Psych Prep U Obsessive-Compulsive and Related Disorders

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." 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 client has a diagnosis of obsessive-compulsive disorder. The symptoms of the disorder have seriously interfered with the client's ability to work. In order to effectively work with the client, the nurse must understand that a compulsion is what?

A repetitive, intrusive, and unwanted urge to perform or performance of an act contrary to one's usual standards A compulsion is an urge to perform a behavior or the actual performance of the behavior (such as washing the hands), while an obsession is an intrusive thought that recurs, even when unwanted. Depersonalization is a feeling of unreality or strangeness concerning self, environment, or both. Obsessions are insistent thoughts, recognized as arising from the self, which cannot be controlled. Delusions encompass fixed false beliefs not true and not ordinarily accepted by other members of the person's culture.

What intervention does the nurse perform to assist the client in decreasing the frequency of repetitive behaviors?

Assist the client to keep a record of when time is used in performing activities. 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.

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?

Excoriation disorder Excoriation disorder (skin picking) is the inability to stop recurrent picking at skin for emotional release or anxiety release. Body dysmorphic disorder is a preoccupation with slight or imagined physical defects that are not apparent to others. There is not enough information to diagnose disrupted family dynamics or control issues within the family unit.

What interventions does the nurse use to promote therapeutic communication with the client diagnosed with obsessive-compulsive disorder (OCD)?

Explore the thoughts and feelings that trouble the client. The nurse discusses the client's thoughts and feelings in as much detail as possible. This helps to relieve the client of some of the "burden" the client has been keeping to the self. The client is aware that the anxiety is irrational. The nurse validates the irresistible feelings that the client experiences but assures the client that these can be controlled. OCD clients tend to hide their rituals and obsessions from friends and family. However, discussing them with the nurse is an important step in treatment.

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

Hoarding Hoarding is a progressive, debilitating, and late-onset disorder. It increases with age. Onychophagia or nail biting is a self-soothing behavior. Typical onset is in childhood and gradually decreases by age 18. Oniomania is a compulsive buying disorder. 80% of the clients are female with onset of the behavior in the early 20s. Ordering is a commonly seen compulsion in clients with OCD, in which the client arranges and rearranges objects in a perfect order. It is treated with medication and behavior therapy.

A client performs ritualistic washing of the hands and dishes, along with rearranging the table before settling down to a meal. What intervention does the nurse implement to help this client complete this daily routine? Select all that apply.

Include the time taken for the ritual in the day's timetable. Come to an agreement with the client on a time to stop the ritual. Encourage a gradual decrease in the time allotted for the ritual. The nurse includes the time taken for the ritual while planning the client's schedule. Exposure and response prevention techniques are successful only if the client agrees to cooperate during the treatment. Therefore, the nurse and client should agree on a time to stop the ritual and continue daily activities. It does not help to create distractions by asking the client to perform another activity instead of the daily ritual. The nurse does not interrupt the client during the ritual because this can escalate the client's anxiety. The nurse supports and encourages the client to gradually decrease the time allotted for the ritual each day. This helps to gradually eliminate the client's ritualistic behavior.

The partner of a client with obsessive-compulsive disorder (OCD) reports that the client regularly exhibits "strange behaviors." What does the nurse tell the partner about these behaviors? Select all that apply.

It is an attempt by the client to overcome anxiety. It is associated with an irrational persistent thought. The client will repeat the act several times during the day. The behavior exhibited by the client with OCD is an attempt to overcome anxiety. Irrational, persistent thoughts stimulate the client to repeat the act several times during the day. The client is aware that the thoughts are unreasonable but is compelled to perform them to alleviate anxiety. It is not a degenerative disorder because there is no organic cause for the behavior.

What kind of behavior does the nurse anticipate observing when treating a client obsessed with blasphemous thoughts?

Praying repeatedly. The client obsessed with blasphemous thoughts is compelled to pray or chant. The client obsessed with order vacuums the rug in a particular direction. The client worried about infection or cleanliness washes and scrubs until the skin is raw. Some clients have an obsession for counting; they count each step taken, tiles, and other objects in the surroundings.

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 Safety is a paramount consideration for clients with hoarding disorder. Clients are not normally open to differentiating between necessary and unnecessary items. Relaxation techniques are secondary to safety and there is not normally a need to involve law enforcement.

The nurse is assisting a client with behavior therapy for OCD. What nursing intervention may help enhance self-esteem?

Provide opportunities for the client to accomplish an activity. The nurse should provide the client with the opportunity to participate in activities that are easily accomplished or enjoyed by the client. The nurse teaches the client to confront situations that activate compulsive behavior during the "exposure" training. The nurse does not interrupt the client when performing a ritualistic behavior. This elevates anxiety levels in the client. Deep breathing exercises are performed when anxiety levels rise.

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. Show interest and concern for the client. Involve client in activities that can be easily accomplished. 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

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 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 evidence 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 behavior neutralizes anxiety caused by obsessive thoughts. 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 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.

What finding during the assessment indicates the effect of obsessive-compulsive disorder (OCD) in the client?

The client does not get adequate sleep. The client with OCD has trouble sleeping. Anxiety and ritualistic behaviors take time away from sleep. The client is left with little time to do productive work. This client reports loss of appetite following anxiety and little time to care for self. This client has unwanted weight loss. The client's ritualistic behavior and uncontrolled thought processes cause embarrassment and leaves the client with little time for socializing.

The nurse is caring for an adolescent with dermatillomania. What does the nurse tell the client's parent about this disorder? Select all that apply.

The client finds comfort in skin picking. It can lead to loss of occupational functioning. It can lead to medical complications. Dermatillomania is an obsessive-compulsive disorder (OCD) in which the client seeks comfort in skin picking. This behavior can lead to the loss of occupational functioning if the client refuses to interact with others due to disfigurement. The condition can also lead to infections and other medical complications. Dermatillomania is not caused by substance use nor is it a reward-seeking behavior.

A client reports to the nurse that compulsive buying is causing distress and financial problems. What assessment findings does the nurse relate to compulsive buying?

The client has a high comorbidity for depression. Compulsive buying runs in families that have a high comorbidity for depression and substance use. The client enjoys the thrill of acquiring new items and does not distribute it among the needy. The client purchases objects that may be used infrequently or never be used. Oniomania or compulsive buying is a reward-seeking behavior.

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 is preoccupied with perfection. The client who is obsessed with perfection performs compulsive rituals such as arranging and rearranging items around the house. The client who has a fear of contamination is obsessed with cleanliness. This client repeatedly washes hands and cleans and scrubs the surroundings. The client who is obsessed with blasphemous thoughts engages in repeated prayers or confession.

The nurse is assessing the physiological effects of severe obsessive-compulsive disorder (OCD) in a client. What does the nurse expect to find during assessment?

The client is unable to maintain adequate personal hygiene. In severe OCD, the client is unable to complete routine tasks because of compulsive ritual behaviors. A lot of time is spent on performing rituals and the client may not have enough time to sleep. The client is so obsessed with thoughts and compulsive behaviors that physical needs such as sleep, food, drink, and hygiene are neglected. Thus, the client may report unwanted weight loss. Rituals also interfere with the client's ability to complete activities quickly.

A client with obsessive-compulsive disorder (OCD) spends several hours each day cleansing the home and washing the hands. The client tells the nurse, "I don't think you quite realize how many bacteria, viruses, and fungi live around us." What is the nurse's most accurate interpretation of this client's statement?

The client may lack insight into the OCD The client's statement is an attempt to present a rational justification for the client's actions. This suggests a lack of insight. There is no particular association between this client's statement and physiologic factors. A lack of insight is a challenge for treatment, but it does not necessarily mean that the client will be unresponsive to treatment. Rituals often have no direct relationship with a specific event in the past

The nurse is caring for a client with obsessive-compulsive disorder (OCD). What does the nurse tell the client's family about the disorder?

The client may need to try different medications until a satisfactory response is obtained. The nurse tells the client's family that the client may have to change medications until a satisfactory response is obtained. The nurse informs the client's family that the client has unwanted obsessions that lead to compulsive behaviors. The client has a stable mind. The nurse helps the client and family to talk openly about the obsessions, anxiety, and rituals. This eliminates the client's need to keep these things secret and to carry the guilty burden alone. The client needs a supportive network of family and/or friends. Telling the family to disengage could render treatment ineffective as support is an important element in recovery from OCD and related disorders.

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 performs the ritual to relieve anxiety temporarily. 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.

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 performs the ritual to relieve anxiety temporarily. 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.

The nurse is assessing a client who habitually counts the number of objects in the client's surroundings. What finding does the nurse identify with obsessive-compulsive disorder (OCD)? Select all that apply.

The client repeatedly counts objects several times in a day. The client develops anxiety if the count ends with an odd number. The client avoids an interview in an office situated on the ninth floor. The client's mother rearranges objects around the house several times a day. The client with OCD performs ritualistic behaviors such as counting. The client may count books, stairs, or similar-looking items in the surroundings. The client repeatedly counts until an even number is obtained to soothe feelings of anxiety. The client's behavior is interfering with the client's functioning. The client missed an opportunity for progress by avoiding an interview. OCD is found to run in families. Inherited genetic factors are known to influence a person's thoughts. An individual's passion for numbers does not indicate presence of OCD in the client.

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 Relaxation techniques can reduce anxiety and improve sleep. They are less likely to enhance insight. Thought blocking focuses on stopping obsessive thoughts.

The nurse is caring for a client undergoing cognitive behavior therapy for obsessive-compulsive disorder. How does the cognitive model describe the client's thought process? Select all that apply.

The client wants to control own thoughts. The client has intolerance for uncertainty. The client overestimates the threats caused by the thoughts. According to the cognitive model, the person believes that "if I think, it will happen." Therefore, the client wants to control the client's own thoughts. This client tries to be perfect and has intolerance for uncertainty. The client feels threatened by the thoughts. All this causes an increased anxiety in the client leading to some compulsive ritualistic behavior. As per the cognitive model, the client's thoughts are influenced by an inflated sense of responsibility. This may be a result of strict moral or religious upbringing.

Which goal is appropriate for the client being treated for obsessive-compulsive disorder with response prevention therapy?

The client will experience notably less anxiety when engaged in delaying the ritual within 3 months 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.

The nurse is providing care for a client who has obsessive-compulsive disorder (OCD). What aspect of this client's history was the most likely contributor to its etiology?

The client's mother had OCD OCD has a genetic component. Psychosocial factors such as child neglect, substance abuse, and personality type are thought to be less significant than neurobiologic factors.

What does the nurse find on assessment of the thought processes of a client with obsessive-compulsive disorder (OCD)?

The obsessions become intense as the client tries to stop the behavior. Clients with OCD do not willingly have obsessions or images, and their obsessions become more intense when they try to prevent them. Clients with OCD do not experience effects in memory or intellectual functioning. However, they have difficulty concentrating when the obsessions are strong. For most, the obsessions arise out of nowhere, during other activities.

The nurse is assessing a teenage client with onychophagia. What does the nurse teach the parent about the disorder?

Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants is effective. SSRI depressants are found to be effective in the treatment of onychophagia or nail biting disorder. The typical onset of the disorder is in childhood with a decrease in behavior by age 18. It is a self-soothing behavior. It cannot be classified as a generalized anxiety disorder. It is known to be an obsessive-compulsive disorder. The client bites the nails to overcome anxiety caused by obsessions.

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

Unwanted Intrusive Impulsive The client with OCD has unwanted, intrusive, and impulsive thoughts and images. These thoughts are unreasonable and cause marked anxiety. Interesting and intelligent thoughts are not characteristic of what is described when clients experience episodes of ritualistic behavior to neutralize anxiety

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 experiencing low anxiety levels. The nurse teaches relaxation techniques when the client's anxiety level is low. This helps the client learn the technique more effectively and the client begins to use these techniques when anxiety increases. The nurse does not interrupt the client during a repetitive ritual because it agitates the client. The nurse does not teach relaxation techniques after the client has taken medication. The client has disturbed sleep so the nurse promotes a comfortable and quiet environment for the client.

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 client's statement implies that:

the client may lack insight into the diagnosis 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.

What question by the nurse is focused on identifying oniomaniac tendencies in a client diagnosed with depression?

"Do you get enjoyment out of all the clothes you buy?" Oniomania, or compulsive buying, is an acquisition type of reward-seeking behavior. The pleasure is in acquiring the purchased object rather than any subsequent enjoyment of its use. Once acquired, the object may be infrequently or never used. The person demonstrating oniomaniac behaviors is not usually suicidal. Kleptomania is compulsive stealing while body identity integrity disorder (BIID) involves the removal or amputation of alienated body parts.

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." 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

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 OCD is responsive to treatment with SSRIs. Trichotillomania, excoriation disorder, and hoarding are not normally treated with SSRIs.

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. BDD is characterized by a disproportionate focus on a minor physical characteristic. Clients with BDD do not necessarily binge and purge or engage in dangerous weight loss. Underestimation of obesity is not typical of BDD.

The nurse is assessing a client who wants an amputation of the client's healthy left arm. The client feels that the left arm "does not belong" to the body and it feels unnatural. What condition does the nurse identify in this client?

Body identity integrity disorder A client who feels alienated from a part of the body and is desiring amputation is identified as having body identity integrity disorder. Clients report feeling "natural" after amputation. The client with body dysmorphic disorder seeks elective surgery to correct slight defects in appearance. The client who suffers from guilt all the time is diagnosed with major depressive disorder. Illness anxiety disorder compels a person to be preoccupied with an imaginary illness.

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 While the etiology of trichotillomania is not fully understood, the problem is known to benefit from enhanced coping skills. Trichotillomania involves hair pulling, not skin picking. Relationships are vital to support and recovery, but healthy coping is even more important. It is beneficial for the client to understand the disease, but it is more important to develop coping skills

Which medication does the nurse anticipate the health care provider will prescribe for a client who is beginning treatment for obsessive-compulsive disorder (OCD)?

Fluvoxamine 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.

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?

Early onset may indicate family history of OCD. 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?

Encourage the client to participate in follow-up therapy. 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.

How does the nurse help to decrease anxiety and build confidence in a client with obsessive-compulsive disorder?

Help the client find alternative methods to deal with anxiety. 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.

While planning care for a child who has excoriation disorder, which would be the priority NANDA nursing diagnosis?

Impaired skin integrity The nursing diagnoses applied to patients with obsessive-compulsive disorder can run the gamut from the primary diagnosis of anxiety to other physiologic disturbances of the compulsion, such as impaired skin integrity, which may result from continuous hand washing or picking at the skin.

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 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.

A client brought to the outpatient department by a family member is diagnosed with obsessive-compulsive disorder (OCD). What characteristic of OCD does the nurse expect to find during the assessment of the client?

Rituals that interfere with occupational function. The client with OCD is often diagnosed only when the client's obsessions lead to ritualistic behavior that occupies a larger part of the day. This behavior interferes with the occupational functioning of the client. The client with OCD is aware that the irrational thoughts are promoting these behaviors. This client does not have reduced body and mind coordination. Rituals take up a lot of time and leave the client with little time for the family. The client's intellectual functioning is found to be intact during assessment.

A client spends an hour cleaning and rearranging the client's desk prior to starting work after every break. This occurs about five to six times a day. How does the nurse rate the client according to the Yale-Brown Obsessive Compulsive Scale?

Severe The nurse records severe OCD for the client who spends greater than 3 and up to 8 hours/day performing compulsions. The client loses several productive hours during the day. The client with mild traits of OCD spends less than an hour per day in ritualistic behavior. The client who spends 1 to 3 hours in repetitive behavior every day is said to have moderate OCD. Extreme OCD causes a person to spend more than 8 hours a day performing compulsions

The nurse is assessing a client who performs ritualistic counting of objects in the client's surroundings. What does the nurse tell the client about obsessive-compulsive disorder and its treatment? Select all that apply.

Talk openly with the nurse about obsessions, compulsions, and anxiety. Do not skip medication; it is an important part of the treatment. Learn and practice deep breathing and guided imagery. Treatment includes openly discussing all the obsessions, compulsions, and anxiety with nursing staff to help develop a plan of care. The client will be requried to take prescribed medication and to participate in behavior therapy to gradually eliminate the disorder. Treatment will also include learning deep breathing and guided imagery, which the client should practice and use for relaxation when anxiety levels increase. The client will be encouraged to share all concerns about the disorder with the family to eliminate the guilt of secrecy. The client will learn to tolerate anxiety as a part of the treatment to eliminate irrational behavior. Tolerating anxiety is not harmful to health and well-being

A client explains to the client's health care provider that the client has a cleaning ritual that the client goes through every day. If something disrupts this cleaning schedule, the client becomes:

extremely anxious. Obsessions create tremendous anxiety; individuals perform compulsions to relieve the anxiety temporarily. If the compensatory ritual is not performed, the person feels increased anxiety and distress. Compulsions are necessary, not pleasurable. They are often recognized as odd or strange to the individual. Initially, attempts are made to resist the compulsive behavior, but eventually, resistance fails, and the repetitive behaviors are incorporated into daily routines. Depression, aggression, and isolation are not usual responses to this behavior.

Parents of a child who is exhibiting obsessive-compulsive disorder (OCD) may notice the child:

is failing classes due to a lack of concentration. 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.

The psychiatric mental health is reviewing the health record of a client who will soon be admitted. The client's health history includes a diagnosis of body dysmorphic disorder. The nurse should anticipate that this client:

is fixated on a specific physical flaw. Body dysmorphic disorder involves a focus on a perceived defect in appearance. Comorbidity of an eating disorder is common, but this is not a diagnostic characteristic of the disorder

A client checks and rechecks the lock on the door five times before leaving home. What statement by the client indicates that this behavior is a result of obsessive-compulsive disorder (OCD)?

"I check until my anxiety subsides." The client engages in the ritualistic behavior of rechecking the lock when the anxiety becomes overwhelming. The client is unable to control the client's thoughts. This is a behavior distinctive of OCD. The client with OCD can make sound judgments and recognizes that obsessions are irrational. A person may recheck because the lock is not secure or just to make sure the door is locked. A person may simply double-check the lock. These people are not exhibiting irrational thought process and therefore do not have OCD.

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." OCD is a chronic, progressive disease. Symptoms wax and wane over time, increasing during periods of stress. While the other statements are accurate, they do not provide the most general, encompassing information regarding the management of this chronic, progressive disorder.

The client has begun to wash the client's hands every hour due to the fear of germs becoming embedded in the client's skin leading the client to develop cancer. Which would best describe the client's behavior?

A compulsion Compulsions are ritualistic behaviors that people feel compelled to perform either in accord with a specific set of rules or in a routine manner. A repeated action performed as the result of a persistent thought is termed a compulsion. Obsessions refer to recurrent, intrusive, and persistent ideas, thoughts, images, or impulses. Compulsions are the behaviors people with obsessive-compulsive disorder will carry out in order to neutralize the anxiety caused by the obsessions. Panic attacks typically are characterized by a discrete period of intense apprehension or terror without any real accompanying danger, accompanied by at least four of 13 somatic or cognitive symptoms. Acute stress disorder occurs within the first month of exposure to extreme trauma: combat, rape, physical assault, near-death experience, or witnessing a murder.

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. Obtain history of recent infections. Assess for possible brain injury. 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.

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?

Assess the client for body dysmorphic disorder. The nurse must assess the client for body dysmorphic disorder. Clients with this disorder are unhappy with their appearance and may repeat elective cosmetic surgery to correct the flaws. The client may not be happy after another surgery; therefore, the nurse need not refer the client to another cosmetic surgeon. The client with this disorder is convinced that the flaw in appearance is the reason for all the problems and unhappiness in life. The client will seek methods to correct the appearance even if the nurse suggests that further change is impossible.

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?

Chronicle situations that trigger obsessions. 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.

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 Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. A phobia is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. An obsession is a recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function. Derealization is sensing that things are not real.

The mental health nurse explains that the difference between an obsession and a compulsion can correctly be identified as what?

Compulsion involves repeating a purposeful action An obsession is a persistent, painful, and intrusive thought, emotion, or urge that one is unable to suppress or ignore, while a compulsion is the performance of a repetitious, seemingly purposeful act to prevent some future event or situation.

The nurse is caring for a client with obsessive-compulsive disorder (OCD). What are the expected outcomes for the client who has been stabilized by medication and behavior therapy?

Continue follow-up therapy as needed. Clients with OCD who have been stabilized by medication and behavior therapy may experience long-term difficulties in dealing with obsessive thoughts. These clients are encouraged to continue follow-up therapy. The expected outcome for clients in the stabilization phase of therapy is verbalizing knowledge of illness and treatment plan. In the immediate phase of therapy, clients should be able to list and review strengths and abilities with the nursing staff. These clients should also be able identify stresses and anxieties to enable the nurse to develop a plan of care.

A client diagnosed with body dysmorphic disorder (BDD) will primarily focus on what?

Discussing real or imagined defects in appearance, such as having a "long" nose Individuals with BDD focus on real (but slight) or imagined defects in appearance, such as a large nose, thinning hair, or small genitals. Preoccupation with the perceived defect causes significant distress and interferes with their ability to function socially. They feel so self-conscious that they avoid work or public situations. Some fear that their "ugly" body part will malfunction. Surgical correction of the problem by a plastic surgeon or a dermatologist does not correct their preoccupation and distress. BDD is an extremely debilitating disorder and can significantly impair an individual's quality of life.

The nurse is caring for a client with dermatillomania. What symptoms of this disorder does the nurse recognize in this client?

Excoriation of the skin The client with dermatillomania attempts to reduce anxiety by picking on the skin. This client has excoriated skin. Trichotillomania is a disorder which causes the client to repeatedly pull the hair to reduce anxiety. The client with onychophagia is likely to have very short nails due to frequent nail biting. Frequent and ritualistic hand washing is an obsessive compulsive disorder leading to dry, cracked hands.

Which is the most common obsession experienced by a client diagnosed with obsessive-compulsive disorder?

Fear of contamination The most common obsession is fear of contamination and results in compulsive hand washing. Fear of contamination usually focuses on dirt or germs, but other materials may be feared as well, such as toxic chemicals, poison, radiation, and heavy metals

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?

Online self-help therapy 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.

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. 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.

What relaxation technique does the nurse teach the client with obsessive-compulsive disorder (OCD)?

Practicing deep breathing The nurse teaches the client deep breathing for relaxation. The nurse encourages the client to practice deep breathing when anxiety increases. The client is taught to maintain a diary to note down situations that trigger obsessions. The nurse sets a timetable for the client's daily routine. This helps to ensure that the client completes tasks within a scheduled time. The effect of music on clients with OCD is not known.

What does the nurse teach the client with obsessive-compulsive disorder about relaxation techniques?

Relaxation techniques should be practiced whenever possible. The nurse asks the client to practice relaxation techniques whenever possible until the client has mastered the technique. Initially, the nurse demonstrates and practices the techniques with the client. The client does not need to depend on a friend to assist with relaxation therapy. It is done by the client without any external assistance. Relaxation techniques along with behavior therapy and medication help to gradually decrease the time spent on ritualistic behavior. It does not eliminate the disorder completely. Relaxation techniques are applied when anxiety increases.

A client's older parent has been diagnosed with hoarding disorder. What does the nurse instruct the client about the parent's hoarding disorder

Treatment may involve community agencies. The treatment for hoarding disorder in the older adult may involve multiple community agencies besides medications and behavior therapy. Hoarding disorder is an obsessive-compulsive disorder (OCD) with a late-age onset; any other recently acquired OCD in the older client may be a degenerative disorder or the result of an injury to the basal ganglia. Long-term, not short-term, treatment can result in a successful outcome.

What intervention does the nurse implement to enable the client with repetitive behavior to complete daily activities?

Verbally direct the client during the activity. 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.

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. 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.

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. "Pushing through" a client's compulsion in order to face the resulting anxiety is characteristic of ERP. Thought stopping, cue cards and relaxation do not involve this direct form of confrontation with compulsions.

To rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must:

take up more than 1 hour/day and cause stress to the client. OCD is diagnosed when recurrent obsessions or compulsions (or both) take up more than 1 hour a day or cause considerable stress to the individual. These obsessions or compulsions are not caused by substance or medication use or other disorders. Some individuals recognize that these obsessions or compulsions are excessive and unrealistic; others have limited insight and are unsure whether the obsessive thoughts are true but continue to have the thoughts and feel compelled to perform the actions. Another group of individuals are convinced that their obsessive thoughts are true. These thoughts and compulsive behaviors are stressful and interfere with normal daily routines.