cHaP 23 DisRuPtiVE BeHAviOraL DisOrdEr Flashcards
(18 cards)
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 might anticipate which diagnosis?
A. intermittent explosive disorder
B. oppositional disorder
C. conduct disorder
D. childhood depressive disorder
ANS: C
Rationale: Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These clients have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft,and serious violation of rules. This is an example of moderate conduct. Moderate: The number of conduct problems increases as does the amount of harm to others. Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. Many children can experience depression with social isolation but in this case it is a symptom not a diagnosis.
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?’
ANS: A
Rationale: The nurse must set limits on unacceptable behavior at the beginning of treatment.Limit setting involves three steps: (1) informing clients of the rule or limit; (2) explaining the consequences if clients exceed the limit; and (3) stating expected behavior. Saying “Stopwhat you are doing. Go to your room” does not explain the expected behavior. Saying “I would appreciate if you would not do that” does not provide a consequence. Asking, “Why do you do these things” provides none of the three steps.
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: D
Rationale: Many treatments have been used for conduct disorder with only modest effectiveness. Early intervention is more effective, and prevention is more effective than treatment. Parenting education may be necessary, but this is often more effective for familieswith younger children. Many adolescent clients have some involvement with the legal system, including incarceration, as a result of criminal behavior, but this is a consequence ofand not a treatment for conduct disorder.
When a young client is disruptive, the nurse responds, “You must take a time-out.” What is the expectation of a client during a time-out?
A. to go to his or her room until called for the next meal
B. to slowly count to 20 before returning to the group
C. to sit quietly on the lap of one of the staff members
D. to sit in a designated place until able to regain self-control and review the episode
ANS: D
Rationale: Time-out is retreat to a neutral place so clients can regain self-control. It is not a punishment. When a client’s behavior begins to escalate, such as when he or she yells at or threatens someone, a time-out may prevent aggression or acting out. Time-out is designed sothat staff can be consistent in their interventions. Time-out may require going to a designated place or sitting on the periphery of an activity until the child gains self-control and reviews the episode with a staff member. Time-out may not require going to a designated room in this instance, the client is young and must be supervised, and does not involve special attention such as holding. Counting to 10 or 20 is not sufficient.
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 the child can demonstrate dependable behavior.
D. Avoid discussing feelings and expectations with the child.
ANS: A
Rationale: Parents need to replace old patterns such as yelling, hitting, or simply ignoring behavior with more effective strategies. The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities,and acceptable behavior at home. The parents may need to learn effective limit setting with appropriate consequences. Parents often need to learn to communicate their feelings and expectations clearly and directly to these clients
When presenting information about conduct disorders to a community group, the nurse is asked, “Which 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?” 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: C
Rationale: Group homes, halfway houses, and residential treatment settings are designed to provide safe, structured environments and adequate supervision if that cannot be provided athome. Clients with conduct disorder are seen in acute care settings only when their behavioris severe and only for short periods of stabilization. Clients with legal issues may be placed in detention facilities, jails, or jail-diversion programs but this option is reserved for clients with legal issues, not for treatment purposes.
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’s syndrome
C. Attention deficit hyperactivity disorder
D. Conduct disorder
ANS: D
Rationale: Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Behavioral symptoms include physical fights, destruction of property, vandalism, and serious violation of rules among others. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major antisocial violations. Asperger’s disorder is a pervasive developmental disorder characterized by the same impairments of social interaction and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. Attention deficit hyperactivity disorder is characterized by inattentiveness, overactivity, and impulsiveness.
A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today, stating that yesterday the other nurse told the client that the client did not have to go to class if the client did not want to. Which would be the best response by the nurse?
A. “Fine, but you’re confined to your room.”
B. “Missing class is against the rules.”
C. “You and I both know you’re lying.”
D. “Why do you keep fighting the system?”
ANS: B
Rationale: Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance. The nurse must avoid responses that will exacerbate conflict, like “Why do you keep fighting the system?” and “You and I both know you’re lying.” It would be inappropriate to comply with the adolescent’s desire to miss school because this contravenes the rules.
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. It is not a permanent solution; eventually, the goal is for the client to avoid time-out.
D. It is retreat to a neutral place, so clients can regain self-control.
ANS: D
Rationale: Time-out is retreat to a neutral place, so clients can regain self-control. It is not a punishment. When a client’s behavior begins to escalate, such as when he or she yells at or threatens someone, a time-out may prevent aggression or acting out. It can be used as a proactive strategy, not a last resort. Eventually, the goal for clients is to recognize signs of increasing agitation and take a self-instituted time-out to control emotions and outbursts.
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. Attending group-based parenting classes
D. Being overprotective of the child
ANS: C
Rationale: Parental behavior profoundly influences children’s behavior. Group-based parenting classes have been proven to be effective in dealing with problem behaviors in children and preventing later development of conduct disorders. This is a proactive approachto conduct disorders that is preferred over reactive interventions such as medication. Limit setting enhances the management of problem behaviors. Overprotective parenting can inhibit the development of responsibility and overall psychosocial development.
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. The client was seen pushing another client, causing the person to fall. Which approach by nursing staff would be most therapeutic?
A. neutrally permitting refusals
B. coaxing to gain compliance
C. offering rewards in advance
D. establishing firm limits
ANS: D
Rationale: Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other clients from aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the client learn to abide by rules or structure.
The nurse is providing education to the parents of an adolescent newly diagnosed with oppositional defiant disorder (ODD). Which statement made by the parents indicate to the nurse additional teaching is needed?A. “Our child has ODD due to the genes we both passed on to our child.”
B. “Our child will likely have difficulty solving problems and making decisions.”
C. “Our child may be diagnosed with antisocial personality disorder as an adult.”
D. “One thing we can do to help our child is to ignore negative behaviors.”
ANS: A
Rationale: The nurse would provide additional teaching if the parents state genetics as the cause of ODD. ODD is believed to be caused by an interaction between genes, temperament, and adverse social conditions. Children with ODD often exhibit difficulty solving problems, making decisions, limited attention, and inflexible thinking. Children withODD may be diagnosed with antisocial personality disorder as an adult. They may develop conduct disorder as a child. Parents have to learn how to appropriately discipline children with ODD, which includes ignoring negative behaviors and reinforcing positive behaviors.
The nurse is caring for a 17-year-old client newly diagnosed with intermittent explosive disorder (IED). Which prescription will the nurse question?
A. Fluoxetine 20 mg orally every day
B. Cognitive behavior therapy
C. Risperidone 3 mg by mouth daily
D. Anger management classes
ANS: C
Rationale: The nurse would question the prescription for risperidone. Risperidone is an antipsychotic medicine used to treat bipolar disorder, schizophrenia, and autism spectrum disorders in children. Treatment for IED typically includes medications such as fluoxetine, lithium, and anticonvulsant mood stabilizers. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, panic, obsessive disorders such as IED, and anxiety in adolescents. Other treatments include behavior therapy, anger management strategies, avoidance of drugs and alcohol, and relaxation techniques to help reduce outbursts associated with IED.
While the nurse is assessing a 14-year-old client, the caregiver states, “I am worried something is wrong because my child’s behavior has become unpredictable and my child seems very critical of others.” The nursing assessment is otherwise negative. Which action will the nurse take?
A. Notify the primary health care provider
B. Review the client’s medication list
C. Schedule the client for a psychiatric evaluation
D. Inform the caregiver these are expected findings
ANS: D
Rationale: The behaviors the client is exhibiting are expected findings for a toddler and an adolescent. The nurse would inform the caregiver these are normal findings and provide education on how to respond to the behaviors. There is no need to notify the primary health care provider of expected findings. The nurse would not need to review the client’s medication list or schedule the client for an evaluation based on these findings as they are expected.
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: B
Rationale: Working with parents is a crucial aspect of dealing with children with these disorders. The nurse can teach parents age-appropriate activities and expectations for clients and consequently increase the child’s chance of meeting expectations for behavior. Transferring the child to a new home would be a measure of last resort with the goal of protecting the child’s safety. The nurse should avoiding appearing to “side” with the parents in an effort to advocate for the child and maintain a therapeutic relationship. It is presumptuous for the nurse to believe that he or she knows the child’s thoughts and feelings best, and has to interpret them to the parents.
The nurse is caring for an adolescent diagnosed with conduct disorder who is prescribed risperidone. Which statement by the client indicates additional teaching is needed?
A. “This medication may make me more sensitive to really hot and cold temperatures.”
B. “I need to limit the amount of water I drink while I am taking this medication.”
C. “I may not be able to react as quickly while I am taking this medication.”
D. “It is okay for me to take this medication with a meal if I want to.”
ANS: B
Rationale: Risperidone is an antipsychotic medicine used to treat bipolar disorder, schizophrenia, and autism spectrum disorders in children. Risperidone should be taken as prescribed by a primary health care provider. The nurse would provide more education if theclient stated fluids should be limited as risperidone can quickly lead to dehydration. The client should increase fluid intake, especially in hot climates. Risperidone can cause a client to be sensitive to extreme temperatures and decrease thinking and reaction times. It may be taken with or without food.
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.
ANS: C
Rationale: It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. It may also make the nurse feel better and avoid burnout, but that is not the most important reason to do so; the quality of client care is the highest priority. It may encourage camaraderie between colleagues but that is secondary to high quality client care. It will not be possible to ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders, but they must be consistent with limit setting, irrespective of their own attitudes and beliefs.
A pre-teen client has been considered a neighborhood bully for several years. Peers avoid him, and the mother says she cannot believe a thing he tells her. 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
ANS: A
Rationale: Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These clients have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft,and serious violation of rules. This is an example of moderate conduct. Moderate: The number of conduct problems increases as does the amount of harm to others. Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. The behaviors are more pervasive than defiance of authority. To suffer from pyromania is more than one incidence of setting a fire.
