Test Bank - Varcarolis\' Foundations of
Psychiatric Mental Health Nursing
(8th Edition) {Chapters 21-25}
C HAPTER 21: I MPULSE C ONTROL D ISORDERS
MULTIPLE CHOICE
1. Shortl y 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, Id rather stay in m y room and listen to music. Its easie
than thinking about what is happening in m y famil y. Which nursing
diagnosis is most applicable?
a. Chronic low self -esteem related to role within the famil y
b. Decisional conflict related to compliance with school requirements
c. Ineffective coping related to adjustment to changes in famil y
relationships
d. Disturbed personal identit y related to self -perceptions of changing
famil y dynamics
ANS: C
Depression is often associated with impulse control disorder. The
correct nursing diagnosis refers to the patients dysfunctional
management of feelings associated with upcoming changes to the
famil y. The teen displays self -imposed isolation. The distracters are
not supported by data in the scenario.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 395
TOP: Nursing Process: Diagnosis/Anal ysis MSC: Client
Needs: Psychosocial Integrit y
,2. A child known as the neighborhood bull y says, Nobody can tell me what
to do. After receiving a poor grade on a science project, this child secretl y
loaded a virus on the teachers computer. These behaviors support a
diagnosis of:
a. conduct disorder.
b. oppositional defiant disorder.
c. intermittent explosive disorder.
d. attention deficit hyperactivit y disorder.
ANS: B
Oppositional defiant disorder is a repeated and persistent p attern of
having an angry and irritable mood in conjunction with demonstrating
defiant and vindictive behavior. Loading a virus is a vindictive
behavior in retribution for a poor grade. Persons with conduct disorder
are aggressive against people and animal s; destroy propert y; are
deceitful; violate rules; and have impaired social, academic, or
occupational functioning. There is no evidence of explosiveness or
distractibilit y.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 393 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
3. An 11-year-old diagnosed with oppositional defiant disorder becomes
angry over the rules at a residential treatment program and begins
shouting at the nurse. What is the nurses initial action to defuse the
situation?
a. Say to the child, Tell me how youre feeling right now.
b. Take the child swimming at the programs pool.
c. Establish a behavioral contract with the child.
d. Administer an anxiolytic medication.
ANS: B
Redirecting the expression of feelin gs into nondestructive, age -
appropriate behaviors such as a physical activit y helps the child learn
how to modulate the expression of feelings and exert self -control. This
is the least restrictive alternative and should be tried before resorting
, to measures that are more restrictive. A shouting child will not likel y
engage in a discussion about feelings. A behavioral contract could be
considered later, but first the situation must be defused.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 399
TOP: Nursing Process: Implementation MSC: Client
Needs: Safe, Effective Care Environment
4. Parents of an adolescent diagnosed with a conduct disorder say, We dont
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 (PC IT)
b. Behavior modification therapy
c. Multi-systemic therapy (MST)
d. Pharmacotherapy
ANS: A
In parent-child interaction therapy (PC IT), the therapist sits behind
one-way mirrors and coaches parents through an ear audio device while
they interact with their children. The therapist can suggest strategies
that reinforce positive behavior in the adolescent. The goal is to
improve parenting strategies and thereby reduce problematic behavior.
Behavior modification therapy may help the adolescent, but the parents
are seeking help for themselves. Multi -systemic therapy is much
broader and does not target the parents need.
PTS: 1 DIF: Cognitive Level: Appl y (Applica tion)
REF: 401 TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. An adolescent diagnosed with an impulse control disorder said, I just want
to die. I spend all my time getting even with people who have done wrong
to me. When asked about a suicide plan, the adolescent replied Ill jump
from the bridge near my home. My father threw kittens off that bridge,
and they died because they couldnt swim. Rate the suicide risk.
a. Absent
, b. Low
c. Moderate
d. High
ANS: D
The suicide risk is hig h. The child is experiencing feelings of
hopelessness and helplessness. The method described is lethal, and the
means to carry out the plan are available.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 396 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
6. An adolescent diagnosed with conduct disorder has aggression,
impulsivit y, hyperactivit y, and mood sym ptoms. The treatment team
believes this adolescent may benefit from medication. The nurse
anticipates the health car e provider will prescribe which t ype of
medication?
a. Second-generation antipsychotic
b. Anti-anxiet y medication
c. Calcium channel blocker
d. Beta-blocker
ANS: A
Medications for conduct disorder are directed at problematic behaviors
such as aggression, impulsivi t y, hyperactivit y, and mood sym ptoms.
Second-generation antipsychotics are likel y to be prescribed. Beta -
blocking medications may help to calm individuals with intermittent
explosive disorder by slowing the heart rate and reducing blood
pressure. Calcium channel blockers reduce blood pressure but are not
used for persons with impulse control problems. An anti -anxiet y
medication will not assist with impulse control.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 399 TOP: Nursing Process: A ssessment MSC:
Client Needs: Psychosocial Integrit y
Psychiatric Mental Health Nursing
(8th Edition) {Chapters 21-25}
C HAPTER 21: I MPULSE C ONTROL D ISORDERS
MULTIPLE CHOICE
1. Shortl y 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, Id rather stay in m y room and listen to music. Its easie
than thinking about what is happening in m y famil y. Which nursing
diagnosis is most applicable?
a. Chronic low self -esteem related to role within the famil y
b. Decisional conflict related to compliance with school requirements
c. Ineffective coping related to adjustment to changes in famil y
relationships
d. Disturbed personal identit y related to self -perceptions of changing
famil y dynamics
ANS: C
Depression is often associated with impulse control disorder. The
correct nursing diagnosis refers to the patients dysfunctional
management of feelings associated with upcoming changes to the
famil y. The teen displays self -imposed isolation. The distracters are
not supported by data in the scenario.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 395
TOP: Nursing Process: Diagnosis/Anal ysis MSC: Client
Needs: Psychosocial Integrit y
,2. A child known as the neighborhood bull y says, Nobody can tell me what
to do. After receiving a poor grade on a science project, this child secretl y
loaded a virus on the teachers computer. These behaviors support a
diagnosis of:
a. conduct disorder.
b. oppositional defiant disorder.
c. intermittent explosive disorder.
d. attention deficit hyperactivit y disorder.
ANS: B
Oppositional defiant disorder is a repeated and persistent p attern of
having an angry and irritable mood in conjunction with demonstrating
defiant and vindictive behavior. Loading a virus is a vindictive
behavior in retribution for a poor grade. Persons with conduct disorder
are aggressive against people and animal s; destroy propert y; are
deceitful; violate rules; and have impaired social, academic, or
occupational functioning. There is no evidence of explosiveness or
distractibilit y.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 393 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
3. An 11-year-old diagnosed with oppositional defiant disorder becomes
angry over the rules at a residential treatment program and begins
shouting at the nurse. What is the nurses initial action to defuse the
situation?
a. Say to the child, Tell me how youre feeling right now.
b. Take the child swimming at the programs pool.
c. Establish a behavioral contract with the child.
d. Administer an anxiolytic medication.
ANS: B
Redirecting the expression of feelin gs into nondestructive, age -
appropriate behaviors such as a physical activit y helps the child learn
how to modulate the expression of feelings and exert self -control. This
is the least restrictive alternative and should be tried before resorting
, to measures that are more restrictive. A shouting child will not likel y
engage in a discussion about feelings. A behavioral contract could be
considered later, but first the situation must be defused.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 399
TOP: Nursing Process: Implementation MSC: Client
Needs: Safe, Effective Care Environment
4. Parents of an adolescent diagnosed with a conduct disorder say, We dont
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 (PC IT)
b. Behavior modification therapy
c. Multi-systemic therapy (MST)
d. Pharmacotherapy
ANS: A
In parent-child interaction therapy (PC IT), the therapist sits behind
one-way mirrors and coaches parents through an ear audio device while
they interact with their children. The therapist can suggest strategies
that reinforce positive behavior in the adolescent. The goal is to
improve parenting strategies and thereby reduce problematic behavior.
Behavior modification therapy may help the adolescent, but the parents
are seeking help for themselves. Multi -systemic therapy is much
broader and does not target the parents need.
PTS: 1 DIF: Cognitive Level: Appl y (Applica tion)
REF: 401 TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. An adolescent diagnosed with an impulse control disorder said, I just want
to die. I spend all my time getting even with people who have done wrong
to me. When asked about a suicide plan, the adolescent replied Ill jump
from the bridge near my home. My father threw kittens off that bridge,
and they died because they couldnt swim. Rate the suicide risk.
a. Absent
, b. Low
c. Moderate
d. High
ANS: D
The suicide risk is hig h. The child is experiencing feelings of
hopelessness and helplessness. The method described is lethal, and the
means to carry out the plan are available.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 396 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
6. An adolescent diagnosed with conduct disorder has aggression,
impulsivit y, hyperactivit y, and mood sym ptoms. The treatment team
believes this adolescent may benefit from medication. The nurse
anticipates the health car e provider will prescribe which t ype of
medication?
a. Second-generation antipsychotic
b. Anti-anxiet y medication
c. Calcium channel blocker
d. Beta-blocker
ANS: A
Medications for conduct disorder are directed at problematic behaviors
such as aggression, impulsivi t y, hyperactivit y, and mood sym ptoms.
Second-generation antipsychotics are likel y to be prescribed. Beta -
blocking medications may help to calm individuals with intermittent
explosive disorder by slowing the heart rate and reducing blood
pressure. Calcium channel blockers reduce blood pressure but are not
used for persons with impulse control problems. An anti -anxiet y
medication will not assist with impulse control.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 399 TOP: Nursing Process: A ssessment MSC:
Client Needs: Psychosocial Integrit y
