Chapter 21: Impulse Control Disorders |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 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. ANS: A The adolescent and the parents must agree on a behavioral contract that clearly outlines rules, expected behaviors, and consequences for misbehavior. It must also include rewards for following the rules. The adolescent will continue to experience anger and frustration. The adolescent and parents must continue with family therapy to work on boundary and communication issues. It is not necessary to separate the adolescent from the family to work on these issues. Separation is detrimental to the healing process. While it is helpful for the adolescent to identify peers who are a positive influence, it is more important for behavior to be managed for an adolescent diagnosed with a CD. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 2127, 28, 30, 45 (Table 21-2) TOP: Nursing Process: Outcomes Identification MSC: Client Needs: Psychosocial Integrity 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. CD ANS: D CDs are manifested by a persistent pattern of behavior in which the rights of others and age- appropriate societal norms are violated. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. Criteria for ADHD and PTSD are not met in the scenario. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 21-17, 44 (Table 21-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 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 ANS: B Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teen‘s thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, ignoring, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 21-28, 29, 47 (Box 21-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 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