Mental Health- PrepU Chapter 28
client has obsessive-compulsive disorder that manifests in elaborate handwashing compulsions. What question should the nurse prioritize when addressing the client's safety?
"Have you ever had any thoughts of deliberately hurting yourself?"
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 may have a risk of suicidal thoughts with the medication."
The community health nurse assesses an older adult client who reports "I've started praying all the time; it helps me with my worries." The client tells the nurse that they must have e disorder after reading articles online. Which would be the nurse's best response?obsessive-compulsiv
"If you are concerned, I would recommend you discuss this with a psychiatrist."
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?
"It's important to know that the symptoms will intensify during periods of stress."
A psychiatric-mental health nurse has completed an in-service education on effective care for clients diagnosed with obsessive-compulsive disorder (OCD). Which statement made by the nurse indicates a need for further teaching?
"The models for primary care and behavioral care are different and incompatible to combine."
The nurse provides an education session on the topic of obsessive-compulsive disorder. The nurse knows the teaching has been effective when a participant makes which statement?
"To be diagnosed, your symptoms interfere with your life, work, and friends."
An older adult client is brought into the behavioral health outpatient clinic by a family member. The family member is concerned that the client is hoarding again. Which information obtained by the family member is of most concern to the nurse that correlates with the suspicion? Select all that apply.
- A large number of cats living in the home - Unable to enter into the rooms due to clutter piled up - When trying to remove items, the client becomes angry and upset.
A nurse is caring for a client with obsessive-compulsive disorder who continually checks appliances to be sure the appliances are turned off. Which areas should the nurse address in the plan of care? Select all that apply.
- relaxation techniques such as deep breathing - cognitive restructuring for dysfunctional thoughts - thought stopping when having obsessional thoughts
In order to rule a behavior as OCD, a nurse knows that the obsession or compulsion must have which characteristic(s)? Select all that apply.
- take up more than 1 hour/day and cause stress to the individual - cannot be caused by substance or medication use or other disorders
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
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.
A nurse is visiting a client in the home setting after discharge from the hospital for treatment of multiple area skin infection and cellulitis. Which behavior does the nurse document as a sign that the client is hoarding?
A single path throughout the yard and house
The psychiatric mental health nurse is participating in an interdisciplinary meeting about an inpatient client with severe obsessive-compulsive disorder. It comes to light that some members of the care team are allowing the client unlimited time to complete her rituals while others are enforced strict limits. What is the team's best response?
Agree on specific limits that will be consistently enforced
The nurse is interviewing a client with diagnoses of obsessive-compulsive disorder (OCD) and depression. The client has scored high on the Yale-Brown Obsessive Compulsive Scale and acknowledges that his rituals cause him great distress. What is the nurse's best initial action?
Assess the client's risk for self-harm
When a client with obsessive-compulsive disorder (OCD) has developed self-harming thoughts and actions, the emergency department nurse should expect to administer which medication to assist with the client's anxiety/panic?
Benzodiazepines such as lorazepam
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
The psychiatric mental health nurse is planning the care of a client whose elaborate room entry and exit rituals have led to a diagnosis of obsessive-compulsive disorder (OCD). What action by the nurse best addresses possible psychodynamic aspects of the etiology?
Exploring the characteristics of the client's defense mechanisms
A counselor is conducting a therapy session with a client who performs time-consuming compulsions. The client is exposed to a situation or object that induces anxiety in the client and the client is asked to refrain from performing the ritualized behavior. What therapy is the counselor utilizing with the client?
Exposure and Response Prevention (ERP)
Following an incident of self-harm, a client with obsessive-compulsive disorder is being admitted to the psychiatric unit. How should the nurse best address the client's anxiety around performing compulsive rituals in this unfamiliar setting?
Give the client a clear and detailed description of unit routines
Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. What is the most important treatment goal for this client?
Gradually decrease the amount of time spent performing rituals.
The nurse is providing education to family members of an older adult client who is hoarding again. Which information is important for the nurse to emphasize?
It is likely that even with treatment, the hoarding behaviors will continue.
The psychiatric mental health nurse has received a referral from a community health nurse regarding a client who appears to have hoarding disorder. When planning this client's care, the nurse should prioritize what consideration?
Promoting the client's safety in the home environment
The nurse observes a client with symptoms of onychophagia becoming anxious. The client stops the behavior and starts putting a puzzle together. Which action should the nurse take?
Provide genuine praise that the client used a coping strategy.
The nurse is caring for a client experiencing an obsession with cleanliness and compulsive handwashing behaviors. The rationale for allowing for extra time to complete handwashing rituals is based on what understanding?
Rushing completion of the ritual will increase anxiety.
The psychiatric mental health nurse is performing a suicide assessment of a client who has obsessive-compulsive disorder (OCD). What data should the nurse prioritize in order to maximize the accuracy of this assessment?
The amount of psychological distress that the client's compulsions cause
A 79 year-old client was diagnosed with late onset obsessive-compulsive disorder (OCD) related to fear of infection. What characteristic of the client's earlier life may have constituted a subclinical symptom?
The client always lined up to get her seasonal influenza vaccine on the first day it was made available
The psychiatric mental health nurse has taught some relaxation techniques to a client with obsessive-compulsive disorder (OCD). What outcome would most clearly suggest that this intervention has been successful?
The client reports increased quality and quantity of sleep
A client with obsessive-compulsive disorder (OCD) has been taught thought-stopping techniques. The nurse should recognize what potential benefit of this intervention?
The client will be able to take control of obsessions
Which best describes the primary goal of treatment for obsessive-compulsive disorder?
The client will consistently use techniques to manage symptoms.
A client with obsessive-compulsive disorder has just been prescribed sertraline. When administering this medication, the nurse should:
ensure the client knows that benefits will not be sensed for several weeks.
The inpatient psychiatric nurse plans to care for a client whose obsessive-compulsive behaviors have caused significant disruption in life routines. Which expected outcome is appropriate for the first 24 to 48 hours following admission?
The client will talk with the staff and identify sources of anxiety.
The nurse is educating a client and family member regarding obsessive-compulsive disorder (OCD). Which is essential for the nurse to communicate to the client and to the client's family to promote management of the disorder?
The importance of medication adherence and that it may be necessary for medication to be changed to find the one that works best.
A teenage girl has been diagnosed with obsessive-compulsive disorder (OCD) that manifests with excessive handwashing. The client's father is exasperated, stating, "The simplest solution would be to take away her access to soap and water." How should the nurse best interpret the father's suggestion?
This action would cause the client significant anxiety and distress
A client is being assessed for a skin infection. Upon further physical examination, the client appears to have multiple scars, lesions, and physical disfigurement. For which disorder should the nurse further assess the client?
excoriation disorder
A nurse is providing care to several clients with obsessive-compulsive disorder. Which client would the nurse identify as most likely to benefit from psychosurgery?
a client with severe obsessive compulsive disorder who has not responded to conservative treatment
The nurse has been working with a client who has obsessive-compulsive disorder (OCD) and the nurse is meeting the client's mother and father for the first time. During this interaction, the nurse should:
assess the parents' willingness to assist with behavioral techniques the client has been taught.
The nurse is assessing a newly admitted client experiencing obsessions of contamination and a compulsion to clean. The nurse would expect the client to report that the obsessions arise during which circumstances?
come from nowhere when doing normal activities
A client has been receiving medications and supportive therapy for the outpatient treatment of obsessive-compulsive disorder. When asked about the effect of treatment on the rituals, the client is vague and noncommittal. Which action would the nurse do next?
consult with the client's family.
The client is diagnosed with obsessive-compulsive disorder. Which assessment finding is most important when creating the nursing care plan?
content of obsessive thoughts and compulsions
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.
A client diagnosed with obsessive-compulsive disorder (OCD) is prescribed a medication to decrease symptoms. Which medication does the nurse anticipate being prescribed for the treatment of OCD?
fluoxetine
An adult client is seeking counseling for impulsive buying behavior that has caused financial distress in the client's life. What disorder will the nurse document in the medical record for the client?
oniomania
The nurse performs a screening for obsessive-compulsive disorder (OCD) with a client who displays symptoms of distress and a withdrawn affect. Which other screening is a priority to perform?
suicide risk assessment
The advanced practice psychiatric nurse is teaching thought stopping techniques to a client with obsessive-compulsive disorder (OCD). When providing this educational intervention, the nurse should:
teach the client how to identify and interrupt obsessional thinking.
A client diagnosed with obsessive-compulsive disorder (OCD) is prescribed a noninvasive procedure that uses magnetic fields to simulate brain cells. Which treatment will the nurse anticipate ordered for the client?
transcranial magnetic stimulation (TMS)