Chapter 21 - Impulse Control Disorders
Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder? A 9-year-old male who smokes half a pack of cigarettes a day A 9-year-old female who engages in sexually provocative behaviors A 12-year-old male who steals a bicycle as a gang initiation A 12-year-old female who regularly bullies her younger siblings
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.
Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults? Sadness Callousness Remorse Guilt
Callousness Callousness may be a predictor of future antisocial personality disorder in adults. The remaining options would indicate a degree of empathy not observed in a client who is demonstrating antisocial tendencies.
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 focus on what client need? Client centered and includes the client's input Family centered and long term in nature Age appropriate and achievable in a short period of time Simple and easily defined
Client centered and includes 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. While the other options may be appropriate, they are not the priority.
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 which diagnosis? Oppositional defiant disorder Conduct disorder Attention deficit hyperactivity disorder (ADHD) Social phobia
Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type.
Which comorbid conditions are commonly associated with oppositional defiant disorder? (Select all that apply.) Select all that apply. Depression Conversion disorder Substance abuse Attention deficit hyperactivity disorder (ADHD) Anxiety
Depression Attention deficit hyperactivity disorder (ADHD) Anxiety
A client diagnosed with conduct disorder craves what experience? 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. None of the other options demonstrates a need associated with conduct disorder.
A 17-year-old client is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this client? Maintains self-control during hospitalization Expresses feelings Mother will improve communication skills to interact with Eli. Engages in appropriate coping skills to manage stressors
Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the client to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the client are being discussed, not outcomes for the client's mother.
Which statement is true about the characteristics of the oppositional defiant child? Girls display more blaming than do boys. The defiance is generally directed toward parents and siblings. These behaviors are a predictor of future mental health disorders. Arguing tends to be more prevalent in boys.
These behaviors are a predictor of future mental health disorders. Oppositional defiant disorder is often predictive of emotional disorders in young adulthood. None of the other statements are necessarily correct.
When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is demonstrating which characteristic? Depression Emotionally immature Anxiety Vindictiveness
Vindictiveness 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!" The description is not associated with any of the other options.
A poorly developed sense of empathy is thought to be the result of having what life experience? A family history of mental illness suffered head trauma at an early age a low serum testosterone level 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. Research does not support any of the other options.
Which of the following classifications of medication may be prescribed in intermittent explosive disorder? Psychostimulants Antianxiety agents such as benzodiazepines Anticonvulsants Monoamine oxidase (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.
As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder? Obsessive-compulsive disorder Antipersonality 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. Research does not support any of the other options.
Assessment for oppositional defiant disorder should include which interventions? Assessing the history, frequency, and triggers for violent outbursts Assessing issues that result in power struggles and triggers for 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 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.
When working with a client demonstrating impulse control disorders, which nursing interventions have initial priority? (Select all that apply.) Select all that apply. Establishing a therapeutic nurse-client relationship Setting and enforcing limits Confronting the client concerning the disruptive behavior Presenting appropriate expectations Providing a safe environment
Establishing a therapeutic nurse-client relationship Setting and enforcing limits Presenting appropriate expectations Providing a safe environment
Which nursing intervention is appropriate for the management of intermittent explosive disorder? Setting up loose boundaries so the client will feel relaxed Providing intensive family therapy Limiting decision-making opportunities to avoid frustration Establishing a trusting relationship with the client
Establishing a trusting relationship with the client Establishing rapport with the client 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 clients to make good decisions and reach goals should be given, not limited.
When treating impulse control disorders, psychodynamic psychotherapy is directed toward which goal? Helping the client replace the rage with acceptable alternative feelings Identifying the triggers of the rage Mastering relaxation techniques Teaching the client self-distracting techniques
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. None of the other options are considered goals of this form of therapy.
Which of the following statements are true regarding childhood-onset conduct disorder? (Select all that apply.) Select all that apply. It is characterized by disregard for the rights of others. It is more commonly diagnosed in males. It is usually outgrown by early adulthood. It is characterized by feelings of remorse and regret. Those with conduct disorder rationalize their aggressive behaviors. It is usually diagnosed in late teen years.
It is characterized by disregard for the rights of others. It is more commonly diagnosed in males. Those with conduct disorder rationalize their aggressive behaviors.
Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in what behavior? Self-mutilate Directing anger toward others Starting fires Stealing for thrill
Starting fires Pyromania is described as repeated, deliberate fire setting. This behavior does not include any of the other stated options.
