Chapter 21 - Impulse Control Disorder (Psych) EAQ's

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."

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." 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. Text Reference p. 395-396

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

1 - Pyromania 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. Text Reference p. 399

Which question is focused on the assessment of a child with a possible diagnosis of oppositional defiant disorder? Select all that apply. 1 - "What seems to trigger your outbursts?" 2 - "Do you like going to school and learning?" 3 - "What would help you control your outbursts?" 4 - "How do your outbursts make your parents feel?" 5 - "What do your parents do when you won't do as they ask?"

1 - "What seems to trigger your outbursts?" 3 - "What would help you control your outbursts?" 4 - "How do your outbursts make your parents feel?" 5 - "What do your parents do when you won't do as they ask?" Assessment guidelines that focus on oppositional defiant disorder include: identifying issues that result in power struggles and triggers for outbursts—when they begin and how they are handled, assessing the child's or adolescent's view of his or her behavior and its impact on others, and exploring feelings of empathy and remorse; exploring how the child or adolescent can exercise control and take responsibility, problem solving for situations that occur, and planning to handle things differently in the future; and assessing barriers and motivation to change and potential rewards to engage the patient. Discussing the child's interest in school and learning are not associated with the problems demonstrated with this disorder. Text Reference p. 393, 401

Which classification of medication may be prescribed in intermittent explosive disorder? 1 - Anticonvulsants 2 - Benzodiazepines 3 - Psychostimulants 4 - Monoamine oxidase (MAO) inhibitors

1 - 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. Text Reference p. 396

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 - 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. Text Reference p. 397

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

1 - 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. Text Reference p. 403-404

Which factors are considered when determining a patient is at high risk for suicide? Select all that apply. 1 - Attempted suicide two years ago 2 - Father committed suicide at age 45 3 - Consistently did poorly in school 4 - Reports excessive reliance upon alcohol 5 - Is currently living with family members

1 - Attempted suicide two years ago 2 - Father committed suicide at age 45 4 - Reports excessive reliance upon alcohol Factors that increase this patient's risk for suicide include a past history, family member who successfully committed suicide, and the abuse of alcohol. Poor academics and living with family are not strong predictors of such behavior. Text Reference p. 399-400

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

1 - Decreased aggressive behavior 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. Text Reference p. 403-404

Which characteristic in a child serves to support the diagnosis of oppositional defiant disorder? Select all that apply. 1 - Deliberately agitating family members 2 - Vindictive responses to imagined personal wrongs 3 - Manipulation is regularly used to achieve personal goals 4 - Cannot assume responsibility when proven responsible for failures 5 - Seldom shows anger but rather is passive-aggressive when frustrated

1 - Deliberately agitating family members 2 - Vindictive responses to imagined personal wrongs 4 - 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. Text Reference p. 393-394

A patient diagnosed with conduct disorder craves 1 - Excitement without concern for possible negative outcomes 2 - Control of situations and constantly strategizes for such power 3 - Friendship but from those older than him- or herself 4 - Material possessions, but lacks focus and direction

1 - 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. Text Reference p. 397

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 - 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. Text Reference p. 401, Table 21.2

Which behaviors in an adolescent support the diagnosis of conduct disorder? Select all that apply. 1 - Has a history of school truancy 2 - Is sexually suggestive and aggressive 3 - Physically and verbally bullies classmates regularly 4 - Demonstrates signs of depression with suicidal tendencies 5 - Has a juvenile arrest record for stealing on three separate occasions

1 - Has a history of school truancy 2 - Is sexually suggestive and aggressive 3 - Physically and verbally bullies classmates regularly 5 - Has a juvenile arrest record for stealing on three separate occasions 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. Text Reference p. 397

The nurse is teaching the family of a patient with intermittent explosive disorder. What conditions may be associated with intermittent explosive disorder? Select all that apply. 1 - Hypertension 2 - Diabetes 3 - Depression 4 - Anxiety disorders 5 - Attention deficit hyperactivity disorder

1 - Hypertension 2 - Diabetes 4 - 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. Text Reference p. 395

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

1 - 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. Text Reference p. 399, Table 21.1

Which statements are true regarding childhood-onset conduct disorder? Select all that apply. 1 - It is more commonly diagnosed in males. 2 - It is characterized by feelings of remorse and regret. 3 - It is usually diagnosed in late teen years. 4 - It is characterized by disregard for the rights of others. 5 - It allows patients to rationalize their aggressive behaviors.

1 - It is more commonly diagnosed in males. 4 - It is characterized by disregard for the rights of others. 5 - It allows patients to rationalize their aggressive behaviors. 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. Text Reference p. 397

A nurse is caring for a child who has callousness as a type of conduct disorder. Which behaviors does the nurse identify as features of this disorder? Select all that apply. 1 - Lack of empathy 2 - Concern about schoolwork 3 - Indifference to family commitments 4 - Expressive and emotionally bonded 5 - Unconcerned about other's emotions

1 - Lack of empathy 3 - Indifference to family commitments 5 - Unconcerned about other's emotions Callousness means having a lack of empathy and an inability to appreciate other's feelings. Callous persons are indifferent to family members and ignore their family commitments. They are unemotional and seem unconcerned about others' emotions. They do not care about schoolwork or other responsibilities. Callous persons are unexpressive and superficial. Text Reference p. 397

Which technique for managing disruptive behaviors is most analogous to assertiveness? 1 - Limit setting 2 - Restructuring 3 - Planned ignoring 4 - Positive feedback

1 - 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. Text Reference 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? Select all that apply. 1 - Low self-esteem 2 - Low intelligence 3 - Violence in the family 4 - Chaotic and negligent parenting 5 - Conflict in marriage 6 - Remorseful nature

1 - Low self-esteem 2 - Low intelligence 4 - Chaotic and negligent parenting 5 - 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. Text Reference p. 398

Which characteristic supports the diagnosis of intermittent explosive disorder? Select all that apply. 1 - Man who is 19 years old 2 - Often demonstrates anger by shouting 3 - Demonstrates poor intellectual abilities 4 - Has a history of damaging the property of others 5 - Displays of aggressive behaviors began abruptly at age 14

1 - Man who is 19 years old 2 - Often demonstrates anger by shouting 4 - Has a history of damaging the property of others 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. Text Reference 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? Select all that apply. 1 - Mindfulness 2 - Emotional Regulation 3 - Role-playing 4 - Uncovering underlying feelings 5 - Distress tolerance 6 - Personal effectiveness

1 - Mindfulness 2 - Emotional Regulation 5 - Distress tolerance 6 - Personal effectiveness 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. Text Reference p. 403

Which statement concerning impulse control disorders is true? Select all that apply. 1 - Oppositional defiant disorder is one such illness. 2 - Obsessive compulsive disorder is one such illness. 3 - Early diagnosis and treatment is vital to future behaviors. 4 - The associated behaviors can lead to problems with the law. 5 - A common misconception is that the behaviors are a result of poor parenting.

1 - Oppositional defiant disorder is one such illness. 3 - Early diagnosis and treatment is vital to future behaviors. 4 - The associated behaviors can lead to problems with the law. 5 - 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. Text Reference p. 393

A nurse is assessing a group of children with oppositional defiant disorder. Which predisposing factors does the nurse identify with this disorder? Select all that apply. 1 - Parental rejection 2 - Good family support 3 - Sociable child behaviors 4 - Harsh discipline at home 5 - Attention deficit hyperactivity disorder

1 - Parental rejection 4 - Harsh discipline at home 5 - 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. Text Reference p. 398

The nurse is meeting with the healthcare team of a child who has intermittent explosive disorder. The team is discussing pharmacologic interventions. Which medications may be prescribed for this patient? Select all that apply. 1 - Paroxetine (Paxil) 2 - Fluoxetine (Prozac) 3 - Alprazolam (Xanax) 4 - Lorazepam (Ativan) 5 - Escitalopram (Lexapro)

1 - Paroxetine (Paxil) 2 - Fluoxetine (Prozac) 5 - Escitalopram (Lexapro) Selective serotonin reuptake inhibitors (SSRIs) may be used to treat intermittent explosive disorder based on the premise that explosive behaviors are related to dysfunction of serotonin production. Fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro) are SSRIs that may be prescribed for this patient. Alprazolam (Xanax) and lorazepam (Ativan) are benzodiazepines which are contraindicated for individuals with intermittent explosive disorder because they can further reduce inhibitions. Text Reference p. 396

The nurse is assessing a patient with impulse disorder for suicidal tendencies. What suicidal predictors does the nurse assess for in the patient? Select all that apply. 1 - Past suicidal attempts 2 - Family history of suicide attempt 3 - Hostile laughter 4 - Clenching of fists and jaws 5 - Feeling of hopelessness 6 - Drug or alcohol use

1 - Past suicidal attempts 2 - Family history of suicide attempt 5 - Feeling of hopelessness 6 - Drug or alcohol use 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. Text Reference p. 399-400

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 - Provide a climate of safety. 2 - Set limits and expectations. 4 - 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. Text Reference p. 402

Which outcomes will the nurse identify for a patient who has a nursing diagnosis of risk for suicide? Select all that apply. 1 - Talks about suicidal ideas 2 - Expresses feelings to others 3 - Makes fun plans for the future 4 - Refrains from thinking about suicidal behaviors 5 - Replaces thoughts about suicide with work or play

1 - Talks about suicidal ideas 2 - Expresses feelings to others 3 - Makes fun plans for the future Outcomes for patients with a nursing diagnosis of risk for suicide include expressing feelings, making plans for the future, and talking about suicidal ideas. It is not realistic for the patient to refrain from thinking about suicidal behaviors. Replacing suicidal thoughts with other things is just masking the issue rather than dealing with it. Text Reference p. 399, 401

Which nursing interventions are helpful when working with parents or caregivers of children and adolescents with impulse disorders? Select all that apply. 1 - Teach them role-playing techniques. 2 - Show them how to make home a safe environment. 3 - Refer parents and caregivers to local self-help groups. 4 - Tell them to have strict control over the child's behavior. 5 - Teach them to manage the child with physical power if they become violent.

1 - Teach them role-playing techniques. 2 - Show them how to make home a safe environment. 3 - Refer parents and caregivers to local self-help groups. Role-playing is a behavior modification technique. It helps parents and caregivers to tackle different problem situations that might arise with their child or adolescent. Patients who show aggressive behavior may become violent. In such situations, family members should be aware of weapons, drugs, and attempts by the patient to talk separately with other family members. When the family knows these things it can make the home a safe environment in which to live. Local self-help groups teach good parenting skills that have a positive effect on the child's behavior. If parents or caregivers are overly controlling, the child may suffer detrimental effects at the developmental point at which the trauma occurs. This may precipitate an aggressive response and the disorder may worsen. If parents engage in physical power, this shows confrontational behavior with the patient, which may further increase the patient's aggression. Text Reference p. 402-403

Which behavior can the nurse anticipate when caring for a patient who has oppositional defiant disorder (ODD)? 1 - The patient is argumentative with the nurse. 2 - The patient will make attempts to set something on fire. 3 - The patient explodes into verbal and physical temper tantrums. 4 - The patient may try to steal one of the nurse's assessment tools.

1 - 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. Text Reference p. 393

Which unit intervention is appropriate for a hospitalized child diagnosed with an impulse control disorder? Select all that apply. 1 - Therapy will be goal-oriented in its focus. 2 - There are posted consequences for specific unacceptable behaviors. 3 - Orientation to unit will include detailed explanation of rules and boundaries. 4 - Care plans will include daily relationship strengthening activities with each child. 5 - Flexibility is encouraged regarding rule interruption among unit staff members.

1 - Therapy will be goal-oriented in its focus. 2 - There are posted consequences for specific unacceptable behaviors. 3 - Orientation to unit will include detailed explanation of rules and boundaries. 4 - Care plans will include daily relationship strengthening activities with each child. General interventions for these patients include the following: promote a climate of safety for the patient and for others; establish a rapport with the patient; set limits and expectations; consistently follow through with consequences of rule breaking; provide structure and boundaries; and provide activities and opportunities for achievement of goals to promote a sense of purpose. Text Reference p. 402

Which statement regarding associated environmental factors is true regarding oppositional defiant disorder? Select all that apply. 1 - This disorder appears to run in families. 2 - The divorce of parents has a traumatic effect on a child. 3 - These behaviors can be learned as well as resulting from genetics. 4 - The child's world view is a result of internalized events, not parental example. 5 - The timing of traumatic effects has a great impact on a child's future development.

1 - This disorder appears to run in families. 2 - The divorce of parents has a traumatic effect on a child. 3 - These behaviors can be learned as well as resulting from genetics. 5 - The timing of traumatic effects has a great impact on a child's future development. During childhood, the main context is the family. While these disorders seem to run in families, it may reflect behavior that is learned from generation to generation rather than resulting from genetics. Parents model behavior and provide the child with a view of the world. If parents are abusive, rejecting, or overly controlling, the child may suffer detrimental effects at the developmental point(s) at which the trauma occurs. Other stressors can include major disruptions such as placement in foster care, severe marital discord, or a separation of parents. Text Reference - p. 394

Which statement regarding associated environmental factors is true regarding oppositional defiant disorder? Select all that apply. 1 - This disorder appears to run in families. 2 - The divorce of parents has a traumatic effect on a child. 3 - These behaviors can be learned as well as resulting from genetics. 4 - The child's world view is a result of internalized events, not parental example. 5 - The timing of traumatic effects has a great impact on a child's future development.

1 - This disorder appears to run in families. 2 - The divorce of parents has a traumatic effect on a child. 3 - These behaviors can be learned as well as resulting from genetics. 5 - The timing of traumatic effects has a great impact on a child's future development. During childhood, the main context is the family. While these disorders seem to run in families, it may reflect behavior that is learned from generation to generation rather than resulting from genetics. Parents model behavior and provide the child with a view of the world. If parents are abusive, rejecting, or overly controlling, the child may suffer detrimental effects at the developmental point(s) at which the trauma occurs. Other stressors can include major disruptions such as placement in foster care, severe marital discord, or a separation of parents. Text Reference p. 394

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

3 - Vindictive 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!" Text Reference p. 393

A nurse works in a psychiatric clinic and manages patients with impulsive disorders. Why should the nurse apply cognitive-behavior therapy (CBT)? Select all that apply. 1 - To develop realistic and positive thoughts 2 - To teach mindfulness and emotional regulation 3 - To focus on the patient's emotions and behavior 4 - To identify the triggers of maladaptive behaviors 5 - To improve parenting strategies of child interaction

1 - To develop realistic and positive thoughts 3 - To focus on the patient's emotions and behavior 4 - To identify the triggers of maladaptive behaviors CBT is a talk therapy. It is based on the concept that when thoughts become realistic and positive, the way of experiencing life can be changed. CBT focuses on the patient's emotions and behavior for improvement. It aims at recognizing the triggers of maladaptive behaviors and finding methods to prevent them. Teaching mindfulness and emotional regulation is dealt with in dialectical behavioral therapy (DBT). Improving parenting strategies of child interaction is the aim of parent-child interaction therapy (PCIT). Text Reference p. 403

A nurse works in a psychiatric clinic and manages patients with impulsive disorders. Why should the nurse apply cognitive-behavior therapy (CBT)? Select all that apply. 1 -To develop realistic and positive thoughts 2 - To teach mindfulness and emotional regulation 3 - To focus on the patient's emotions and behavior 4 - To identify the triggers of maladaptive behaviors 5 - To improve parenting strategies of child interaction

1 - To develop realistic and positive thoughts 3 - To focus on the patient's emotions and behavior 4 - To identify the triggers of maladaptive behaviors CBT is a talk therapy. It is based on the concept that when thoughts become realistic and positive, the way of experiencing life can be changed. CBT focuses on the patient's emotions and behavior for improvement. It aims at recognizing the triggers of maladaptive behaviors and finding methods to prevent them. Teaching mindfulness and emotional regulation is dealt with in dialectical behavioral therapy (DBT). Improving parenting strategies of child interaction is the aim of parent-child interaction therapy (PCIT). Text Reference p. 403

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.

1 - 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. Text Reference p. 394

Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in which problematic behavior? 1 - start fires. 2 - steal for thrill. 3 - self-mutilate. 4 - direct anger toward others.

1 - start fires. Pyromania is described as repeated, deliberate fire setting. None of the other options adequately describes pyromania. Text Reference 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? 1 - "Do you ever bully or scare other people?" 2 - "Do you ever bother people on purpose?" 3 - "Are you ever physically mean to animals?" 4 - "Can you think of a time when you ran away from home?"

2 - "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. Text Reference p. 400

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 - 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. Text Reference p. 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? 1 - Histrionic 2 - Antisocial 3 - Dependent 4 - Schizotypal

2 - 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 Text Reference p. 397

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

2 - Being an only child 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. Text Reference p. 398

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

2 - Conduct disorder 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. Text Reference p. 397

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 1 - Social phobia 2 - Conduct disorder 3 - Oppositional defiant disorder 4 - Attention deficit hyperactivity disorder

2 - Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type. Text Reference 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? 1 - Risk for suicide 2 - Defensive coping 3 - Impaired parenting 4 - Risk for other-directed violence

2 - 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. Text Reference p. 401, Table 21.2

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

2 - 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. Text Reference p. 402

Which nursing intervention is appropriate for a care plan that focuses on intermittent explosive disorder? 1 - Providing intensive family therapy 2 - Establishing a trusting relationship with the patient 3 - Setting up loose boundaries so the patient will feel relaxed 4 - Limiting decision-making opportunities to avoid frustration

2 - Establishing a trusting relationship with the patient Establishing rapport with the patient is essential in working to set goals, boundaries, and consequences, and for providing opportunities for goal achievement. Intensive family therapy is not a basic-level registered nurse (RN) intervention. Boundaries and structure are essential. Opportunities for patients to make good decisions and reach goals should be given, not limited. Text Reference p. 402

A nurse is assessing a patient with conduct disorder. Which assessment findings would indicate suicidal risk in the patient? Select all that apply. 1 - Fine coping skills 2 - Feelings of despair 3 - Impulsive behavior 4 - Past suicide attempts 5 - Improved decision making

2 - Feelings of despair 3 - Impulsive behavior 4 - 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. Text Reference p. 399-400

The nurse observes a student nurse managing psychosocial interventions for a child with oppositional defiant disorder. Which action made by the student nurse causes the nurse to intervene? 1 - Establishes rapport and trust with the patient 2 - Gives the patient freedom and no boundaries to test the patient's limits 3 - Provides activities that help promote a sense of purpose for the patient 4 - Promotes a safe climate and environment for the patient and the patient's parents

2 - Gives the patient freedom and no boundaries to test the patient's limits The nurse intervenes when the student nurse fails to establish limits, expectations, structure, and boundaries. These are important general interventions when dealing with patients who have oppositional defiant disorder. Promoting a safe climate and environment for the patient and for others, establishing trust and rapport, and providing activities that promote a sense of purpose are appropriate interventions for the child with oppositional defiant disorder. Text Reference p. 402

Which short-term outcomes would be appropriate for a teenager diagnosed with impulse control disorder who has been hospitalized for suicidal ideations? Select all that apply. 1 - Express two negative outcomes of acting on ideations 2 - Identify support persons to contact when ideations occur 3 - Express feelings that trigger ideations to staff as soon as they occur 4 - Agree not to harm self for the next 12 hours 5 - Identify two coping strategies to implement when ideations occur

2 - Identify support persons to contact when ideations occur 3 - Express feelings that trigger ideations to staff as soon as they occur 4 - Agree not to harm self for the next 12 hours Short-term outcomes for a teenage patient experiencing suicidal ideations would include identifying support persons, expressing feelings that trigger the ideations, and agreeing to not harm him or herself for 12 hours. Identifying negative outcomes and coping strategies is associated with the existence of ineffective coping skills. Text Reference p. 401, Table 21.2

When treating impulse control disorders, psychodynamic psychotherapy is directed toward 1 - Mastering relaxation techniques 2 - Identifying the triggers of the rage 3 - Teaching the patient self-distracting techniques 4 - Helping the patient replace the rage with acceptable alternative feelings

2 - 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. Text Reference p. 403

A nurse is assessing a patient known to have oppositional defiant disorder. Which diagnosis does the nurse formulate when the child shows hostile laughter? 1 - Risk of suicide 2 - Ineffective coping 3 - Impaired parenting 4 - Risk of violence directed at others

2 - Ineffective coping Ineffective coping is observed when the person blames others for his or her behaviors or has hostile laughter. Risk of suicide is noted when the person has a history of suicidal attempts, talks about suicidal thoughts, or shows impulsivity. Impaired parenting includes an unsafe home environment or hostility or rejection by family. Rigid body posture, clenched fists, or invading others' space signals increased chances of inflicting violence on others. Text Reference p. 401, Table 21.2

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

2 - 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. Text Reference p. 402, Box 21.1

Which statement is true regarding the relationship between parenting and behavioral problems in a child? 1 - Mothers exert greater influence on their children's behavior than do fathers. 2 - Poor parenting does not necessarily result in behavioral problems. 3 - Single-parent homes are a risk factor for the development of behavioral problems. 4 - The absence of a father figure contributes significantly to dysfunctional behavior.

2 - 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. Text Reference p. 394

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 - 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. Text Reference p. 402

Which intervention is NOT therapeutic when attempting to reduce a patient's agitation? 1 - Using a flat, neutral tone of voice when correcting behavior 2 - Relaxing rules before they trigger aggression 3 - Using "we" or "us" when setting limits 4 - Making rules easy to understand by using simple words and phrases

2 - Relaxing rules before they trigger aggression The best way to communicate with a potentially hostile patient is to set and enforce consistent limits. Using a flat, neutral tone of voice when correcting behavior, using "we" or "us" when setting limits, and making rules easy to understand by using simple words and phrases have been shown to be effective when used to reduce patient's agitation. Text Reference p. 403-404

The nurse performs an assessment on a 12-year-old child. Which finding does the nurse identify as a risk factor for conduct disorder? 1 - Decreased respirations 2 - Slower resting heart rate 3 - Increased blood pressure 4 - Elevated normal temperature

2 - 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. Text Reference p. 398

Which statement is true about the characteristics of the oppositional defiant child? 1 - The defiance generally is directed toward parents and siblings. 2 - These behaviors are a predictor of future mental health disorders. 3 - Arguing tends to be more prevalent in boys. 4 - Girls display more blaming than do boys.

2 - These behaviors are a predictor of future mental health disorders. Oppositional defiant disorder often is predictive of emotional disorders in young adulthood. Text Reference p. 393

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? Select all that apply. 1 - "I should avoid using high-expressed emotion." 2 - "I should avoid standing too close to the patient." 3 - "I should avoid using matter-of-fact sentences." 4 - "I should avoid acting in an authoritative way." 5 - "I should avoid setting limits consistently."

3 - "I should avoid using matter-of-fact sentences." 5 - "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. Text Reference p. 403-404

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? 1 - The child stating, "I don't want to live here or anywhere." 2 - The child's preoccupation with violent television programs. 3 - A notation in the child's medical history describing a previous suicide attempt. 4 - The father's report that the child "is really clumsy and is always hurting him- or herself."

3 - 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. Text Reference p. 401, Table 21.2

While using pharmacological therapy to treat a patient with intermittent explosive disorder, which therapy should be avoided? 1 - Mood stabilizers 2 - Anticonvulsants 3 - Antianxiety medications 4 - Selective serotonin reuptake inhibitors (SSRIs)

3 - 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. Text Reference p. 396

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

3 - Chronic low self-esteem 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. Text Reference p. 397

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? Select all that apply. 1 - Improvement in uncovering underlying feelings 2 - Improvement in recognizing the impulse to explode 3 - Improvement in functioning of the child within the family 4 - Improvement in school performance 5 - Improvement in distress tolerance

3 - Improvement in functioning of the child within the family 4 - 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. Text Reference p. 403

While reviewing a patient's medical report, the nurse finds out that there is an increase in gray matter in left temporal area of the patient's brain. Which behavioral symptoms does the nurse correlate with this report? Select all that apply. 1 - Empathy 2 - Remorse 3 - Impulsivity 4 - Aggression 5 - Antisocial personality

3 - Impulsivity 4 - Aggression 5 - Antisocial personality Structural abnormalities in the left temporal area of the brain are associated with impulsivity, antisocial activity, and aggression. Adolescents with conduct disorder have significant changes in the insulate cortex and amygdala of the brain, which are involved in feeling remorse and empathy. Text Reference p. 394

A patient is diagnosed with oppositional defiant disorder. Which neurobiological changes in the brain are related to oppositional defiant disorder? Select all that apply. 1 - Decreased gray matter in the left amygdala 2 - Difference in serotonin regulation in the brain 3 - Increased gray matter in the left temporal area 4 - Decreased gray matter density in the orbitofrontal cortex 5 - Decreased gray matter density in the left prefrontal cortex

3 - Increased gray matter in the left temporal area 4 - Decreased gray matter density in the orbitofrontal cortex 5 - Decreased gray matter density in the left prefrontal cortex The left temporal area is linked to aggression, impulsivity, and antisocial behavior, as seen in oppositional defiant disorder. This area is found to have an increased density of gray matter. The orbitofrontal cortex is found to have a reduced density of gray matter and is linked to impulse control and self-regulation, which is affected in oppositional defiant disorder. The left prefrontal cortex is found to have less dense gray matter. It is associated with impulse control and self-regulation, which is affected in oppositional defiant disorder. The left amygdala is linked to processing emotional reactions, which is affected in conduct disorders. This area is found to have decrease density of gray matter. Difference in serotonin regulation in the brain is linked to intermittent explosive disorder. Text Reference p. 394

A nurse is assessing a young man who has repeated outbursts of aggression. The family complains that the man seems to calm down initially but then explodes with rage and may even hit others. What does the nurse identify this condition as? 1 - Conduct disorder 2 - Oppositional defiant disorder 3 - Intermittent explosive disorder 4 - Obsessive-compulsive disorder

3 - Intermittent explosive disorder Intermittent explosive disorder is seen when a person is unable to control aggressive impulses. A person with conduct disorder violates other's rights and social norms. Oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Obsessive-compulsive disorder is characterized by repetitive thoughts or a strong urge to perform a task or activity repetitively. Text Reference p. 395

Staff working on an inpatient adolescent mental health unit desire to maintain safety and a calm milieu. Which technique should staff use most for interactions with patients? 1 - Direction 2 - Clarification 3 - Low expressed emotion 4 - High expressed emotion

3 - Low expressed emotion Low expressed emotion uses calm communication that reduces confrontation and decreases the need for seclusion and restraint. Clarification is a type of low expressed emotion and can help correct misunderstandings that may be the source of frustration and potential loss of control. High expressed emotion includes criticisms, resentment, or annoyance about patient behavior, which ultimately increases aggression. Direction may be perceived as high expressed emotion. Text Reference p. 403-404

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? 1 - Pyromania 2 - Kleptomania 3 - Oppositional defiant disorder 4 - Intermittent explosive disorder

3 - 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. Text Reference p. 393-394

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 1 - Simple and easily defined 2 - Family centered and long term in nature 3 - Patient centered and include the patient's input 4 - Age appropriate and achievable in a short period

3 - 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. Text Reference 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? 1 - Counseling 2 - Role-playing 3 - Physical restraint 4 - Planned ignoring

3 - 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. Text Reference p. 402, 404, Box 21.1

The nurse assesses a 9-year-old child whom the parents report was recently suspended from school for physically assaulting a peer. When asked about it, the child states, "I don't care if I got suspended. He deserved it!" The parents admit that the child is very bright but disrupts the class so much that the child has started to fall behind. What can the nurse infer about the child? 1 - The child shows signs of impulse control. 2 - The child likely has oppositional defiant disorder. 3 - The child presents with criteria for conduct disorder. 4 - The child is presenting normal behavior for a 9-year-old.

3 - The child presents with criteria for conduct disorder. The child is presenting with criteria for conduct disorder, showing signs of antisocial reasoning when stating "he deserved it." Individuals with conduct disorder can have normal intelligence, which the parents report is the case with the child. This is not normal behavior for a 9-year-old child. This child presents with more violent and disruptive behaviors than are common with oppositional disorders. Impulse control is not evident in this scenario. Text Reference p. 397

Which assessment is of importance for supporting a diagnosis of oppositional defiant disorder? 1 - The history, frequency, and triggers for violent outbursts 2 - 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 3 - The issues that result in power struggles and triggers for outbursts 4 - Sibling birth order to understand the dynamics of family interaction

3 - 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. Text Reference p. 401

A 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

3 - Unmet physical and emotional needs A history of not having one's own needs met may indicate an individual who has a less well-developed sense of empathy. Text Reference p. 398

A 10-year-old diagnosed with childhood-onset conduct disorder gave a snack with a hidden peanut ingredient to a classmate with a known allergy to peanuts. The classmate suffered a severe allergic reaction. When the nurse counsels the child about this harmful behavior, which comment is most likely? 1 - "I am sorry I did it. I didn't mean to hurt him." 2 - "I did not know there were peanuts in that snack." 3 - "Why are you blaming me? I did not give snacks to anyone." 4 - "He should have helped me cheat on a test when I asked him."

4 - "He should have helped me cheat on a test when I asked him." Children diagnosed with conduct disorders believe their aggressive behavior is justified. These children often display antisocial reasoning when rationalizing aggressive behavior. Denial is possible, but rationalization is more likely. Remorse is not an expected response. Text Reference p. 397

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? 1 - "Many of the drugs approved to treat ODD cause negative side effects." 2 - "ODD is treated with the same pharmacologic agents that are used to treat anxiety." 3 - "There are several pharmacologic options that can be used to manage your child's disruptive behaviors." 4 - "There are currently no drugs approved to treat ODD, but certain medications can help control anger and aggression."

4 - "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. Text Reference p. 395

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: 1 - The prescribed medications and group therapies 2 - Appropriate socializing activities and academic support 3 - Adequate food, clothing, shelter, and medical care 4 - A nurturing home life with consistent limits and boundaries

4 - 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. Text Reference 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? 1 - Ignoring the patient 2 - Giving the patient increased physical space 3 - Providing the patient with emotional support 4 - Acting out a scenario to enhance understanding

4 - 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. Text Reference p. 402

A nurse is teaching a group of teachers about managing children with disruptive behaviors. What suggestion can help the teachers plan their activities to prevent these children from getting frustrated? 1 - Maintain long hours of sports 2 - Have long classes 3 - Continue with only mental activities 4 - Alternate physical and mental activities

4 - Alternate physical and mental activities Alternating physical and mental activities can help in preventing children from getting overstimulated and avoiding frustration. Long hours of sports should be avoided as they can make them physically tired and overstimulated and can result in frustration. Long classes should be avoided as they can wear them out or overstimulate them, which can result in frustration. Mental activities only should be avoided as they can wear them out or overstimulate them, which can result in frustration. Text Reference p. 402, Box 21.1

What is the most common condition associated with oppositional defiant disorder? 1 - Obesity 2 - Hypotension 3 - Type 1 diabetes 4 - Attention deficit disorder

4 - Attention deficit disorder Attention deficit disorder is the most common condition associated with oppositional defiant disorder. Nearly 40% of individuals with oppositional defiant disorder also have attention deficit disorder. Type 1 diabetes, hypotension, and obesity are not common comorbidities for oppositional defiant disorder. Text Reference p. 394

Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults? 1 - Sadness 2 - Remorse 3 - Guilt 4 - Callousness

4 - 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. Text Reference p. 397

The nurse is assessing an adult patient with a history of immature coping skills and poor problem-solving abilities. Which impulsive disorder do these features represent? 1 - Intermittent explosive disorder 2 - Oppositional deficient disorder 3 - Attention deficit hyperactivity disorder 4 - Conduct disorder

4 - Conduct disorder Children with conduct disorder tend to use immature styles of coping and problem solving. A patient with intermittent explosive disorder shows aggressive outbursts, which are a way of protecting the ego. Oppositional deficient disorder and attention deficit hyperactivity disorder are the predisposing factors of child-onset conduct disorder. Text Reference p. 397

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

4 - Confronting the patient concerning the disruptive behavior 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. Text Reference p. 402

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

4 - Kleptomania 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. Text Reference p. 399

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 - 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. Text Reference p. 399

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? 1 - Criticize the child for the disruptive behavior 2 - Use firm, consistent punishment for this behavior 3 - Ignore the child's actions and behavior 4 - Make the child replace the disturbed furniture

4 - 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. Text Reference p. 402, Box 21.1

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

4 - 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. Text Reference p. 401, Table 21.2

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.

4 - 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. Text Reference p. 393