Deck 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

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

Question 2

Parents of an adolescent diagnosed with a 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 2

Parent-child interaction therapy (PCIT)

Question 3

An adolescent was recently diagnosed with ODD. The parents say to the nurse, "Isn't there some medication that will help with this problem?" Select 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 3

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

Question 4

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)

Question 5

What are the primary distinguishing factors between the behavior of persons diagnosed with ODD and those with CD? The person diagnosed with (Select all that apply)

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.

Question 6

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." Rate the suicide risk.

A) Absent
B) Low
C) Moderate
D) High

Question 7

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

Question 8

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

Question 9

Which assessment findings support a diagnosis of 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.

Question 10

An 11-year-old diagnosed with 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.

Question 11

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."

Question 12

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

Question 13

An adolescent diagnosed with 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

Question 14

An adolescent diagnosed with a 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.

Question 15

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) CD

Question 16

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

Question 17

An 11-year-old diagnosed with 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.

Question 18

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

Question 19

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

A) ADHD.
B) intermittent explosive disorder.
C) oppositional defiant disorder (ODD).
D) CD.

Question 20

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

A) CD.
B) ODD.
C) intermittent explosive disorder.
D) ADHD.

Question 21

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 (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.