Deck 33: Adjustment and Impulse Control Disorders

Question 1

A client has been diagnosed with pathological gambling. The client's family inquires about their brother's behavior that led to this diagnosis. Which of the following information should the clinic nurse provide? (Select all that apply.)

A)Your brother has been preoccupied with thoughts about gambling.
B)Your brother has been gambling with increased amounts of money to gain excitement.
C)Your brother has tried but failed to control his gambling.
D)Your brother's gambling is a result of manic behavior.
E)Your brother has lied to you about the extent of his gambling.

Answer 1

Your brother has been preoccupied with thoughts about gambling.
Your brother has been gambling with increased amounts of money to gain excitement.
Your brother has tried but failed to control his gambling.
Your brother has lied to you about the extent of his gambling.

Question 2

A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of adjustment disorder, within what timeframe should the nurse expect the client to exhibit these symptoms?

A)To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident.
B)To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident.
C)To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident.
D)To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

Answer 2

To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident.

Question 3

After a spouse dies, a client is diagnosed with adjustment disorder with depressed mood. Client symptoms include chronic migraines, feelings of hopelessness, social isolation, and self-care deficit. Which outcome would be most appropriate to direct the focus of this client's care?

A)The client will not cope with stress by impulsive behaviors by discharge.
B)The client will accomplish activities of daily living independently by discharge.
C)The client will be able to cope effectively by delaying gratification by discharge.
D)The client will verbalize a positive body image by discharge.

Answer 3

The client will accomplish activities of daily living independently by discharge.

Question 4

A nurse is caring for a client who is suspected of having the diagnosis of trichotillomania. What condition must be ruled out prior to a definitive diagnosis of this disorder?

A)Bipolar disorder
B)Alopecia areata
C)Post-traumatic stress disorder
D)Body dysmorphic disorder

Question 5

Which individual would most likely be diagnosed with intermittent explosive disorder?

A)A client diagnosed with antisocial personality disorder who attacks the nursing staff
B)A client diagnosed with diabetes mellitus who has a history of multiple severe assaultive acts
C)A client diagnosed with schizophrenia who sets fires because of command hallucinations
D)A client diagnosed with alcohol dependence who severely beats wife while intoxicated

Question 6

During her aunt's wake, before a mother can stop her 4-year-old child, the child runs up to the casket. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child?

A)Complicated grieving
B)Altered family processes
C)Ineffective coping
D)Body image disturbance

Question 7

A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder?

A)The 60-year-old because of memory deficits
B)The 60-year-old because of decreased cognitive processing ability
C)The 20-year-old because of limited cognitive experiences
D)The 20-year-old because of lack of developmental maturity

Question 8

A client is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate teaching about which medication?

A)Citalopram (Celexa)
B)Risperidone (Risperdal)
C)Fluvoxamine (Luvox)
D)Isocarboxazid (Marplan)

Question 9

A nursing instructor is teaching about the correlation between pathological gambling and abnormalities in the neurotransmitter system. What statement by the nursing student indicates that learning has occurred?

A)"Pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine."
B)"Pathological gamblers present with increased serotonin, increased norepinephrine, and increased dopamine."
C)"Pathological gamblers present with decreased serotonin, decreased norepinephrine, and decreased dopamine."
D)"Pathological gamblers present with increased serotonin, decreased norepinephrine, and decreased dopamine."

Question 10

A 15-year-old who is angry about not being chosen as the basketball team's captain, spray paints obscene words on the newly chosen captain's car. What information would cause a school nurse to consider a diagnosis of intermittent explosive disorder?

A)The destruction of property is grossly out of proportion to the precipitating factor.
B)The destruction of property is not a pattern of failure to resist aggressive impulses.
C)The teenager has a diagnosis of conduct disorder.
D)The teenager has previously been diagnosed with Tourette's syndrome.

Question 11

A client has discovered that her husband is having an affair with a neighbor. During a visit to the neighbor's home, the wife steals the neighbor's diamond ring from the kitchen windowsill. What information would cause a nurse to rule out a diagnosis of kleptomania?

A)The wife did not experience a sense of relief when she took the ring.
B)The wife did not experience a sense of tension immediately before stealing the ring.
C)The stealing was committed to express the wife's anger.
D)The ring is desired by the wife for her personal use.

Question 12

A client diagnosed with an adjustment disorder asks the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing replies? (Select all that apply.)

A)"Medications can interfere with your ability to find a more permanent problem solution."
B)"Medications may mask the real problem at the root of this diagnosis."
C)"Adjustment disorders are not commonly treated with medications."
D)"Psychoactive drugs carry the potential for physiological and psychological dependence."
E)"Psychoactive drugs will be prescribed only if your problems persist for more than 3 months."

Question 13

In evaluating nursing interventions, which of the following types of questions would a nurse use to gather information from a client diagnosed with an impulse control disorder? (Select all that apply.)

A)Can the client demonstrate the ability to delay gratification?
B)Does the client demonstrate evidence of progression along the grief response?
C)Can the client accomplish activities of daily living independently?
D)Does the client verbalize symptoms of tension preceding unacceptable behavior?
E)Does the client verbalize the unacceptability of maladaptive behaviors?

Question 14

A 13-year-old client's father has recently been deployed to Afghanistan. Since deployment, the client has begun to participate in isolative behaviors, truancy, vandalism, and fighting. The pediatric nurse practitioner should identify this behavior with which adjustment disorder?

A)An adjustment disorder with anxiety
B)An adjustment disorder with disturbance of conduct
C)An adjustment disorder with mixed disturbance of emotions and conduct
D)An adjustment disorder unspecified

Question 15

A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis?

A)The client worries continually and appears nervous and jittery.
B)The client complains of a depressed mood, is tearful, and feels hopeless.
C)The client is belligerent, violates the rights of others, and defaults on legal responsibilities.
D)The client complains of many physical ailments, refuses to socialize, and quits her job.