Ch 21 - Impulse Control Disorders

Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder? A 12-year-old male who steals a bicycle as a gang initiation A 9-year-old male who smokes half a pack of cigarettes a day A 12-year-old female who regularly bullies her younger siblings A 9-year-old female who engages in sexually provocative behaviors

A 12-year-old male who steals a bicycle as a gang initiation In adolescent-onset conduct disorder, no symptoms are present prior to age 10. Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight, steal, vandalize, and have school discipline problems, whereas girls tend to lie, be truant, run away, abuse substances, and engage in prostitution.REF: Page 402

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

Callousness Callousness may be a predictor of future antisocial personality disorder in adults.REF: 402

Which of the following would not be considered a predisposing factor for conduct disorder? Chaotic home life ADHD Being an only child Exposure to drug abuse among family members

Being an only child Predisposing factors 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.REF: Page 402

Eli is a 17-year-old patient admitted to the psychiatric unit with conduct disorder after threatening his mother during an argument. Which of the following would be an appropriate short-term outcome for Eli? Engages in appropriate coping skills to manage stressors Expresses feelings Maintains self-control during hospitalization Mother will improve communication skills to interact with Eli

Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the patient to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the patient are being discussed, not outcomes for the patient's mother.Cognitive Level: Apply (Application)Nursing Process: Outcome IdentificationNCLEX: Psychosocial IntegrityText page: 406 (Table 21-2)

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

Relaxing rules before they trigger aggression The best way to communicate with a potentially hostile client is to set and enforce consistent limits.REF: 409

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

These behaviors are a predicter of future mental health disorders. Oppositional defiant disorder is often predictive of emotional disorders in young adulthood.REF: Page 401-402

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing antipersonality disorder. obsessive-compulsive disorder. kleptomania. depression.

antipersonality 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.REF: 402

Assessment for oppositional defiant disorder should include: assessing the history, frequency, and triggers for violent outbursts. assessing 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. assessing issues that result in power struggles and triggers for outbursts. assessing sibling birth order to understand the dynamics of family interaction.

assessing 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.Cognitive level: Apply (Application)Nursing Process: AssessmentNCLEX: Psychosocial IntegrityText page: 401

A poorly developed sense of empathy is thought to be the result of having a family history of mental illness. a low serum testosterone level. suffered head trauma at an early age. unmet physical and emotional needs.

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.REF: 403-404

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is emotionally immature. experiencing anxiety. vindictive. depressed.

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!"REF: Page 401

The nurse responsible for the safety of a 10-year-old client diagnosed with impulse control disorder is most concerned about which of the following? The child stating, "I don't want to live here or anywhere." The child's preoccupation with violent television programs. A notation in the child's medical history describing a previous suicide attempt. The father's report that the child "is really clumsy and is always hurting himself."

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.REF: 404

Which of the following classifications of medication may be prescribed in intermittent explosive disorder? Anticonvulsants Psychostimulants Antianxiety agents such as benzodiazepines MAO inhibitors

Anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. The other options are incorrect for use in intermittent explosive disorder.Cognitive Level: Apply (Application)Nursing Process: ImplementationNCLEX: Physiological IntegrityText page: 407

Which of the following statements are true regarding childhood-onset conduct disorder? (select all that apply): It is more commonly diagnosed in males. It is characterized by feelings of remorse and regret. It is usually diagnosed in late teen years. It is characterized by disregard for the rights of others. Those with conduct disorder rationalize their aggressive behaviors. It is usually outgrown by early adulthood.

It is more commonly diagnosed in males. It is characterized by disregard for the rights of others. Those with conduct disorder 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. The other options are the opposite of what is correct.Cognitive Level: Analyze (Analysis)Nursing Process: AssessmentNCLEX: Psychosocial IntegrityText page: 402

The nurse provides parenting skills education to the parents of children diagnosed with oppositional defiant disorder with the expectation that they will then be prepared to provide the child with the prescribed medications and group therapies. appropriate socializing activities and academic support. adequate food, clothing, shelter, and medical care. a nurturing home life with consistent limits and boundaries.

a nurturing home life with consistent limits and boundaries. When the client is a child or an adolescent, families are actively engaged and given support in using parenting skills to provide nurturance and set consistent limits.REF: 407

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 client centered and include the client's input. age appropriate and achievable in a short period of time. simple and easily defined. family centered and long term in nature.

client centered and include the client's input. Whenever possible, outcomes should be client centered and agreed upon by both the nurse and the client or the client's designee.REF: 406

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with the DSM-5 diagnosis of social phobia. conduct disorder. oppositional defiant disorder. attention deficit hyperactivity disorder (ADHD).

conduct disorder. The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type.REF: Page 402-403

When working with a client demonstrating impulse control disorders, all of the following nursing interventions have priority except providing a safe environment. establishing a therapeutic nurse-client relationship. setting and enforcing limits and expectations. confronting the client concerning the disruptive behavior.

confronting the client concerning the disruptive behavior.

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

conversion disorder. Oppositional defiant disorder is related to a variety of other problems, including attention deficit hyperactivity disorder, anxiety, depression, suicide, bipolar disorder, and substance abuse.REF: 402-403

Nursing interventions for intermittent explosive disorder include: providing intensive family therapy. establishing a trusting relationship with the patient. setting up loose boundaries so the patient will feel relaxed. limiting decision-making opportunities to avoid frustration.

establishing a trusting relationship with the patient. Establishing rapport with the patient is essential in working to set goals, boundaries, and consequences, and providing opportunities for goal achievement. Intensive family therapy would not be a basic-level RN intervention. Boundaries and structure are essential. Opportunities for patients to make good decisions and reach goals should be given, not limited.Cognitive Level: Apply (Application)Nursing Process: PlanningNCLEX: Psychosocial IntegrityText page: 407

A client diagnosed with conduct disorder craves excitement without concern for possible negative outcomes. control of situations and constantly strategizes for such power. friendship but from those older than themselves. material possessions but lacks focus and direction.

excitement without concern for possible negative outcomes. People with conduct disorder crave excitement and do not worry as much about consequences as other people do.REF: Page 402

When treating impulse control disorders, psychodynamic psychotherapy is directed toward mastering relaxation techniques. identifying the triggers of the rage. teaching the client self-distracting techniques. helping the client replace the rage with acceptable alternative feelings.

identifying the triggers of the rage. Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help them to develop better ways to think about and control their behavior.REF: Page 409

A nursing diagnosis that should be considered for a child diagnosed with conduct disorder who shows no capacity for empathy would be fear. anxiety. impaired social interaction. risk for self-mutilation.

impaired social interaction. The tendency to lack empathy for others is reflected best in the nursing diagnosis of impaired social interaction.REF: Page 406 (Table 21-2)

The primary characteristic that separates intermittent explosive disorder (IED) from oppositional defiance is that IED is diagnosed in individuals 18 years of age or older. has very specific, predictable triggers. rarely involves physical self-harm. seldom results in remorse for the aggessive behavior.

is diagnosed in individuals 18 years of age or older. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The aggression can be verbal or physical and targeted toward other people, animals, or property, or even themselves.REF: Page 401-402

With regard to the relationship between parenting and behavioral problems in a child, it is true that mothers exert greater influence on their children's behavior than do fathers. poor parenting does not necessarily result in behavioral problems. single-parent homes are a risk factor of the development of behavioral problems. the absence of a father figure contributes significantly to dysfunctional behavior.

poor parenting does not necessarily result in behavioral problems. External factors in the environment can either support or put stress on children and adolescents and shape their development. Supportive families help children with behavior problems do better, and children without supportive families may have a harder time. Bad parenting does not necessarily cause behavior problems; however, a supportive family or environment can help improve a child's future outcome.REF: 404

Pyromania, a behavior associated with impulse control disorders, causes an individual to start fires. steal for thrill. self-mutilate. direct anger toward others.

start fires. Pyromania is described as repeated, deliberate fire setting.REF: 402-403