Chapter 23: Disruptive Behavior Disorders; PrepU

When assessing children, the nurse needs to ask more of which type of question compared with assessment of adults?

Closed ended Children think in more concrete terms; thus, the nurse needs to ask more specific and fewer open-ended questions than would typically be asked of adults.

Which nursing interventions are focused on promoting safety and compliance when working with a child diagnosed with a conduct disorder? Select all that apply.

• All staff consult the care plan when determining interventions. • The agreed upon routine is adhered to by all staff members • Time-out is implemented when limits are not respected.

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.

• Strategies for anger management • Strategies to avoid alcohol and substance use • Relaxation techniques 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 IED are unlikely to have pain or diet-related problems, therefore, these need not be taught to the client. (less)

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 behave disrespectfully to the nurse. • The adolescent may make derogatory comments about his parents and teachers. 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 healthcare 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 adolescent 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. (less)

Which of the following would be the most appropriate intervention for an adolescent who is manipulative and exhibiting aggressive behaviors?

Limit setting 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.

Which of the following children is most likely to be diagnosed with oppositional defiant disorder or conduct disorder?

An 11-year-old boy who was caught breaking into a home to steal money Crime is a common manifestation of oppositional defiant disorder and conduct disorder. High-risk sexual behavior may accompany the disorders but is not diagnostic. Tics and verbal outbursts are characteristic of Tourette's syndrome. Difficulty in relating to others is characteristic of autism spectrum disorders. (less)

A 16 year old male client is highly disruptive in class and has been in trouble at home. His mother recently found him torturing a cat. When she questioned him about how he could hurt an animal, he laughed at her. Which of the following conditions will the client most likely be diagnosed with?

Conduct disorder Adolescents with conduct disorder are often unmanageable at home and disruptive in the community. They have little empathy or concern for others. They may be callous and lack appropriate feelings of guilt, although they may express remorse superficially to avoid punishment. They often blame others for their actions. Risk-taking behaviors such as drinking, smoking, using illegal substances, experimenting with sex, and participating in crime are typical. Cruelty to animals or people, destruction of property, theft, and serious violation of rules are diagnostic criteria. (less)

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?

Impaired social interaction due to aggressive behavior 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. (less)

A nurse is assessing a 15-year-old adolescent with conduct disorder. Which appearance might the nurse see in the adolescent?

The adolescent has lots of tattoos and body piercings. 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. (less)

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 prefers stealing money over working for it. 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 he 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. (less)

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 Verbal bullying is an example of a behavior seen 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. (less)

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?

attention deficit hyperactivity disorder 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. (less)

A pre-teen client has been considered a neighborhood bully for several years. Peers avoid him, and the mother says she cannot believe a thing he tells her. Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first time. A nurse would assess these behaviors as being most consistent with which disorder?

conduct disorder Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These clients have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules. This is an example of moderate conduct. Moderate: The number of conduct problems increases as does the amount of harm to others. Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. The behaviors are more pervasive than defiance of authority. To suffer from pyromania is more than one incidence of setting a fire. (less)

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?

increased blood pressure It has been postulated that intermittent explosive disorder is correlated with adverse physical outcomes such as coronary artery disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headache and other forms of chronic pain. (less)

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?

"I want to continue to work with you but I don't accept the language you have chosen." Clients with conduct disorder frequently experience rejection. The client needs support to increase self-esteem while understanding that behavioral changes are necessary. When working with a client diagnosed with conduct disorder, the client needs to be made aware that he or she is an accepted person although a particular behavior may not be acceptable. Telling the client that "now is not a good time" may be perceived by the client as rejection. An opportunity to discuss behavioral change may be lost if the session does not continue. In this scenario, it is evident that the adolescent is attempting to mask low self-esteem by acting tough. Telling the adolescent that the work cannot begin until he or she is invested in it would indicate the nurse has not acknowledged this feature of the disorder. Voicing fear that the client may act out communicates mistrust to the client and can hinder the development of a therapeutic relationship. (less)

The nurse is counseling a family with a child who has been abused by an adult family friend in the past. When explaining the child's needs to the family, which of the following would be most important for the nurse to stress?

A supportive relationship with an adult A major protective factor against psychopathology stemming from abuse and neglect is the establishment of a supportive relationship with at least one adult who can provide empathy, consistency, and possibly a corrective experience. Long-term psychotherapy and antidepressant medication may or may not be appropriate. Short-term parental separation would be unlikely because the abuser was a family friend, not a parent. (less)

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 can be perpetuated at school 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. (less)

Which of the following childhood disorders is characterized by serious violations of social norms, such as destruction of property?

Conduct disorder 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. (less)

The nurse uses the technique of timeout for a client with conduct disorder. Which problem demonstrated by the client would have led the nurse to use this intervention?

Threatening the nurse Timeout 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. (less)

A 15-year-old client with intermittent explosive disorder gives no history of childhood abuse, neglect, or maltreatment. What could be the cause of the disorder in this client?

Imbalance in the production of serotonin Childhood abuse, neglect, or maltreatment is often the cause of intermittent explosive disorder (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. (less)

A client is diagnosed with oppositional defiant disorder (ODD). Which assessment finding would indicate that the client needs medications?

Presence of comorbid psychiatric disorders 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. (less)

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, "That's not an acceptable thing to say." A direct, matter-of-fact approach to hostile or inappropriate behavior is beneficial when engaging with adolescents.

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. 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. (less)

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 parent's voiced loss of hope?

The adolescent may have limited sensitivity to reward and punishment. The most likely reason for the parent's sense of loss of control and hope with their adolescents 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 inadvertently reinforced in the home. (less)

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 only stares at the nurse when asked how the client is doing today. 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. (less)

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 ignore the child's behavior. Parental behavioral interventions are the mainstay of therapy for adolescents with ODD. Parents are instructed to ignore maladaptive behaviors instead of giving the behaviors negative attention. Positive behaviors should be rewarded with praise and reinforcers. The parents are asked not to deal with their child in a negative way, such as scolding or punishing. The child most likely will not require the help of a psychotherapist. The child may not be able to understand the inappropriateness of his or her behavior. (less)

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 conduct disorder. Most children with conduct disorder have siblings with the same psychiatric disorder. Although it is possible to develop CD 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. (less)

For which of the following reasons would a nurse ask an adolescent client with conduct disorder to maintain a diary?

To help identify her feelings. 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 timeout to address these challenges. (less)

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?

improving coping skills and self-esteem Nursing interventions for conduct disorder include teaching and practicing problem-solving skills. In this scenario, the nurse is asking the client to reflect on the situation in order find healthier, adaptive solutions. Teaching and practicing problem-solving skills is aimed at the ultimate goal of improving coping skills and self-esteem for clients with conduct disorder. (less)

Which behaviors should the nurse anticipate in children with mild conduct disorder? Select all that apply.

• Repeated lying • Minor shoplifting Repeated lying and minor shoplifting are examples of the mild form of conduct disorder. Behaviors such as conning people and drinking alcohol are seen with moderate forms of conduct disorder. Cruelty to classmates is seen with the severe form of conduct disorder. (less)

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 tell me more about what you are having difficulty with." 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. (less)

A nurse is providing community education regarding adolescents with oppositional defiance disorder (ODD). Which point should the nurse include in the educational session?

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

A physician in an outpatient clinic has prescribed fluoxetine (Prozac) to a client with intermittent explosive disorder. What should the nurse include in teaching about this medication?

Emphasize the need to seek medical help if suicidal thoughts arise. Selective serotonin re-uptake inhibitor antidepressant medications may increase the risk of suicidal thinking and behavior in some children and adolescents. Close monitoring of suicidal thinking is warranted for the first four weeks of treatment with this medication. Drowsiness is a common and nonthreatening side effect of this medication that can last for up to four weeks after treatment is initiated. The client should be told to expect this side effect but not to stop taking the medication because of it. Appetite loss is a side effect that is common in the first four weeks of treatment. It does not persist throughout treatment. Giving the client this information would be inaccurate. Sleep changes are common in the first four to six weeks of treatment with this medication. The client should be warned to expect this change rather than informing the client that it is not common. (less)

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone (Risperdol) by the primary healthcare provider. What would be the most likely reason for the healthcare provider to prescribe this drug to the client?

The adolescent's behavior poses a danger to others. Risperidone (Risperdol) 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. (less)

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. 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. (less)

When discussing a school-aged child's behavioral contract with the school staff, how should the nurse most effectively explain a time-out?

a retreat away to regain self-control A time-out is a retreat to a neutral place so clients can regain self-control. It is not a punishment, therefore it would be inaccurate to describe this technique as a consequence for unacceptable behavior. A time-out should not signal the end of the school day for the child. Instead, it should be an opportunity to practice emotional regulation in order to progressively gain the ability to tolerate the school environment in a nondisruptive way. A time-out is not moving the child to sit with a different group of peers. In order for this technique to be effective, there must be little or no external stimulus as this may prevent the child's ability to regain self-control. (less)

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 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. (less)

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 is constantly involved in activities resulting in damage to school property • A student who always uses abusive language while speaking to teachers 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. (less)

A nurse suspects that a child has oppositional defiant disorder. When reviewing the child's history, which of the following would support this suspicion? Select all that apply.

• Blaming others for problems • Angry outbursts • Disobedience Oppositional defiant disorder is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Children with oppositional defiant disorder have trouble making friends and often find themselves in conflict with adults. Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. (less)

A 14-year-old client's behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has (Select all that apply.)

• 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 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. (less)

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.

• Effective parenting skills • Skills to improve peer relationships • Skills to improve academic performance 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. (less)

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.)

• 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. (less)

An adolescent was expelled from school for being extremely verbally abusive to female students in the classroom. What other behavioral abnormalities does the nurse expect to find in this adolescent? Select all that apply.

• Low self-esteem • Emotional instablity • Frequent temper outbursts Abusing female students in class is indicative of conduct disorder. Children with conduct disorder have low self-esteem and frequently lose their temper. Such children show no guilt or remorse for their behavior. Therefore, they are unlikely to have anxiety or depression. Children with conduct disorder are known to be unemotional, thus they cannot behave in an emotionally unstable way. (less)

When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply.

• Set clear limits with consequences • Keep to regular routines • Maintain a calm environment Interventions that can help the parents of a child with ADHD include: setting clear limits with clear consequences, using few words and simplifying instructions; establishing and maintaining a predictable environment with clear rules and regular routines for eating, sleeping, and playing; promoting attention by maintaining a calm environment with few stimuli; establishing eye contact before giving directions and asking the child to repeat what was heard; encouraging the child to do homework in a quiet place outside of a traffic pattern; and assisting the child to work on one assignment at a time (reward with a break after each completion). (less)

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.

• Temperament of the adolescent • Peer group of the adolescent • Behavior of parents 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. (less)

A nurse is reassessing a 6-year-old client with oppositional defiant disorder (ODD). Which findings would suggest that the patient is at a high risk of developing conduct disorder? Select all that apply.

• The client has developed new psychiatric symptoms. • The client has become more aggressive since the last assessment. • The client has developed symptoms of ODD at a very young age. Development of co-morbid psychiatric disorders, age of onset (younger the age worse the prognosis), increased severity of symptoms are factors that determine the prognosis of the ODD and the development of conduct disorder. Becoming more playful and talkative are normal changes related to age. These changes do not indicate the susceptibility of the child to develop conduct disorder. (less)

A nurse is developing a plan of care for a client with conduct disorder. Which of the following would be treatment outcomes for this client? Select all that apply.

• The client will not hurt others or damage property. • The client will engage in socially acceptable behavior. • The client will learn effective problem-solving skills. If a client undergoes successful treatment, he or she should be able to behave in a socially acceptable manner, display appropriate problem-solving skills, 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. (less)