Chapter 15 OCD

When assessing the insight and self-concept of a client with obsessive-compulsive disorder (OCD), what does the nurse note?

The client has a fear of "going crazy."

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 a fear of acquiring infections.

A client with obsessive-compulsive disorder has been taking fluoxetine for one month. The client tells the nurse, "These pills are making me sick. I think I'm getting a brain tumor because of the headaches." Which response by the nurse would be most appropriate?

"These medications have side effects that can cause increased headaches."

Susan has begun to wash her hands every hour on the hour because she fears that if germs become embedded in her skin, she will contract cancer. Which of the following would best describe Susan's behavior?

A compulsion

The nurse is caring for a client receiving fluvoxamine and behavior therapy for obsessive compulsive disorder (OCD). What outcome does the nurse expect of this client?

Able to sleep for at least 4 hours per night after 5 days.

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.

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 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.

The nurse is assessing a client who wants an amputation of his 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 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.

The mental health nurse explains that the difference between an obsession and a compulsion is that only the ...

Compulsion involves repeating a purposeful action

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.

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

Discuss the thoughts and feelings that trouble the client.

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.

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.

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

Which of the following is the most common obsession experienced by a client diagnosed with obsessive-compulsive disorder (OCD)?

Fear of contamination

Which medication does the nurse anticipate the health care provider will prescribe for a client who is beginning treatment for OCD?

Fluvoxamine

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

Help the client find alternative methods to deal with anxiety.

During a home visit, the nurse finds that her 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?

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?

Hoarding

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.

A client states that she copes with anxiety by cleaning compulsively, which irritates her husband. What does the nurse consider this?

Maladaptive, because it is an avoidance response

The nurse is caring for a client who performs ritualistic hand washing and cleaning for about 30 minutes several times a day. What does the nurse tell the client's partner about caring for this client?

Monitor own health and anxiety levels.

The nurse is using the Yale-Brown obsessive-compulsive scale to assess a client diagnosed with obsessive-compulsive disorder (OCD). What assessment findings indicate severe OCD in the client?

Obsessive intrusions occur more than 8 times a day.

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

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

Practice relaxation techniques whenever possible.

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

Practicing deep breathing

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

Praying repeatedly.

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.

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?

Psychosurgery is an option for severe OCD but is not typically used for the treatment of trichotillomania, hoarding, or skin-picking disorder.

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.

A client spends an hour cleaning and rearranging the 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

A client with obsessive-compulsive disorder describes all doorknobs as being contaminated with a variety of viruses. He cleans each knob three times with paper towels before use. Such behavior allows the client to do what?

Temporarily reduce anxiety

The nurse is educating the client's family about compulsive behavior. What does the nurse tell them?

The behavior neutralizes anxiety caused by obsessive thoughts.

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.

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

The client does not get adequate sleep.

The nurse is caring for a client diagnosed with kleptomania. What behavior does the nurse expect of this client?

The client gets a thrill from stealing and not getting caught.

The nurse is assessing a client who has been receiving treatment for obsessive-compulsive disorder (OCD). What finding helps the nurse to evaluate the effectiveness of the treatment?

The client is able to carry out all responsibilities.

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 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.

The nurse is assessing a client with a strong urge to arrange and rearrange the items on the table several times a day. What other finding does the nurse associate with obsessive-compulsive disorder (OCD)?

The client is unable to tolerate deviations from routine.

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.

A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, "She's 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 which of the following would the nurse need to incorporate into the response?

The client performs the ritual to relieve anxiety temporarily.

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.

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

Treatment may involve community agencies.

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

Treatment with SSRI antidepressants is effective.

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 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.

A client with obsessive-compulsive disorder (OCD) is using cue cards to help restructure thought patterns. Which statements would be appropriate to include on a cue card? Select all that apply.

• "I did it right the first time." • "Trust myself." • "These are the OCD thoughts."

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.

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.

• 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. • Include the time taken for the ritual in the day's timetable.

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

• Impulsive • Intrusive • Unwanted

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.

• It can lead to medical complications. • The client finds comfort in skin picking. • It can lead to loss of occupational functioning.

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

• Learn and practice deep breathing and guided imagery. • Do not skip medication; it is an important part of the treatment. • Talk openly with the nurse about obsessions, compulsions, and anxiety.

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

• The client wants to control own thoughts. • The client overestimates the threats caused by the thoughts. • The client has intolerance for uncertainty.

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.

• The client will repeat the act several times during the day. • It is associated with an irrational persistent thought. • It is an attempt by the client to overcome anxiety.