Chapter 15: Obsessive-Compulsive and Related Disorders
The nurse is providing education to a client prescribed clomipramine to help with obsessive-compulsive disorder. Which statement by the client indicates the teaching was effective? "I should be feeling better in a week once I am on the medication." "I will not feel sleepy as a side effect of the medication." "I should take the medication on an empty stomach. "I may have a risk of suicidal thoughts with the medication."
"I may have a risk of suicidal thoughts with the medication." Explanation: The client would have a risk of suicidal thoughts so needs to be aware so that these can be reported to the healthcare provider. The medication would take usually several weeks before the client notices therapeutic effects so should not expect to feel better in a week. The medication also has a side-effect of sedation so that the client should be careful with driving and operating heavy machinery. The medication is best taken with food, not on an empty stomach.
Which statement by the nurse providing care for a client diagnosed with obsessive-compulsive disorder (OCD), indicates a need for additional education regarding the client's ritualistic hand washing? "Let me help you find something less time consuming to do to manage your anxiety." "Let's talk about how this ritualistic behavior makes you feel." "I believe you when you say you just can't stop washing your hands." "Let's talk about how you plan to manage your anxiety in the years to come."
"Let me help you find something less time consuming to do to manage your anxiety." Explanation: People with OCD are usually aware that their ritualistic behavior appear senseless or even bizarre to others. Given that, family and friends may believe that the person "should just stop" the ritualistic behavior. "Just find something else to do" or other unsolicited advice only adds to the guilt and shame that people with OCD experience. It is important for the nurse (and other health professionals) to avoid taking that same point of view. Most times, people with OCD appear "perfectly normal" and therefore capable of controlling their own behavior. The nurse must remember that overwhelming fear and anxiety interfere with the person's ability to monitor or control their own actions. In addition, OCD is often chronic in nature, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals doesn't mean they will never need professional help in the future.
A new client with a long-standing history of obsessive-compulsive disorder (OCD) is describing to the nurse the complex ritual of locking and unlocking a door after entering a room alone. What is the nurse's most therapeutic response? "The process you're describing sounds like it must require quite a bit of time and energy." "It sounds like you're trying to address a problem that in all likelihood doesn't exist." "What would you say to me if I had similar rituals with locking and unlocking doors?" "Is there a history of OCD or any other mental health disorders in your family?"
"The process you're describing sounds like it must require quite a bit of time and energy." Explanation: Saying, "The process you're describing sounds like it must require quite a bit of time and energy" encourages the client to elaborate on the effect that the client's rituals have on the client's life. Rapport is likely to be harmed if the nurse focuses on "a problem that doesn't exist." Focusing on the prevalence of mental health disorders is likely to inhibit communication at this fragile, early stage of the nurse-patient relationship. Turing the tables by asking, "What would you say to me if I had similar rituals with locking and unlocking doors?" is not a recognized therapeutic technique.
What interventions does the nurse perform to foster self-esteem in the client with obsessive-compulsive disorder (OCD)? Select all that apply. Teach appropriate social skills. Encourage participation in follow-up therapy. Show interest and concern for the client. Teach alternative methods for dealing with anxiety. Involve client in activities that can be easily accomplished.
-Teach appropriate social skills. -Show interest and concern for the client. -Involve client in activities that can be easily accomplished. Explanation: The client withdraws from socializing due to OCD behaviors. The nurse teaches the client appropriate social skills such as listening attentively. When the nurse conveys genuine interest and concern, the client feels accepted. The nurse supports the client's participation in activities that can be easily accomplished. All of these interventions enhance the client's self-esteem and confidence. The nurse encourages the client to participate in follow-up therapy to overcome long-term difficulties in dealing with obsessive thoughts. The nurse teaches alternative methods to deal with anxiety to promote the client's confidence in managing anxiety and other feelings.
The nurse is assessing an older client with late onset of obsessive-compulsive disorder (OCD). What assessment does the nurse perform for this client? Select all that apply. Assess for degenerative disorders. Assess client for onychophagia. Check for a family history of OCD. Obtain history of recent infections. Assess for possible brain injury.
Assess for degenerative disorders. Obtain history of recent infections. Assess for possible brain injury. Explanation: Late onset of OCD may be triggered by an organic cause such degenerative disorders, infections, or brain injury. The nurse must alert the health care provider about the cause for the disorder. The nurse does not assess the client for onychophagia or nail biting. This disorder begins in childhood and subsides by age 18 for most clients. Clients with an early onset of OCD have a greater likelihood of family history of OCD. OCD other than hoarding rarely manifests after the age of 50.
What intervention does the nurse perform to assist the client in decreasing the frequency of repetitive behaviors? Teach the client to practice conversation and attentive listening. Help the client identify supportive resources in the community. Assist the client to keep a record of when time is used in performing activities. Interrupt repeated behaviors to reduce the time used for activities.
Assist the client to keep a record of when time is used in performing activities. Explanation: The nurse should teach the client to keep a record of the frequency of and time used to perform activities. This helps the client to observe the decrease, an improvement in the condition. The client who avoids people and has limited social contact is taught conversation and attentive listening. The nurse helps the client who needs long-therapy to identify supportive resources in the community. The client is usually agitated when repeated behaviors are interrupted by others in an attempt to reduce the time taken for activities.
The nurse is assisting a client with behavior therapy for obsessive-compulsive disorder (OCD). What intervention does the nurse implement for the client during exposure? Assists the client to confront situations. Assists the client to interact with other clients. Tries various selective serotonin reuptake inhibitor (SSRI) medications to determine a right fit. Distracts the client during compulsive rituals.
Assists the client to confront situations. Explanation: During "exposure" phase of behavior therapy, the nurse assists the client to confront situations that the client normally tries to avoid. The nurse should assist clients with interacting with other clients to build self-confidence to prepare a good plan of care. These interventions, however, are not part of the exposure phase of behavior therapy. Trying SSRI medication is not a component of exposure therapy but can be used concomitantly with this type of treatment for OCD. The client must not be distracted during compulsive rituals as it agitates the client and increases anxiety.
A client with obsessive-compulsive disorder (OCD) is preparing for exposure and response prevention behavioral therapy. What does the nurse recommend as the first step? Learn deep breathing exercises. Chronicle situations that trigger obsessions. Seek assistance of family to complete daily activities. Follow a written schedule with specified times for completion.
Chronicle situations that trigger obsessions. Explanation: Exposure and behavioral prevention therapy begins by having the client maintain a diary to note the situations that trigger obsessions, time spent performing the ritual behavior, and avoidance behaviors. Relaxation techniques to assist in managing anxiety can be performed regardless of participation in exposure and response prevention therapy. This is also true of following a written schedule with specified times for completion. The client must be able to complete daily activities without assistance in a scheduled time frame.
The nurse is assessing a client recently diagnosed with obsessive-compulsive disorder (OCD). What does the nurse tell the client about the onset of the disorder? It starts in the 20s in male clients. It starts in childhood in female clients. Early onset may indicate family history of OCD. It is diagnosed very early in most clients.
Early onset may indicate family history of OCD. Explanation: Early onset of OCD indicates the likelihood of a family history of OCD. OCD starts in childhood especially in males. In females the onset is in the 20s. OCD is diagnosed only when the client's compulsive behavior interferes with the client's personal, social, and occupational function.
A client with obsessive-compulsive disorder (OCD) is being discharged from the health care facility. What does the nurse teach the client and the family? Discontinue medications after mastering behavior therapy. Apply relaxation techniques when anxiety level is low. Encourage the client to participate in follow-up therapy. Encourage the family to assist the client in completing daily activities.
Encourage the client to participate in follow-up therapy. Explanation: Clients with OCD experience long-term difficulties in dealing with obsessive thoughts. The nurse helps the client identify supportive resources in the community. Medications are just as important as mastering behavior therapy. The client must not stop medications without consulting the health care provider. The nurse asks the client to practice relaxation techniques when the client's anxiety level is low and apply them when anxiety levels increase. The client must learn to tolerate obsessive thoughts and complete daily activities without help from others.
What interventions does the nurse perform when caring for a client with obsessive-compulsive disorder (OCD)? Select all that apply Encourage the client to perform activities of daily living within a fixed time. Teach the client social skills such as appropriate conversation topics. Reward the client for every activity that is performed. Teach the client to avoid trigger situations. Talk to the client in a calm, reassuring voice.
Encourage the client to perform activities of daily living within a fixed time. Teach the client social skills such as appropriate conversation topics. Teach the client to avoid trigger situations. Explanation: Nursing interventions for OCD include encouraging the client to perform activities of daily living within a fixed time, teaching the client social skills such as appropriate conversation topics, and teaching the client to avoid trigger situations. The nurse should not provide undue praise, such as rewarding the client for every activity. Clients with OCD benefit from genuine praise that is earned. The nurse should convey interest when speaking to the client; however, a calm, reassuring voice is not necessary. This tone is used with clients experiencing a panic attack.
The nurse is interviewing the parents of a child who is exhibiting obsessive-compulsive disorder (OCD). The nurse would anticipate that the parents would report the occurrence of which situation with the child? Failing classes due to a lack of concentration. Spending excessive amount of times in the child's room. Frequently "staring off into space." Appearing jittery and nervous all the time.
Failing classes due to a lack of concentration. Explanation: Assessment reveals intact intellectual functioning. The client may describe difficulty concentrating or paying attention when obsessions are strong. Because children subscribe to myths, superstition, and magical thinking, obsessive and ritualistic behaviors may go unnoticed. Behaviors such as touching every third tree, avoiding cracks in the sidewalk, or consistently verbalizing fears of losing a parent in an accident may have some underlying pathology but are common behaviors in childhood. Typically, parents notice that a child's grades begin to fall as a result of decreased concentration and great amounts of time spent performing rituals. Isolating themselves, staring off into space, and being nervous could be considered normal behavior at certain developmental ages.
Which medication does the nurse anticipate the health care provider will prescribe for a client who is beginning treatment for obsessive-compulsive disorder (OCD)? Risperidone Fluvoxamine Quetiapine Olanzapine
Fluvoxamine Explanation: The client who is beginning treatment for OCD is prescribed the selective serotonin reuptake inhibitor depressant fluvoxamine as a first-line choice. Clients with treatment-resistant OCD may respond to second-generation antipsychotics such as risperidone, quetiapine, and olanzapine.
How does the nurse help to decrease anxiety and build confidence in a client with obsessive-compulsive disorder? Provide opportunities to perform tasks usually avoided by the client. Help the client find alternative methods to deal with anxiety. Permit minimal interactions with other clients during the therapy. Provide the client with a quiet and dimly lit room.
Help the client find alternative methods to deal with anxiety. Explanation: The nurse teaches the client alternative methods such as deep breathing to deal with anxiety. The nurse provides opportunities to allow the client to perform tasks enjoyed by the client. Accomplishing these tasks in a set time enhances confidence and self-esteem. The client is encouraged to develop social skills by interacting with other staff members and clients. The client is given a room that is quiet and dimly lit room to promote sleep and rest.
A client states that the client copes with anxiety by cleaning compulsively, which irritates the client's spouse. What does the nurse consider this? Maladaptive, because it is an avoidance response Maladaptive, because it bothers the client's spouse Adaptive, because the client chooses to clean Adaptive, because the client's behavior isn't harming anyone
Maladaptive, because it is an avoidance response Explanation: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. -Functional responses tend to be voluntary, conscious behaviors that address and acknowledge the stressful situation and help clients to find solutions. -Dysfunctional responses tend to be involuntary, inflexible, avoidance-type solutions that impair productivity. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms. In other words, it is not appropriate to expect a client to just stop worrying, compulsively checking doors, or otherwise trying to cope with anxiety.
The nurse is caring for a client who has been admitted by the family to the health care facility. The client is unwilling to discuss obsessive-compulsive disorder (OCD) symptoms. Besides the standard therapy, what additional therapy does the nurse recommend for this client? Psychodynamic therapy Interpersonal therapy Online self-help therapy Follow-up therapy
Online self-help therapy Explanation: Online self-help therapy can be an effective add-on to standard therapy. This is especially beneficial for clients who are ashamed and stigmatized by their OCD symptoms and unwilling to discuss it with the nurse. Psychodynamic and interpersonal therapy are not typically recommended for treatment of OCD. If these treatments are used, it would be with the aim of treating other issues the client is experiencing comorbid to the OCD, not the OCD alone. The client who is unwilling to share fears and obsessions may not report for follow-up therapy.
A client with obsessive-compulsive disorder (OCD) has been assessed by the primary care provider. What treatment is most likely? Paroxetine Phenelzine Olanzapine Lorazepam
Paroxetine Explanation: Paroxetine is a sustained serotonin reuptake inhibitor (SSRI). SSRIs are a first line treatment for OCD. Phenelzine is a monoamine oxidase inhibitor and olanzapine is an antipsychotic; neither are commonly used to treat OCD. Benzodiazepines such as lorazepam are not normally used.
What does the nurse teach the client with obsessive-compulsive disorder about reducing anxiety? Select all that apply. Practice guided imagery. Perform progressive muscle relaxation. Reduce time spent on rituals. Breathe deeply when anxiety increases. Refrain from discussing the obsessions.
Practice guided imagery. Perform progressive muscle relaxation. Reduce time spent on rituals. Breathe deeply when anxiety increases. Explanation: The nurse teaches the client to practice relaxation techniques such as guided imagery, progressive muscle relaxation, and deep breathing. The client should apply these techniques when anxiety levels increase. The client should gradually reduce time spent on rituals. The client openly discusses obsessions with the nurse and family to relieve anxiety caused by the "burden" of keeping a secret.
A client with obsessive-compulsive disorder (OCD) states making a concerted effort to reduce the frequency and duration of rituals. What intervention should the nurse include to assist in these efforts? Teach the client nonpharmacologic relaxation techniques Administer mood stabilizers as prescribed Teach the client how to complete the client's rituals in less time Educate the client about the negative effects of obsessions and compulsions
Teach the client nonpharmacologic relaxation techniques Explanation: Reducing the frequency of rituals for a person with OCD causes anxiety. Clients consequently benefit from learning techniques that can reduce their stress in a healthy way. Mood stabilizers are not typically used in the treatment of OCD, and nurses do not normally facilitate the performance of rituals. The client is likely aware of the negative consequences of obsessions and rituals, as evidenced by efforts to eliminate them.
The nurse is educating the client's family about compulsive behavior. The nurse is correct when making which statement? The client's thoughts and behaviors are realistically connected. The behavior neutralizes anxiety caused by obsessive thoughts. The client stops the ritual only when prompted by external stimuli. The behavior eventually leads to insanity.
The behavior neutralizes anxiety caused by obsessive thoughts. Explanation: The client attempts to suppress or ignore the intrusive thoughts by indulging in ritualistic behavior. This behavior neutralizes the anxiety caused by obsessive thoughts. However, the thoughts and behaviors are not realistically connected. The client becomes agitated and anxiety levels increase when prompted to stop by external stimuli. The client has normal intellectual functioning and is not on the verge of insanity.
What signs of stabilization does the nurse recognize during the follow-up visit of a client undergoing behavior therapy for obsessive-compulsive disorder (OCD)? The client completes daily routine within a specified time. The client identifies stresses and anxieties. The client verbalizes conflicting thoughts and fears. The client recognizes and lists strengths and abilities.
The client completes daily routine within a specified time. Explanation: The client who has achieved stabilization following behavior therapy for OCD is able to complete the daily routine within a specified time. The other outcomes are expected in a client in the immediate phase of behavior therapy. In that phase, the client is able to identify stresses and anxieties, talk to the nurse about conflicting thoughts and fears and, with nursing staff help, recognize personal strengths and abilities.
When assessing the insight and self-concept of a client with obsessive-compulsive disorder (OCD), what does the nurse note? The client has the will power to stop intrusive thoughts. The client has a fear of "going crazy." The client is unable to make sound judgments. The client feels that the images and thoughts are real.
The client has a fear of "going crazy." Explanation: Clients with OCD express concern that they may be "going crazy." Feelings of powerlessness to control the obsessions or compulsions contribute to their low self-esteem. These clients also feel that they could control the thoughts and behaviors if they had stronger willpower. These clients are able to make sound judgments but are unable to act on them. Clients with OCD are aware that the intrusive images and thoughts are irrational, but they cannot control the overwhelming anxiety.
The nurse is caring for a client receiving fluvoxamine and behavior therapy for obsessive compulsive disorder. What outcome does the nurse expect of this client? The client establishes adequate nutrition after 1 to 2 days. The client is able to sleep for at least 4 hours per night after 5 days. The client is able to identify the cause of anxiety after 1 week. The client is able to identify individual strengths and abilities after 2 weeks.
The client is able to sleep for at least 4 hours per night after 5 days. Explanation: The client responding effectively to treatment must be able to sleep for at least 4 hours per night. -Adequate nutrition must be established within 4 to 5 days. -The client is expected to identify the cause of stress and anxiety within 2 to 3 days. -Individual strengths and abilities must be identified and reviewed with staff within 3 to 4 days.
A client diagnosed with obsessive-compulsive disorder comes to the clinic with the client's spouse. During the visit, the spouse states, "The client is always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time. Isn't checking once enough?" An understanding of what would the nurse need to incorporate into the response? The client is attempting to exert control over the situation. The client performs the ritual to relieve anxiety temporarily. The client's behavior reflects a need for safety. The client is attempting to use thought stopping to decrease the behavior.
The client performs the ritual to relieve anxiety temporarily. Explanation: The nurse needs to explain to the spouse that the client's compulsion is done to relieve anxiety temporarily. The compulsion is necessary, not pleasurable, and if not performed, increased anxiety and distress occur. The compulsion is an anxiety response, not a means to control the situation or promote safety. Thought stopping is a mechanism used to control obsessions.
Which goal is appropriate for the client being treated for obsessive-compulsive disorder with response prevention therapy? The client will demonstrate an understanding of the benefits of deep breathing within 2 days. The client will experience notably less anxiety when engaged in delaying the ritual within 3 months. The client will implement relaxation techniques to help manage his or her anxiety within 2 days. The client will deliberately confront the trigger of his or her anxiety within 3 months.
The client will experience notably less anxiety when engaged in delaying the ritual within 3 months. Explanation: Response prevention focuses on delaying or avoiding performance of rituals. The client learns to tolerate the thoughts and the anxiety and to recognize that it will recede without the disastrous imagined consequences. Other techniques, such as deep breathing and relaxation, can also assist the person to tolerate and eventually manage the anxiety. Exposure involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids.
What intervention does the nurse implement to enable the client with repetitive behavior to complete daily activities? Tell the client to take as much time as needed to complete the task. Limit stimuli that activate repetitive behavior in the client. Verbally direct the client during the activity. Allow family to participate in the activity.
Verbally direct the client during the activity. Explanation: -The nurse talks and guides the client throughout the activity to prevent the client from being distracted by anxious thoughts. -Telling the client to take as much time as is needed to complete the task gives the client permission to engage in maladaptive rituals to neutralize anxiety rather than work at developing healthier coping through the use of exposure and response therapy. The client may not be able to estimate the amount of time a normal person would need to complete the given task. -The nurse does not try to limit stimuli that activate repetitive behavior. The client must learn to overcome these stresses during behavior therapy. -The family does not participate in the activity but the nurse teaches the family about the illness and methods of treatment.
2.Which of the following characteristics describe the obsessional thoughts experienced by clients with OCD? a.Intrusive b.Realistic c.Recurrent d.Uncontrollable e.Unwanted f.Voluntary
a.Intrusive c.Recurrent d.Uncontrollable e.Unwanted
The nurse is participating in an interdisciplinary care conference for a client who has obsessive-compulsive disorder (OCD). In order to best promote the client's recovery, the care team must: agree on a consistent expectations for the client's behavior. establish meaningful consequences for the client in case of nonadherence. allow the client to lead the care conference and identify the desired outcomes. identify the precise etiology of the client's obsessive-compulsive disorder.
agree on a consistent expectations for the client's behavior. Explanation: The care team must be agreed on the expectations for the client in order to promote recovery. It is not possible to identify the precise etiology of a multifactorial disease like OCD. The client's preferences and goals are important, but it is unrealistic to expect the client to lead an interdisciplinary care conference. Adherence is promoted through positive reinforcement, not negative consequences.
Interventions for a client with OCD would include a.encouraging the client to verbalize feelings. b.helping the client avoid obsessive thinking. c.interrupting rituals with appropriate distractions. d.planning with the client to limit rituals. e.teaching relaxation exercises to the client. f.telling the client to tolerate any anxious feelings.
d.planning with the client to limit rituals. e.teaching relaxation exercises to the client. f.telling the client to tolerate any anxious feelings.
The nurse is interviewing a client who is being treated for obsessive-compulsive disorder (OCD). The client's compulsions involve cleanliness rituals, which the client justifies by describing potential contaminants in great detail. The nurse interprets the client's statement as implying that: the client may lack insight into the diagnosis. the client's fears can likely be alleviated by presenting evidence about the safety of water. the client may develop more serious obsessions and compulsions over time. the client would likely benefit from inpatient treatment.
the client may lack insight into the diagnosis. Explanation: The client's attempt to justify the client's obsessions and compulsions suggests a lack of insight. This does not mean, however, that the client's disease will worsen over time or that inpatient treatment is needed. Objective evidence does not dissuade clients from their obsessions or rituals.
