Chapter 21 - Impulse Control Disorders

Question 1

A 16-year-old diagnosed with a conduct disorder (CD) 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.

Answer 1

a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences.

Question 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 (CD)

Answer 2

d. Conduct disorder (CD)

Question 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
b. Establish firm limits
c. Neutrally permit refusals
d. Coaxing to gain compliance

Answer 3

b. Establish firm limits

Question 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
b. Bibliotherapy
c. Play therapy
d. Art therapy

Answer 4

a. Family therapy

Question 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. Defensive 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

Answer 5

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

Question 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 which diagnosis?

a. Attention-deficit/hyperactivity disorder (ADHD)
b. Intermittent explosive disorder.
c. Oppositional defiant disorder (ODD).
d. Conduct disorder (CD)

Answer 6

d. Conduct disorder (CD)

Question 7

An 11-year-old diagnosed with oppositional defiant disorder (ODD) 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 for 2 hours.
c. Take the child to the gym and engage in an activity.
d. Role-play a more appropriate behavior with the child.

Answer 7

c. Take the child to the gym and engage in an activity.

Question 8

An adolescent acts out in disruptive ways. When this adolescent threatens to throw a heavy 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.”

Answer 8

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

Question 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
b. Providing positive feedback
c. Formulating nursing diagnoses
d. Dialectical behavioral therapy (DBT)

Answer 9

d. Dialectical behavioral therapy (DBT)

Question 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. Defensive coping related to adjustment to changes in family relationships
d. Disturbed personal identity related to self-perceptions of changing family dynamics

Answer 10

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

Question 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 which diagnosis?

a. Conduct disorder (CD).
b. Oppositional defiant disorder (ODD).
c. Intermittent explosive disorder.
d. Attention-deficit/hyperactivity disorder (ADHD).

Answer 11

b. Oppositional defiant disorder (ODD).

Question 12

An 11-year-old diagnosed with oppositional defiant disorder (ODD) 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 facility’s pool.
c. Establish a behavioral contract with the child.
d. Administer an anxiolytic medication.

Answer 12

b. Take the child swimming at the facility’s pool.

Question 13

Parents of an adolescent diagnosed with a conduct disorder (CD) 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

Answer 13

a. Parent–child interaction therapy (PCIT)

Question 14

An adolescent diagnosed with an impulse control disorder says, “I want to die. I spend my time getting even with people who hurt me.” When asked about a suicide plan, the adolescent replies, “I’ll jump from a bridge near my home. My father threw kittens off that bridge and they died.” What is the client’s suicide risk?

a. Absent
b. Low
c. Moderate
d. High

Answer 14

d. High

Question 15

An adolescent diagnosed with conduct disorder (CD) 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
b. Antianxiety medication
c. Calcium channel blocker
d. b-blocker

Answer 15

a. Second-generation antipsychotic

Question 16

An adolescent was recently diagnosed with oppositional defiant disorder (ODD). The parents say to the nurse, “Isn’t there some
medication that will help with this problem?” What is the nurse’s best response?

a. “There are no medications to treat this problem. This diagnosis is behavioral in nature.”
b. “It’s a common misconception that there is a medication available to treat every health problem.”
c. “Medication is usually not prescribed for this problem. Let’s discuss some behavioral strategies you can use.”
d. “There are many medications that will help your child manage aggression and destructiveness. The health care provider will discuss them with you.”

Answer 16

c. “Medication is usually not prescribed for this problem. Let’s discuss some behavioral strategies you can use.”

Question 17

An adolescent diagnosed with a conduct disorder (CD) 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?

a. Serotonin dysregulation and increased testosterone activity impair one’s capacity for remorse.
b. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules.
c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy.
d. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of behavior.

Answer 17

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

Question 18

Which assessment findings support a diagnosis of oppositional defiant disorder (ODD)?

a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior.
b. Exhibits involuntary facial twitching and blinking; makes barking sounds.
c. Violates others’ rights; cruelty toward people or animals; steals; truancy.
d. Displays poor academic performance and reports frequent nightmares.

Answer 18

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

Question 19

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? (Select all that apply.)

a. Family history of mental illness
b. Allergies to multiple antibiotics
c. Long history of severe facial acne
d. Father with history of alcohol abuse
e. History of an abusive relationship with one parent

Answer 19

a. Family history of mental illness
d. Father with history of alcohol abuse
e. History of an abusive relationship with one parent

Question 20

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 (Select all that apply.)

a. The person diagnosed with ODD relives traumatic events by acting them out.
b. The person diagnosed with ODD tests limits and disobeys authority figures.
c. The person diagnosed with ODD has difficulty separating from loved ones.
d. The person diagnosed with CD uses stereotypical or repetitive language.
e. The person diagnosed with CD often violates the rights of others.

Answer 20

b. The person diagnosed with ODD tests limits and disobeys authority figures.
e. The person diagnosed with CD often violates the rights of others.

Question 21

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Why is
establishing rapport with this adolescent is a priority? (Select all that apply.)

a. it is a vital component of implementing a behavior modification program.
b. a therapeutic alliance is the first step in a nurse’s therapeutic use of self.
c. the adolescent has demonstrated resistance to other authority figures.
d. acceptance and trust convey feelings of security for the adolescent.
e. adolescents usually relate better to authority figures than peers.

Answer 21

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.