PREP U CHPT 15

"I check until my anxiety subsides."

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)?

Discussing real or imagined defects in appearance, such as having a "long" nose

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

The client performs the ritual to relieve anxiety temporarily.

A client diagnosed with obsessive-compulsive disorder comes to the clinic with the client's spouse. During the visit, the spouse states, "The client is always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time. Isn't checking once enough?" An understanding of what would the nurse need to incorporate into the response?

hair loss on the scalp, eyebrows and/or eyelashes

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

The client is trying to reduce anxiety by repeating specific tasks.

A client is late for work every day because the client spends about 20 minutes checking and rechecking the lights and water taps before leaving home. What kind of behavior does the nurse understand is exhibited by the client?

The client has a high comorbidity for depression.

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

compulsion

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?

Encourage the client to participate in follow-up therapy.

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?

Chronicle situations that trigger obsessions.

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?

Teach the client nonpharmacologic relaxation techniques

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?

exposure and response prevention.

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:

Treatment may involve community agencies.

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

"The process you're describing sounds like it must require quite a bit of time and energy."

A new client with a long-standing history of obsessive-compulsive disorder (OCD) is describing to the nurse the complex ritual of locking and unlocking a door after entering a room alone. What is the nurse's most therapeutic response?

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

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?

Client will demonstrate healthy coping strategies for dealing with stressors

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?

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

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?

Excoriation disorder

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?

risperidone, quetiapine, and olanzapine.

Clients with treatment-resistant OCD may respond to second-generation antipsychotics such as

aggressive/sexual/religious/checking

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?

dry, cracked hands.

Frequent and ritualistic hand washing is an obsessive compulsive disorder leading to

Help the client find alternative methods to deal with anxiety.

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

OCD is responsive to treatment with

SSRIs. Trichotillomania, excoriation disorder, and hoarding are not normally treated with SSRIs.

communication .. exmp

Saying, "The process you're describing sounds like it must require quite a bit of time and energy" encourages the client to elaborate on the effect that the client's rituals have on the client's life. Rapport is likely to be harmed if the nurse focuses on "a problem that doesn't exist." Focusing on the prevalence of mental health disorders is likely to inhibit communication at this fragile, early stage of the nurse-patient relationship. Turing the tables by asking, "What would you say to me if I had similar rituals with locking and unlocking doors?" is not a recognized therapeutic technique.

A compulsion

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?

fluvoxamine as a first-line choice

The client who is beginning treatment for OCD is prescribed the selective serotonin reuptake inhibitor depressant

Compulsion involves repeating a purposeful action

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

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

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

Early onset may indicate family history of OCD.

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?

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

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

The client is preoccupied with perfection.

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 has a fear of acquiring infections.

The nurse is assessing a client whose hands are red and cracked from repeated hand washing and cleaning. What finding does the nurse identify with obsessive-compulsive disorder (OCD)?

The client is unable to maintain adequate personal hygiene.

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?

Provide opportunities for the client to accomplish an activity.

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

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

Excoriation of the skin

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

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

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

Hoarding

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

The client's mother had OCD

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?

"I may have a risk of suicidal thoughts with the medication."

The nurse is providing education to a client prescribed clomipramine to help with obsessive-compulsive disorder. Which statement by the client indicates the teaching was effective?

When the client is experiencing low 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 to teach relaxation techniques?

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.

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 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.

is fixated on a specific physical flaw.

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

Promoting the client's safety in the home environment

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?

OCD treatment

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

The obsessions become intense as the client tries to stop the behavior.

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

Relaxation techniques should be practiced whenever possible.

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

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

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

praying repeatedly

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

Unwanted Intrusive Impulsive

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

"Do you get enjoyment out of all the clothes you buy?"

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

Practicing deep breathing

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

A client who firmly believes that everyone who sees the client fixates on the size of the client's ears

Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)?

A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive- behavioral therapy

Which client is most likely to benefit from the administration of selective serotonin reuptake inhibitors (SSRIs)?

Fluvoxamine

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

"It's important to know that the symptoms will intensify during periods of stress."

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?

Body dysmorphic disorder involves

a focus on a perceived defect in appearance. Comorbidity of an eating disorder is common, but this is not a diagnostic characteristic of the disorder.

OCD has

a genetic component. Psychosocial factors such as child neglect, substance abuse, and personality type are thought to be less significant than neurobiologic factors.

A client with trichotillomania would have

a loss of hair from hair-pulling including the scalp, eyebrows and eyelashes. Reddened hands from handwashing would be associated with obsessive-compulsive disorder. Skin redness and potential skin breakdown would be associated with excoriation (skin-picking) disorder. A report by the client about having large ears would be associated with body-dysmorphic disorder.

Hoarding is

a progressive, debilitating, and late-onset disorder. It increases with age.

The client who is obsessed with perfection performs compulsive rituals such as

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

Symmetry/ordering/arranging is expressed by the need to

be perfect or exact with concerns about symmetry. The individual will take a great deal of time to continually rearrange objects until they are organized in a symmetrical or "just right" fashion.

compulsions

behaviors people with obsessive-compulsive disorder will carry out in order to neutralize the anxiety caused by the obsessions.

Reducing the frequency of rituals for a person with OCD

causes anxiety. Clients consequently benefit from learning techniques that can reduce their stress in a healthy way. Mood stabilizers are not typically used in the treatment of OCD, and nurses do not normally facilitate the performance of rituals. The client is likely aware of the negative consequences of obsessions and rituals, as evidence by efforts to eliminate them.

panic attacks typically are

characterized by a discrete period of intense apprehension or terror without any real accompanying danger, accompanied by at least four of 13 somatic or cognitive symptoms.

Obsessive-compulsive symptoms tend to fall into different patterns obsessive-compulsive symptom dimensions.

collecting/hoarding contamination/cleaning Symmetry/ordering/arranging aggressive/sexual/religious/checking

The client obsessed with blasphemous thoughts is

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

Aggressive/sexual/religious/checking

dimension involves excessive worries or fears that something very bad will happen such as a death of a relative or accident. Individuals may have intrusive thoughts about inappropriate violent, sexual or religious content and may need to do something repeatedly, such as praying or confessing to avoid or dismiss these thoughts.

Exposure and behavioral prevention therapy begins by

having the client maintain a diary to note the situations that trigger obsessions, time spent performing the ritual behavior, and avoidance behaviors.

Collecting/hoarding

involves collecting or storing many things or useless objects.

Safety

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

an obsession

is a recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function.

a phobia

is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning.

Derealization

is sensing that things are not real.

The client with onychophagia is

likely to have very short nails due to frequent nail biting.

Dermatillomania is an

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

Oniomania

or compulsive buying is a reward-seeking behavior.

Individuals with BDD focus on real (but slight)

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

The client with dermatillomania attempts to reduce anxiety by

picking on the skin. This client has excoriated skin. Trichotillomania is a disorder which causes the client to repeatedly pull the hair to reduce anxiety.

obsessions refer to

recurrent, intrusive, and persistent ideas, thoughts, images, or impulses.

compulsions are

ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

Compulsions are ritualistic behaviors

that people feel compelled to perform either in accord with a specific set of rules or in a routine manner. A repeated action performed as the result of a persistent thought is termed a compulsion.

Excoriation disorder (skin picking) is

the inability to stop recurrent picking at skin for emotional release or anxiety release.

While the etiology of trichotillomania is not fully understood,

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

Relaxation techniques

to assist in managing anxiety can be performed regardless of participation in exposure and response prevention therapy.

The client with OCD has

unwanted, intrusive, and impulsive thoughts and images. These thoughts are unreasonable and cause marked anxiety. Interesting and intelligent thoughts are not characteristic of what is described when clients experience episodes of ritualistic behavior to neutralize anxiety.

acute stress disorder occurs

within the first month of exposure to extreme trauma: combat, rape, physical assault, near-death experience, or witnessing a murder.

the contamination/cleaning dimension involves

worrying about being physically sick, contaminated by dirt or bacteria and is expressed through ritualized washing or cleaning excessively.