Chapter 21 Impulse Control Disorders

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.

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?

conduct disorder

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?

b. Establish firm limits

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?

family therapy

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?

c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out

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:

d. conduct disorder.

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.

c. Accompany the child to the gym and shoot baskets.

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?

c. "Do not throw the ball. Put it back on the pool table."

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?

d. Dialectical behavioral therapy (DBT)

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?

c. Ineffective coping related to adjustment to changes in family relationships

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:

b. oppositional defiant disorder.

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?

b. Take the child swimming at the program's pool.

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)

An adolescent diagnosed with an impulse control disorder said, "I just want to die. I spend all my time getting even with people who have done wrong to me." When asked about a suicide plan, the adolescent replied, "I'll jump from the bridge near my home. My father threw kittens off that bridge, and they died because they couldn't swim." Rate the suicide risk.

high

An adolescent diagnosed with conduct disorder has aggression, impulsivity, hyperactivity, and mood symptoms. The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care provider will prescribe which type of medication?

a. Second-generation antipsychotic

An adolescent was recently diagnosed with oppositional defiant disorder. The parents say to the nurse, "Isn't there some medication that will help with this problem?" Select the nurse's best response.

c. "Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use."

An adolescent diagnosed with a conduct disorder stole and wrecked a neighbor's motorcycle. Afterward, the adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous system best explains the adolescent's reaction?

c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy.

Which assessment findings support a diagnosis of oppositional defiant disorder?

a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior.

Select all that apply.

A nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old. An impulse control disorder is suspected. Which aspects of the patient's history support the suspected diagnosis?

a. Family history of mental illness

d. Father with history of alcohol abuse

e. History of an abusive relationship with one parent

Select all that apply.

What are the primary distinguishing factors between the behavior of persons diagnosed with oppositional defiant disorder (ODD) and those with conduct disorder (CD)? The person diagnosed with:

a. ODD relives traumatic events by acting them out.

b. ODD tests limits and disobeys authority figures.

c. ODD has difficulty separating from loved ones.

d. CD uses stereotypical or repetitive language.

e. CD often violates the rights of others.

b. ODD tests limits and disobeys authority figures.

e. CD often violates the rights of others.

Select all that apply.

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Establishing rapport with this adolescent is a priority because:

b. a therapeutic alliance is the first step in a nurse's therapeutic use of self.

d. acceptance and trust convey feelings of security for the adolescent.