Module 31: Exemplar C - Obsessive-Compulsive Disorder

The mother of a 12-year-old child with obsessive-compulsive disorder (OCD) tells the nurse that the child tends to get angry and throw a fit when the parents prevent him from performing compulsions in public. She tells the nurse that they don't have this problem at home because they just let him perform his rituals. The mother asks the nurse why he has these. What is the best response by the nurse? A) "It would be best if you don't take your child out in public until he can learn to control himself." B) "Rage attacks by children with OCD are often made worse if the parents accommodate the OCD behaviors." C) "The best way to prevent the rage attacks is to reinforce the OCD behaviors, especially when in public." D) "When he has rage attacks, you need to discipline him immediately and remove him from the area."

Answer: B Explanation: A) Studies indicate that children and adolescents are more likely than adults to suffer rage attacks in relation to their OCD, a phenomenon that is enhanced if their family accommodates or reinforces their OCD behaviors. Telling the mother about this link can help the parents see the need to change their actions, which may eventually help decrease the rage attacks in public. Not taking the child out in public, reinforcing the behaviors in public, or immediately disciplining the child will not be beneficial to the child. B) Studies indicate that children and adolescents are more likely than adults to suffer rage attacks in relation to their OCD, a phenomenon that is enhanced if their family accommodates or reinforces their OCD behaviors. Telling the mother about this link can help the parents see the need to change their actions, which may eventually help decrease the rage attacks in public. Not taking the child out in public, reinforcing the behaviors in public, or immediately disciplining the child will not be beneficial to the child. C) Studies indicate that children and adolescents are more likely than adults to suffer rage attacks in relation to their OCD, a phenomenon that is enhanced if their family accommodates or reinforces their OCD behaviors. Telling the mother about this link can help the parents see the need to change their actions, which may eventually help decrease the rage attacks in public. Not taking the child out in public, reinforcing the behaviors in public, or immediately disciplining the child will not be beneficial to the child. D) Studies indicate that children and adolescents are more likely than adults to suffer rage attacks in relation to their OCD, a phenomenon that is enhanced if their family accommodates or reinforces their OCD behaviors. Telling the mother about this link can help the parents see the need to change their actions, which may eventually help decrease the rage attacks in public. Not taking the child out in public, reinforcing the behaviors in public, or immediately disciplining the child will not be beneficial to the child. Page Ref: 2098 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing Process: Implementation Learning Outcome: 31.C.6. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Differentiate considerations for care of clients with OCD across the lifespan. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

For a client with obsessive-compulsive disorder with contamination obsessions, what nursing assessment is essential to development of an effective client care plan? A) Assessment for skin integrity B) Assessment for sexual activity C) Assessment for tics D) Assessment for religious beliefs

Answer: A Explanation: A) Clients with contamination obsessions often have compulsions related to cleaning and washing, especially washing the hands. Continual exposure to water and cleansing agents may result in loss of skin integrity. Assessment for sexual activity or religious beliefs would be more important if the client had aggressive, sexual, or religious obsessions. Assessment for tics would be more important for individuals with symmetry obsessions. B) Clients with contamination obsessions often have compulsions related to cleaning and washing, especially washing the hands. Continual exposure to water and cleansing agents may result in loss of skin integrity. Assessment for sexual activity or religious beliefs would be more important if the client had aggressive, sexual, or religious obsessions. Assessment for tics would be more important for individuals with symmetry obsessions. C) Clients with contamination obsessions often have compulsions related to cleaning and washing, especially washing the hands. Continual exposure to water and cleansing agents may result in loss of skin integrity. Assessment for sexual activity or religious beliefs would be more important if the client had aggressive, sexual, or religious obsessions. Assessment for tics would be more important for individuals with symmetry obsessions. D) Clients with contamination obsessions often have compulsions related to cleaning and washing, especially washing the hands. Continual exposure to water and cleansing agents may result in loss of skin integrity. Assessment for sexual activity or religious beliefs would be more important if the client had aggressive, sexual, or religious obsessions. Assessment for tics would be more important for individuals with symmetry obsessions. Page Ref: 2100 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 31.C.7. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Apply the nursing process in providing culturally competent care to an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

When caring for a client newly diagnosed with obsessive-compulsive disorder, which action by the nurse is appropriate? A) Do not interrupt the ritual. B) Interrupt the ritual. C) Teach about antianxiety foods. D) Teach ritual interruption skills.

Answer: A Explanation: A) Do not interrupt the ritual because the client may feel compelled to start from the beginning. For the newly diagnosed client, teaching ritual interruption skills and teaching about antianxiety foods would not be the priority. B) Do not interrupt the ritual because the client may feel compelled to start from the beginning. For the newly diagnosed client, teaching ritual interruption skills and teaching about antianxiety foods would not be the priority. C) Do not interrupt the ritual because the client may feel compelled to start from the beginning. For the newly diagnosed client, teaching ritual interruption skills and teaching about antianxiety foods would not be the priority. D) Do not interrupt the ritual because the client may feel compelled to start from the beginning. For the newly diagnosed client, teaching ritual interruption skills and teaching about antianxiety foods would not be the priority. Page Ref: 2099 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Implementation Learning Outcome: 31.C.7. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Apply the nursing process in providing culturally competent care to an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

Which finding would indicate that treatment for a client with obsessive-compulsive disorder is effective? A) The client watches television while eating meals and engages in conversation with a roommate. B) The client conducts ritualistic hand washing every hour. C) While walking, the client counts 13 steps and then reverses the direction and repeats the process. D) The client folds and refolds clothing in a drawer before each meal.

Answer: A Explanation: A) The client who watches television while eating meals and engages in conversation with a roommate is exhibiting behavior that suggests treatment for obsessive-compulsive disorder is effective. This behavior is evidence of reduced anxiety and less of a need to engage in ritualistic behavior. The other observations would indicate the need for additional treatment. B) The client who watches television while eating meals and engages in conversation with a roommate is exhibiting behavior that suggests treatment for obsessive-compulsive disorder is effective. This behavior is evidence of reduced anxiety and less of a need to engage in ritualistic behavior. The other observations would indicate the need for additional treatment. C) The client who watches television while eating meals and engages in conversation with a roommate is exhibiting behavior that suggests treatment for obsessive-compulsive disorder is effective. This behavior is evidence of reduced anxiety and less of a need to engage in ritualistic behavior. The other observations would indicate the need for additional treatment. D) The client who watches television while eating meals and engages in conversation with a roommate is exhibiting behavior that suggests treatment for obsessive-compulsive disorder is effective. This behavior is evidence of reduced anxiety and less of a need to engage in ritualistic behavior. The other observations would indicate the need for additional treatment. Page Ref: 2100 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Evaluation Learning Outcome: 31.C.4. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Identify the clinical manifestations of OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A 68-year-old female client was recently diagnosed with depression and subclinical obsessive-compulsive symptoms. What does the nurse need to consider when planning care for this client? A) This client will not need treatment for the OCD symptoms because they are subclinical. B) This client may take longer to meet goals than a younger client with similar symptoms. C) This client will need to be assessed frequently for signs of dementia. D) This client may need a higher dose of medication than a younger client.

Answer: B Explanation: A) The comorbidity of obsessive-compulsive symptoms and other mental disorders may interfere with responsiveness to treatment and increase the time it takes for medications to be effective in older adults. The obsessive-compulsive symptoms do still need to be treated in the older adult, even though they are subclinical. Although older adult clients with multiple mental health disorders should be assessed for dementia, the assessments do not need to be performed more frequently than normal. Older adults often need lower doses of medication because of an increased risk of side effects. B) The comorbidity of obsessive-compulsive symptoms and other mental disorders may interfere with responsiveness to treatment and increase the time it takes for medications to be effective in older adults. The obsessive-compulsive symptoms do still need to be treated in the older adult, even though they are subclinical. Although older adult clients with multiple mental health disorders should be assessed for dementia, the assessments do not need to be performed more frequently than normal. Older adults often need lower doses of medication because of an increased risk of side effects. C) The comorbidity of obsessive-compulsive symptoms and other mental disorders may interfere with responsiveness to treatment and increase the time it takes for medications to be effective in older adults. The obsessive-compulsive symptoms do still need to be treated in the older adult, even though they are subclinical. Although older adult clients with multiple mental health disorders should be assessed for dementia, the assessments do not need to be performed more frequently than normal. Older adults often need lower doses of medication because of an increased risk of side effects. D) The comorbidity of obsessive-compulsive symptoms and other mental disorders may interfere with responsiveness to treatment and increase the time it takes for medications to be effective in older adults. The obsessive-compulsive symptoms do still need to be treated in the older adult, even though they are subclinical. Although older adult clients with multiple mental health disorders should be assessed for dementia, the assessments do not need to be performed more frequently than normal. Older adults often need lower doses of medication because of an increased risk of side effects. Page Ref: 2098 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essential Competencies: IX.9 Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health. | Nursing Process: Planning Learning Outcome: 31.C.6. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Differentiate considerations for care of clients with OCD across the lifespan. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

What important fact should the nurse relay to the young adult who was just diagnosed with obsessive-compulsive disorder? A) Not acting on compulsions is the best cure. B) Treatment is essential to remission. C) Recognizing the obsessions as false will lessen their impact. D) The disorder will gradually get better over time.

Answer: B Explanation: A) Without treatment, the rate of remission of OCD is estimated to be low. Therefore, treatment is essential; the disorder will not usually get better over time without treatment. Many individuals with OCD recognize that their obsessive thoughts are false or unlikely to happen, but that does not lessen their impact. Individuals with OCD perform compulsions to lessen anxiety, and they are often unable to control whether or not they perform the actions. B) Without treatment, the rate of remission of OCD is estimated to be low. Therefore, treatment is essential; the disorder will not usually get better over time without treatment. Many individuals with OCD recognize that their obsessive thoughts are false or unlikely to happen, but that does not lessen their impact. Individuals with OCD perform compulsions to lessen anxiety, and they are often unable to control whether or not they perform the actions. C) Without treatment, the rate of remission of OCD is estimated to be low. Therefore, treatment is essential; the disorder will not usually get better over time without treatment. Many individuals with OCD recognize that their obsessive thoughts are false or unlikely to happen, but that does not lessen their impact. Individuals with OCD perform compulsions to lessen anxiety, and they are often unable to control whether or not they perform the actions. D) Without treatment, the rate of remission of OCD is estimated to be low. Therefore, treatment is essential; the disorder will not usually get better over time without treatment. Many individuals with OCD recognize that their obsessive thoughts are false or unlikely to happen, but that does not lessen their impact. Individuals with OCD perform compulsions to lessen anxiety, and they are often unable to control whether or not they perform the actions. Page Ref: 2096, 2098 Cognitive Level: Understanding Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care: Patient/family/community preferences, values; Coordination and integration of care; Information, communication, and education; Physical comfort and emotional support; Involvement of family and friends Transition and continuity. | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental state, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship Centered Care: Effective communication. | Nursing Process: Evaluation Learning Outcome: 31.C.2. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Describe the etiology of OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

The nurse is concerned that a client is demonstrating signs of obsessive-compulsive disorder. Which clinical manifestations and risk factors identified during the nursing assessment caused the nurse's concern? Select all that apply. A) Not making eye contact with the nurse B) Female age 25 C) Client checking the contents of a purse several times within minutes D) Client repeating the words "third floor" E) Client asking to use the bathroom in the middle of the assessment

Answer: B, C, D Explanation: A) Obsessive-compulsive disorder affects men and women equally; however, women often develop the disorder in adolescence or early adulthood. Checking and repeating are two common compulsions related to symmetry obsessions. Lack of eye contact and using the bathroom during an assessment are not manifestations of the disorder. B) Obsessive-compulsive disorder affects men and women equally; however, women often develop the disorder in adolescence or early adulthood. Checking and repeating are two common compulsions related to symmetry obsessions. Lack of eye contact and using the bathroom during an assessment are not manifestations of the disorder. C) Obsessive-compulsive disorder affects men and women equally; however, women often develop the disorder in adolescence or early adulthood. Checking and repeating are two common compulsions related to symmetry obsessions. Lack of eye contact and using the bathroom during an assessment are not manifestations of the disorder. D) Obsessive-compulsive disorder affects men and women equally; however, women often develop the disorder in adolescence or early adulthood. Checking and repeating are two common compulsions related to symmetry obsessions. Lack of eye contact and using the bathroom during an assessment are not manifestations of the disorder. E) Obsessive-compulsive disorder affects men and women equally; however, women often develop the disorder in adolescence or early adulthood. Checking and repeating are two common compulsions related to symmetry obsessions. Lack of eye contact and using the bathroom during an assessment are not manifestations of the disorder. Page Ref: 2095-2096 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Assessment Learning Outcome: 31.C.4. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Identify the clinical manifestations of OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A client diagnosed with obsessive-compulsive disorder (OCD) is being admitted as an inpatient. The client is obsessed with thoughts of symmetry. Which compulsive behaviors does the nurse anticipate when performing the admission assessment? Select all that apply. A) The client repeatedly washes his hands. B) The client repeatedly taps both wrists on the bedside table. C) The client avoids shaking the nurse's hand D) The client begins counting the floor tiles. E) The client repeatedly cleans the top of the bedside table.

Answer: B, D Explanation: A) Repeatedly tapping both wrists on the bedside table and counting the floor tiles demonstrate common behaviors of a client whose obsession is symmetry. A client whose obsession is symmetry often demonstrates counting, ensuring orderliness of items, or fixation on maintaining symmetrical positioning of items, such as repeatedly tapping both wrists on the bedside table. On the other hand, a client whose obsession is cleaning typically demonstrates repetitive performance of decontamination practices, such as repetitive hand washing; avoidance of contamination, such as refusing to shake hands; or repetitive environmental cleaning, such as repeatedly cleaning the top of the bedside table. B) Repeatedly tapping both wrists on the bedside table and counting the floor tiles demonstrate common behaviors of a client whose obsession is symmetry. A client whose obsession is symmetry often demonstrates counting, ensuring orderliness of items, or fixation on maintaining symmetrical positioning of items, such as repeatedly tapping both wrists on the bedside table. On the other hand, a client whose obsession is cleaning typically demonstrates repetitive performance of decontamination practices, such as repetitive hand washing; avoidance of contamination, such as refusing to shake hands; or repetitive environmental cleaning, such as repeatedly cleaning the top of the bedside table. C) Repeatedly tapping both wrists on the bedside table and counting the floor tiles demonstrate common behaviors of a client whose obsession is symmetry. A client whose obsession is symmetry often demonstrates counting, ensuring orderliness of items, or fixation on maintaining symmetrical positioning of items, such as repeatedly tapping both wrists on the bedside table. On the other hand, a client whose obsession is cleaning typically demonstrates repetitive performance of decontamination practices, such as repetitive hand washing; avoidance of contamination, such as refusing to shake hands; or repetitive environmental cleaning, such as repeatedly cleaning the top of the bedside table. D) Repeatedly tapping both wrists on the bedside table and counting the floor tiles demonstrate common behaviors of a client whose obsession is symmetry. A client whose obsession is symmetry often demonstrates counting, ensuring orderliness of items, or fixation on maintaining symmetrical positioning of items, such as repeatedly tapping both wrists on the bedside table. On the other hand, a client whose obsession is cleaning typically demonstrates repetitive performance of decontamination practices, such as repetitive hand washing; avoidance of contamination, such as refusing to shake hands; or repetitive environmental cleaning, such as repeatedly cleaning the top of the bedside table. E) Repeatedly tapping both wrists on the bedside table and counting the floor tiles demonstrate common behaviors of a client whose obsession is symmetry. A client whose obsession is symmetry often demonstrates counting, ensuring orderliness of items, or fixation on maintaining symmetrical positioning of items, such as repeatedly tapping both wrists on the bedside table. On the other hand, a client whose obsession is cleaning typically demonstrates repetitive performance of decontamination practices, such as repetitive hand washing; avoidance of contamination, such as refusing to shake hands; or repetitive environmental cleaning, such as repeatedly cleaning the top of the bedside table. Page Ref: 2097 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1. Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Assessment Learning Outcome: 31.C.4. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Identify the clinical manifestations of OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A mother says to the nurse, "I think my teenage son is showing signs of obsessive-compulsive disorder, just like his father." Which risk factors in the client's medical history would support this diagnosis? Select all that apply. A) Lives with parents B) Male gender C) Unemployed D) History of chronic illnesses E) Family history

Answer: B, E Explanation: A) Risk factors for obsessive-compulsive disorder include having a first-degree relative with the disorder and going through a major life stressor. Men develop the disorder earlier than women. Living with parents, being unemployed, or having a history of chronic illnesses are not risk factors for the disorder. B) Risk factors for obsessive-compulsive disorder include having a first-degree relative with the disorder and going through a major life stressor. Men develop the disorder earlier than women. Living with parents, being unemployed, or having a history of chronic illnesses are not risk factors for the disorder. C) Risk factors for obsessive-compulsive disorder include having a first-degree relative with the disorder and going through a major life stressor. Men develop the disorder earlier than women. Living with parents, being unemployed, or having a history of chronic illnesses are not risk factors for the disorder. D) Risk factors for obsessive-compulsive disorder include having a first-degree relative with the disorder and going through a major life stressor. Men develop the disorder earlier than women. Living with parents, being unemployed, or having a history of chronic illnesses are not risk factors for the disorder. E) Risk factors for obsessive-compulsive disorder include having a first-degree relative with the disorder and going through a major life stressor. Men develop the disorder earlier than women. Living with parents, being unemployed, or having a history of chronic illnesses are not risk factors for the disorder. Page Ref: 2096 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Assessment Learning Outcome: 31.C.3. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Outline the risk factors for OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A malfunction in what system is thought to contribute to the development of obsessive-compulsive disorder? A) Frontal-subcortical circuit B) Hypothalamic-pituitary-adrenal axis C) Cortico-striato-thalamo-cortical circuit D) Microbiome-gut-brain axis

Answer: C Explanation: A) A malfunction in the cortico-striato-thalamo-cortical (CSTC) circuit in the brain is the possible cause for OCD. A malfunction in the other pathways contributes to other conditions or diseases, but they have not been linked to OCD. B) A malfunction in the cortico-striato-thalamo-cortical (CSTC) circuit in the brain is the possible cause for OCD. A malfunction in the other pathways contributes to other conditions or diseases, but they have not been linked to OCD. C) A malfunction in the cortico-striato-thalamo-cortical (CSTC) circuit in the brain is the possible cause for OCD. A malfunction in the other pathways contributes to other conditions or diseases, but they have not been linked to OCD. D) A malfunction in the cortico-striato-thalamo-cortical (CSTC) circuit in the brain is the possible cause for OCD. A malfunction in the other pathways contributes to other conditions or diseases, but they have not been linked to OCD. Page Ref: 2095-2096 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 31.C.1. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Describe the pathophysiology of OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A client is prescribed fluoxetine (Prozac) for treatment of obsessive-compulsive disorder. During the latest office visit, the client washes the hands while counting to 10 and repeats the process every 5 minutes. Which is the priority assessment for the nurse to complete for this client? A) The amount of medication the client is taking B) Side effects from the medication the client is experiencing C) Whether the client is taking the medication as prescribed D) Foods that may be interacting with the client's medication

Answer: C Explanation: A) Fluoxetine (Prozac) is one medication prescribed for the treatment of obsessive-compulsive disorder. Because the client is demonstrating continuing signs of the disorder, the nurse should assess if the client is taking the medication as prescribed. The client would have other signs and symptoms if taking too much medication. There are no specific foods to avoid when taking this medication. Continuing symptoms of obsessive-compulsive disorder is not a side effect of the medication. B) Fluoxetine (Prozac) is one medication prescribed for the treatment of obsessive-compulsive disorder. Because the client is demonstrating continuing signs of the disorder, the nurse should assess if the client is taking the medication as prescribed. The client would have other signs and symptoms if taking too much medication. There are no specific foods to avoid when taking this medication. Continuing symptoms of obsessive-compulsive disorder is not a side effect of the medication. C) Fluoxetine (Prozac) is one medication prescribed for the treatment of obsessive-compulsive disorder. Because the client is demonstrating continuing signs of the disorder, the nurse should assess if the client is taking the medication as prescribed. The client would have other signs and symptoms if taking too much medication. There are no specific foods to avoid when taking this medication. Continuing symptoms of obsessive-compulsive disorder is not a side effect of the medication. D) Fluoxetine (Prozac) is one medication prescribed for the treatment of obsessive-compulsive disorder. Because the client is demonstrating continuing signs of the disorder, the nurse should assess if the client is taking the medication as prescribed. The client would have other signs and symptoms if taking too much medication. There are no specific foods to avoid when taking this medication. Continuing symptoms of obsessive-compulsive disorder is not a side effect of the medication. Page Ref: 2097 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.5. Examine common barriers to active involvement of patients in their own health care processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health. | Nursing Process: Assessment Learning Outcome: 31.C.5. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Summarize diagnostic tests and therapies used by interdisciplinary teams in the collaborative care of an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A nurse is evaluating the plan of care for a client diagnosed with obsessive-compulsive disorder (OCD). Which client statement indicates a positive outcome for the plan of care? A) "Instead of washing my hands several times a day I use hand sanitizer several times a day." B) "I am still hand washing frequently, and even though it is less than before I am a failure." C) "I am still hand washing frequently but it is less often than before. I think I am improving." D) "I don't know why I can't wash my hands several times a day; I have nothing else to do anyway."

Answer: C Explanation: A) The client who acknowledges improvement when washing hands less frequently recognizes that continued obsessive-compulsive behaviors are not an indication of treatment failure and that reductions in behavior signify positive progress. The client who has substituted the ritualistic use of hand sanitizer for the ritualistic hand washing has not demonstrated adequate coping skills to control anxiety related to absence of ritualistic compulsive behaviors. The client who sees nothing wrong with washing hands several times a day does not recognize that the ritualistic hand washing is a problem. B) The client who acknowledges improvement when washing hands less frequently recognizes that continued obsessive-compulsive behaviors are not an indication of treatment failure and that reductions in behavior signify positive progress. The client who has substituted the ritualistic use of hand sanitizer for the ritualistic hand washing has not demonstrated adequate coping skills to control anxiety related to absence of ritualistic compulsive behaviors. The client who sees nothing wrong with washing hands several times a day does not recognize that the ritualistic hand washing is a problem. C) The client who acknowledges improvement when washing hands less frequently recognizes that continued obsessive-compulsive behaviors are not an indication of treatment failure and that reductions in behavior signify positive progress. The client who has substituted the ritualistic use of hand sanitizer for the ritualistic hand washing has not demonstrated adequate coping skills to control anxiety related to absence of ritualistic compulsive behaviors. The client who sees nothing wrong with washing hands several times a day does not recognize that the ritualistic hand washing is a problem. D) The client who acknowledges improvement when washing hands less frequently recognizes that continued obsessive-compulsive behaviors are not an indication of treatment failure and that reductions in behavior signify positive progress. The client who has substituted the ritualistic use of hand sanitizer for the ritualistic hand washing has not demonstrated adequate coping skills to control anxiety related to absence of ritualistic compulsive behaviors. The client who sees nothing wrong with washing hands several times a day does not recognize that the ritualistic hand washing is a problem. Page Ref: 2100 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.13 Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Relationship Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing Process: Evaluation Learning Outcome: 31.C.7. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Apply the nursing process in providing culturally competent care to an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

A nurse is providing discharge instructions to a client recently diagnosed with obsessive-compulsive disorder (OCD) and prescribed fluvoxamine (Luvox). Which statement made by the client indicates to the nurse that the client understands the instructions? A) "I am glad the physician chose this medication because it does not have any side effects." B) "I should continue taking this medication and in 1-2 years I can stop taking it." C) "I should continue taking this medication and in 1-2 years my physician may taper me off gradually." D) "Even though I don't think this medication is for my OCD, I will take it because the physician wants me to."

Answer: C Explanation: A) This statement indicates that the client understands instruction regarding this medication. A client should continue taking fluvoxamine (Luvox) for 1—2 years, at which time a physician may begin gradually tapering, while observing the client for symptom exacerbation. Fluvoxamine (Luvox) does have side effects; however, it has fewer side effects than clomipramine and is recommended for the first medication trial. Fluvoxamine (Luvox) is approved by the U.S. Food and Drug Administration (FDA) for treatment of OCD. B) This statement indicates that the client understands instruction regarding this medication. A client should continue taking fluvoxamine (Luvox) for 1—2 years, at which time a physician may begin gradually tapering, while observing the client for symptom exacerbation. Fluvoxamine (Luvox) does have side effects; however, it has fewer side effects than clomipramine and is recommended for the first medication trial. Fluvoxamine (Luvox) is approved by the U.S. Food and Drug Administration (FDA) for treatment of OCD. C) This statement indicates that the client understands instruction regarding this medication. A client should continue taking fluvoxamine (Luvox) for 1—2 years, at which time a physician may begin gradually tapering, while observing the client for symptom exacerbation. Fluvoxamine (Luvox) does have side effects; however, it has fewer side effects than clomipramine and is recommended for the first medication trial. Fluvoxamine (Luvox) is approved by the U.S. Food and Drug Administration (FDA) for treatment of OCD. D) This statement indicates that the client understands instruction regarding this medication. A client should continue taking fluvoxamine (Luvox) for 1—2 years, at which time a physician may begin gradually tapering, while observing the client for symptom exacerbation. Fluvoxamine (Luvox) does have side effects; however, it has fewer side effects than clomipramine and is recommended for the first medication trial. Fluvoxamine (Luvox) is approved by the U.S. Food and Drug Administration (FDA) for treatment of OCD. Page Ref: 2098 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.11. Examine nursing roles in assuring coordination, integration, and continuity of care. | AACN Essential Competencies: IX.10 Facilitate patient-centered transitions of care, including discharge planning and ensuring the caregiver's knowledge of care requirements to promote safe care. | NLN Competencies: Relationship Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing Process: Evaluation Learning Outcome: 31.C.5. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Summarize diagnostic tests and therapies used by interdisciplinary teams in the collaborative care of an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

The home care nurse observes a client scrubbing areas throughout the house over and over, especially areas where the family gathers. Prior to planning care for this client, which must the nurse assess? A) If the client is forgetful B) If the client does not clean thoroughly C) How frequently the client cleans the house D) The impact of symptoms on the family system

Answer: D Explanation: A) Obsessive-compulsive disorder impacts the family system, especially with impaired role function. How frequently or thoroughly the client cleans the house may be important to assess, but they are not the most important. Forgetfulness is not a component of obsessive-compulsive disorder. B) Obsessive-compulsive disorder impacts the family system, especially with impaired role function. How frequently or thoroughly the client cleans the house may be important to assess, but they are not the most important. Forgetfulness is not a component of obsessive-compulsive disorder. C) Obsessive-compulsive disorder impacts the family system, especially with impaired role function. How frequently or thoroughly the client cleans the house may be important to assess, but they are not the most important. Forgetfulness is not a component of obsessive-compulsive disorder. D) Obsessive-compulsive disorder impacts the family system, especially with impaired role function. How frequently or thoroughly the client cleans the house may be important to assess, but they are not the most important. Forgetfulness is not a component of obsessive-compulsive disorder. Page Ref: 2098 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychosocial, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship Centered Care: Threats to the integrity of relationships, and the potential for conflict and abuse. | Nursing Process: Assessment Learning Outcome: 31.C.7. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Apply the nursing process in providing culturally competent care to an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.

The nurse is providing care to a client who is diagnosed with obsessive-compulsive disorder. Which nursing intervention is most appropriate when providing care to this client? A) Confront the client and ask what purpose the behavior serves. B) Tell the client that the behavior is unacceptable and must end. C) Interrupt the ritualistic behavior when observed. D) Discuss the need to incorporate the behavior with other hospital routines.

Answer: D Explanation: A) The client with obsessive-compulsive behavior will not be able to perform the behavior at will, so the nurse needs to discuss the need to incorporate the behavior with other hospital routines. The nurse should not interrupt the behavior, as this will cause the client to start over from the beginning. The nurse should also not confront the client and ask what purpose it serves, as the client might be embarrassed about the behavior. Telling the client that the behavior is unacceptable and must end also will not help the client with the behavior. B) The client with obsessive-compulsive behavior will not be able to perform the behavior at will, so the nurse needs to discuss the need to incorporate the behavior with other hospital routines. The nurse should not interrupt the behavior, as this will cause the client to start over from the beginning. The nurse should also not confront the client and ask what purpose it serves, as the client might be embarrassed about the behavior. Telling the client that the behavior is unacceptable and must end also will not help the client with the behavior. C) The client with obsessive-compulsive behavior will not be able to perform the behavior at will, so the nurse needs to discuss the need to incorporate the behavior with other hospital routines. The nurse should not interrupt the behavior, as this will cause the client to start over from the beginning. The nurse should also not confront the client and ask what purpose it serves, as the client might be embarrassed about the behavior. Telling the client that the behavior is unacceptable and must end also will not help the client with the behavior. D) The client with obsessive-compulsive behavior will not be able to perform the behavior at will, so the nurse needs to discuss the need to incorporate the behavior with other hospital routines. The nurse should not interrupt the behavior, as this will cause the client to start over from the beginning. The nurse should also not confront the client and ask what purpose it serves, as the client might be embarrassed about the behavior. Telling the client that the behavior is unacceptable and must end also will not help the client with the behavior. Page Ref: 2099 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing Process: Implementation Learning Outcome: 31.C.7. Analyze obsessive-compulsive disorder (OCD) as it relates to stress and coping. Apply the nursing process in providing culturally competent care to an individual with OCD. MNL LO: Demonstrate understanding of the concept of stress and coping in the care of a patient with obsessive-compulsive disorder.