MH Chapter 21 Impulse Control AQ

1 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.

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? 1 Risk for suicide 2 Ineffective coping 3 Impaired adjustment 4 Impaired social interaction

1, 2, 3 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; therefore, fearfulness from the parents is expected. Intermittent explosive disorder also is associated with conflict and violence in the family of origin. It is common for these families to have had a history of addiction and substance abuse. Higher levels of the hormone testosterone are associated with intermittent explosive disorder, which would lead to masculine rather than feminine behaviors. Homosexuality usually is not associated with this diagnosis.

A nurse interviews the parents of a 19-year-old man diagnosed with intermittent explosive disorder. Which comments from these parents are most likely? Select all that apply. 1 "We get scared that our son will hurt us." 2 "There has always been chaos in our family." 3 "All of our son's grandparents are alcoholics." 4 "Our son has often behaved in a feminine way." 5 "We have always thought our son was secretly gay."

4 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.

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? 1 Defiance 2 Pyromania 3 Callousness 4 Kleptomania

4 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.

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? 1 The child is remorseful. 2 The child explodes in anger. 3 The child shows callousness. 4 The child is irritable and vindictive.

1 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.

A nurse is caring for a patient with hostile behavior. What strategies should the nurse adopt when communicating with this patient? 1 Apply consistent limits 2 Use an angry tone when talking 3 Maintain a threatening body posture 4 Use negotiations to correct behavior

4 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.

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? 1 Risk of suicide 2 Ineffective coping 3 Impaired parenting 4 Risk of violence to others

2 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.

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? 1 Encourage anger outbursts 2 Provide support to the child 3 Follow flexible rules of parenting 4 Encourage oppositional behavior

2 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.

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? 1 Use of criticism 2 Planned ignoring 3 Physical restraints 4 Immediate attention

1 If communication skills of the UAPs improve, decreased aggressive behavior among the adolescents should result. High expressed emotion is a major cause of aggressive responses from patients with impulse control disorders. Violence increases when people act in an authoritarian way or engage in power struggles. Body language and tone of voice can indicate aggression on the part of staff. Increased competition for the staff's attention, increased use of physical restraint to manage behavior, and better recognition of the consequences of inappropriate behavior suggest the UAPs' communication skills did not improve.

A nurse observes unlicensed assistive personnel (UAPs) in a residential treatment setting for adolescents diagnosed with impulse control disorders. The UAPs often are controlling, challenging, and demanding during interactions. The nurse plans staff development sessions focused on improving communication skills. Which finding regarding the adolescents shows that the desired learning occurred? 1 Decreased aggressive behavior 2 Increased competition for the staff's attention 3 Increased use of physical restraint to manage behavior 4 Better recognition of the consequences of inappropriate behavior

4 Kleptomania is a repeated failure to resist urges to steal objects not needed for personal use or monetary value. The person experiences a buildup of tension before taking the object, followed by relief or pleasure following the theft. Eustress is a positive type of stress. Pyromania refers to repeated deliberate fire setting. Dysthymia refers to a type of depressed mood.

A patient says, "When I go to the mall, I steal things. I don't know why I do it because I take things I don't need." Which term applies to this behavior? 1 Eustress 2 Pyromania 3 Dysthymia 4 Kleptomania

2 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.

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? 1 Guilt 2 Denial 3 Remorse 4 Empathy

1 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.

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing what? 1 Antisocial personality disorder 2 Obsessive-compulsive disorder 3 Kleptomania 4 Depression

1 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.

Comorbid conditions commonly associated with oppositional defiant disorder do NOT include 1 conversion disorder. 2 attention deficit hyperactivity disorder (ADHD). 3 bipolar disorder. 4 anxiety.

2 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.

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? 1 Beta blocker 2 Antipsychotic 3 Anticonvulsant 4 Benzodiazepine

2 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.

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? 1 Histrionic 2 Antisocial 3 Dependent 4 Schizotypal

1, 2, 4 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.

The nurse is caring for a patient with conduct disorder. What psychosocial interventions may be needed for this patient? Select all that apply. 1 Provide a climate of safety. 2 Set limits and expectations. 3 Prescribe antipsychotic medicines. 4 Provide structure and boundaries. 5 Use a physical restraint.

1 Pyromania is the deliberate and repeated act of setting things on fire. People who engage in pyromania behaviors become tense or excited before setting things on fire and show an unusual interest in fire and its contexts, like matches or smoke. Kleptomania is the repeated failure to resist urges to steal objects. Oppositional defiance describes a general group of oppositional behaviors. Impulse control disorder is related to pyromania but is not the best term used to describe the child's behaviors.

The nurse performs an assessment on a child and finds that the child deliberately sets fires and becomes excited when talking about them. Which term best describes this behavior? 1 Pyromania 2 Kleptomania 3 Oppositional defiance 4 Impulse control disorder

3 Children diagnosed with childhood-onset conduct disorder attempt to project a strong image, but they actually have low self-esteem, which is chronic rather than situational. These children have impaired social interactions rather than social isolation. They may also have learning impairments, but that clinical condition is different from the nursing diagnosis deficient knowledge.

The nurse prepares the plan of care for a 9-year-old diagnosed with childhood-onset conduct disorder. Which nursing diagnosis is most likely to apply to this child? 1 Social isolation 2 Deficient knowledge 3 Chronic low self-esteem 4 Situational low self-esteem

2 In conduct disorder, the patient violates others and social norms and rules. The patient can even be involved in physical fights, destruction of property, and drug abuse. Intermittent explosive disorder involves aggressive behavior, a delayed consequence of which is remorsefulness. In oppositional defiant disorder, the patient shows defiant and vindictive behavior and a pattern of annoying people and blaming others for his or her own behavior. Kleptomania is the repeated failure to resist urges to steal objects.

The parents and teachers of a young adult have reported that the person does not obey school rules, destroys school property, and is involved in physical fights. What could be the possible diagnosis for this condition? 1 Kleptomania 2 Conduct disorder 3 Oppositional defiant disorder 4 Intermittent explosive disorder

1 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.

The primary characteristic that separates intermittent explosive disorder (IED) from oppositional defiance is that IED 1 Is diagnosed in individuals 18 years of age or older 2 Has very specific, predictable triggers 3 Rarely involves physical self-harm 4 Seldom results in remorse for the aggressive behavior

3 Vindictiveness is defined as spiteful, malicious behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. This child may frequently be heard to say "He made me do it!" or "It's not my fault!"

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is 1 Emotionally immature 2 Experiencing anxiety 3 Vindictive 4 Depressed

4 The three most important interventions with this population are to promote a climate of safety for the patient and for others, establish rapport with the patient, and set limits and expectations.

When working with a patient demonstrating impulse control disorders, all of the following nursing interventions have priority except 1 Providing a safe environment 2 Setting and enforcing limits and expectations 3 Establishing a therapeutic nurse-patient relationship 4 Confronting the patient concerning the disruptive behavior

2 Predisposing factors for conduct disorder are ADHD, oppositional child behaviors, parental rejection, inconsistent parenting with harsh discipline, early institutional living, chaotic home life, large family size, absent or alcoholic father, antisocial and drug-dependent family members, and association with delinquent peers.

Which of the following would not be considered a predisposing factor for conduct disorder? 1 Chaotic home life 2 Being an only child 3 Attention-deficit/hyperactivity disorder (ADHD) 4 Exposure to drug abuse among family members

3 A history of not having one's own needs met may indicate an individual who has a less well-developed sense of empathy.

poorly developed sense of empathy is thought to be the result of having 1 A family history of mental illness 2 A low serum testosterone level 3 Unmet physical and emotional needs 4 Suffered head trauma at an early age