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) ANS: B An antipsychotic like Risperdal can be prescribed for intermittent explosive disorder. An antidepressant is not the usual drug of choice for this disorder. 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 disorderANS: B Alopecia areata is a dermatological condition that, according to the DSM-IV diagnostic criteria for trichotillomania, must be ruled out to establish this diagnosis. 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." ANS: A Serotonergic function is linked to behavioral initiation, inhibition, and aggression. Noradrenergic function mediates arousal and detects novel and aversive stimuli. Dopaminergic function is associated with reward and reinforcement mechanisms. Thus, pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine. 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 ANS: C The predominant features of an adjustment disorder with mixed disturbance of emotions and conduct include symptoms of anxiety or depression as well as behaviors to include violations of rights of others, truancy, vandalism, and fighting. 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.ANS: D The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, social withdrawal, or work or academic inhibition, without significant depressed or anxious mood. 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. ANS: B According to the DSM-IV diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within 3 months of the onset of the stressor. 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. ANS: A The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that several discrete episodes of destruction of property must occur, and the aggressive episode can not be better accounted for by another mental disorder such as conduct disorder or Tourette's syndrome. The degree of aggressiveness must be grossly out of proportion to the precipitating factor. 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. ANS: C The DSM-IV-TR criteria for the diagnosis of kleptomania state that an individual diagnosed with this disorder experiences a sense of tension before committing theft and relief at the time of the theft. The theft cannot be committed as an act of anger or vengeance, and the object stolen cannot be needed for personal use. 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 ANS: D Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity. By comparison, the 20-year-old does not have the developmental maturity, life experiences, and coping mechanisms that the 60-year-old might possess. 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 ANS: C Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or the inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of the impulse control disorder, trichotillomania, may be assigned. 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. ANS: B Impulsive behaviors and the inability to delay gratification are symptoms of impulse control, not adjustment disorders. There is no evidence presented that the client has a body image distortion. Setting an outcome of independent self-care will direct nursing interventions toward encouraging the client to meet self-care needs. 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 intoxicatedANS: B The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that the aggressive episodes are not better accounted for by another mental disorder like antisocial personality disorder or schizophrenia. Also, the aggressive episodes are not due to the direct physiological effect of a substance such as alcohol. 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. ANS: A, B, C, E The DSM-IV-TR criteria for the diagnosis of pathological gambling include all and more of the behaviors presented. The gambling behavior cannot be better accounted for by a manic episode. 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? ANS: A, D, E A client diagnosed with an impulse control disorder should not have difficulty accomplishing activities of daily living or progressing through the grief process. These types of questions would be appropriate for clients diagnosed with adjustment disorders, not impulse control disorders. 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."