A nurse is caring for an adolescent client who has a recent diagnosis of conduct disorder.
The client has demonstrated episodic aggression toward animals and humans, and has been known to threaten individuals with a knife and has sexually assaulted another adolescent.
Nurses' Notes: - 09:00: Client showed signs of agitation during group therapy.
- 13:00: Client had a verbal altercation with another client.
- 17:00: Client participated in one-on-one counseling, showed some signs of remorse.
Medical History: - Numerous instances of property destruction (breaking windows, damaging cars, and setting small fires) of family members as well as neighbors.
- Guardians are fearful of the client being around their other children.
Select the three findings that indicate the client is experiencing positive outcomes from the prescribed treatment:
Expression of guilt feelings
Statement regarding unit rules
Renewed relationship with uncle
Positive attitude toward school .
Correct Answer : A,B,D
Choice A rationale: Expression of guilt feelings is a positive outcome in the treatment of conduct disorder. Guilt is an emotional response to one’s actions that are perceived as wrong or inappropriate. It is a self-conscious emotion that often involves a
sense of tension and regret. In the context of conduct disorder, the expression of guilt feelings can be seen as a sign of developing empathy and understanding the consequences of one’s actions. This is a crucial step in the process of behavior change and rehabilitation. The client showing signs of remorse during one-on-one counseling is a positive sign indicating that the treatment is having an effect.
Choice B rationale: A statement regarding unit rules is another positive outcome in the treatment of conduct disorder. Understanding and acknowledging the rules of the unit indicates that the client is beginning to accept the boundaries and norms set by the authority. This is a significant step towards improving their behavior, as individuals with conduct disorder often have difficulties following rules and respecting authority. The verbal altercation with another client could be seen as a negative event, but it also could indicate that the client is engaging with others, which could be a step towards improvement, depending on the context of the altercation.
Choice C rationale: A renewed relationship with an uncle does not necessarily indicate a positive outcome from the treatment of conduct disorder. While family support can be beneficial in the treatment process, it does not directly indicate that the client’s conduct disorder is improving. More information would be needed to determine if this is a positive outcome related to the treatment.
Choice D rationale: A positive attitude toward school is a positive outcome in the treatment of conduct disorder. School is a structured environment where rules and expectations are clearly laid out, and a positive attitude towards school can indicate that the client is beginning to accept these structures. This can be a sign of improvement in their behavior and attitude.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
Choice A rationale:
Repression: This statement suggests that the client is unconsciously blocking out memories of the tragedy as a way to cope with the anxiety. While repression can be a defense mechanism, it's not considered an adaptive use of sublimation.
Sublimation involves channeling anxiety into a productive or socially acceptable activity.
Denial of anxiety: The client's denial of anxiety, despite outward signs of distress, indicates a lack of awareness or acceptance of their emotional state. This can hinder effective coping and processing of the trauma.
Potential for delayed or prolonged distress: Repressed memories can resurface later, often in unexpected or disruptive ways, potentially leading to prolonged or intensified distress.
Choice B rationale:
Hopelessness and helplessness: The client's statement reflects a sense of defeat and a belief that they are incapable of overcoming the trauma. This can lead to feelings of despair, isolation, and withdrawal.
Lack of adaptive coping mechanisms: The client's inability to envision a future beyond the tragedy suggests a lack of healthy coping strategies to manage their anxiety and move forward.
Risk of prolonged distress and potential for depression: Persistent feelings of hopelessness and helplessness can increase the risk of developing depression or other mental health conditions.
Choice C rationale:
Denial of anxiety and potential lack of insight: The client's denial of anxiety, despite the nurse's observation, suggests a lack of awareness or acceptance of their emotional state. This can impede effective coping and processing of the trauma.
Potential resistance to support: The client's defensiveness may make it challenging for them to receive support or engage in therapeutic interventions.
Risk of delayed or unmanaged distress: If the client continues to deny their anxiety, they may not seek appropriate help, potentially leading to prolonged or intensified distress.
Choice D rationale:
Sublimation: This statement demonstrates the client's ability to channel their anxiety into a constructive and healthy outlet. Physical activity can provide a release for pent-up emotions, reduce stress, and improve overall well-being.
Adaptive coping mechanism: The client's choice to engage in physical activity as a way to manage their emotions indicates a positive coping strategy that can promote resilience and recovery.
Potential for improved mental and physical health: Regular exercise has numerous benefits for both mental and physical health, which can support the client's overall well-being and recovery process.
Correct Answer is C
Explanation
Choice A rationale:
Manifestations of seizure activity are not a common adverse effect of clonazepam. In fact, clonazepam is often used to treat seizures. It is a benzodiazepine that works by decreasing abnormal electrical activity in the brain.
While it is possible for clonazepam to worsen seizures in some individuals, this is not a typical response. Therefore, it is not the most important adverse effect for the nurse to monitor.
Choice B rationale:
Decreased urine output is not a known adverse effect of clonazepam.
Some medications can affect kidney function and urine output, but clonazepam is not one of them. Therefore, it is not necessary for the nurse to monitor urine output in a client taking clonazepam. Choice C rationale:
Inability to recall events, also known as amnesia, is a common adverse effect of clonazepam.
Clonazepam can impair short-term memory, making it difficult for people to remember things that happened recently.
This can be a significant problem for clients who need to be able to recall important information, such as instructions from their healthcare providers.
Therefore, it is important for the nurse to monitor clients taking clonazepam for signs of amnesia.
Choice D rationale:
An increase in white blood cell count is not a known adverse effect of clonazepam. In fact, clonazepam can sometimes cause a decrease in white blood cell count.
However, this is a rare side effect and is not typically something that the nurse would need to monitor.
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