Chapter 15: Obsessive-Compulsive Related Disorders

What question by the nurse is focused on identifying oniomaniac tendencies in a client diagnosed with depression? "Do you ever feel like hurting yourself?" "Have you ever been arrested for stealing?" "Can you explain to me why you want to have your leg amputated?" "Do you get enjoyment out of all the clothes you buy?"

"Do you get enjoyment out of all the clothes you buy?"

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"

The nurse is teaching a client with obsessive-compulsive disorder about cognitive restructuring. Which client statement best demonstrates effectiveness of teaching? "I never need to wash my hands again." "I may not always have harmful germs on my hands." "I can wash my hands as long as I put lotion on them." "I should wash my hands with lukewarm water only."

"I may not always have harmful germs on my hands"

The nurse provides care to a client who is diagnosed with body dysmorphic disorder (BDD). Which client statement indicates a need for the nurse to include risk for suicide into the client's plan of care? "I was recently diagnosed with obsessive-compulsive disorder." "I attend a support group weekly to deal with my body image issues." "I was diagnosed with substance use disorder last year and I still struggle with it." "I never use the built-in laptop camera in meetings because it makes my nose look huge."

"I was diagnosed with substance use disorder last year and I still struggle with it."

Which statement made by the nurse to the family of a client diagnosed with obsessive-compulsive disorder (OCD) demonstrates the best general understanding of the chronic nature of the disorder and its management? "The symptoms will require lifelong medication therapy." "OCD often lasts well into adulthood." "There are several comorbid conditions that can develop from the anxiety." "It's important to know that the symptoms will intensify during periods of stress."

"It's important to know that symptoms will intensify during periods of stress"

Which statement made by the nurse to the family of a client diagnosed with obsessive-compulsive disorder (OCD) demonstrates the best general understanding of the chronic nature of the disorder and its management? "The symptoms will require lifelong medication therapy." "OCD often lasts well into adulthood." "There are several comorbid conditions that can develop from the anxiety." "It's important to know that the symptoms will intensify during periods of stress."

"It's important to know that the symptoms will intensify during periods of stress."

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."

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."

Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)? A client who firmly believes that everyone who sees the client fixates on the size of the client's ears A client who has a pattern of overeating and then inducing vomiting A client who is more than 150 pounds overweight but who believes the self to be healthy A client who is dangerously underweight but persists in weight-loss efforts

A client who firmly believes that everyone who sees the client fixates on the size of the client's ears

Which client is most likely to benefit from the administration of selective serotonin reuptake inhibitors (SSRIs)? A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive- behavioral therapy A client whose unusual pattern of hair loss has been attributed to a mental health disorder A client who has diffuse skin lesions as a result of excoriation disorder A client whose family is deeply concerned that the client may have hoarding disorder

A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive- behavioral therapy

The client has begun to wash the hands every hour due to the fear of germs becoming embedded in the client's skin leading the client to develop cancer. The nurse interprets this behavior as indicating which condition? An obsession A panic attack A compulsion Acute stress disorder

A compulsion

The mental health nurse explains that the difference between an obsession and a compulsion can correctly be identified as what? A compulsion involves repeating a seemingly purposeful action. The client experiencing compulsions has insight into the disorder. An obsession responds well to psychiatric treatment. The client experiencing an obsession usually experiences delusions as well.

A compulsion involves repeating a seemingly purposeful action.

__________ are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

Compulsions

The nurse is assessing a client who is unsatisfied with the results of two previous cosmetic surgeries and wants to have another surgery to correct the perceived flaws. What is the best response on the part of the nurse? Refer the client to another cosmetic surgeon. Convince the client that the current look is normal. Assess the client for body dysmorphic disorder. Explain to the client that no further change is possible.

Assess the client for body dysmorphic disorder

A nurse is planning care for a client who has been diagnosed with trichotillomania. Which outcome should the nurse include in the client's plan of care? Client will demonstrate healthy coping strategies for dealing with stressors Client will consistently refrain from skin picking Client will reestablish mutually supportive relationships with family members Client will accurately describe the etiology and clinical course of trichotillomania

Client will demonstrate healthy coping strategies for dealing with stressors

A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior? Compulsion Phobia Obsession Derealization

Compulsion

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.

The nurse provides education regarding the introduction of virtual services provided by mental health care practitioners. Which expectation of virtual service does the nurse include in the teaching session? Select all that apply. Encrypt client data in transit and in storage. Protect display screens from incidental viewing. Exchange protected health information (PHI) only when necessary. Ensure that audio transmissions are protected from eavesdropping. Negotiate HIPAA-compliant business associate agreement (BAA) with cloud hosts.

Encrypt client data in transit and in storage. Protect display screens from incidental viewing. Exchange protected health information (PHI) only when necessary. Ensure that audio transmissions are protected from eavesdropping. Negotiate HIPAA-compliant business associate agreement (BAA) with cloud hosts.

A teenager and the teenager's parents visit the clinic to discuss the teen's skin picking. There are many bleeding wounds and various stages of scabs located up and down both arms. The parents are very upset about this behavior and want it to stop. Which would the health care provider document? Body dysmorphic disorder Disrupted family dynamics Excoriation disorder Control dysfunction

Excoriation disorder

A client with obsessive-compulsive disorder tells the nurse, "I never thought I'd be able to survive the feeling of leaving a room without going back through the door eight times, but I just did it with my therapist!" This client's treatment most likely included: exposure and response prevention. thought stopping. cue cards. progressive relaxation.

Exposure and response prevention

True or False: Most treatment for obsessive compulsive disorder (OCD) is inpatient.

False

True or False: Oniomania is a preoccupation with imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life.

False

True or False: The incidence of hoarding decreases with age.

False

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

During a home visit, the nurse finds that an older adult client has amassed a large quantity of newspapers and magazines. When the nurse offers to remove some of the newspapers, the client becomes anxious. What disorder does the nurse suspect? Body dysmorphic Hoarding Body identity integrity Oniomania

Hoarding

The nurse is caring for clients with obsessive-compulsive disorder (OCD). Which progressive and debilitating disorder is most commonly seen with a late onset? Onychophagia Hoarding Oniomania Ordering

Hoarding

__________, or compulsive stealing, is a reward-seeking behavior.

Kleptomania

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

What kind of behavior does the nurse anticipate observing when treating a client obsessed with blasphemous thoughts? Praying repeatedly. Vacuuming in a particular direction. Continually washing and scrubbing. Counting each step taken.

Praying repeatedly

What does the nurse teach the client with obsessive-compulsive disorder about relaxation techniques? A friend should assist with relaxation therapy. They help to eliminate ritualistic behavior completely. Relaxation techniques should be practiced whenever possible. Relaxation techniques should be attempted when anxiety subsides.

Relaxation techniques should be practiced whenever possible.

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

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

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.

The nurse is assessing a client whose hands are red and cracked from repeated hand washing and cleaning. What finding does the nurse identify with obsessive-compulsive disorder (OCD)? The client has recently started using a different detergent. The client is inflicting injury on self to punish others. The client has a fear of acquiring infections. The client is indulging in attention-seeking behaviors.

The client has a fear of acquiring infections

The nurse is assessing a client who spends several hours arranging and rearranging items around the house. What does the nurse anticipate is the cause of this compulsive behavior? The client has a fear of contamination. The client is obsessed with cleanliness. The client is preoccupied with perfection. The client is obsessed with blasphemous thoughts.

The client is preoccupied with perfection

The nurse is assessing a client who spends several hours arranging and rearranging items around the house. What does the nurse anticipate is the cause of this compulsive behavior? The client has a fear of contamination. The client is obsessed with cleanliness. The client is preoccupied with perfection. The client is obsessed with blasphemous thoughts.

The client is preoccupied with perfection

What does the nurse find on assessment of the thought processes of a client with obsessive-compulsive disorder (OCD)? The client has gradual memory loss. The client's intellectual functioning is deteriorating. Obsessions occur when the client is not engaged in an activity. The obsessions become intense as the client tries to stop the behavior.

The obsessions become intense as the client tries to stop the behavior

A client's older parent has been diagnosed with hoarding disorder. What does the nurse instruct the client about the parent's hoarding disorder? It is a degenerative disorder. It is caused by an injury to the basal ganglia. Treatment may involve community agencies. Short-term treatment can provide a successful outcome.

Treatment may involve community agencies

True or False: Exposure and response prevention therapies are first-line, evidence-based treatments for obsessive compulsive disorder (OCD).

True

True or False: The client diagnosed with obsessive compulsive disorder (OCD) recognizes that the obsessions are irrational, but he or she cannot stop them.

True

What kinds of thoughts does the nurse identify in a client with obsessive-compulsive disorder (OCD)? Select all that apply. Unwanted Interesting Intrusive Impulsive Intelligent

Unwanted Intrusive Impulsive

The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When does the nurse teach relaxation techniques to the client? When the client is performing a repetitive ritual. After the client has taken medication. When the client is experiencing low anxiety levels. Just before the client goes to bed.

When the client is experiencing low anxiety levels

__________ involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids.

exposure

Optimal treatment for OCD combines medication and __________ therapy.

behavior

A client is diagnosed with trichotillomania. What would the nurse expect to observe with the client? report by the client about having large ears skin redness and irritation over bilateral arms hair loss on the scalp, eyebrows and/or eyelashes reddened hands from continuous hand-washing

hair loss on the scalp, eyebrows and/or eyelashes

The nurse provides care to a client who is newly diagnosed with hoarding disorder. Which treatments are appropriate for the nurse to include in this client's plan of care? Select all that apply. safety education pharmacotherapy peer-led support group electroconvulsive therapy (ECT) Cognitive behavioral therapy (CBT)

safety education pharmacotherapy peer-led support group electroconvulsive therapy (ECT)

__________ is a chronic, repetitive act of hair pulling.

trichotillomania