Ch. 23 Disruptive Behavior Disorders M.C.

The nurse is conducting a health history of a 35-year-old male client with a history of intermittent explosive disorder, diagnosed in adolescence. The nurse should include an assessment of which health issue? hearing loss obesity blood disorders increased blood pressure

increased blood pressure

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, "I had a stomachache and felt like vomiting. I couldn't help it. I was just so mad at my dad." Which would be the most appropriate response by the nurse? "I can see that you're angry. Let's look at better ways to express it." "I can understand your anger, but you can't disrupt the classroom." "If you can get rid of your anger, perhaps your stomachache will go away." "Perhaps it would be helpful if you let your dad know you're angry."

"I can see that you're angry. Let's look at better ways to express it."

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 don't want to be friends with the stupid idiots at school." "I prefer doing useful productive work instead of making friends." "I am not a social person. It is difficult for me to make friends." "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."

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 don't want to interact or be friends with dumb and meek people in school." "I prefer doing useful productive work instead of making friends." "I am not a social person. It is difficult for me to make friends." "I am such an awful person. Who will be friends with me?"

"I don't want to interact or be friends with dumb and meek people 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." "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."

"It sounds like very challenging behavior, testing is quite normal at this age."

A nurse is seeing an adolescent with a diagnosis of conduct disorder for the first time to establish goals for treatment. During the first meeting, the adolescent yells a profanity at the nurse and states, "This is pointless." What is the nurse's best response? "We can't begin this work until you feel invested in it." "Now is not a good time. Maybe we can meet another day?" "I want to continue to work with you but I don't accept the language you have chosen." "I am concerned that you are going to act out right now."

"I want to continue to work with you but I don't accept the language you have chosen."

Which observation demonstrates the effective use of cognitive behavioral therapy with a client diagnosed with intermittent explosive disorder? "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?"

"Do you usually have an explosive episode after a work day?"

An effective nursing intervention for the impulsive and aggressive behaviors that accompany conduct disorder is assertiveness training consistent limit setting negotiation of rules open expression of feelings

consistent limit setting

A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse? "Fine, but you're confined to your room." "Missing class is against the rules." "You and I both know you're lying." "Why do you keep fighting the system?"

"Missing class is against the rules."

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? "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." "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."

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 requires individualized behavioral therapy." "Your child requires your support and motivation." "Your child needs to be incarcerated." "Your child should be sent to boot camp."

"Your child requires your support and motivation."

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

"Talking with other staff helps."

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child? "That is not allowed here. You will lose a privilege. You need to stop." "Stop what you are doing. Go to your room." "I would appreciate if you would not do that." "Why do you do these things?"

"That is not allowed here. You will lose a privilege. You need to stop."

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? "How would you feel if someone yelled at you like that?" "What's the matter with you? Don't you know any better?" "Yelling at others is unacceptable. You need to let staff know you're upset." "You're still having problems controlling your anger."

"Yelling at others is unacceptable. You need to let staff know you're upset."

A nurse is caring for a 10-year-old child with conduct disorder. The child starts throwing stones at the staff. What statement made by the nurse to control the child's behavior is most appropriate? "You may injure people around you. If you feel angry, you could always come and talk to me or another nurse." "You are a hopeless child. Your behavior will make you a criminal one day." "Are you out of your mind? You could hurt people." "You should be ashamed of what you've done."

"You may injure people around you. If you feel angry, you could always come and talk to me or another nurse."

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 file a case against the school for punishing your child so severely." "You should be supportive of your child as your child might be very depressed after receiving detention." "You should be supportive of the school for taking this step regarding your child's inappropriate behavior."

"You should be supportive of the school for taking this step regarding your child's inappropriate 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 requires individualized therapy." "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."

"You will need to be involved in the therapeutic process for your child."

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 only fear their parents and teachers. Adolescents with ODD are closest to their parents and teachers. 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 learn maladaptive behavior at home and it can be perpetuated at school.

Which of the following children is most likely to be diagnosed with oppositional defiant disorder or conduct disorder? A 6-year-old boy who finds school profoundly stressful due to his inability to relate to others A 13-year-old boy who experiences tics and has occasional outbursts of obscenities for no apparent reason A 14-year-old girl who admits to having had four different sex partners in the past several months An 11-year-old boy who was caught breaking into a home to steal money

An 11-year-old boy who was caught breaking into a home to steal money

A 13-year-old child is constantly involved in breaking tables and chairs at school. On further assessment, the nurse finds that the child has conduct disorder. Which condition is the child most likely to develop in the future if not treated effectively for this condition? Schizophrenia Depression Antisocial personality disorder Anxiety disorder

Antisocial personality disorder

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

Antisocial personality disorder

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 home while confronting parents At school while confronting teachers At school while confronting students of the opposite sex

At home while confronting parents

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

Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors.

Which of the following is normal adolescent behavior? Being critical of self and others Defiant, negative, and depressed behavior Frequent hypochondriacal complaints Unwillingness to assume greater autonomy

Being critical of self and others

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 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

Clearly identifying what is required for the child

A 16-year-old client is highly disruptive in class and has been in trouble at home. The client's parent recently found the client torturing a cat. When the parent questioned the client about how the client could hurt an animal, the client laughed. Which condition will the client most likely be diagnosed with? Bipolar disorder Conduct disorder Tourette syndrome Asperger syndrome

Conduct disorder

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling as the child is experiencing signs of which disorder? Oppositional defiant disorder Asperger's syndrome Attention deficit hyperactivity disorder Conduct disorder

Conduct disorder

A group of nursing students is reviewing information about disruptive behavior disorders. The students demonstrate understanding of the topic when they identify which as an externalizing disorder? Anxiety Depression Schizophrenia Conduct disorder

Conduct disorder

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

Conduct disorder

Which disorder of childhood is characterized by aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules? Pica Rumination disorder Attention deficit hyperactivity disorder (ADHD) Conduct disorder

Conduct disorder

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? Disturbed peer relationships Decreased interest in social activities Decreased social inhibitions Unemotional behavior

Decreased social inhibitions

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? Conduct disorder Oppositional defiant disorder Depression Antisocial personality disorder

Depression

Which is likely to be most effective for adolescents with conduct disorder? Involvement with the legal system Focusing on the parenting education Incarceration Early intervention

Early intervention

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders? Administering medications Avoiding setting limits Group-based parenting classes Being overprotective of the child

Group-based parenting classes

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

Have the child accept responsibility for individual behavior

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. Help the client develop peer relationships. Evaluate the client's frustration tolerance. Teach the client to deal with problems.

Help the client develop peer relationships.

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

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old boy who has been referred to the home by the court system. Knowing that the boy has a documented history of conduct disorder, which of the following nursing diagnoses should the nurse prioritize during the boy's transition into the group home? Risk for Injury related to poor safety awareness Hopelessness related to separation from family Impaired Social Interaction due to withdrawal Impaired Social Interaction due to alienation from others secondary to aggressive acts

Impaired Social Interaction due to alienation from others secondary to aggressive acts

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? Risk for injury related to poor safety awareness Impaired social interaction due to aggressive behavior Impaired social interaction due to withdrawal Hopelessness related to separation from family

Impaired social interaction due to aggressive behavior

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? Family therapy Medication Group therapy Individualized behavior therapy

Individualized behavior therapy

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

The nurse has completed teaching sessions for parents about conduct disorder. Which of the following statements indicates a need for further teaching? "Being consistent with rules at home will probably be a real challenge for me and my child." "It helps to know that these problems will get better as my child gets older." "Real progress for our child is likely to take several weeks or even months." "We need to set up a system of rewards and consequences for our child's behaviors."

It helps to know that these problems will get better as my child gets older."

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? Identifying the consequence of the unacceptable behavior Giving the child a warning Labeling the behavior Instituting the time out

Labeling the behavior

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

Limit setting

Which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity? Intermittent explosive disorder Mild conduct disorder Oppositional defiance Disorder Moderate conduct disorder

Moderate conduct disorder

Which is the most commonly used treatment for oppositional defiant disorder? Pharmacologic treatment Parent training models of behavioral interventions Individual therapy "Boot camp"

Parent training models of behavioral interventions

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

Presence of comorbid psychiatric disorders

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use? Provide consistent consequences for behaviors. Set earlier curfews than the child's peers adhere to. Release the child from household responsibilities until he can demonstrate dependable behavior. Avoid discussing feelings and expectations with the child.

Provide consistent consequences for behaviors.

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? Remind the client about the behavior contract. Take the client into a quiet area for a therapy session. Encourage the client to log the event in a diary. Role-model how to be social during meals.

Remind the client about the behavior contract.

When presenting information about conduct disorders to a community group, the nurse is asked, "which is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?" Which would be the most appropriate reply by the nurse? The acute care setting School Residential treatment settings Jail-diversion program

Residential treatment settings

A 13-year-old boy who has been diagnosed with oppositional defiant disorder has taunted the nurse when she bent over to pick something up and mocked her weight. How should then nurse respond? Say, "How would you like it if someone said that to you?" Pretend not to hear the boy and leave the room. Say, "That makes me feel embarrassed and I don't appreciate it." Say, "That's not an acceptable thing to say."

Say, "That's not an acceptable thing to say."

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 appropriate conversation and social skills. Teach the client about limit setting and the need for limits. Teach the client the problem-solving process. Encourage the client to discuss thoughts and feelings.

Teach the client about limit setting and the need for limits.

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

The adolescent has lots of tattoos and body piercings.

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 adolescent may have been abused in childhood. The parents may have been pampering the adolescent too much. The parents may have not taught appropriate behavior to the adolescent. The adolescent may have limited sensitivity to reward and punishment.

The adolescent may have limited sensitivity to reward and punishment.

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 has poor social behavior. The adolescent's behavior poses a danger to others. The adolescent is experiencing disturbances in concentration. The adolescent is depressed because of the inappropriate behavior.

The adolescent's behavior poses a danger to others.

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 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 given psychotropic drugs. The child can be managed if admitted to a juvenile home.

The child can be managed if the parents modify their own behavior.

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 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 pushed over a chair during the session.

The client only stares at the nurse when asked how the client is doing today.

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 prefers stealing money over working for it. The client feels that depression and anxiety would interfere with working.

The client prefers stealing money over working for it.

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

The disorder is difficult to detect and treat.

A nurse is counseling the parents of a child with oppositional defiant disorder (ODD). What does the nurse advise the parents for dealing with the maladaptive behavior of their child? The parents should take the child to a psychotherapist. The parents should scold their child. The parents should explain to the child the inappropriateness of the behavior. The parents should ignore the child's behavior.

The parents should ignore the child's behavior.

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? Risk of developing seizures The presence of aggression Predisposition to kleptomania Difficulty with decision-making skills

The presence of aggression

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 client has a chronic medical condition. The sibling of the client has conduct disorder. The adolescent loves to play with pets.

The sibling of the client has conduct disorder.

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 Threatening the nurse Unwilling to talk to the nurse Refusing to perform a daily chore

Threatening the nurse

Which is true of the time-out strategy that may be used for persons with conduct disorder? It is a punishment. It should only be used as a last resort. Eventually, the goal is for the client to avoid time-out. Time-out is retreat to a neutral place, so clients can regain self-control.

Time-out is retreat to a neutral place, so clients can regain self-control.

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 ensure safety of others. 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.

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

To help identify feelings.

The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time? Review effective disciplinary practices with the parents again. Refer the parents to a family therapist. Try to remember that the parents are trying to the best of their ability to carry out the suggestions. Explore alternative living arrangements for the child.

Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

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. Provide reassurance that frequent sexual activity is normal in adolescence. Tell the adolescent to go to their room as a consequence for using profanity. Act as the adolescent's advocate at school when the client is disruptive.

Use 'I' language and express an emotion when setting limits.

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? Truancy Verbal bullying Cruelty to animals Attempted robbery

Verbal bullying

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

What type of discipline do you use at home?"

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 cognitive impairment kleptomania attention deficit hyperactivity disorder

attention deficit hyperactivity disorder

A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention? increasing treatment compliance improving coping skills and self-esteem promoting social interaction providing client education

improving coping skills and self-esteem

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? intermittent explosive disorder conduct disorder oppositional defiant disorder pyromania

intermittent explosive disorder

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? intermittent explosive disorder pyromania internalizing behavior kleptomania

kleptomania

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 mild conduct problems severe conduct disorder does not meet criteria for conduct disorder

moderate conduct disorder

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

personal values regarding child rearing

When providing education to a client with intermittent explosive disorder, the nurse explains that antidepressant medications can be effective in the treatment of the condition because they: promote balancing of serotonin. can replace the need for cognitive behavioral therapy. help to improve loss of appetite. provide sedation during explosive episodes.

promote balancing of serotonin.