Mental Health Chapter 15

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

Relaxation techniques should be practiced whenever possible.

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

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.

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

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 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?

A compulsion

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 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 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

What interventions does the nurse perform when caring for a client with obsessive-compulsive disorder (OCD)? Select all that apply.

Encourage the client to perform activities of daily living within a fixed time. Teach the client social skills such as appropriate conversation topics. Teach the client to avoid trigger situations.

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

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.

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 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 with obsessive-compulsive disorder (OCD) has been assessed by the primary care provider. What treatment is most likely?

Paroxetine

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 observing when treating a client obsessed with blasphemous thoughts?

Praying repeatedly.

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.

During an interview, a client diagnosed with obsessive-compulsive disorder tells the nurse, "I'm constantly worrying that something bad will happen to my mother and that she will die. So, I'm always praying so that this won't happen." The nurse interprets this as which obsessive-compulsive symptom dimension?

aggressive/sexual/religious/checking

The nurse is interviewing a client who is being treated for obsessive-compulsive disorder (OCD). The client's compulsions involve cleanliness rituals, which the client justifies by describing potential contaminants in great detail. The nurse interprets the client's statement as implying that:

the client may lack insight into the diagnosis.

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

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.

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 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.

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 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 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.

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

Unwanted Impulsive Intrusive

A nurse is assessing a client and suspects obsessive-compulsive disorder .The nurse understands that to rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must meet which criteria?

Take up more than 1 hour/day and cause stress to the client.

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 nurse is admitting a client with obsessive-compulsive disorder whose compulsion is washing hands. What should the nurse explain to the client?

"Applying lotion will help keep your skin from breaking down."

The nurse is teaching a client with obsessive-compulsive disorder about cognitive restructuring. Which client statement best demonstrates effectiveness of teaching?

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

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."

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

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

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?"

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

Verbally direct the client during the activity.

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.

thought stopping when having obsessional thoughts relaxation techniques such as deep breathing cognitive restructuring for dysfunctional thoughts

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."

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."

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

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

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.

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.

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

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.

Encourage a gradual decrease in the time allotted for the ritual. 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.

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

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

The client is able to sleep for at least 4 hours per night after 5 days.

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.

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

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

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 is diagnosed with trichotillomania. What would the nurse expect to observe with the client?

hair loss on the scalp, eyebrows and/or eyelashes

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 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 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

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.

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.

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 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.

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.