NR 242 Impulse Control Disorders

MULTIPLE CHOICE 1. A 16-year-old diagnosed with a conduct disorder has been in a residential program for 3 months. Which outcome should occur before discharge? a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences. b. The adolescent identifies friends in the home community who are a positive influence. c. Temporary placement is arranged with a foster family until the parents complete a parenting skills class. d. The adolescent experiences no anger and frustration for 1 week. ANS: A The adolescent and the parents must agree on a behavioral contract that clearly outlines rules, expected behaviors, and consequences for misbehavior. It must also include rewards for following the rules. The adolescent will continue to experience anger and frustration. The adolescent and parents must continue with family therapy to work on boundary and communication issues. It is not necessary to separate the adolescent from the family to work on these issues. Separation is detrimental to the healing process. While it is helpful for the adolescent to identify peers who are a positive influence, it’s more important for behavior to be managed for an adolescent diagnosed with a conduct disorder. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 406 (Table 21-2) | Page 408 (Box 21-1) | Page 409 TOP: Nursing Process: Outcomes Identification MSC: Client Needs: Psychosocial Integrity 2. A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the court, “We can’t manage our teenager.” The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent’s behavior? a. Attention deficit hyperactivity disorder (ADHD) b. Posttraumatic stress disorder (PTSD) c. Intermittent explosive disorder d. Conduct disorder ANS: D Conduct disorders are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. Criteria for ADHD and PTSD are not met in the scenario. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 402-403 (Table 21-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity https://www.coursehero.com/file/12796660/ch21/ This study resource was shared via CourseHero.com 3. A 15-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which approach by nursing staff will be most therapeutic? a. Planned ignoring c. Neutrally permit refusals b. Establish firm limits d. Coaxing to gain compliance ANS: B Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teen’s thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, ignoring, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 406-408 (Box 21-1) | Page 409 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 4. An adolescent was arrested for prostitution and assault on a parent. The adolescent says, “I hate my parents. They focus all attention on my brother, who’s perfect in their eyes.” Which type of therapy might promote the greatest change in the adolescent’s behavior? a. Family therapy c. Play therapy b. Bibliotherapy d. Art therapy ANS: A Family therapy focuses on problematic family relationships and interactions. The patient has identified problems within the family. Play therapy is more appropriate for younger patients. Art therapy and bibliotherapy would not focus specifically on the identified problem. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 407 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 5. An adolescent was arrested for prostitution and assault on a parent. The adolescent says, “I hate my parents. They focus all attention on my brother, who’s perfect in their eyes.” Which nursing diagnosis is most applicable? a. Disturbed personal identity related to acting out as evidenced by prostitution b. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out d. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another ANS: C The patient demonstrates a failure to follow age-appropriate social norms and an inability to problem solve by using adaptive behaviors to meet life’s demands and roles. The defining characteristics are not present for the other nursing diagnoses. The patient never mentioned hopelessness or disturbed personal identity. The problem relates to the patient’s perceptions of parental behavior rather than the actual behavior. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 406 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity https://www.coursehero.com/file/12796660/ch21/ This study resource was shared via CourseHero.com 6. A 12-year-old has engaged in bullying for several years. The parents say, “We can’t believe anything our child says.” Recently this child shot a dog with a pellet gun and set fire to a neighbor’s trash bin. The child’s behaviors support the diagnosis of: a. attention deficit hyperactivity disorder. b. intermittent explosive disorder. c. defiance of authority. d. conduct disorder. ANS: D The behaviors mentioned are most consistent with criteria for conduct disorder, for example, aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The behaviors are not consistent with attention deficit and are more pervasive than defiance of authority. See related audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 401-403 (Table 21-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. a. Ignore the child’s behavior. b. Send the child to time-out. c. Accompany the child to the gym and shoot baskets. d. Role-play a more appropriate behavior with the child. ANS: C The child’s behavior warrants an active response. Redirecting the expression of feelings into nondestructive age-appropriate behaviors, such as a physical activity, helps defuse the situation here and now. This response helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative and should be tried before resorting to a more restrictive measure. Role-playing is appropriate after the child’s anger is defused. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 406-408 (Box 21-1) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 8. An adolescent acts out in disruptive ways. When this adolescent threatens to throw a pool ball at another adolescent, which comment by the nurse would set appropriate limits? a. “Attention everyone: we are all going to the craft room.” b. “You will be taken to seclusion if you throw that ball.” c. “Do not throw the ball. Put it back on the pool table.” d. “Please do not lose control of your emotions.” ANS: C https://www.coursehero.com/file/12796660/ch21/ This study resource was shared via CourseHero.com Setting limits uses clear, sharp statements about prohibited behavior and guidance for performing a behavior that is expected. The incorrect options represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child’s developing self-control that may be ineffective. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 406-408 (Box 21-1) | Page 409 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 9. The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which aspect of the child’s plan of care will be provided by an advanced practice nurse rather than a staff nurse? a. Leading an activity group c. Formulating nursing diagnoses b. Providing positive feedback d. Dialectical behavioral therapy (DBT) ANS: D The advanced practice nurse role includes individual, group, and family psychotherapist; educator of nurses, other professions, and the community; clinical supervisor; consultant to professional and nonprofessional groups; and researcher. Dialectical behavioral therapy (DBT) is an aspect of psychotherapy. The distracters describe actions of a nurse generalist. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 408-409 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. Shortly after the parents announced that they were divorcing, a 15-year-old became truant from school and assaulted a friend. The adolescent told the school nurse, “I’d rather stay in my room and listen to music. It’s easier than thinking about what is happening in my family.” Which nursing diagnosis is most applicable? a. Chronic low self-esteem related to role within the family b. Decisional conflict related to compliance with school requirements c. Ineffective coping related to adjustment to changes in family relationships d. Disturbed personal identity related to self-perceptions of changing family dynamics ANS: C Depression is often associated with impulse control disorder. The correct nursing diagnosis refers to the patient’s dysfunctional management of feelings associated with upcoming changes to the family. The teen displays self-imposed isolation. The distracters are not supported by data in the scenario. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 403-404 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity 11. A child known as the neighborhood bully says, “Nobody can tell me what to do.” After receiving a poor grade on a science project, this child secretly loaded a virus on the teacher’s computer. These behaviors support a diagnosis of: a. conduct disorder. b. oppositional defiant disorder. c. intermittent explosive disorder. https://www.coursehero.com/file/12796660/ch21/ This study resource was shared via CourseHero.com d. attention deficit hyperactivity disorder. ANS: B Oppositional defiant disorder is a repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. Loading a virus is a vindictive behavior in retribution for a poor grade. Persons with conduct disorder are aggressive against people and animals; destroy property; are deceitful; violate rules; and have impaired social, academic, or occupational functioning. There is no evidence of explosiveness or distractibility. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 401 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the nurse’s initial action to defuse the situation? a. Say to the child, “Tell me how you’re feeling right now.” b. Take the child swimming at the program’s pool. c. Establish a behavioral contract with the child. d. Administer an anxiolytic medication. ANS: B Redirecting the expression of feelings into nondestructive, age-appropriate behaviors such as a physical activity helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative and should be tried before resorting to measures that are more restrictive. A shouting child will not likely engage in a discussion about feelings. A behavioral contract could be considered later, but first the situation must be defused. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 407-408 (Box 21-1) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 13. Parents of an adolescent diagnosed with a conduct disorder say, “We don’t know how to respond when our child breaks the rules in our house. Is there any treatment that might help us?” Which therapy is likely to be helpful for these parents? a. Parent-child interaction therapy (PCIT) b. Behavior modification therapy c. Multi-systemic therapy (MST) d. Pharmacotherapy ANS: A In parent-child interaction therapy (PCIT), the therapist sits behind one-way mirrors and coaches parents through an ear audio device while they interact with their children. The therapist can suggest strategies that reinforce positive behavior in the adolescent. The goal is to improve parenting strategies and thereby reduce problematic behavior. Behavior modification therapy may help the adolescent, but the parents are seeking help for themselves. Multi-systemic therapy is much broader and does not target the parents’ need. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 409 TOP: Nursing Process: Implementation