Ch. 23 - Disruptive Behavior Disorders

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

and are formulating a collaborative plan. The child is experiencing signs of which disorder?

A. Oppositional defiant disorder

B. Asperger syndrome

C. Attention-deficit/hyperactivity disorder

D. Conduct disorder

D. Conduct disorder

An adolescent is displaying behaviors associated with conduct disorder such as stealing, fighting, skipping school, and not adhering to the rules at home. Which factor(s) stated by the client does the nurse correlate with the behaviors exhibited by the adolescent? Select all that apply.

A. "Our family is dysfunctional and no one gets along."

B. "My parents are strict and set firm limits."

C. "My parents are into drugs and alcohol."

D. "If I don't do what my parent says, I get beaten."

E. "We live in a rundown apartment on a bad side of town."

A. "Our family is dysfunctional and no one gets along."

C. "My parents are into drugs and alcohol."

D. "If I don't do what my parent says, I get beaten."

E. "We live in a rundown apartment on a bad side of town."

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?

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

B. "Stop what you are doing. Go to your room."

C. "I would appreciate if you would not do that."

D. "Why do you do these things?"

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

Parents bring their child to the clinic and state to the nurse, "We just don't know what to do anymore. It must be a medical disorder because our child has never been in trouble or acted this way. They are lying, stealing, and destroying property." Which is likely to be the most effective intervention for this adolescent?

A. Placing the child in a "boot camp"

B. Parenteral education about discipline

C. Incarceration into the penal system

D. Prevention and early intervention

D. Prevention and early intervention

A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today and states that "Yesterday, the other nurse told them they didn't have to go to class if they didn't want to." Which is the best response by the nurse?

A. "Fine, but you're confined to your room and not allowed to socialize."

B. "You are obligated to attend class. Missing class is against the rules."

C. "You and I both know that the nurse didn't say that."

D. "Why do you keep fighting the system, just go along with the rules."

B. "You are obligated to attend class. Missing class is against the rules."

The nurse is meeting with the family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child manage problematic behaviors. Which parenting technique will the nurse educate the parents to use?

A. Provide consistent consequences for behaviors.

B. Set earlier curfews than the child's peers adhere to.

C. Release the child from household responsibilities until they are dependable.

D. Avoid discussing feelings and expectations with the child.

A. Provide consistent consequences for behaviors.

The nurse is educating a pregnant client about prenatal care and the potential for decreasing the risk for conduct disorder. The client presently has a child with a conduct disorder and is concerned that this will happen again. Which statement made by the client indicates further education is required?

A. "As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

B. "I should be sure to be adherent to my prescribed prenatal vitamins and folic acid."

C. "Prenatal care is important and I will attend all of my visits routinely.

D. "There are several factors that are involved for a child to develop a conduct disorder."

A. "As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

The nurse is admitting an adolescent client with a conduct disorder to an inpatient facility. Which will the nurse discuss with the client that will be enforced throughout the stay related to limit setting? Select all that apply.

A. State the expected behavior of the client in the facility.

B. Inform the client about the rules or limits.

C. Inform the client they will be incarcerated for nonadherence to the rules.

D. Explain the consequences if clients exceed the limit.

E. Occasionally limit enforcement but allow some freedoms.

A. State the expected behavior of the client in the facility.

B. Inform the client about the rules or limits.

D. Explain the consequences if clients exceed the limit.

An adolescent is exhibiting out-of-control behavior and yelling and threatening another person on the behavioral health unit. Which is the priority action by the nurse and health care team?

A. Inform the adolescent they will be placed isolation.

B. Notify the police that the client is out of control.

C. Place the adolescent in restraints.

D. Institute a time-out.

D. Institute a time-out.

The nurse is talking with the parents of a child with disruptive behavior disorder about ways to help the child manage behaviors. Which action is best for the nurse advocate for the child to have their needs met?

A. Support transferring the child to a healthy living environment.

B. Teach the parents age-appropriate expectations of the child.

C. Reinforce the parents' expectations of the child's behavior.

D. Interpret the child's thoughts and feelings to the parent.

B. Teach the parents age-appropriate expectations of the child.

The nurse is assessing an adolescent client. The parent is in the room and answers most of the questions, even though the questions are directed at the client. Which action(s) from the parents of a child with conduct disorders does the nurse identify may be a contributing factor to the behaviors? Select all that apply.

A. The parents may not behave appropriately because of a lack of knowledge.

B. The parents blame the school when the child causes a disturbance in school.

C. The parents engage in yelling at, hitting, or simply ignoring the behavior of the child.

D. The parents make reasonable curfews that are age appropriate.

E. The parents establish household responsibilities that are age appropriate.

A. The parents may not behave appropriately because of a lack of knowledge.

B. The parents blame the school when the child causes a disturbance in school.

C. The parents engage in yelling at, hitting, or simply ignoring the behavior of the child.

The nurse is presenting information about conduct disorders to a community group. Which recommendation will the nurse provide that is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision?

A. An acute care setting

B. School

C. Residential treatment settings

D. Jail-diversion program

C. Residential treatment settings

Parents of a child who has behavioral problems ask the nurse which is the most effective way to deal with these behaviors and prevent them in their other children. Which is the best response by the nurse?

A. Administering medications

B. Adopting more of a relaxed limit setting strategy

C. Attending group-based parenting classes

D. Being overprotective of the child

C. Attending group-based parenting classes

The adolescent client is exhibiting "bullying behaviors." Which may be concern(s) that a nurse has when caring for clients who have conduct disorders? Select all that apply.

A. Believing that the client should be able to refrain from hostility and aggression through use of will power

B. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude

C. Discussing feelings, fears, or frustrations with colleagues

D. Having anxiety and fears for the nurse's personal safety

E. Believing that aggression is the most productive way to deal with anger

A. Believing that the client should be able to refrain from hostility and aggression through use of will power

B. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude

D. Having anxiety and fears for the nurse's personal safety

The nurse is working with clients who have disruptive behavior disorders. Which are important point(s) for the nurse to consider when working with these clients and their families? Select all that apply.

A. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods.

B. Remember to focus on the client's strengths and assets, as well as their problems.

C. Transient conduct disorders are common in all children.

D. Avoid a "blaming" attitude toward clients and/or families.

E. Focus on positive actions to improve situations and/or behaviors.

B. Remember to focus on the client's strengths and assets, as well as their problems.

D. Avoid a "blaming" attitude toward clients and/or families.

E. Focus on positive actions to improve situations and/or behaviors.

The nurse is considering switching to another area of nursing due to feelings of stress prior to going to work. Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues?

A. To make the nurse feel better about working in the area and avoid burnout

B. To encourage camaraderie between colleagues and to provide the same treatment to the children

C. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression

D. To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders

C. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression

After being arrested for prostitution, an adolescent client has been referred to a mental health clinic by a juvenile officer. The client has a history of truancy and being physically abusive to siblings. From the history gathered during assessment, the nurse identifies that these behaviors correlate with which disorder?

A. Intermittent explosive disorder

B. Oppositional disorder

C. Conduct disorder

D. Childhood depressive disorder

C. Conduct disorder

A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities and was observed pushing another client. Which action by the nurse is the most therapeutic?

A. Neutrally permitting refusals

B. Coaxing to gain compliance

C. Offering rewards in advance

D. Establishing firm limits

D. Establishing firm limits

A preadolescent client has been considered a neighborhood bully for several years. Peers avoid them, and the parent says, "I cannot believe a thing my child tells me." 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?

A. Conduct disorder

B. Oppositional defiant disorder

C. Pyromania

D. Defiance of authority

A. Conduct disorder

When a young client is disruptive, the nurse responds, "You must take a time-out." Which is the priority outcome for intervention with a time-out?

A. The client will have increased socialization.

B. The client will develop adequate coping skills.

C. The client will understand the consequences of poor behavior.

D. The client will identify signs of increasing agitation.

D. The client will identify signs of increasing agitation.

The nurse is working with an aggressive adolescent with behavioral disorder, and the client has been resistant to the treatment plan. Which action can the nurse take to keep the negative emotions from interfering with a positive outcome for the client?

A. Have another nurse care for the client to refrain from showing bias.

B. Discuss feelings, fears, and frustrations with colleagues regarding the client.

C. Inform the client that their behaviors are causing frustration and anger.

D. Consider another area of nursing since this is likely to continue to happen.

D. Consider another area of nursing since this is likely to continue to happen.

The nurse is performing an assessment for a 14-year-old client whose parents are concerned with recent behaviors exhibited by the adolescent. Which statement(s) by the client in the interview portion of the assessment does the nurse identify as typical adolescent behaviors? Select all that apply.

A. Consistent and predictable behaviors

B. Lacks caring about peer approval

C. Inability to postpone gratification

D. Verbally aggressive with parents

E. Critical of self and others

D. Verbally aggressive with parents

E. Critical of self and others

The nurse is talking with an adolescent client who has been externalizing behaviors indicating a conduct disorder. Which client statement(s) indicate that externalizing behaviors are being experienced?

A. "I got caught cheating on an exam. I cheat all of the time, why should I study?"

B. "I set fire to a trash can on school property when I threw my cigarette in it."

C. "When I get dropped off at school, I skip and go drink with my friends."

D. "My stomach hurts and I feel nauseated all of the time."

E. "I'm always tired and sleepy. Just don't feel like going anywhere or doing things."

A. "I got caught cheating on an exam. I cheat all of the time, why should I study?"

B. "I set fire to a trash can on school property when I threw my cigarette in it."

C. "When I get dropped off at school, I skip and go drink with my friends."

The nurse is performing a family assessment to determine why an adolescent is engaging in risky behaviors. The parent states, "I just don't understand why my child would want to drink alcohol when my spouse is an alcoholic and has had several DUI's as well as being abusive to the children and I." Which is the best response by the nurse?

A. "If the spouse doesn't know right from wrong, how can you expect the child to behave any differently?"

B. "Parents that engage in risky behaviors are more likely to have children that engage in these behaviors."

C. "I realize this is unusual behavior because you would think the child would not want to repeat those behaviors."

D. "You never know what type of things children will pick up. You have to be the best parent for you and your spouse."

B. "Parents that engage in risky behaviors are more likely to have children that engage in these behaviors."

The nurse is having a group activity in the day room with adolescent clients with behavioral issues. One of the clients becomes angry and picks up someone else's project and throws it on the floor, breaking it. Which response by the nurse is most appropriate?

A. "If you can't behave when we are trying to have an activity, you won't be able to participate."

B. "I am so frustrated with you and the way you always have to have your way."

C. "Did it make you feel better to hurt your peers' feelings and destroy their hard work?"

D. "Throwing things is unacceptable behavior. Tell me why you are upset and let's talk about it."

D. "Throwing things is unacceptable behavior. Tell me why you are upset and let's talk about it."