Ch 23- Disruptive Behavior Disorders

Ans: Conduct disorder

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 as the child is experiencing signs of which disorder?
A) Oppositional defiant disorder
B) Asperger's syndrome
C) Attention deficit hyperactivity disorder
D) Conduct disorder

Ans: Poor family functioning

Family history of substance abuse
D) Possible child abuse
E) Poverty conditions

A child has been displaying behaviors associated with conduct disorder. The nurse should further assess for which common risk factors seen in children with conduct disorder. Select all that apply.
A) Poor family functioning
B) Strict disciplinary practices
C) Family history of substance abuse
D) Possible child abuse
E) Poverty conditions

Ans:The episode may occur with seemingly no warning.
B) They usually last less than 30 minutes.

It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.

Which are characteristics of intermittent explosive disorder (IED)? Select all that apply.
A) The episode may occur with seemingly no warning.
B) They usually last less than 30 minutes.
C) Afterward, the person with IED will not have any remorse.
D) It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.
E) The intensity of the emotional outburst is usually within proportion to the stressor or situation.

Ans: Moderate conduct disorder

Which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity?
A) Intermittent explosive disorder
B) Mild conduct disorder
C) Oppositional defiance Disorder
D) Moderate conduct disorder

Ans: I can see that you're angry. Let's look at better ways to express it.î

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, ìI had a stomachache and felt like vomiting. I couldn't help it. I was just so mad at my dad.î Which would be the most appropriate response by the nurse?
A) ìI can see that you're angry. Let's look at better ways to express it.î
B) ìI can understand your anger, but you can't disrupt the classroom.î
C) ìIf you can get rid of your anger, perhaps your stomachache will go away.î
D) ìPerhaps it would be helpful if you let your dad know you're angry.î

Ans:That is not allowed here. You will lose a privilege. You need to stop.î

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) ìThat is not allowed here. You will lose a privilege. You need to stop.î
B) ìStop what you are doing. Go to your room.î
C) ìI would appreciate if you would not do that.î
D) ìWhy do you do these things?î

Ans: ìYelling at others is unacceptable. You need to let staff know you're upset.î

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse?
A) ìHow would you feel if someone yelled at you like that?î
B) ìWhat's the matter with you? Don't you know any better?î
C) ìYelling at others is unacceptable. You need to let staff know you're upset.î
D) ìYou're still having problems controlling your anger.î

Ans:Parent training models of behavioral interventions

Which is the most commonly used treatment for oppositional defiant disorder?
A) Pharmacologic treatment
B) Parent training models of behavioral interventions
C) Individual therapy
D) "Boot camp"

Ans: Early intervention

Which is likely to be most effective for adolescents with conduct disorder?
A) Involvement with the legal system
B) Focusing on the parenting education
C) Incarceration
D) Early intervention

Ans: ìMissing class is against the rules.î

A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse?
A) ìFine, but you're confined to your room.î
B) ìMissing class is against the rules.î
C) ìYou and I both know you're lying.î
D) ìWhy do you keep fighting the system?î

Ans: Provide consistent consequences for behaviors.

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage 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 he can demonstrate
dependable behavior.
D) Avoid discussing feelings and expectations with the child.

Ans: Disturbed relationships with peers,

Aggression toward people or animals
D) Destruction of property
E) Serious violation of rules

Which are most likely included in the history of a child with conduct disorder? Select all that apply.
A) Disturbed relationships with peers
B) Major antisocial violations
C) Aggression toward people or animals
D) Destruction of property
E) Serious violation of rules

Ans: State expected behavior.
B) Inform clients or the rule or limit..

Explain the consequences if clients exceed the limit.

Which steps are involved in limit setting? Select all that apply.
A) State expected behavior.
B) Inform clients or the rule or limit.
C) Threaten incarceration.
D) Explain the consequences if clients exceed the limit.
E) Occasionally limit enforcement.

Ans: Time-out is retreat to a neutral place, so clients can regain self-control.

Which is true of the time-out strategy that may be used for persons with conduct disorder?
A) It is a punishment.
B) It should only be used as a last resort.
C) Eventually, the goal is for the client to avoid time-out.
D) Time-out is retreat to a neutral place, so clients can regain self-control.

Ans:Teach the parents age-appropriate expectations of the child.

The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child?
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.

Ans: The parents may not behave appropriately themselves because of a lack of
knowledge.
B) The parents blame the school when the child causes a disturbance in school and
receives detention.
C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their
child..

Which are actions of the parents of a child with conduct disorders that may contribute to the problems of the child? Select all that apply.
A) The parents may not behave appropriately themselves because of a lack of
knowledge.
B) The parents blame the school when the child causes a disturbance in school and
receives detention.
C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their
child.
D) The parents make reasonable curfews that are appropriate for the age of the client.
E) The parents establish household responsibilities that are appropriate for the age of
the client.

Ans: Residential treatment settings

When presenting information about conduct disorders to a community group, the nurse is asked, ìwhich is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?î Which would be the most appropriate reply by the nurse?
A) The acute care setting
B) School
C) Residential treatment settings
D) Jail-diversion program

Ans: Group-based parenting classes

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders?
A) Administering medications
B) Avoiding setting limits
C) Group-based parenting classes
D) Being overprotective of the child

Ans: Try to remember that the parents are trying to the best of their ability to carry out
the suggestions.

The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time?
A) Review effective disciplinary practices with the parents again.
B) Refer the parents to a family therapist.
C) Try to remember that the parents are trying to the best of their ability to carry out
the suggestions.
D) Explore alternative living arrangements for the child.

Ans:

Thinking 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

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

Which may be concerns that a nurse has when caring for clients who have conduct disorders? Select all that apply.
A) Thinking 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 aggression.

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

,Avoid a ìblamingî attitude toward clients and/or families.

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

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders 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 ìblamingî attitude toward clients and/or families.
E) Focus on positive actions to improve situations and/or behaviors.

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

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 and avoid burnout.
B) To encourage camaraderie between colleagues.
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.