Chapter 23: Disruptive Behavior Disorders

While interviewing a client with conduct disorder, the nurse asks the client about having friends in school. What is the most likely response of the client? "I am not a social person. It is difficult for me to make friends." "I prefer doing useful productive work instead of making friends." "I don't want to be friends with the stupid idiots at school." "I am such an awful person. Who will be friends with me?"

"I don't want to be friends with the stupid idiots at school." Explanation: In clients with conduct disorder, good peer relationships are often not seen. These clients view their peers who follow rules as stupid or afraid. Clients with conduct disorders are not likely to get involved in "productive" work such as studies. In this disorder, the client does not accept negative qualities such as not being a social person. These clients have a low self-esteem but they do not show this externally. Depressive, guilt laden behavior is not seen in this client.

Children with conduct disorder may be diagnosed with which disorder as adults? Antisocial personality disorder Schizophrenia Depression Bipolar disorder

Antisocial personality disorder Explanation: As many as 30% to 50% of children diagnosed with conduct disorder are diagnosed with antisocial personality disorder as adults.

A nurse suspects that an adolescent has oppositional defiant disorder (ODD). In which situation will the client most likely display behavior consistent with ODD? At play while confronting peers At school while confronting students of the opposite sex At home while confronting parents At school while confronting teachers

At home while confronting parents Explanation: In clients with ODD, the disruptive, defiant behavior usually starts at home. Therefore, if the nurse suspects that the patient has ODD, the nurse should observe the behavior of the client at home while he or she confronts the parents. The behavior is generally seen later in school or during play.

A nurse is educating a group of parents about conduct disorder. According to the nurse, which children are most at risk for developing conduct disorder? Select all that apply. Children with low self-esteem Children neglected by their parents Children with a resilient nature Children with poor peer relationships Children with emotional instability

Children with low self-esteem Children with poor peer relationships Children neglected by their parents Explanation: Children with low self-esteem, poor peer relationships, and poor parenting tend are at risk for developing conduct disorders. A resilient nature places the child at lower risk for developing conduct disorder. Children with conduct disorder are known to have a flat affect.

Which childhood disorder is characterized by serious violations of social norms, such as destruction of property? Conduct disorder Attention deficit hyperactivity disorder (ADHD) Oppositional defiant disorder (ODD) Obsessive-compulsive disorder (OCD)

Conduct disorder Explanation: Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty of animals. ODD is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and tendency to blame others for misfortunes. OCD is characterized by intrusive thoughts that are difficult to dislodge (obsessions) or ritualized behaviors that the child feels driven to perform (compulsions). ADHD is a persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.

A nurse is planning to teach parents of children with conduct disorder about the treatment methods. Which topics should the nurse address in the session? Select all that apply. Skills to improve peer relationships Skills to improve academic performance Legal procedures for criminal behavior Sedative medications for conduct and antisocial personality disorder Effective parenting skills

Effective parenting skills Skills to improve peer relationships Skills to improve academic performance Explanation: Family therapy is most desirable to treat school-aged children with conduct disorder. While teaching parents about strategies to treat this disorder, the nurse should talk about good parenting, skills to improve peer relationships, and skills to improve academic performance. Legal procedures for criminal behavior and medications for conduct and antisocial personality disorder need not be addressed in this teaching.

A 15-year-old client with intermittent explosive disorder (IED) gives no history of childhood abuse, neglect, or maltreatment. What could be the cause of the disorder in this client? Dysfunction of the parietal lobe Presence of coronary artery disease Imbalance in the production of serotonin Depleted levels of glucose in the blood

Imbalance in the production of serotonin Explanation: Childhood abuse, neglect, or maltreatment is often the cause of IED. As the client does not have a history of any of these, the client likely has the disorder because of other factors. Other etiologic factors include imbalance in the production of serotonin and dysfunction of the frontal lobe. Parietal lobe dysfunction and depleted blood glucose levels are not associated with IED. Presence of coronary artery disease is not a known etiologic factor in IED but is strongly correlated with the disease.

A nurse is counseling the parents of an adolescent client with oppositional defiant disorder (ODD). The parents state, "We've tried everything, what else are we supposed to do?" What is the most likely reason for the parents' voiced loss of hope? The parents may have been pampering the adolescent too much. The adolescent may have limited sensitivity to reward and punishment. The parents may have not taught appropriate behavior to the adolescent. The adolescent may have been abused in childhood.

The adolescent may have limited sensitivity to reward and punishment. Explanation: The most likely reason for the parents' sense of loss of control and hope with their adolescent child who has a diagnosis of ODD is that the client has a limited ability to make associations between a behavior and the consequences of that behavior—both negative and positive. The parents likely did not neglect to teach the client appropriate behavior. Childhood abuse may be a predisposing factor for ODD. The parents likely did not pamper the client; however, problem behaviors may have been inadvertently reinforced in the home.

A nurse is caring for a client with conduct disorder who injures people around the client when angry. Which is the primary goal for intervention in this case? To reduce the aggression of the client. To help the client express his/her feelings. To help the client develop good peer relationships. To ensure safety of others.

To ensure safety of others. Explanation: With a physically agressive client, the nurse should first ensure the safety of others. Reducing the aggression of the client, helping the client express feelings, and helping the client to develop good peer relationships are all goals of treatment. These outcomes are of a comparatively lesser priority than safety.

The nurse is assessing a child diagnosed with conduct disorder. Based on which behavior would this client be described as exhibiting the disorder at moderate intensity? Verbal bullying Truancy Cruelty to animals Attempted robbery

Verbal bullying Explanation: Verbal bullying is an example of a behavior seen in clients exhibiting a moderate intensity form of conduct disorder. Truancy is described as a behavior seen in a mild intensity form of the disorder. Cruelty to animals and attempted robbery are described as a behavior seen in a severe intensity form of conduct disorder.

A nurse is assessing a 10-year-old child who is displaying behaviors that are consistent with oppositional defiance disorder. When conducting the assessment, the nurse should also assess for which co-morbidity? schizophrenia kleptomania attention deficit hyperactivity disorder cognitive impairment

attention deficit hyperactivity disorder Explanation: Oppositional defiance disorder is often co-morbid with other psychiatric disorders that need to be treated as well. It is possible that the oppositional defiance disorder is superimposed on the attention deficit hyperactivity disorder because this problem is the underlying cause of the child's maladaptive behaviors.

A high school teacher has referred an adolescent to the school health nurse for repeated episodes of aggressive behavior and verbalizing profanities loudly at other students in the class. The adolescent can sometimes be apologetic. The nurse should suspect which disruptive behavior disorder? oppositional defiant disorder intermittent explosive disorder conduct disorder pyromania

intermittent explosive disorder Explanation: Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts. The adolescent in this scenario is displaying the behaviors associated with this disorder. Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. Remorse or apology is not a characteristic associated with conduct disorder due to impaired ability to function in social, academic, or occupational settings. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures. In this case, the adolescent directs outbursts at peers. Pyromania is characterized by repeated, intentional fire-setting.

A nurse is seeing a female client who has been mandated to counseling sessions after shoplifting numerous times. Which disruptive behavior disorder is the client most likely experiencing? kleptomania internalizing behavior pyromania intermittent explosive disorder

kleptomania Explanation: Kleptomania is characterized by the impulsive, repetitive theft of items not needed by the person, either for personal use or monetary gain. This problem is more common in females. Pyromania is characterized by repeated, intentional fire-setting. Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts. Children who respond to pressures by internalizing emotions can see that result in somatic complaints, withdrawal, isolative behavior and problems with anxiety and depression. In this case, the client is engaging in externalizing behaviors.

Which factor will most influence a nurse's interaction with a child diagnosed with conduct disorder? age and gender of the child nursing education personal values regarding child rearing severity of the behavior

personal values regarding child rearing Explanation: The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The remaining options may contribute but they are not the most influential factor.

Which observation demonstrates the effective use of cognitive behavioral therapy with a client diagnosed with intermittent explosive disorder? "Do you usually have an explosive episode after a work day?" "Does anyone in your family have problems with alcohol use?" "Do you have any side effects from the antidepressant medication?" "Which member of your family makes you the most angry?"

"Do you usually have an explosive episode after a work day?" Explanation: Cognitive behavioral therapy focuses on helping the client recognize triggers or circumstances associated with the onset of the explosive episode to develop adaptive behaviors and prevent episodes from occurring. By asking the client if he tends to explode at the end of the work day, the nurse is helping the client identify the influence of work stress on the explosive behavior. Asking the client about the side effects of medication is not part of cognitive behavior therapy. This is the pharmacological component of treatment for this disorder. Asking the client if anyone in his family has problems with alcohol use assesses for the presence of addiction which can be a major factor in intermittent explosive disorder. Treating an addiction is not a goal of cognitive behavioral therapy. Asking the client which family member makes the client the most angry communicates an externalization of the problem. The client must learn to understand the problem by developing personal responsibility for responses to triggers.

The parents of a 15-year-old adolescent report that their child is behaving abnormally. After obtaining the history of the client, the nurse responds by telling the parents that their child's behavior is normal for his age. What would the parents have told the nurse regarding their child? Select all that apply. "Our child has no friends at school." "Our child spends more time playing than studying." "Our child is an extreme pessimist and tends to stay away from everybody." "Our child has difficulty learning and understanding concepts." "Our child doesn't listen to us, preferring to listen to friends."

"Our child spends more time playing than studying." "Our child doesn't listen to us, preferring to listen to friends." Explanation: Spending more time playing than working indicates an erratic work-leisure pattern behavior that is common among adolescents. Giving more importance to friends indicates the adolescent's eagerness to seek peer approval; this behavior is also acceptable in adolescents. Having no friends and poor peer relationships is not a normal adolescent behavior. Having difficulty learning and understanding concepts indicates that the child has a learning disability. Extreme pessimism and social withdrawal indicate abnormal behavior in adolescents.

Which statement by the nurse demonstrates an understanding of the importance of keeping negative emotions from interfering with care provided to aggressive clients? "Safety is the priority." "I need to know that I'm never alone." "I'm their advocate." "Talking with other staff helps."

"Talking with other staff helps." Explanation: It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. While the other options are true statements, they are not focused on eliminating or managing negative emotions toward the client.

A client is diagnosed with intermittent explosive disorder (IED). What drugs are likely to be prescribed for the client? Select all that apply. Typical antipsychotics Mood-stabilizing agents Stimulants Antidepressants Barbiturates

Antidepressants Mood-stabilizing agents Explanation: The client is likely to be prescribed antidepressant drugs, such as fluoxetine. The client may also be prescribed mood-stabilizing drugs, such as valproic acid and phenytoin. These drugs are used to reduce excessive irritability and anger impulses. The client is unlikely to be prescribed typical antipsychotic medication; atypical antipsychotic medications may be considered due to the effect on serotonin. The client should not be administered a stimulant drug, as the central nervous system function is already heightened. The client need not be sedated with barbiturates.

A nurse is assessing an adolescent client with oppositional defiant disorder (ODD). What factors influence the development of this disorder in the adolescent? Select all that apply. Behavior of parents Peer group of the adolescent Eating habits of the adolescent Academic performance of the adolescent Temperament of the adolescent

Behavior of parents Temperament of the adolescent Peer group of the adolescent Explanation: It is believed that interaction of genes, temperament, and adverse social conditions cause oppositional defiant disorder (ODD). Behavior of the parents suggests genetic linkage. Characteristics of the peer group is indicative of the adversity of the social conditions around the adolescent. Eating habits and academic performance are affected due to ODD, but are not known to be a cause of ODD.

A nurse is providing training for parents of a child diagnosed with a disruptive behavior disorder involving the use of "time out." When describing how to implement this, which would the nurse identify as the first step? Placing the child in a designated area removed from others Clearly identifying what is required for the child Informing the child what will happen because of the behavior Having the child recount the reason for the time out

Clearly identifying what is required for the child Explanation: When implementing "time out," the first step is to label the behavior that the child is expected to perform, or cease performing. Then the child is informed that if he or she does not perform the expected behavior or stop the unacceptable behavior, time out will be given. If the child does not heed the warning, then he or she is told to take the time out, sitting in a designated chair away from general activity but within view.

A 14-year-old client's behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has what? Select all that apply. Resorted to threatening to cut the self when angry Confessed to hurting the neighbor's dog Been caught lying on a regular basis Served after-school detention for repeatedly disobeying the teaching staff Been regularly accused by family members of "stealing their stuff"

Confessed to hurting the neighbor's dog Served after-school detention for repeatedly disobeying the teaching staff Been regularly accused by family members of "stealing their stuff" Been caught lying on a regular basis Explanation: A 14-year-old client's behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has done the following: confessed to hurting the neighbor's dog, served detention, been accused of stealing, and been caught lying.

A nurse is speaking to parents of a child at school. The parents tell the nurse that their child has a calm temperament. However, the child experiences bed wetting at night when exposed to new situations. If emotionally upset, the child is unable to articulate feelings and prefers to cry alone. What psychiatric disorder is this child likely to develop in the future? Antisocial personality disorder Oppositional defiant disorder Depression Conduct disorder

Depression Explanation: According to the parents, the child prefers to be left alone when disturbed emotionally. This behavior indicates that the child has the tendency to internalize emotions. Such children are likely to develop anxiety and depression. Conduct disorder, oppositional defiant disorder, and antisocial personality disorder are more common in children who tend to externalize their emotional issues by directing anger and frustration into aggressive behavior.

A nurse is teaching parents of a child with a disruptive behavior disorder how to use "time-out." The nurse determines the education was successful when the parents identify which as the first step? Labeling the behavior Giving the child a warning Instituting the time out Identifying the consequence of the unacceptable behavior

Labeling the behavior Explanation: The first step is to label the behavior, that is, identify the behavior that the child is expected to perform or cease. The aim of this statement is to make clear what is required of the child. It typically takes the form of a simple declarative sentence: "Threatening is not acceptable." The next step is the warning. In this step, the child is informed that if he or she does not perform the expected behavior or stop the unacceptable behavior, he or she will be given a "time-out." "This is a warning: if you continue threatening to hit people, you'll have a time-out." The last step is the actual time-out. If the child does not heed the warning, he or she is told to take a time-out in simple straightforward terms: "Take a time-out."

Which would be the most appropriate intervention for an adolescent who is manipulative and exhibiting aggressive behaviors? Time out Limit setting Self-esteem enhancement Social skills training

Limit setting Explanation: Limit setting involves three steps: informing the client of the rule or limit, explaining the consequences if the client exceeds the limit, and stating the expected behavior.

A high school teacher has referred an adolescent to the school health nurse for repeated episodes of aggressive behavior and verbalizing profanities loudly at other students in the class. The adolescent can sometimes be apologetic. The nurse should suspect which disruptive behavior disorder? pyromania conduct disorder intermittent explosive disorder oppositional defiant disorder

intermittent explosive disorder Explanation: Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts. The adolescent in this scenario is displaying the behaviors associated with this disorder. Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. Remorse or apology is not a characteristic associated with conduct disorder due to impaired ability to function in social, academic, or occupational settings. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures. In this case, the adolescent directs outbursts at peers. Pyromania is characterized by repeated, intentional fire-setting.

A client is diagnosed with oppositional defiant disorder (ODD). Which assessment finding would indicate that the client needs medications? Use of abusive language by the client Presence of comorbid psychiatric disorders Extreme hostile behavior toward the parents Less than 3 years of age

Presence of comorbid psychiatric disorders Explanation: Clients with ODD are likely to have comorbid psychiatric symptoms related to conditions like attention deficit hyperactivity disorder (ADHD). Pharmacological therapy for these comorbid conditions can be helpful in reducing the severity of ODD symptoms. Children less than 3 years of age are expected to exhibit behavior similar to ODD, but this is considered normal and does not require any therapy. Use of abusive language and hostile behavior toward parents are signs consistent with ODD and do not require pharmacological therapy.

A nurse is assessing a client with oppositional defiant disorder (ODD). What questions related to the disorder should the nurse ask the parents while taking the history of the client? Select all that apply. "Is your child extremely obsessed with sports?" "Does your child suddenly wake up at night from nightmares?" "Does your child have difficulty paying attention?" "Does your child get extremely upset for getting poor grades in school? "Does your child get confused much of the time?"

"Does your child get confused much of the time?" "Does your child have difficulty paying attention?" "Does your child get extremely upset for getting poor grades in school? Explanation: Children with ODD may have impaired decision-making ability, which may render them confused most of the time. Attention deficit hyperactivity disorder is known to coexist with ODD. Therefore, the nurse should assess whether the condition exists. Children with ODD are not known to have nightmares or bad dreams. Being obsessed with sports is normal behavior in a school-age child. Children with ODD fail to make associations between their behavior and its consequences. They are unlikely to be upset for getting poor grades in school.

A nurse is assessing a 2-year-old child in a child and family outpatient mental health clinic. The parents tell the nurse that the child can be combative when the child's wants are not met. The parents describe the child as "defiant." What is the most appropriate response of the nurse to the parents? "Your child may be showing early signs of conduct disorder." "It sounds like very challenging behavior, testing is quite normal at this age." "You should withhold the food as a consequence for poor choices." "Your child will require some antidepressant medication."

"It sounds like very challenging behavior, testing is quite normal at this age." Explanation: A certain level of disruptive behavior is expected in a 2-year-old child. During the toddler developmental phase, children will test limits and act in defiance in an effort to gain control. The nurse should provide the parents with reassurance and education regarding expected developmental tasks for this age group. The nurse should never ask the parents to punish a young child, especially by withholding a physiological need. The child should not be prescribed any medications or therapy for such behaviors. There is no evidence to support the statement that the child is showing signs of developing conduct disorder.

A nurse is speaking to the parents of a 15-year-old client who has been suspended from school for physically abusing classmates. The client has had many warnings from school staff; however, the client's behavior persists. What other statements by the parents would lead the nurse to suspect this client has conduct disorder? Select all that apply. "My child feels guilty and regrets the inappropriate behavior." "My child is extremely well-behaved at home." "My child is consistently performing poorly academically." "My child cries a lot and does not want to be alone." "My child does not have any friends."

"My child is consistently performing poorly academically." "My child does not have any friends." Explanation: Children with conduct disorder exhibit callous and unemotional behavior, such as physically abusing classmates. They are unconcerned about poor performance in school. These clients show no guilt or remorse for their behavior. They are unemotional, and their conduct at home is also poor.

After completing a series of parent training sessions with parents of an 8-year-old client with oppositional defiant disorder, the child's mother calls the nurse with concerns. The mother states, "What you taught us isn't working. Can you please talk to my child about his behavior?" Which is the nurse's most effective response? "Tell me how you have been using negotiation when limit setting with your child." "Please tell me more about what you are having difficulty with." "Please bring your child to my office for another session." "I can meet with your child individually at the school counseling office."

"Please tell me more about what you are having difficulty with." Explanation: Exploring in depth what the client's mother is having difficulty with can help the nurse build the parental capacity to address the behavioral difficulties they are having on their own. Identifying specific pitfalls can promote problem solving. Meeting with the child individually at the school counseling office takes the child out of the environment where the behavior is most problematic (in the home). Working with the child individually is ineffective as the best treatment for oppositional defiant disorder is to work with the parents in building their capacity for behavior management. Telling the mother to bring the client to the nurse's office for another session communicates that the parents do not already have the tools to manage the child's behaviors independently.

The nurse is teaching the parents of a child with conduct disorder about methods to deal with their child's detention from school for breaking science equipment. What advice should the nurse give the parents to deal with the situation? "You should punish your child so that the child never repeats the same mistake at school." "You should be supportive of the school for taking this step regarding your child's inappropriate behavior." "You should be supportive of your child as your child might be very depressed after receiving detention." "You should file a case against the school for punishing your child so severely."

"You should be supportive of the school for taking this step regarding your child's inappropriate behavior." Explanation: The nurse should explain to the parents that the child has received detention for behaving inappropriately in school and that they should support the school for this instead of blaming it. Using severe punishment is not a recommended treatment strategy for conduct disorder. The child with conduct disorder is unlikely to be depressed or feel guilty for receiving detention from school.

hich statement, made by the parent of a teen diagnosed with conduct disorder, demonstrates effective parenting? "When are you going to learn that bullying is not acceptable behavior?" "You will lose your driving privileges for a week if you don't clean your room today." "A person your age knows better than to skip school." "Do you understand that you hurt your sister's feelings when you call her names?"

"You will lose your driving privileges for a week if you don't clean your room today." Explanation: The nurse should help parents identify appropriate discipline strategies. While the other options express appropriate parental emotions, they do not address parenting strategies that will effectively address the teen's behavior.

A nurse is assessing a 9-year-old child diagnosed with conduct disorder. Which advice should the nurse give the child's parents regarding treatment of the disorder? "Your child should be sent to boot camp." "Your child needs to be incarcerated." "You will need to be involved in the therapeutic process for your child." "Your child requires individualized therapy."

"You will need to be involved in the therapeutic process for your child." Explanation: Family therapy is most desirable to treat a 9-year-old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy.

A nurse is performing a general assessment of adolescents in a school to identify students with conduct disorder. Which students are likely to be identified with the condition, based on the nurse's assessment? Select all that apply. A student who repeatedly bullies younger students A student who always uses abusive language while speaking to teachers A student who is constantly involved in activities resulting in damage to school property A student who has had a fight with a classmate A student who persistently gets poor grades

A student who repeatedly bullies younger students A student who is constantly involved in activities resulting in damage to school property A student who always uses abusive language while speaking to teachers Explanation: Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of other people. The disorder could be in the form of aggression toward people and animals, destruction of property, deceitfulness and theft, and/or serious violation of rules. A student who persistently abuses younger children may be classified as having conduct disorder. A student who is constantly involved in activities that result in damage to school property (destruction of property) may have conduct disorder. A student who constantly uses extremely abusive language while speaking to teachers (aggression toward people) also may have conduct disorder. Having a fight with a classmate and getting bad grades in a class are not abnormal behavior in adolescents.

In a discussion with a group of high school teachers about oppositional defiant disorder (ODD), the nurse says that behavior modification of the parents and teachers toward such children forms the basis of therapy. What is the most appropriate rationale that the nurse gives when asked about this strategy? Adolescents with ODD learn maladaptive behavior at home and it can be perpetuated at school. Adolescents with ODD are less aggressive toward parents and teachers. Adolescents with ODD are closest to their parents and teachers. Adolescents with ODD only fear their parents and teachers.

Adolescents with ODD learn maladaptive behavior at home and it can be perpetuated at school. Explanation: The treatment of ODD is based on parental behavioral interventions. It is believed that problem behaviors in ODD are learned and reinforced in the home and at school, hence the approach of the parents and teachers toward the child may help to eliminate this disorder at earlier ages. In adolescents, behavioral therapy may also be required along with parental management. It may not be true that these children are closest to their parents. Such clients are usually very aggressive and lack a sense of fear of anybody.

A nurse is providing community education regarding adolescents with oppositional defiance disorder (ODD). Which point should the nurse include in the educational session? Rewarding positive behaviors consistently can lead to ODD. Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors. It is ideal if parents can wait until adolescence to seek treatment. Parental roles do not influence the development of ODD.

Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors. Explanation: The disruptive, defiant behaviors associated with ODD usually begin at home with parents or parental figures and are more intense in this setting than in settings outside the home. Consistently giving attention to maladaptive behaviors and ignoring any positive ones can lead to the development of ODD. With ODD, the problem develops as a result of the parents or parental figures to miss opportunities to reward the child for demonstrating positive behaviors but attention, whether it is positive or negative, is typically given when the child is engaging in maladaptive behavior. Parents/parental figures play a key role in preventing or perpetuating ODD. The problem behaviors are learned and inadvertently reinforced in the home. The most effective treatment for ODD begins when the child is young, preferably elementary school-aged. Waiting until adolescence to seek treatment can render the client more treatment resistant.

In clients with conduct disorder, reactivity of the autonomic nervous system is reduced. Which sign related to this physiological abnormality can be seen in clients with conduct disorder? Unemotional behavior Decreased social inhibitions Decreased interest in social activities Disturbed peer relationships

Decreased social inhibitions Explanation: In clients with conduct disorder, there is a lack of reactivity of the autonomic nervous system, which results in decreased normal avoidance or social inhibitions. Decreased interest in social activities, disturbed peer relationships, and unemotional behavior may be secondary effects of such decreased levels of avoidance and social inhibition.

An adolescent client demonstrates callous and unemotional behavior in the absence of extreme aggressive behavior and mood disturbances. The client has a diagnosis of conduct disorder. Which treatment would be most effective for this client? Group therapy Medication Individualized behavior therapy Family therapy

Individualized behavior therapy Explanation: Adolescents rely less on their parents than younger children do. An adolescent with conduct disorder would benefit most from individualized behavior therapy. These adolescents are usually not attached to their parents, thus family therapy is not useful for them. Group therapy will also not be beneficial for these clients, as they are uncomfortable socializing. The client here does not have extreme aggressive behavior and mood disturbances; therefore, it is unlikely that the client would be prescribed psychotropic drugs or mood stabilizers.

A 12-year-old child is brought to the mental health clinic by the child's parents because of a court-ordered evaluation. When assessing the child, which would lead the nurse to suspect that the child has a conduct disorder? Select all that apply. Blaming of others for problems Repetitive disobedience of parents Evidence of overt lying Destruction of neighbor's car on two separate occasions Arrests for petty larceny several times

Evidence of overt lying Destruction of neighbor's car on two separate occasions Arrests for petty larceny several times Explanation: Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. Children and adolescents with conduct disorder often lie to achieve short-term ends, may be truant from school, may run away from home, and may engage in petty larceny or even mugging. Oppositional defiant disorder is characterized by a persistent pattern of disobedience; argumentativeness; angry outbursts; low tolerance for frustration; and a tendency to blame others for misfortunes, large and small.

A nurse is meeting the parents of an 8-year-old child with oppositional defiant disorder. Which strategies can the nurse offer the parents to promote the use of positive reinforcement? (Select all that apply.) Engage in discussion with the child when the child is arguing. Take the child out for ice cream after a weekend free of arguing or questioning. Give high-fives for following through on a request the first time. Offer the child a toy or a game after a week of good behavior at school. Provide hugs and cuddles when the child and throwing objects during a tantrum.

Give high-fives for following through on a request the first time. Offer the child a toy or a game after a week of good behavior at school. Take the child out for ice cream after a weekend free of arguing or questioning. Explanation: When offering management training and behavioral interventions for a child with oppositional defiant disorder, the nurse should emphasize the importance of rewarding positive behaviors with praise and re-inforcers such as high fives, treats, or toys/games. Consequences for the child's defiant behavior, such as throwing objects during a tantrum or arguing, must be consistent and not positively rewarded such as by providing a hug and cuddle or engaging in discussion. Responses to positive and negative behaviors must be distinct and employed consistently in order to sustain adaptive behaviors in the child.

Which would be an appropriate intervention for a child diagnosed with conduct disorder? Allow self-monitoring of the child's own behavior Have the child accept responsibility for individual behavior Avoid limiting setting to decrease confrontation Allow the child increased control over situations

Have the child accept responsibility for individual behavior Explanation: The child diagnosed with conduct disorder needs to accept responsibility for his or her own actions. The nurse must protect others from the manipulative or aggressive behaviors with these clients.

A nurse is caring for an adolescent with conduct disorder. The nurse tries to involve the client in discussions on age-related topics such as books, current trends, and movies. What is the nurse trying to accomplish by doing this? Teach about the relationship between behavior and its consequences. Evaluate the client's frustration tolerance. Teach the client to deal with problems. Help the client develop peer relationships.

Help the client develop peer relationships. Explanation: Engaging clients with conduct disorder in conversation on age-related topics helps them practice how to interact as other adolescents do. This should help the client to develop peer relationships. This intervention is not useful for teaching clients to deal with problems, evaluating frustration tolerance, or understanding the relationship between behavior and its consequences.

A nurse is assessing an adolescent with oppositional defiant disorder (ODD). Other than disruptive behavior, what other findings might the nurse expect to see during the assessment? Select all that apply. Impaired physical ability Impaired attention Impaired decision making Impaired problem-solving abilities Impaired sense of direction

Impaired decision making Impaired attention Impaired problem-solving abilities Explanation: Other than disruptive behavior, clients with ODD have impaired decision making and deficiencies in attention and problem-solving abilities. Physical impairment and impaired sense of direction are not associated with ODD.

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old client who has been referred to the home by the court system. Knowing that the client has a documented history of conduct disorder, which nursing diagnosis should the nurse prioritize during the client's transition into the group home? Hopelessness related to separation from family Impaired social interaction due to withdrawal Impaired social interaction due to aggressive behavior Risk for injury related to poor safety awareness

Impaired social interaction due to aggressive behavior Explanation: The aggression, acting out, and antisocial behavior associated with conduct disorder create the potential for social alienation in a group setting. Such individuals are less likely to withdraw, injure themselves, or experience hopelessness.

A nurse is planning to educate a client who is diagnosed with intermittent explosive disorder about self-management strategies for the condition. What topics should the nurse address while teaching this client? Select all that apply. Relaxation techniques A healthy diet regimen Strategies for anger management Strategies to eliminate pain Strategies to avoid alcohol and substance use

Relaxation techniques Strategies for anger management Strategies to avoid alcohol and substance use Explanation: The education imparted by the nurse should focus on helping the client manage the symptoms associated with intermittent explosive disorder. The nurse should teach the client relaxation techniques, anger management strategies, and strategies to prevent the use of alcohol and drugs. Clients with intermittent explosive disorder are unlikely to have pain or diet-related problems; therefore, these need not be taught to the client.

During dinner time on an inpatient unit, an adolescent client throws a tray across the table. What would be an effective use of limit setting with this client? Encourage the client to log the event in a diary. Remind the client about the behavior contract. Take the client into a quiet area for a therapy session. Role-model how to be social during meals.

Remind the client about the behavior contract. Explanation: In order to decrease violence and increase compliance with treatment, it is important for the nurse to remind the client about the behavior contract. The contract outlines expected behaviors, limits, and rewards to increase treatment compliance. Taking the client to a quiet area during a time when the client is exhibiting violent behavior could be unsafe for the nurse and the client. A therapy session may not be helpful if the client is in a heightened emotional state. Encouraging the client to log the event in a diary is an intervention used to improve coping skills and self-esteem, not limit setting. Role-modeling how to be social during meals is an intervention used to promote social interaction, not limit setting.

A nurse is counseling the parents of a client with conduct disorder. The nurse tells them that they should be vigilant in watching for certain behaviors that their child is prone to exhibit. Which behaviors would the nurse want the parents to watch for? Select all that apply. Early onset of sexual behavior Binge eating Alcohol and substance abuse Smoking Suicidal tendencies

Smoking Alcohol and substance abuse Early onset of sexual behavior Explanation: Children with conduct disorder are likely to have problems such as smoking, alcohol and substance abuse, and early onset of sexual behavior. The nurse should advise the parents of the client to watch for such behaviors. Binge eating and suicidal tendencies are not known to be associated with conduct disorder.

A nurse is caring for a client with conduct disorder. The nurse needs to help the client understand the relationship between aberrant behavior and the consequences when the behavior is problematic. Which nursing intervention is most appropriate to help this client? Teach the client about limit setting and the need for limits. Teach appropriate conversation and social skills. Encourage the client to discuss thoughts and feelings. Teach the client the problem-solving process.

Teach the client about limit setting and the need for limits. Explanation: Clients with conduct disorder may have no knowledge of the concept of limits and how they can be beneficial. The nurse should teach about limit setting and the need for limits to help clients understand the relationship between aberrant behavior and the consequences when the behavior is problematic. The problem-solving process should be taught to clients, as they may not know how to solve problems constructively. Appropriate conversation and social skills should be taught to clients to assist them in socializing with others. Clients should be encouraged to discuss their thoughts and feelings, as this is the first step in dealing with clients with conduct disorder.

The nurse can accurately identify which client behaviors as externalizing? (Select all that apply.) Not coming to school for several days Consistently reports having a stomach ache with no identifiable cause Telling someone how much money the client's dad makes Submitting the copied homework of a peer Described as a "loner" by peers

Telling someone how much money the client's dad makes Not coming to school for several days Submitting the copied homework of a peer Explanation: Externalizing behaviors include telling someone how much money their parent makes (bragging), not coming to school for several days (truancy) and submitting copied homework (cheating at school). If a client is described as a "loner," this indicates the client spend much time in isolation which is an example of internalizing behavior. Somatic aches and pains such as a a stomach ache with no identifiable cause are an example of an internalizing behavior.

A nurse is assessing a 15-year-old adolescent with conduct disorder. Which appearance might the nurse see in the adolescent? The adolescent appears terrified. The adolescent has lots of tattoos and body piercings. The adolescent has lots of cuts on the face and body. The adolescent has poor physical hygiene.

The adolescent has lots of tattoos and body piercings. Explanation: Adolescents with conduct disorder appear normal for their age group but may have an extreme appearance, such as having tattoos and body piercings. They appear normal in terms of personal hygiene. These adolescents have no guilt associated with their behavior, thus they probably will not look terrified. The nurse is unlikely to observe changes associated with self-harm.

A nurse is developing a plan of care for a client with conduct disorder. Which would be treatment outcomes for this client? Select all that apply. The client will learn effective problem-solving skills. The client will be relieved of anxiety and depression. The client will engage in socially acceptable behavior. The client will not hurt others or damage property. The client will have a hygienic lifestyle.

The client will engage in socially acceptable behavior. The client will learn effective problem-solving skills. The client will not hurt others or damage property. Explanation: If a client undergoes successful treatment, he or she should be able to behave in a socially acceptable manner, display appropriate problem-solving skills, and no longer hurt others or damage property. Clients with conduct disorder usually do not have issues related to personal hygiene. Such clients do require relief from anxiety or depression, as they are considered unemotional and do not show regret or feel any remorse after inappropriate behavior.

A nurse is assessing an adolescent with conduct disorder. Which should the nurse expect to find in this adolescent? Select all that apply. The adolescent may be unwilling to speak to the nurse. The adolescent may sob because of guilt for behavior. The adolescent may make derogatory comments about parents and teachers. The adolescent may give false reports of having a physical illness. The adolescent may behave disrespectfully to the nurse. The adolescent may have physical manifestations related to stress.

The adolescent may be unwilling to speak to the nurse. The adolescent may behave disrespectfully to the nurse. The adolescent may make derogatory comments about parents and teachers. Explanation: Adolescents with conduct disorder may act lazy and be unwilling to be interviewed. They may be disrespectful to the nurse and other personnel in the health care facility. They may also make derogatory comments about their parents and teachers. People with conduct disorder are very unlikely to express grief. They show no guilt or remorse associated with their acts. These adolescents are unlikely to be stressed. Clients with conduct disorder are very unlikely to behave like a hypochondriac and give false complaints of having a physical illness.

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone by the primary health care provider. What would be the most likely reason for the health care provider to prescribe this drug to the client? The adolescent is experiencing disturbances in concentration. The adolescent's behavior poses a danger to others. The adolescent has poor social behavior. The adolescent is depressed because of the inappropriate behavior.

The adolescent's behavior poses a danger to others. Explanation: Risperidone is given to those clients with conduct disorder whose behavior poses a threat to others. Poor social behavior and disturbances in concentration need not be treated with drugs. Unlike in intermittent explosive disorder, the client with conduct disorder has no remorse, guilt, or depression after behaving violently.

A nurse is counseling the parents of a 5-year-old child with oppositional defiant disorder (ODD). What type of management does the nurse suggest to help the parents deal with the disorder? The child can be managed if admitted to a juvenile home. The child can be managed if given psychotropic drugs. The child can be managed by ensuring punishments are suited to the behavior. The child can be managed if the parents modify their own behavior.

The child can be managed if the parents modify their own behavior. Explanation: Treatment of ODD is based on parent management training models of behavioral interventions. It requires that the parents modify their behavior in such a way that they ignore maladaptive behavior and reward positive behavior. ODD need not be treated with psychotherapy or psychotropic drugs or by admittance to a juvenile home. These may be required if the client has developed a more severe form of the condition, such as conduct disorder.

Which responses to an emotional stressor would indicate that a child is at risk for conduct disorder? Select all that apply. The child screams loudly. The child breaks things around her or him. The child goes to a secluded place. The child has crying spells. The child stops talking.

The child screams loudly. The child breaks things around her or him. Explanation: Screaming loudly and breaking things are behaviors indicating externalization of emotions. Such behaviors put the child at risk for conduct disorder. Having crying spells, not talking to anyone, and going to a secluded place in response to an emotional stressor indicate that the child has a tendency to internalize emotions related to the stressor. These children are likely to develop somatic disorders, anxiety disorder, and depression.

The nurse is documenting clinical observations after a therapeutic session with an adolescent client with a disruptive behavior disorder. What should the nurse identify is an internalizing behavior? The client has not shown up for three consecutive appointments. The client pushed over a chair during the session. The client tells the nurse the client's grandmother died when this is not true. The client only stares at the nurse when asked how the client is doing today.

The client only stares at the nurse when asked how the client is doing today. Explanation: An example of an internalizing behavior that can be observed in clients with disruptive behavior disorders is refraining from talking. The client who just stares at the nurse when asked a question is demonstrating internalizing behaviors common in disruptive behavior disorders. Not showing up for multiple appointments is an example of truancy, an externalizing behavior common in disruptive behavior disorders. Telling the nurse that her grandmother passed away when, in fact, this is not true, indicates that the client is lying. Lying is one example of an externalizing behavior in disruptive behavior disorders. Pushing a chair over during the therapeutic session is an example of an angry outburst with aggression. This is an externalizing behavior.

The nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent is not interested in seeking summer employment. What is the most likely reason for the client's disinterest in getting a job? The client feels that the client is too disturbed to work. The client feels that the client will not be efficient in the workplace. The client feels that depression and anxiety would interfere with working. The client prefers stealing money over working for it.

The client prefers stealing money over working for it. Explanation: The adolescent with conduct disorder is most likely to steal money for survival instead of earning it through employment. Feeling too disturbed to be able to work and feeling that the client would be inefficient at work are not behaviors related to clients with conduct disorder. Depression and anxiety are not present in clients with conduct disorder.

A nurse is developing a plan of care for an adolescent with conduct disorder. What changes in behavior should the nurse expect to find in the client within the first 3 days if therapy is proceeding successfully? Select all that apply. The client will assess personal strengths and weaknesses. The client will start developing relationships with peers. The client will verbalize feelings and emotions. The client will have learned strategies for solving the client's own problems. The client will show improvement in academic performance.

The client will verbalize feelings and emotions. The client will have learned strategies for solving the client's own problems. Explanation: The immediate goals of management of conduct disorder are that the client be able to verbalize feelings and emotions and learn strategies to solve problems. Changes like developing relationships with peers, being able to assess one's strengths and weaknesses, and improving academic performance are longer term goals of intervention.

After teaching a group of nursing students about kleptomania, the instructor determines that the education was successful when the students state what? The disorder is difficult to detect and treat. Anxiolytics are the drug of choice for treatment. Information related to treatment is widespread. The disorder is more common in males.

The disorder is difficult to detect and treat. Explanation: Kleptomania is difficult to detect and treat. There are few accounts of treatment. It appears that behavior therapy is frequently used. Antidepressant medication that helps relieve the depression has been successful in some cases. However, more investigation is needed.

A nurse is assessing a 14-year-old adolescent who is known for constantly bullying children. On assessment, the nurse finds that the adolescent had early onset conduct disorder. What other findings during the assessment are suggestive of early onset conduct disorder? Select all that apply. The client has never abused the children physically. The client is susceptible to developing antisocial personality disorder. The maladaptive behavior started before the age of 10 years. The client does not have extremely aggressive behavior. The client does not have normal peer relationships.

The maladaptive behavior started before the age of 10 years. The client does not have normal peer relationships. Explanation: In early onset conduct disorder, the aggressive behavior begins before the age of 10 years. Unlike individuals with the adolescent-onset type, this client does not have normal peer relationships. In early onset conduct disorder, the behavior of the child is extremely aggressive. Information regarding the susceptibility of the child to develop antisocial personality disorder cannot be obtained during assessment. Severity of maladaptive behavior is not indicative of the type of conduct disorder (on the basis of age).

A nurse is studying the medical records of a client with conduct disorder. The nurse finds that the client was prescribed lithium. What would be the most likely reason for prescribing this drug for this client? Predisposition to kleptomania Difficulty with decision-making skills The presence of aggression Risk of developing seizures

The presence of aggression Explanation: Clients with conduct disorder who are aggressive can sometimes be prescribed medications such as mood stabilizers that have antiaggression properties such as lithium. Lithium is also an antiseizure agent; however, the client history does not indicate this is part of the pathology. Lithium is not generally indicated for the treatment of kleptomania. Behavioral therapy and psychotherapy are required to improve decision-making abilities.

A nurse is assessing an adolescent with conduct disorder. Which statement by the nurse about the adolescent is most likely to be true? The sibling of the client has a mood disorder. The adolescent loves to play with pets. The sibling of the client has conduct disorder. The client has a chronic medical condition.

The sibling of the client has conduct disorder. Explanation: Most children with conduct disorder have siblings with the same psychiatric disorder. Although it is possible to develop conduct disorder if a sibling has a mood disorder, the likelihood is higher that the client would also develop a mood disorder. Clients with conduct disorder will show cruelty to animals. A client with a chronic medical condition is more likely to be able to experience and convey empathy, eliminating the presence of conduct disorder.

A nurse observes a middle school student having an angry outburst in the hallway. The nurse is aware that the student has these outbursts frequently. The nurse suspects that the student has intermittent explosive disorder (IED). What other assessment findings would support this conclusion? Select all that apply. The student has had an anger episode that lasted more than 30 minutes. The student has caused extensive damage to school property. The student has no sense of guilt or remorse after the anger outburst. The student has experienced anger episodes over very minor events. The student has had outbursts of anger without any warning.

The student has caused extensive damage to school property. The student has experienced anger episodes over very minor events. The student has had outbursts of anger without any warning. Explanation: In IED, there are repeated episodes of aggressive, violent behavior and angry verbal outbursts. There may be physical injury or damage to property during the anger episodes. The outburst is usually out of proportion to the stimulus causing it. The episode usually occurs with no warning. The anger episode in IED usually lasts no more than 30 minutes. The client usually has a sense of guilt and remorse after the outburst.

The nurse uses the technique of time-out for a client with conduct disorder. Which problem demonstrated by the client would have led the nurse to use this intervention? Unwilling to build social relationships Unwilling to talk to the nurse Threatening the nurse Refusing to perform a daily chore

Threatening the nurse Explanation: Time-out is used to prevent aggression when the client's behavior starts to escalate, such as yelling or threatening someone. This technique helps the client with conduct disorder to gain control of emotions and outbursts. This technique may not be useful for helping the client interact with the nurse, to build better social relationships, or to perform daily chores.

For which reason would a nurse ask an adolescent client with conduct disorder to maintain a diary? To help reduce the chances of having outbursts of anger. To help learn socially acceptable behavior. To improve problem solving skills. To help identify feelings.

To help identify feelings. Explanation: Clients with conduct disorder are tough on the exterior but have difficulty expressing their feelings and emotions. Keeping a diary can be very useful to help these clients to identify and express their emotions and feelings. Keeping a diary would not improve problem solving or teach socially acceptable behavior. It also does not reduce the chances of an angry outburst. The nurse should teach problem-solving skills, continually involve the client in age-appropriate discussions, and use techniques such as time-out to address these challenges.

When providing education to the parents of a client with conduct disorder, which is a valid teaching point? Use 'I' language and express an emotion when setting limits. Act as the adolescent's advocate at school when the client is disruptive. Provide reassurance that frequent sexual activity is normal in adolescence. Tell the adolescent to go to their room as a consequence for using profanity.

Use 'I' language and express an emotion when setting limits. Explanation: With clients diagnosed with conduct disorder, parents need to replace old patterns of communicating such as yelling, hitting, or simply ignoring with more effective communication strategies such as assertive limit setting. Using 'I' language and identifying an emotion can help the parents set limits in a healthy way. Consequences will only be effective if something of value is taken from the client. Many adolescents prefer time alone in their rooms. This would not be the most effective information to provide to the parents. Some parents need to let the client experience the consequences of their actions rather than rescuing them. Advocating for the adolescent when the client is disruptive in school will only perpetuate the negative behavior. Adolescents with conduct disorder are prone to thrill-seeking, risky behavior including frequent sexual activity. This should not be normalized as part of the education provided to the parents.

The nurse is interviewing the parents of a child with conduct disorder. Which question is appropriate for the nurse to ask? "How often do you punish your child?" "What words do you use while scolding your child?" "What type of punishments do you give your child?" What type of discipline do you use at home?"

What type of discipline do you use at home?" Explanation: While asking questions on sensitive topics like parenting, the nurse should use nonjudgmental language and a matter-of-fact tone. This avoids giving the client verbal cues to become defensive or to not tell the truth and to be free while expressing thoughts. Asking about the type of discipline used at home indicates that the nurse does not have any presumptions about the parental behavior. Asking about the frequency of punishments to the child indicates that the nurse presumes that the child gets punished by the parents. Questions such as "What words do you use while scolding your child?" indicates the nurse's notion that the parents scold their child. Asking about the types of punishment the parents give indicates that the parents punish the child in different ways. These questions reflect the judgmental behavior of the nurse.

A school counselor has made a referral to the school health nurse for a 14-year-old client who has been bringing alcohol to school in a water bottle. The client was overheard talking about having multiple sexual partners over the past week. This client can be accurately identified as having which intensity level of conduct disorder? moderate conduct disorder severe conduct disorder mild conduct problems does not meet criteria for conduct disorder

moderate conduct disorder Explanation: Moderate intensity of conduct disorder is characterized by an increase in the number of conduct problems as well as the amount of harm to others. Examples of moderate conduct disorder include drinking alcohol and sexual promiscuity. The client does meet the criteria for conduct disorder. Mild conduct problems cause relatively minor harm to others. Examples include repeated lying and truancy. Severe conduct disorder is characterized by a person having many conduct problems that cause considerable harm to others. Examples include forced sex, cruelty to animals, and use of weapons.