching a group of parents in a child development class. What does the nurse suggest to the parents to avoid impulse disorders in children? Encourage anger outbursts Provide support to the child Follow flexible rules of parenting Encourage oppositional behavior
Provide support to the child A supportive family environment can help in the normal development of the child and also improve the child's future. Conflicts in marriage or at home can affect a child's development and increase the chances of impulse disorders in children. Oppositional behavior such as anger outbursts should not be encouraged but should be identified and resolved in a timely manner. Inconsistent parenting and harsh discipline can make the child emotionally detached and affect child development. p. 402
A nurse assesses a 15-year-old who stole and wrecked a neighbor's classic antique car. Two years ago, this adolescent self-inflicted stab wounds. Which nursing diagnosis has priority? Risk for suicide Ineffective coping Impaired adjustment Impaired social interaction
Risk for suicide Safety is the nurse's priority concern. The number one predictor of suicidal risk is a past suicide attempt. Impulsivity and aggression make the possibility of suicide attempts more likely. Ineffective coping, impaired adjustment, and impaired social interaction may apply, but are not the priority. p. 401, Table 21.2
A nurse is caring for a patient with impulse control disorders. What nursing diagnosis is appropriate when the patient shows clenched fists and has a rigid body posture? Risk of suicide Ineffective coping Impaired parenting Risk of violence to others
Risk of violence to others Rigid body posture and clenched fists signal increased chances of inflicting violence on others. Risk of suicide is noted when the person has a history of suicidal attempts, talks about suicidal thoughts, or shows impulsivity. Ineffective coping is observed when the person blames others for his or her behaviors. Impaired parenting includes an unsafe home environment or hostility or rejection by the child's family. p. 401, Table 21.2
The nurse performs an assessment on a 12-year-old child. Which finding does the nurse identify as a risk factor for conduct disorder? Decreased respirations Slower resting heart rate Increased blood pressure Elevated normal temperature
Slower resting heart rate A slower resting heart rate is associated with conduct disorder. Increased blood pressure, elevated normal temperature, and decreased respirations are not risk factors associated with conduct disorder. p. 398
A nurse is caring for a child with behavior issues and reads the diagnosis as oppositional disorder. Which behavior does the nurse observe in relation to this diagnosis? The child is remorseful. The child explodes in anger. The child shows callousness. The child is irritable and vindictive.
The child is irritable and vindictive. Oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Getting remorseful for an act of aggression is observed in intermittent explosive disorder and usually in adults. Exploding in anger is observed in intermittent explosive disorder, usually seen in adults. A child with conduct disorder has a callous attitude. p. 393
Which assessment is of importance for supporting a diagnosis of oppositional defiant disorder? The history, frequency, and triggers for violent outbursts The moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse The issues that result in power struggles and triggers for outbursts Sibling birth order to understand the dynamics of family interaction
The issues that result in power struggles and triggers for outbursts Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important. Assessing for violent outbursts refers to assessment for intermittent explosive disorder. Oppositional defiant disorder is not characterized by violent behaviors. Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for conduct disorder. Birth order is not known to play a part in oppositional defiant disorder. p. 401
Which behavior can the nurse anticipate when caring for a patient who has oppositional defiant disorder (ODD)? The patient is argumentative with the nurse. The patient will make attempts to set something on fire. The patient explodes into verbal and physical temper tantrums. The patient may try to steal one of the nurse's assessment tools.
The patient is argumentative with the nurse. Patients with ODD present with argumentative behaviors. Making attempts to set something on fire is characteristic of pyromania. Stealing one of the nurse's assessment tools is characteristic of kleptomania. Exploding into verbal and physical temper tantrums is characteristic of intermittent explosive disorder. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 393
Which statement is true about the characteristics of the oppositional defiant child? The defiance generally is directed toward parents and siblings. These behaviors are a predictor of future mental health disorders. Arguing tends to be more prevalent in boys. Girls display more blaming than do boys.
These behaviors are a predictor of future mental health disorders. Oppositional defiant disorder often is predictive of emotional disorders in young adulthood. p. 393
Comorbid conditions commonly associated with oppositional defiant disorder do NOT include conversion disorder. attention deficit hyperactivity disorder (ADHD). bipolar disorder. anxiety.
conversion disorder. Oppositional defiant disorder is related to a variety of other problems, including attention deficit hyperactivity disorder, anxiety, depression, suicide, bipolar disorder, and substance abuse. Conversion disorder is not generally associated with oppositional defiant disorder. p. 394
Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in which problematic behavior? start fires. steal for thrill. self-mutilate. direct anger toward others.
start fires. Pyromania is described as repeated, deliberate fire setting. None of the other options adequately describes pyromania. p. 399
The nurse prepares to conduct an oppositional defiant disorder (ODD) assessment for a pediatric patient. Which question will the nurse include in the assessment? "Do you ever bully or scare other people?" "Do you ever bother people on purpose?" "Are you ever physically mean to animals?" "Can you think of a time when you ran away from home?"
"Do you ever bother people on purpose?" Asking if the patient ever bothers other people on purpose is an appropriate question to ask, as this can help the nurse gauge the child's behaviors that are characteristic of ODD. Asking if the patient has ever bullied or scared other people, been physically mean to animals, or ran away from home are more appropriate for assessing conduct disorder, not ODD. p. 400
A patient has an impulse-control disorder. The nurse is teaching the patient's family how to prevent an aggressive response from the patient. What statements made by a family member indicate a need for further education? "I should avoid using high-expressed emotion." "I should avoid standing too close to the patient." "I should avoid using matter-of-fact sentences." "I should avoid acting in an authoritative way." "I should avoid setting limits consistently."
"I should avoid using matter-of-fact sentences." "I should avoid setting limits consistently." Nurses, staff, and family should use matter-of-fact sentences while communicating with such patients to reduce confrontation. One of the best ways to communicate with a hostile patient is by consistently setting limits. It provides a climate of safety for the patient and others. High-expressed emotion, such as criticism, resentment, or annoyance in the treatment environment is a major cause of aggressive response from patients with an impulse-control disorder. The nurse, the hospital staff, or the family members should not stand too close and should not act in an authoritative manner. Such behavior may indicate aggression and may generate an aggressive response, including violence, from the patient. pp. 403-404
The nurse meets with the parents of a child who has oppositional defiant disorder (ODD). The parents ask about pharmacologic treatment options to treat the child's disorder. What is the best response by the nurse? "Many of the drugs approved to treat ODD cause negative side effects." "ODD is treated with the same pharmacologic agents that are used to treat anxiety." "There are several pharmacologic options that can be used to manage your child's disruptive behaviors." "There are currently no drugs approved to treat ODD, but certain medications can help control anger and aggression."
"There are currently no drugs approved to treat ODD, but certain medications can help control anger and aggression." The US Food and Drug Administration does not have any approved drugs for the treatment of ODD. However, there are medications available for individuals with ODD that can be used to manage and control anger and aggression. It is inaccurate to say that there are several pharmacologic options available to manage disruptive behaviors. It is not true that ODD is treated with the same medications used for anxiety. It is inaccurate to say that many of the drugs used to treat ODD cause negative side effects because this implies that there are drugs approved to treat ODD, which is incorrect.
The nurse responsible for the safety of a 10-year-old patient diagnosed with impulse control disorder is most concerned about which of the following? The child stating, "I don't want to live here or anywhere." The child's preoccupation with violent television programs. A notation in the child's medical history describing a previous suicide attempt. The father's report that the child "is really clumsy and is always hurting him- or herself."
A notation in the child's medical history describing a previous suicide attempt. The number one predictor of suicidal risk is a past suicide attempt. Although the child stating, "I don't want to live here or anywhere," a preoccupation with violent television programs, or a father's report that the child "is really clumsy and is always hurting him- or herself" may be considered, they do not have the predictive ability of a previous attempt. p. 401, Table 21.2
The nurse provides parenting skills education to the parents of children diagnosed with oppositional defiant disorder with the primary expectation that they will then be prepared to provide the child with: The prescribed medications and group therapies Appropriate socializing activities and academic support Adequate food, clothing, shelter, and medical care A nurturing home life with consistent limits and boundaries
A nurturing home life with consistent limits and boundaries When the patient is a child or an adolescent, families are engaged actively and given support in using parenting skills to provide nurturance and set consistent limits. With the basic need being externally applied boundaries and limits, prescribed medications, group therapies, appropriate socializing activities, academic support, and adequate food, clothing, shelter, and medical care would not meet those needs. p. 402
The nurse provides care to a patient who was diagnosed with impulse control disorder. The nurse wants to use the therapeutic technique of role playing to manage the patient's disruptive behaviors. What action will this include? Ignoring the patient Giving the patient increased physical space Providing the patient with emotional support Acting out a scenario to enhance understanding
Acting out a scenario to enhance understanding Acting out a scenario to enhance understanding is role playing, a counseling technique that can help the nurse or patient better comprehend a particular role or behaviors. Ignoring the patient is a therapeutic approach known as planned ignoring. Giving the patient increased physical space is called physical distance and touch control. Providing the patient with emotional support is a form of positive feedback. p. 402
While using pharmacological therapy to treat a patient with intermittent explosive disorder, which therapy should be avoided? Mood stabilizers Anticonvulsants Antianxiety medications Selective serotonin reuptake inhibitors (SSRIs)
Antianxiety medications Antianxiety medications may reduce inhibitions and self-control. So, antianxiety medications should be avoided in patients with intermittent explosive disorder. Mood stabilizers, anticonvulsants, and selective serotonin reuptake inhibitors are used in an "off-label" way to help control outbursts and are used in patients with intermittent explosive disorder. p. 396
Which classification of medication may be prescribed in intermittent explosive disorder? Anticonvulsants Benzodiazepines Psychostimulants Monoamine oxidase (MAO) inhibitors
Anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. Psychostimulants, benzodiazepines, and MAO inhibitors are incorrect for use in intermittent explosive disorder. p. 396
The health care provider considers medication for a 14 year old diagnosed with conduct disorder. This adolescent's behavior shows aggression, impulsivity, and hyperactivity. The nurse will prepare educational materials regarding which type of medication? Beta blocker Antipsychotic Anticonvulsant Benzodiazepine
Antipsychotic Antipsychotic medications for persons diagnosed with conduct disorder are directed at problematic behaviors such as aggression, impulsivity, and hyperactivity. Beta-blocking medications also may help to calm individuals with intermittent explosive disorder by slowing the heart rate and reducing blood pressure. Medications for intermittent explosive disorder might include the selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers, such as lithium or an anticonvulsant agent. Antianxiety medications, such as benzodiazepines, should be avoided because they reduce inhibitions and self-control in a similar way as alcohol. pp. 398-399
The health history for an adolescent diagnosed with conduct disorder indicates frequent callous behavior toward others. When this adolescent reaches adulthood, which personality disorder is most likely to emerge? Histrionic Antisocial Dependent Schizotypal
Antisocial Callousness may be a predictor of a future antisocial personality disorder in adults. Callousness refers to a lack of empathy, such as disregarding and being unconcerned about the feelings of others, lack of remorse or guilt, unconcerned about meeting obligations, and demonstrating a shallow, unexpressive, and superficial affect. Histrionic, dependent, and schizotypal disorders are associated with other behaviors. p. 397
As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing what? Antisocial personality disorder Obsessive-compulsive disorder Kleptomania Depression
Antisocial personality disorder Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults. There is no research to definitively associate childhood onset conduct disorder with any of the other options. p. 397
A nurse is caring for a patient with hostile behavior. What strategies should the nurse adopt when communicating with this patient? Apply consistent limits Use an angry tone when talking Maintain a threatening body posture Use negotiations to correct behavior
Apply consistent limits Consistently setting limits helps to manage a hostile patient and avoids confrontation. A neutral tone of voice and calm communication help to manage hostility. The body posture should be unthreatening and calm when communicating with a hostile patient to avoid confrontation. Using negotiations when correcting the behavior of hostile patients should be avoided to prevent aggression. pp. 403-404
Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults? Sadness Remorse Guilt Callousness
Callousness Callousness may be a predictor of future antisocial personality disorder in adults. There is no research to definitively associate any of the other options with the development of antisocial personality disorder in adults. p. 397
