disruptive behavior disorders

Question 1

A 12-year-old child is brought to the mental health clinic by the child’s parents because of a court-ordered evaluation. When assessing the child, which would lead the nurse to suspect that the child has a conduct disorder? Select all that apply.

a. Destruction of neighbor’s car on two separate occasions
b. Arrests for petty larceny several times
c. Blaming of others for problems
d. Repetitive disobedience of parents
e. Evidence of overt lying

Answer 1

a, b, e

Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. Children and adolescents with conduct disorder often lie to achieve short-term ends, may be truant from school, may run away from home, and may engage in petty larceny or even mugging. Oppositional defiant disorder is characterized by a persistent pattern of disobedience; argumentativeness; angry outbursts; low tolerance for frustration; and a tendency to blame others for misfortunes, large and small.

Question 2

A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention?

a. promoting social interaction
b. increasing treatment compliance
c. improving coping skills and self-esteem
d. providing client education

Answer 2

c

Nursing interventions for conduct disorder include teaching and practicing problem-solving skills. In this scenario, the nurse is asking the client to reflect on the situation in order find healthier, adaptive solutions. Teaching and practicing problem-solving skills is aimed at the ultimate goal of improving coping skills and self-esteem for clients with conduct disorder.

Question 3

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old client who has been referred to the home by the court system. Knowing that the client has a documented history of conduct disorder, which nursing diagnosis should the nurse prioritize during the client’s transition into the group home?

a. Risk for injury related to poor safety awareness
b. Impaired social interaction due to aggressive behavior
c. Hopelessness related to separation from family
d. Impaired social interaction due to withdrawal

Answer 3

b

The aggression, acting out, and antisocial behavior associated with conduct disorder create the potential for social alienation in a group setting. Such individuals are less likely to withdraw, injure themselves, or experience hopelessness.

Question 4

The nurse is interviewing the parents of a child with conduct disorder. Which question is appropriate for the nurse to ask?

a. “What words do you use while scolding your child?”
b. “What type of punishments do you give your child?”
c. “How often do you punish your child?”
d. “What type of discipline do you use at home?”

Answer 4

d.

While asking questions on sensitive topics like parenting, the nurse should use nonjudgmental language and a matter-of-fact tone. This avoids giving the client verbal cues to become defensive or to not tell the truth and to be free while expressing thoughts. Asking about the type of discipline used at home indicates that the nurse does not have any presumptions about the parental behavior. Asking about the frequency of punishments to the child indicates that the nurse presumes that the child gets punished by the parents. Questions such as “What words do you use while scolding your child?” indicates the nurse’s notion that the parents scold their child. Asking about the types of punishment the parents give indicates that the parents punish the child in different ways. These questions reflect the judgmental behavior of the nurse.

Question 5

A 14-year-old client’s behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has what? Select all that apply.

a. Served after-school detention for repeatedly disobeying the teaching staff
b. Been regularly accused by family members of “stealing their stuff”
c. Been caught lying on a regular basis
d. Resorted to threatening to cut the self when angry
e. Confessed to hurting the neighbor’s dog

Answer 5

a, b, c, e

A 14-year-old client’s behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has done the following: confessed to hurting the neighbor’s dog, served detention, been accused of stealing, and been caught lying.

Question 6

A nurse is assessing a 15-year-old adolescent with conduct disorder. Which appearance might the nurse see in the adolescent?

a. The adolescent has lots of cuts on the face and body.
b. The adolescent appears terrified.
c. The adolescent has lots of tattoos and body piercings.
d. The adolescent has poor physical hygiene.

Answer 6

c

Adolescents with conduct disorder appear normal for their age group but may have an extreme appearance, such as having tattoos and body piercings. They appear normal in terms of personal hygiene. These adolescents have no guilt associated with their behavior, thus they probably will not look terrified. The nurse is unlikely to observe changes associated with self-harm.

Question 7

A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention?

a. increasing treatment compliance
b. promoting social interaction
c. providing client education
d. improving coping skills and self-esteem

Answer 7

d

Nursing interventions for conduct disorder include teaching and practicing problem-solving skills. In this scenario, the nurse is asking the client to reflect on the situation in order find healthier, adaptive solutions. Teaching and practicing problem-solving skills is aimed at the ultimate goal of improving coping skills and self-esteem for clients with conduct disorder.

Question 8

Which would be the most appropriate intervention for an adolescent who is manipulative and exhibiting aggressive behaviors?

a. Time out
b. Self-esteem enhancement
c. Limit setting
d. Social skills training

Answer 8

c

Limit setting involves three steps: informing the client of the rule or limit, explaining the consequences if the client exceeds the limit, and stating the expected behavior.

Question 9

For which reason would a nurse ask an adolescent client with conduct disorder to maintain a diary?

a. To help identify feelings.
b. To improve problem solving skills.
c. To help reduce the chances of having outbursts of anger.
d. To help learn socially acceptable behavior.

Answer 9

a

Clients with conduct disorder are tough on the exterior but have difficulty expressing their feelings and emotions. Keeping a diary can be very useful to help these clients to identify and express their emotions and feelings. Keeping a diary would not improve problem solving or teach socially acceptable behavior. It also does not reduce the chances of an angry outburst. The nurse should teach problem-solving skills, continually involve the client in age-appropriate discussions, and use techniques such as time-out to address these challenges.

Question 10

A nurse is caring for a client with conduct disorder. The nurse needs to help the client understand the relationship between aberrant behavior and the consequences when the behavior is problematic. Which nursing intervention is most appropriate to help this client?

a. Encourage the client to discuss thoughts and feelings.
b. Teach the client the problem-solving process.
c. Teach appropriate conversation and social skills.
d. Teach the client about limit setting and the need for limits.

Answer 10

d

Clients with conduct disorder may have no knowledge of the concept of limits and how they can be beneficial. The nurse should teach about limit setting and the need for limits to help clients understand the relationship between aberrant behavior and the consequences when the behavior is problematic. The problem-solving process should be taught to clients, as they may not know how to solve problems constructively. Appropriate conversation and social skills should be taught to clients to assist them in socializing with others. Clients should be encouraged to discuss their thoughts and feelings, as this is the first step in dealing with clients with conduct disorder.

Question 11

A nurse is assessing an adolescent with conduct disorder. Which statement by the nurse about the adolescent is most likely to be true?

a. The adolescent loves to play with pets.
b. The sibling of the client has a mood disorder.
c. The client has a chronic medical condition.
d. The sibling of the client has conduct disorder.

Answer 11

d

Most children with conduct disorder have siblings with the same psychiatric disorder. Although it is possible to develop conduct disorder if a sibling has a mood disorder, the likelihood is higher that the client would also develop a mood disorder. Clients with conduct disorder will show cruelty to animals. A client with a chronic medical condition is more likely to be able to experience and convey empathy, eliminating the presence of conduct disorder.

Question 12

A nurse is caring for a client with conduct disorder who injures people around the client when angry. Which is the primary goal for intervention in this case?
a. To help the client express feelings.
b. To ensure safety of others.
c. To help the client develop good peer relationships.
d. To reduce the aggression of the client.

Answer 12

b

With a physically aggressive client, the nurse should first ensure the safety of others. Reducing the aggression of the client, helping the client express feelings, and helping the client to develop good peer relationships are all goals of treatment. These outcomes are of a comparatively lesser priority than safety.

Question 13

A nurse is assessing a 9-year-old child diagnosed with conduct disorder. Which advice should the nurse give the child’s parents regarding treatment of the disorder?

a. “Your child needs to be incarcerated.”
b. “Your child should be sent to boot camp.”
c. “You will need to be involved in the therapeutic process for your child.”
d. “Your child requires individualized therapy.”

Answer 13

c

Family therapy is most desirable to treat a 9-year-old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy.

Question 14

A nurse is developing a plan of care for a client with conduct disorder. Which would be treatment outcomes for this client? Select all that apply.

a. The client will not hurt others or damage property.
b. The client will be relieved of anxiety and depression.
c. The client will have a hygienic lifestyle.
d. The client will learn effective problem-solving skills.
e. The client will engage in socially acceptable behavior.

Answer 14

a, d, e

If a client undergoes successful treatment, they should be able to behave in a socially acceptable manner, display appropriate problem-solving skills, and no longer hurt others or damage property. Clients with conduct disorder usually do not have issues related to personal hygiene. Such clients do require relief from anxiety or depression, as they are considered unemotional and do not show regret or feel any remorse after inappropriate behavior.

Question 15

An adolescent client diagnosed with conduct disorder continues to experience aggressive outbursts despite behavioral management techniques used by the parents. Which medication would likely be prescribed to the client?
a. sertraline
b. lorazepam
c. clonazepam
d. risperidone

Answer 15

d

Medications alone have little effect in clients diagnosed with conduct disorder but may be used in conjunction with treatment for specific symptoms. For example, the client who presents a clear danger to others (physical aggression) may be prescribed an antipsychotic medication, such as risperidone. Clonazepam and lorazepam are benzodiazepines, which would inhibit inhibitions further and may worsen the problem. Sertraline is an antidepressant, which would not be prescribed for aggressive behavior in the client.

Question 16

An adolescent client demonstrates callous and unemotional behavior in the absence of extreme aggressive behavior and mood disturbances. The client has a diagnosis of conduct disorder. Which treatment would be most effective for this client?
a. Individualized behavior therapy
b. Family therapy
c. Group therapy
d. Medication

Answer 16

a

Adolescents rely less on their parents than younger children do. An adolescent with conduct disorder would benefit most from individualized behavior therapy. These adolescents are usually not attached to their parents, thus family therapy is not useful for them. Group therapy will also not be beneficial for these clients, as they are uncomfortable socializing. The client here does not have extreme aggressive behavior and mood disturbances; therefore, it is unlikely that the client would be prescribed psychotropic drugs or mood stabilizers.

Question 17

A 10-year-old client diagnosed with conduct disorder is currently in the stabilization phase of care. Which client outcome would be appropriate in the stabilization phase?

a, “Learn problem-solving process within 2 to 3 days.”
b, “Demonstrate development of relationships with peers.”
c. “Demonstrate effective problem-solving and coping skills.”
d. “Verbalize feelings within 2 to 3 days.”

Answer 17

c

Client outcomes vary depending on the phase of care that the client is currently in. In the immediate phase of care, outcomes are short term and focus on the immediate needs of the client. The outcomes, “Verbalize feelings within 2 to 3 days”, and “Learn problem-solving process within 2 to 3 days” are appropriate in the immediate phase of care. The stabilization phase focuses on educating and empowering the client. The outcome, “Demonstrate effective problem-solving and coping skills” is appropriate in the stabilization phase of care. Finally, in the community phase of care, the outcomes are long term. The outcome, “Demonstrate development of relationships with peers” is appropriate in the community phase of care.

Question 18

A nurse is studying the medical records of a client with conduct disorder. The nurse finds that the client was prescribed lithium. What would be the most likely reason for prescribing this drug for this client?
a. Difficulty with decision-making skills
b. Predisposition to kleptomania
c. Risk of developing seizures
d. The presence of aggression

Answer 18

d

Clients with conduct disorder who are aggressive can sometimes be prescribed medications such as mood stabilizers that have antiaggression properties such as lithium. Lithium is also an antiseizure agent; however, the client history does not indicate this is part of the pathology. Lithium is not generally indicated for the treatment of kleptomania. Behavioral therapy and psychotherapy are required to improve decision-making abilities.

Question 19

The nurse is assessing a child diagnosed with conduct disorder. Based on which behavior would this client be described as exhibiting the disorder at moderate intensity?

a. Truancy
b. Verbal bullying
c. Cruelty to animals
d. Attempted robbery

Answer 19

a

Verbal bullying is an example of a behavior seen in clients exhibiting a moderate intensity form of conduct disorder. Truancy is described as a behavior seen in a mild intensity form of the disorder. Cruelty to animals and attempted robbery are described as a behavior seen in a severe intensity form of conduct disorder.

Question 20

A nurse is seeing an adolescent with a diagnosis of conduct disorder for the first time to establish goals for treatment. During the first meeting, the adolescent yells a profanity at the nurse and states, “This is pointless.” What is the nurse’s best response?

a. “I want to continue to work with you but I don’t accept the language you have chosen.”
b. “Now is not a good time. Maybe we can meet another day?”
c. “We can’t begin this work until you feel invested in it.”
d. “I am concerned that you are going to act out right now.”

Answer 20

a

Clients with conduct disorder frequently experience rejection. The client needs support to increase self-esteem while understanding that behavioral changes are necessary. When working with a client diagnosed with conduct disorder, the client needs to be made aware that they are an accepted person although a particular behavior may not be acceptable. Telling the client that “now is not a good time” may be perceived by the client as rejection. An opportunity to discuss behavioral change may be lost if the session does not continue. In this scenario, it is evident that the adolescent is attempting to mask low self-esteem by acting tough. Telling the adolescent that the work cannot begin until they are invested in it would indicate the nurse has not acknowledged this feature of the disorder. Voicing fear that the client may act out communicates mistrust to the client and can hinder the development of a therapeutic relationship.

Question 20

A nurse is counseling the parents of a client with conduct disorder. The nurse tells them that they should be vigilant in watching for certain behaviors that their child is prone to exhibit. Which behaviors would the nurse want the parents to watch for? Select all that apply.

a. Smoking
b. Binge eating
c. Suicidal tendencies
d. Alcohol and substance use
e. Early onset of sexual behavior

Answer 20

a, d, e

Children with conduct disorder are likely to have problems such as smoking, alcohol and substance use, and early onset of sexual behavior. The nurse should advise the parents of the client to watch for such behaviors. Binge eating and suicidal tendencies are not known to be associated with conduct disorder.

Question 21

A nurse is caring for a 10-year-old child with conduct disorder. The child starts throwing items at the staff. Which statement made by the nurse to control the child’s behavior is most appropriate?

a. “Don’t you care that you may harm someone when doing that?”
b. “Your behavior is unacceptable and you will be restricted to your room.”
c. “You must stop throwing things. Let’s talk about what may be frustrating you.”
d. Because of your behavior, you will have difficulty making friends.”

Answer 21

c.

When the nurse sets limits on the child’s behavior by telling them to stop, safety issues are being addressed and the nurse is offering self to help discuss issues and frustration that may be triggers for the child. The child may lack empathy, so asking if they care about harming someone may have no true meaning. The child should not be restricted to their room since this may increase frustration. The child is not considering friendships at this time so the consequence does not mean anything to them.

Question 22

The nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent is not interested in seeking summer employment. What is the most likely reason for the client’s disinterest in getting a job?

a. The client prefers stealing money over working for it.
b. The client feels that the client is too disturbed to work.
c. The client feels that the client will not be efficient in the workplace.
d. The client feels that depression and anxiety would interfere with working.

Answer 22

a

The adolescent with conduct disorder is most likely to steal money for survival instead of earning it through employment. Feeling too disturbed to be able to work and feeling that the client would be inefficient at work are not behaviors related to clients with conduct disorder. Depression and anxiety are not present in clients with conduct disorder.

Question 23

A nurse is planning to teach parents of children with conduct disorder about the treatment methods. Which topics should the nurse address in the session? Select all that apply.

a. Effective parenting skills
b. Skills to improve peer relationships
c. Legal procedures for criminal behavior
d. Skills to improve academic performance
e. Sedative medications for conduct and antisocial personality disorder

Answer 23

a. b. d

Family therapy is most desirable to treat school-aged children with conduct disorder. While teaching parents about strategies to treat this disorder, the nurse should talk about good parenting, skills to improve peer relationships, and skills to improve academic performance. Legal procedures for criminal behavior and medications for conduct and antisocial personality disorder need not be addressed in this teaching.

Question 24

During dinner time on an inpatient unit, an adolescent client throws a tray across the table. What would be an effective use of limit setting with this client?

a. Remind the client about the behavior contract.
b. Take the client into a quiet area for a therapy session.
c. Encourage the client to log the event in a diary.
d. Role-model how to be social during meals.

Answer 24

a

In order to decrease violence and increase compliance with treatment, it is important for the nurse to remind the client about the behavior contract. The contract outlines expected behaviors, limits, and rewards to increase treatment compliance. Taking the client to a quiet area during a time when the client is exhibiting violent behavior could be unsafe for the nurse and the client. A therapy session may not be helpful if the client is in a heightened emotional state. Encouraging the client to log the event in a diary is an intervention used to improve coping skills and self-esteem, not limit setting. Role-modeling how to be social during meals is an intervention used to promote social interaction, not limit setting.

Question 25

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone by the primary health care provider. What would be the most likely reason for the health care provider to prescribe this drug to the client?

a. The adolescent has poor social behavior.
b. The adolescent’s behavior poses a danger to others.
c. The adolescent is experiencing disturbances in concentration.
d. The adolescent is depressed because of the inappropriate behavior.

Answer 25

b

Risperidone is given to those clients with conduct disorder whose behavior poses a threat to others. Poor social behavior and disturbances in concentration need not be treated with drugs. Unlike in intermittent explosive disorder, the client with conduct disorder has no remorse, guilt, or depression after behaving violently.

Question 26

A family is concerned about their school-aged child who keeps getting into fights. The parents state that the child does not listen, is aggressive toward others, and prefers to be alone. What is the best nursing response to the stated concerns?
a. Suggest that the family bring in the child so that a direct assessment can be made.
b. Offer community support groups to help the child focus on group activities.
c. Schedule the family and child for a therapy session.
d. Contact the health care provider for a referral to a psychologist.

Answer 26

a

Based on the provided information, the nurse should suspect that the client may have a disruptive behavior disorder, but additional information and direct observation of the client is required in order to proceed with a plan of care. Offering community support groups does not address the inappropriate behavior and may lead to increased outbursts. Scheduling the family and child for a therapy session and/or contacting the health care provider for a referral to a psychologist may eventually be needed, but there is insufficient information at this time to proceed.

Question 27

A nurse is assessing an adolescent who is constantly bullying other children. Which findings during the assessment are suggestive of early onset conduct disorder? Select all that apply.

a. No extremely aggressive behavior is observed.
b. The maladaptive behavior started before the age of 10 years.
c. Client does not have normal peer relationships.
d. Client is susceptible to developing schizoid personality disorder.
e. Client never abused other children physically.

Answer 27

b, c

In early onset conduct disorder, the aggressive behavior begins before the age of 10 years. Unlike individuals with the adolescent-onset type, this client does not have normal peer relationships. In early onset conduct disorder, the behavior of the child is extremely aggressive. Information regarding the susceptibility of the child to develop antisocial personality disorder cannot be obtained during assessment. Severity of maladaptive behavior is not indicative of the type of conduct disorder (on the basis of age). The client may have a history of being abusive to children.

Question 28

A nurse is speaking to the parents of a 15-year-old client who has been suspended from school for physically abusing classmates. The client has had many warnings from school staff; however, the client’s behavior persists. What other statements by the parents would lead the nurse to suspect this client has conduct disorder? Select all that apply.

a. “My child is consistently performing poorly academically.”
b. “My child feels guilty and regrets the inappropriate behavior.”
c. “My child does not have any friends.”
d. “My child cries a lot and does not want to be alone.”
e. “My child is extremely well-behaved at home.”

Answer 28

a, c

Children with conduct disorder exhibit callous and unemotional behavior, such as physically abusing classmates. They are unconcerned about poor performance in school. These clients show no guilt or remorse for their behavior. They are unemotional, and their conduct at home is also poor.

Question 29

Which responses to an emotional stressor would indicate that a child is at risk for conduct disorder? Select all that apply.

a. The child has crying spells.
b. The child screams loudly.
c. The child stops talking.
d. The child goes to a secluded place.
e. The child breaks things around them.

Answer 29

b, e

Screaming loudly and breaking things are behaviors indicating externalization of emotions. Such behaviors put the child at risk for conduct disorder. Having crying spells, not talking to anyone, and going to a secluded place in response to an emotional stressor indicate that the child has a tendency to internalize emotions related to the stressor. These children are likely to develop somatic disorders, anxiety disorder, and depression.