Ch 23- Disruptive Behavior Disorders
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1. A child is expelled from school
for repeated fighting and vandal-
izing school property. The school
nurse and counselor meet with
the parents to explain that the
child may benefit from counsel-
ing as the child is experiencing
signs of which disorder?
A) Oppositional defiant disorder
B) Asperger's syndrome
C) Attention deficit hyperactivity
disorder
D) Conduct disorder
2. A child has been displaying be-
haviors associated with conduct
disorder. The nurse should fur-
ther assess for which common
risk factors seen in children with
conduct disorder. Select all that
apply.
A) Poor family functioning
B) Strict disciplinary practices
C) Family history of substance
abuse
D) Possible child abuse
E) Poverty conditions
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Ans: D
Feedback:
Conduct disorder is characterized by
persistent antisocial behavior in children
and adolescents that significantly im-
pairs their ability to function in social,
academic, or occupational areas. Behav-
ioral symptoms include physical fights,
destruction of property, vandalism, and
serious violation of rules among others.
ODD consists of an enduring pattern
of uncooperative, defiant, and hostile
behavior toward authority figures with-
out major antisocial violations. Asperg-
er's disorder is a pervasive developmen-
tal disorder characterized by the same
impairments of social interaction and
restricted stereotyped behaviors seen
in autistic disorder, but there are no
language or cognitive delays. Attention
deficit hyperactivity disorder (ADHD) is
characterized by inattentiveness, over-
activity, and impulsiveness.
Ans: A, C, D, E
Feedback:
Risk factors include poor parenting, low
academic achievement, poor peer rela-
tionships, low self-esteem, poor family
functioning, marital discord, family his-
tory of substance abuse and psychi-
atric problems, child abuse, inconsis-
tent parental responses, exposure to vi-
olence in the media, and community so-
cioeconomic disadvantages such as in-
adequate housing, crowded conditions,
and poverty. Protective factors include
resilience, family support, positive peer
relationships, and good health.
 Ch 23- Disruptive Behavior Disorders
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3. Which are characteristics of
intermittent explosive disorder
(IED)? Select all that apply.
A) The episode may occur with
seemingly no warning.
B) They usually last less than 30
minutes.
C) Afterward, the person with IED
will not have any remorse.
D) It involves repeated episodes
of impulsive, aggressive, violent
behavior, and angry verbal out-
bursts.
E) The intensity of the emotional
outburst is usually within propor-
tion to the stressor or situation.
4. Which disorder is exemplified by
vandalism, conning others, run-
ning away from home, verbal bul-
lying and intimidation, drinking
alcohol, and sexual promiscuity?
A) Intermittent explosive disorder
B) Mild conduct disorder
C) Oppositional defiance Disor-
der
D) Moderate conduct disorder
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Ans: A, B, D
Feedback:
Intermittent explosive disorder (IED) in-
volves repeated episodes of impulsive,
aggressive, violent behavior and angry
verbal outbursts, usually lasting less than
30 minutes. During these episodes, there
may be physical injury to others, destruc-
tion of property, and injury to the individ-
ual as well. The intensity of the emotion-
al outburst is grossly out of proportion
to the stressor or situation. The episode
may occur with seemingly no warning.
Afterward, the individual may be embar-
rassed and feel guilty or remorseful for
his or her actions, but that does not
prevent future impulsive, aggressive out-
bursts.
Ans: D Feedback:
Examples of moderate conduct disor-
der include vandalism, conning others,
running away from home, verbal bul-
lying and intimidation, drinking alcohol,
and sexual promiscuity. Intermittent ex-
plosive disorder (IED) involves repeat-
ed episodes of impulsive, aggressive,
violent behavior and angry verbal out-
bursts, usually lasting less than 30 min-
utes. In mild conduct disorder, the child
has some conduct problems that cause
relatively minor harm to others. Exam-
ples include repeated lying, truancy, mi-
nor shoplifting, and staying out late with-
out permission. Oppositional defiant dis-
order (ODD) consists of an enduring pat-
tern of uncooperative, defiant, disobedi-
ent, and hostile behavior toward author-
 Ch 23- Disruptive Behavior Disorders
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ity figures without major antisocial viola-
tions.

5. An 11-year-old child talks to Ans: A

the school nurse about a single Feedback:
episode of disruptive behavior in A child at this age may have difficulty
class. The child states, ìI had a expressing negative or intense emotions
stomachache and felt like vomit- verbally; the nurse's response helps
ing. I couldn't help it. I was just so teach the child appropriate expressions
mad at my dad.î Which would be of anger.
the most appropriate response
by the nurse?
A) ìI can see that you're angry.
Let's look at better ways to ex-
press it.î
B) ìI can understand your anger,
but you can't disrupt the class-
room.î
C) ìIf you can get rid of
your anger, perhaps your stom-
achache will go away.î
D) ìPerhaps it would be helpful
if you let your dad know you're
angry.î

6. The nurse is using limit setting Ans: A Feedback:

with a child diagnosed with con- The nurse must set limits on unaccept-
duct disorder. Which statement able behavior at the beginning of treat-
reflects the most effective way for ment. Limit setting involves three steps:
the nurse to set limits with the (1) informing clients of the rule or limit;
child? (2)explaining the consequences if clients
A) ìThat is not allowed here. You exceed the limit; and (3) stating expected
will lose a privilege. You need to behavior.
stop.î
B) ìStop what you are doing. Go
to your room.î
C) ìI would appreciate if you
would not do that.î
D) ìWhy do you do these things?î

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 Ch 23- Disruptive Behavior Disorders
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7. A client with conduct disorder Ans: C Feedback:
starts yelling at another client The nurse must show acceptance of
and calling the client insulting clients as worthwhile persons even if
names. Which is the most appro- their behavior is unacceptable. This
priate response by the nurse? means that the nurse must be matter
A) ìHow would you feel if some- of fact about setting limits and must
one yelled at you like that?î not make judgmental statements about
B) ìWhat's the matter with you? clients. He or she must focus only on the
Don't you know any better?î behavior.
C) ìYelling at others is unaccept-
able. You need to let staff know
you're upset.î
D) ìYou're still having problems
controlling your anger.î

8. Which is the most commonly Ans: B

used treatment for oppositional Feedback:
defiant disorder? Treatment for ODD is based on parent
A) Pharmacologic treatment management training models of behav-
B) Parent training models of be- ioral interventions. These programs are
havioral interventions based on the idea that ODD problem
C) Individual therapy behaviors are learned and inadvertently
D) "Boot camp" reinforced in the home and school. Older
children may also benefit from individual
therapy in addition to the behavioral pro-
gram. There is little evidence that med-
ications help ODD behaviors; however,
successful pharmacologic treatment of
comorbid disorders such as ADHD may
also decrease the severity of ODD symp-
toms. Dramatic interventions, such as
ìboot campî or incarceration, have not
proved effective and may even worsen
the situation.

9. Which is likely to be most effec- Ans: D

tive for adolescents with conduct Feedback:
disorder? Many treatments have been used for
A) Involvement with the legal sys- conduct disorder with only modest effec-

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 Ch 23- Disruptive Behavior Disorders
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tem tiveness. Early intervention is more ef-
B) Focusing on the parenting ed- fective, and prevention is more effective
ucation than treatment. Dramatic interventions,
C) Incarceration such as ìboot campî or incarceration,
D) Early intervention have not proved effective and may even
worsen the situation. Treatment must be
geared toward the client's developmen-
tal age. For school-aged children with
conduct disorder, the child, family, and
school environment are the focus of
treatment. Adolescents rely less on their
parents and more on peers, so treat-
ment for this age group includes indi-
vidual therapy. Many adolescent clients
have some involvement with the legal
system as a result of criminal behavior,
but this is a consequence of and not a
treatment for conduct disorder.

10. A 14-year-old girl is being treat- Ans: B

ed for conduct disorder. She re- Feedback:
fuses to attend class today, stat- Reinforcing rules avoids a power strug-
ing that yesterday the other nurse gle; the nurse must set limits on the unac-
told her she did not have to go to ceptable behavior of missing class. The
class if she did not want to. Which nurse can negotiate with a client a be-
would be the best response by havioral contract outlining expected be-
the nurse? haviors, limits, and rewards to increase
A) ìFine, but you're confined to treatment compliance.
your room.î
B) ìMissing class is against the
rules.î
C) ìYou and I both know you're
lying.î
D) ìWhy do you keep fighting the
system?î

11. The nurse is meeting with a Ans: A

family of a client with conduct Feedback:
disorder. The nurse discusses Parents need to replace old patterns

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 Ch 23- Disruptive Behavior Disorders
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changes the parents can make to
help their child change problem-
atic behaviors. Which parenting
technique would the nurse en-
courage the parents to use?
A) Provide consistent conse-
quences for behaviors.
B) Set earlier curfews than the
child's peers adhere to.
C) Release the child from house-
hold responsibilities until he can
demonstrate
dependable behavior.
D) Avoid discussing feelings and
expectations with the child.
such as yelling, hitting, or simply ignoring
behavior with more effective strategies.
The nurse can teach parents age-ap-
propriate activities and expectations for
clients such as reasonable curfews,
household responsibilities, and accept-
able behavior at home. The parents may
need to learn effective limit setting with
appropriate consequences. Parents of-
ten need to learn to communicate their
feelings and expectations clearly and di-
rectly to these clients. Some parents may
need to let clients experience the con-
sequences of their behavior rather than
rescuing them.

12. Which are most likely included in Ans: A, C, D, E

the history of a child with conduct Feedback:
disorder? Select all that apply. Children with conduct disorder have a
A) Disturbed relationships with history of disturbed relationships with
peers peers, aggression toward people or an-
B) Major antisocial violations imals, destruction of property, deceitful-
C) Aggression toward people or ness or theft, and serious violation of
animals rules (e.g., truancy, running away from
D) Destruction of property home, and staying out all night without
E) Serious violation of rules permission). Major antisocial violations
would be indicative of antisocial behav-
ior.

13. Which steps are involved in limit Ans: A, B, D Feedback:

setting? Select all that apply.
A) State expected behavior.
B) Inform clients or the rule or
limit.
C) Threaten incarceration.
D) Explain the consequences if
clients exceed the limit.
E) Occasionally limit enforce-
ment.
Limit setting involves three steps:
1. Inform clients of the rule or limit.
2. Explain the consequences if clients
exceed the limit.
3. State expected behavior.
Threatening the client with incarceration
is not likely effective. Providing consis-
tent limit enforcement with no exceptions

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 Ch 23- Disruptive Behavior Disorders
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14. Which is true of the time-out
strategy that may be used for per-
sons with conduct disorder?
A) It is a punishment.
B) It should only be used as a last
resort.
C) Eventually, the goal is for the
client to avoid time-out.
D) Time-out is retreat to a neu-
tral place, so clients can regain
self-control.
15. The nurse understands that when
working with a child with a dis-
ruptive behavior disorder, the
family must be included in the
care. Which is one of the best
ways the nurse can advocate for
the child?
A) Support transferring the child
to a healthy living environment.
B) Teach the parents age-appro-
priate expectations of the child.
C) Reinforce the parents' expec-
tations of the child's behavior.
D) Interpret the child's thoughts
and feelings to the parent.
16. Which are actions of the parents
of a child with conduct disorders
that may contribute to the prob-
lems of the child? Select all that
7 / 11
by all members of the health-care team,
including parents, is essential.
Ans: D
Feedback:
Time-out is retreat to a neutral place, so
clients can regain self-control. It is not
a punishment. When a client's behavior
begins to escalate, such as when he
or she yells at or threatens someone,
a time-out may prevent aggression or
acting out. Staff may need to institute
a time-out for clients if they are unwill-
ing or unable to do so. Eventually, the
goal for clients is to recognize signs of
increasing agitation and take a self-in-
stituted time-out to control emotions and
outbursts.
Ans: B
Feedback:
Working with parents is a crucial aspect
of dealing with children with these dis-
orders. Parents often have the most in-
fluence on how these children learn to
cope with their disorders. The nurse can
teach parents age-appropriate activities
and expectations for clients.
Ans: A, B, C
Feedback:
Parents may also need help in learn-
ing social skills, solving problems, and
 Ch 23- Disruptive Behavior Disorders
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apply.
A) The parents may not be-
have appropriately themselves
because of a lack of
knowledge.
B) The parents blame the school
when the child causes a distur-
bance in school and
receives detention.
C) The parents engage in yelling
at, hitting, or simply ignoring the
behavior of their
child.
D) The parents make reasonable
curfews that are appropriate for
the age of the client.
E) The parents establish house-
hold responsibilities that are ap-
propriate for the age of
the client.
17. When presenting information
about conduct disorders to a
community group, the nurse is
asked, ìwhich is the best setting
for care of a client with conduct
disorders when parents cannot
provide safe, structured environ-
ments and adequate supervision
for the client?î Which would be
the most appropriate reply by the
nurse?
A) The acute care setting
B) School
C) Residential treatment settings
D) Jail-diversion program
18. Which is an effective way for par- Ans: C
ents to deal with problem behav- Feedback:
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behaving appropriately. Often, parents
have their own problems, and they have
had difficulties with the client for a long
time before treatment was instituted. Par-
ents need to replace old patterns such
as yelling, hitting, or simply ignoring be-
havior with more effective strategies. The
nurse can teach parents age-appropri-
ate activities and expectations for clients
such as reasonable curfews, household
responsibilities, and acceptable behavior
at home. Some parents may need to let
clients experience the consequences of
their behavior rather than rescuing them.
Ans: C
Feedback:
Group homes, halfway houses, and res-
idential treatment settings are designed
to provide safe, structured environments
and adequate supervision if that cannot
be provided at home. Clients with con-
duct disorder are seen in acute care set-
tings only when their behavior is severe
and only for short periods of stabilization.
Clients with legal issues may be placed
in detention facilities, jails, or jail-diver-
sion programs.
 Ch 23- Disruptive Behavior Disorders
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iors in children and to prevent lat-
er development of conduct disor-
ders?
A) Administering medications
B) Avoiding setting limits
C) Group-based parenting class-
es
D) Being overprotective of the
child
19. The nurse has been working with
the family of a small child with
oppositional defiant disorder. The
nurse is feeling very frustrated
because the parents refuse to im-
plement effective parenting skills
that the nurse has taught. What
is the best nursing action at this
time?
A) Review effective disciplinary
practices with the parents again.
B) Refer the parents to a family
therapist.
C) Try to remember that the par-
ents are trying to the best of their
ability to carry out
the suggestions.
D) Explore alternative living
arrangements for the child.
20. Which may be concerns that a
nurse has when caring for clients
who have conduct disorders? Se-
lect all that apply.
A) Thinking that the client should
be able to refrain from hostility
and aggression
through use of will power.
B) Having conflicted feelings re-
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Parental behavior profoundly influences
children's behavior. Group-based parent-
ing classes are effective to deal with
problem behaviors in children and pre-
vent later development of conduct disor-
ders.
Ans: C
Feedback:
The nurse's beliefs and values about
raising children affect how he or she
deals with children and parents. The
nurse must not be overly critical about
how parents handle their children's prob-
lems until the situation is fully under-
stood: Caring for a child as a nurse
is very different from being responsible
around the clock. The parents likely have
other obstacles in carrying out effective
discipline. Teaching again is not likely to
effect change. It is premature to refer to
family therapy or remove the child from
the home. Emotional barriers to effective
parenting should be explored first.
Ans: A, B, D
Feedback:
The nurse's beliefs and values about
raising children affect how he or she
deals with children and parents. The
nurse may also have personal feelings
about the disruptive and/or aggressive
behaviors, such as thinking the client
should be able to refrain from hostility
 Ch 23- Disruptive Behavior Disorders
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garding holding clients account-
able for their
behaviors without having a puni-
tive attitude.
C) Discussing feelings, fears, or
frustrations with colleagues.
D) Having anxiety and fears for
the nurse's personal safety.
E) Believing that aggression is
the most productive way to deal
with aggression.
21. Which are important points for
the nurse to consider when work-
ing with clients with disruptive
behavior disorders and their fam-
ilies? Select all that apply.
A) Most behavior disorders are
caused by being raised by par-
ents who had behavior
disorders in their own child-
hoods.
B) Remember to focus on the
client's strengths and assets, as
well as their problems.
C) Transient conduct disorders
are common in all children.
D) Avoid a ìblamingî attitude to-
ward clients and/or families.
E) Focus on positive actions to
improve situations and/or behav-
iors.
22. Which is the most important rea-
son for the nurse who cares for
children with conduct disorders
to discuss feelings, fears, or frus-
trations with colleagues?
10 / 11
and aggression through use of will pow-
er. It can be difficult to reconcile holding
clients accountable for their behaviors,
but avoiding a purely punitive attitude.
Working with aggressive clients of any
age may provoke anxiety and fears for
personal safety in the nurse. It is impor-
tant for the nurse to discuss feelings,
fears, or frustrations with colleagues to
keep negative emotions from interfering
with the ability to provide care to clients
with problems with aggression.
Ans: B, D, E
Feedback:
Points to consider when working with
clients with disruptive behavior disorders
and their families include the following:
ï Remember to focus on the client's
strengths and assets, as well as their
problems.
ï Avoid a blaming attitude toward clients
and/or families; rather focus on positive
actions to improve situations and/or be-
haviors.
There is a familial tendency for behavior
disorders, but that is not the only cause
for behavior disorders. Conduct disor-
ders are not common in all children, but
it can be difficult to distinguish normal
child behavior from conduct disorders at
times.
Ans: C
Feedback:
It is important for the nurse to discuss
feelings, fears, or frustrations with col-
leagues to keep negative emotions from
 Ch 23- Disruptive Behavior Disorders
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A) To make the nurse feel better
and avoid burnout.
B) To encourage camaraderie be-
tween colleagues.
C) To keep negative emotions
from interfering with the ability to
provide care to clients with prob-
lems with aggression.
D) To ensure that all caregivers
have the same attitudes and be-
liefs about children with conduct
disorders.
11 / 11
interfering with the ability to provide care
to clients with problems with aggression.
It may also make the nurse feel bet-
ter and avoid burnout, but that is not
the most important reason to do so. It
may encourage camaraderie between
colleagues, but that is not the most im-
portant reason for the nurse to do so.
It will not be possible to ensure that all
caregivers have the same attitudes and
beliefs about children with conduct dis-
orders, but they must be consistent with
limit setting, irrespective of their own at-
titudes and beliefs.