Impulse Control Disorders
The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by:
acting without thought on urges or desires.
Which factor presents the highest risk for a child to develop a psychiatric disorder?
Living with an Alcoholic Parent
A health care provider recently convicted of Medicare fraud says to a nurse, “Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I should get the money.” These statements show:
lack of guilt feelings.
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
Anorexia nervosa
A patient says, “I get in trouble sometimes because I make quick decisions and act on them.” Select the nurse’s most therapeutic response.
“Let’s consider the advantages of being able to stop and think before acting.”
Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders?
Impaired social interaction related to difficulty relating to others
Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others?
Refer requests and questions related to care to the case manager.
Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?
Patient expresses satisfaction with body appearance
Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient’s needs and maintain a therapeutic milieu?
Ability to provoke interpersonal conflict
Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective?
The Child holds the parent’s hand while walking.
As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, “Just leave it on the table. I’ll take it when I finish combing my hair.” What is the nurse’s best response?
Say to the patient, “I must watch you take the medication. Please take it now.”
A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient:
“What do you eat in a typical day?”
A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is:
impaired social interaction.
A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to:
reduce loneliness and increase self-esteem.
What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will:
acknowledge manipulative behavior when it is called to his or her attention.
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, “Describe what you think about your present weight and how you look.” Which response by the patient is most consistent with the diagnosis?
“I am fat and ugly.”
Which nursing intervention is appropriate for the management of intermittent explosive disorder?
Establishing a trusting relationship with the patient
A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on?
Methyphenidate (Ritalin)
Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, “Another nurse said you don’t do your job right.” Collectively, these interactions can be assessed as:
manipulative.
A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?
Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia
Assessment for oppositional defiant disorder should include which interventions?
Assessing issues that result in power struggles and triggers for outbursts
What is the nurse’s priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)?
Sleep disturbances and weight loss
A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed?
Mood stabilizing medication
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient:
not to skip meals or restrict food.
Which of the following classifications of medication may be prescribed in intermittent explosive disorder?
Anticonvulsants
Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization
A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?
Social skills group
One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, “I feel empty and want to hurt myself.” The nurse should:
assist the patient to choose coping strategies for triggering situations.
A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?
The nurse interacts with the patient in a protective fashion.
Which of the following statements are true regarding childhood-onset conduct disorder?
It is more commonly diagnosed in males.
It is characterized by disregard for the rights of others.
Those with conduct disorder rationalize their aggressive behaviors.
The parent of a 6-year-old says, “My child is in constant motion and talks all the time. My child isn’t interested in toys but is out of bed every morning before me.” The child’s behavior is most consistent with diagnostic criteria for:
attention deficit hyperactivity disorder.
What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation?
Maintaining consistent limits
A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will:
identify two alternative methods of coping with loneliness.
A 17-year-old patient is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this patient?
Expresses feelings
A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective?
The Child engages in cooperative play with other children.
When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include:
grandiosity, self-importance, and a sense of entitlement.
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?
Assist the patient to identify triggers to binge eating.
As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder?
Antipersonality disorder
Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults.
When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurse’s best action?
Take the aggressive child to another room.
What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder?
Respect the patient’s need for periods of social isolation.
One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The patient whose weight decreased from:
150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg