PrepU Chapter 15
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?" "Have you ever been arrested for stealing?" "Do you ever feel like hurting yourself?" "Can you explain to me why you want to have your leg amputated?"
"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.
The nurse is discharging a client with a diagnosis of obsessive-compulsive disorder (OCD) following a lengthy inpatient hospitalization. Further teaching is necessary when the client makes which statement? "Being aware of what I was doing is going to help me blend in at work." "Having my family learn about my disorder will help me." "I am relieved to be better and shouldn't need to do all this again." "I now understand that even if I do the ritual, I am still anxious underneath."
"I am relieved to be better and shouldn't need to do all this again." Obsessive-compulsive disorder (OCD) is considered a chronic illness, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals does not mean they will never again need professional help in the future. Clients with successful strategies are equipped to manage their obsessions and compulsions and appear "normal." It is correct that ritual completion does not resolve anxiety. Support persons need education about how the client cannot "just stop" and how to display empathy and understanding. This support is important to long-term stabilization.
The nurse is educating the family member of a client with obsessive-compulsive disorder (OCD) about therapeutic communication techniques to use when interacting with the client. Which statement(s) made by the family member indicates that the education is effective? Select all that apply. "It is important that I remain patient while my family member is feeling anxiety." "I will take care and monitor my anxiety levels so that I don't make things worse." "I am going to try and fix this problem so my family will be able to heal." "I will give advice to the client so they will stay on the right track with treatment." "If I find that I am overwhelmed with the behaviors that I am observing, I will take a break from it."
"I will take care and monitor my anxiety levels so that I don't make things worse." "If I find that I am overwhelmed with the behaviors that I am observing, I will take a break from it." "It is important that I remain patient while my family member is feeling anxiety." The family member demonstrates that they understand the education provided by stating that they will be patient with anxiety or discomfort, monitoring their own anxiety level, and taking a break from the situation when necessary. The family member should avoid giving advice and avoid trying to fix the problem; that never works.
A nurse is teaching a group of clients about obsessive-compulsive disorder. Which statement made by a client would indicate a need for further teaching? "The cause of obsessive-compulsive disorder is not specifically known but includes genetic and environmental factors." "Obsessive-compulsive disorder is universal across countries, with some variations in symptoms." "Obsessive-compulsive disorder can begin in childhood and often lasts into adulthood." "Obsessive-compulsive disorder is a short-term illness with a sudden onset while the person is stressed."
"Obsessive-compulsive disorder is a short-term illness with a sudden onset while the person is stressed." Obsessive-compulsive disorder (OCD) is a chronic, progressive disease. Symptoms wax and wane over time, increasing during periods of stress. OCD can start in childhood and often lasts into adulthood. The cause or etiology of OCD is not specifically known but includes genetic influences and environmental experiences. OCD is universal across countries, with some variation in symptoms. Therefore, the client's statements, "Obsessive-compulsive disorder can begin in childhood and often lasts into adulthood," "The cause of obsessive-compulsive disorder is not specifically known but includes genetic and environmental factors," and "Obsessive-compulsive disorder is universal across countries, with some variations in symptoms" are correct statements. The client's statement, "Obsessive-compulsive disorder is a short-term illness with a sudden onset while the person is stressed" would require further education.
When planning for a client with OCD who has been admitted for severe exacerbation of symptoms, the nursing care should be prioritized. Place the interventions in order from 1 (highest priority) to 4 (lowest priority). All options must be used.
-Assess the client for suicide risk, since they may also have a major depression. -Discuss with the client if their obsessions involve self-mutilation acts like pulling their hair. -Give medications in a timely fashion to maintain steady blood levels. -Reinforce the use of cognitive strategies, including constructive self-talk and cognitive restructuring. Assessing for suicidal thoughts is always the priority. The person may feel a sense of hopelessness and helplessness and may contemplate suicide to end the suffering. An additional risk for suicide is created by the high probability of major depression, which often accompanies OCD. Clients may feel a need to punish themselves for their intrusive thoughts (e.g., hair pulling or skin picking). Unit routines must be carefully and clearly explained to decrease fear of the unknown so that clients should expect medications to be given on time. Reinforcing cognitive strategies and self-talk are still a priority; however, not as important as the previous nursing care.
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. The client is obsessively cleaning the same areas repeatedly. The client is throwing away items in the home that are deemed "unnecessary." 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 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. Hoarding involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Obsessive cleaning of the environment and disposing of articles that are of no value are not the characteristics of hoarding; the client usually exhibits the opposite behaviors.
What intervention does the nurse perform to assist the client in decreasing the frequency of repetitive behaviors? Interrupt repeated behaviors to reduce the time used for activities. Help the client identify supportive resources in the community. Assist the client to keep a record of when time is used in performing activities. Teach the client to practice conversation and attentive listening.
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.
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 interact with other clients. Distracts the client during compulsive rituals. Assists the client to confront situations. Tries various selective serotonin reuptake inhibitor (SSRI) medications to determine a right fit.
Assists the client to confront situations. During "exposure" phase of behavior therapy, the nurse assists the client to confront situations that the client normally tries to avoid. The nurse should assist clients with interacting with other clients to build self-confidence to prepare a good plan of care. These interventions, however, are not part of the exposure phase of behavior therapy. Trying SSRI medication is not a component of exposure therapy but can be used concomitantly with this type of treatment for OCD. The client must not be distracted during compulsive rituals as it agitates the client and increases anxiety.
A psychiatric-mental health nurse is conducting an educational session for families of clients diagnosed with obsessive-compulsive disorder (OCD). What component(s) should the nurse teach the families of clients diagnosed with OCD? Select all that apply. Try to fix the problem that the client is currently having. Expect the client to not have compulsions at all. Be patient with your family member's discomfort. Avoid giving advice such as, "just think of something else." Monitor your own anxiety and take a break if needed.
Avoid giving advice such as, "just think of something else." Be patient with your family member's discomfort. Monitor your own anxiety and take a break if needed. Families of clients diagnosed with obsessive-compulsive disorder (OCD) should be given education to support the client effectively. The families of the client should be instructed to avoid giving advice such as "just think of something else," avoid trying to fix the problem, be patient with the client's discomfort, and monitoring their own anxiety level and taking a break if needed. The families should not be instructed to try to fix the problem for the client or expect the client to not have compulsions at all.
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? It starts in the 20s in male clients. It is diagnosed very early in most clients. Early onset may indicate family history of OCD. It starts in childhood in female clients.
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? Discontinue medications after mastering behavior therapy. Apply relaxation techniques when anxiety level is low. Encourage the client to participate in follow-up therapy. Encourage the family to assist the client in completing daily activities.
Encourage the client to participate in follow-up therapy. 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.
A client explains to the health care provider that a cleaning ritual must be completed every day. If something disrupts this cleaning schedule, what effect does the client experience? Isolation from others Depression Aggression to the point of lashing out Extreme anxiety
Extreme anxiety 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.
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 Olanzapine Quetiapine Risperidone
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 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. It is indicative of a degenerative disorder. The client will repeat the act several times during the day. The client is unaware of the act.
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.
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? If the person had help to clean up their environment, the hoarding will be cured. Obtaining a cleaning service to come in weekly will curtail the hoarding activities. Treatment will likely start to be effective in the short term. It is likely that even with treatment, the hoarding behaviors will continue.
It is likely that even with treatment, the hoarding behaviors will continue. Treatment for hoarding in older adults may need to continue over a long period of time to reach successful outcomes. Most persons who are hoarders will not seek assistance nor accept assistance to clean up their environment because they feel ashamed and do not want to give up their possessions. If the environment were to be cleaned up and no other intervention employed, the person would continue to hoard and the home will go back to its previous state.
A nurse is providing a teaching seminar at the community center on emerging technologies for clients with obsessive-compulsive disorder (OCD). What should the nurse include in this presentation? Select all that apply. Many new changes are available for assessment and management of OCD. Moment-to-moment condition monitoring for actional outcomes. Treatment can be tailored to the individual. Changes will not alter ethics or the professional culture of nursing. Diagnostic procedures can be defined.
Many new changes are available for assessment and management of OCD. Moment-to-moment condition monitoring for actional outcomes. Treatment can be tailored to the individual. Diagnostic procedures can be defined. Profound changes are on the horizon for the assessment and management of OCD, which will help tailor treatment, define diagnostic procedures, and improve moment-to-moment condition monitoring for actional outcomes. What this all means and how it impacts the practices of licensed and advance practice psychiatric nurses are yet to be determined, but it may change education, challenge beliefs and ethics, and even alter the professional culture of nursing.
What relaxation technique does the nurse teach the client with obsessive-compulsive disorder (OCD)? Writing a diary Listening to music Practicing deep breathing Scheduling a timetable
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.
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? Discuss the observation in group therapy. Provide genuine praise that the client used a coping strategy. Tell the client that they are proud of them. Document the observation as the defense mechanism of sublimation.
Provide genuine praise that the client used a coping strategy. Provision of genuine praise can foster self-esteem in clients with symptoms of obsessive-compulsive behaviors. The nurse may feel proud, but it is not helpful to tell a client so because this may be perceived as paternalistic and promote the client making improvements for the nurse, rather than themselves. Discussing the observation in a group setting may worsen client anxiety and feelings of being judged. Documentation that the client displayed the defense mechanism of sublimation does not accurately represent the client consciously choosing to use a coping strategy during feelings of anxiety.
A client admitted to the hospital with pancreatitis is found repeatedly washing their hands. Over the course of the day, the nurse notes that the client has rubbed the skin on their hands raw. Which action would the nurse implement first? Gently tell the client that they are damaging their skin and need to stop. Ask the client if they have ever been diagnosed with obsessive-compulsive disorder. Sit with the client and explore their feelings regarding their hospitalization. Remind the client that washing their hands won't make the anxiety go away.
Sit with the client and explore their feelings regarding their hospitalization. The most appropriate first action is the use of therapeutic communication strategies to convey support. Sitting with the client and exploring their feelings regarding the change in health status creates an adaptive opportunity to express anxiety. Repeatedly washing their hands until the skin is raw would be considered a compulsion, a symptom of unmanaged anxiety. The nurse should anticipate that the client may experience shame regarding the behavior and asking them directly about a diagnosis of obsessive-compulsive disorder may increase feelings of anxiety. It is important to remember that the client is trying to deal with overwhelming urges and emotions, including anxiety. It isn't possible to reason with or tell the client to simply stop or remind that the anxiety will not go away with the compulsion.
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 sleeps for 8 to 10 hours a day. The client is unable to maintain adequate personal hygiene. The client is energetic and completes activities quickly. The client reports unwanted weight gain.
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.
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 family must avoid talking with the client about the anxiety and rituals. The family should disengage from the client in order to prevent enabling of ritual behavior The client's actions indicate that the client is mentally unstable.
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.
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 demonstrates the ability to block negative thoughts The client accurately describes the harmful effects of compulsions The client reports increased quality and quantity of sleep The client accurately describes the effects of obsessions on quality of life
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 lacks religious sentiments. The client has intolerance for uncertainty. The client believes the client has no personal responsibilities. The client wants to control own thoughts. The client overestimates the threats caused by the thoughts.
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.
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? It is important for the client to avoid following a specific routine to prevent increasing anxiety. The client's diagnosis should be kept from everyone outside the immediate family and friends. It is helpful for others to give advice about other activities the client with OCD can engage in. The importance of medication adherence and that it may be necessary for medication to be changed to find the one that works best.
The importance of medication adherence and that it may be necessary for medication to be changed to find the one that works best. Teaching about the importance of medication compliance to combat OCD is essential. It is neither possible nor desirable to keep the client's diagnosis from others since it may make the client feel embarrassed or ashamed of the diagnosis. At home, the client can continue to follow a daily routine or written schedule that helps them stay on tasks and accomplish activities and responsibilities. It is not helpful for others to give unsolicited advice about other activities the client with OCD can engage in as this will add to the guilt and shame that people with OCD experience.
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. The client has gradual memory loss. Obsessions occur when the client is not engaged in an activity. The client's intellectual functioning is deteriorating.
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.
A client's older parent has been diagnosed with hoarding disorder. What does the nurse instruct the client about the parent's hoarding disorder? It is caused by an injury to the basal ganglia. Short-term treatment can provide a successful outcome. It is a degenerative disorder. Treatment may involve community agencies.
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.
The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When does the nurse teach relaxation techniques to the client? When the client is performing a repetitive ritual. After the client has taken medication. Just before the client goes to bed. When the client is experiencing low anxiety levels.
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 school nurse reviews their notes on students who have visited the clinic over the previous month. Which student would be considered more likely to develop an obsessive-compulsive disorder? a 3-year-old client who refuses to eat anything red a 10-year-old client who becomes distraught if unable to complete tasks a 15-year-old client who blames their parents for their poor performance a 5-year-old client whose parents are youth ministers in a church
a 10-year-old client who becomes distraught if unable to complete tasks One of the etiologic theories of obsessive-compulsive disorder (OCD) is the cognitive model, which suggests that someone is more likely to develop OCD if they are unable to effectively manage anxious feelings about not being able to perform perfectly. A middle school-aged child would be expected to manage their feelings of inability to complete a task without becoming distraught. Although children who grow up in strict religious households may develop the disorder, having religious parents is not an independent risk factor. It is developmentally appropriate for a 3-year-old child to resist foods based on color or texture and for an adolescent to blame others.
Upon assessment, a client with a history of obsessive-compulsive disorder is terrified of losing control and has weight overvaluation. For what comorbidity should the nurse assess in the client? eating disorder Tics/Tourette syndrome schizophrenia depression
eating disorder High rates of comorbid conditions can be found in clients diagnosed with obsessive-compulsive disorder (OCD). OCD and eating disorders, such as anorexia nervosa and bulimia nervosa, are highly comorbid and share similarities such as obsessional thinking, ritualized behaviors, and perfectionism. The presence of eating disorders complicates the treatment of OCD. In both disorders, individuals have difficulty controlling their thoughts. With eating disorders, there is weight overvaluation, fear of loss of control, and concerns that others see one eat. The client is experiencing a fear of losing control and weight overvaluation; therefore, the nurse should assess the client for the presence of an eating disorder. Schizophrenia is characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Depression is characterized by a persistent sadness and lack of interest in enjoyable activities. Tics/Tourette syndrome is characterized by sudden, repetitive, stereotyped, or unplanned movements or vocalizations.
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: cue cards. thought stopping. exposure and response prevention. progressive relaxation.
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.
A client has been diagnosed with trichotillomania with abdominal pain. The nurse anticipates the client has ingested the hair. What finding(s) are consistent with the formation of a hair ball? Select all that apply. peritonitis lower esophageal pain intestinal obstruction infection at the hairball site anorexia
peritonitis intestinal obstruction infection at the hairball site peritonitis Trichotillomania is chronic, self-destructive hair pulling resulting in noticeable hair loss, usually in the crown, occipital, or parietal areas of the head, although sometimes also involves the eyebrows and eyelashes. The individual has an increase in tension immediately before pulling out the hair or while attempting to resist the behavior. After the hair has been pulled, the person feels a sense of relief. Hair ingestion may result in the development of a hair ball, which can lead to anorexia, stomach pain, anemia, intestinal obstruction, and peritonitis. Other medical complications include infection at the hair-pulling site. Lower esophageal pain is not associated with this condition.
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? depression inventory substance use pattern suicide risk assessment activities of daily living (ADLs) assessment
suicide risk assessment Depending on the particular obsession and its accompanying compulsions, clients are at increased risk for suicide and self-harm. Screening the client for suicide risk is a priority. The effect of symptoms on the client's physical and emotional health would be important to evaluate with a depression inventory and activities of daily living assessment; however, these would not be the priority screening. Substance use patterns are often altered in persons experiencing obsessive-compulsive and other related disorders and this screening is important to complete, but it is not the priority.