Psych chapter 15 Point
What question by the nurse is focused on identifying oniomaniac tendencies in a client diagnosed with depression? "Do you ever feel like hurting yourself?" "Have you ever been arrested for stealing?" "Do you get enjoyment out of all the clothes you buy?" "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.
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? "There are several comorbid conditions that can develop from the anxiety." "OCD often lasts well into adulthood." "The symptoms will require lifelong medication therapy." "It's important to know that the symptoms will intensify during periods of stress."
"It's important to know that the symptoms will intensify during periods of stress." OCD is a chronic, progressive disease. Symptoms wax and wane over time, increasing during periods of stress. While the other statements are accurate, they do not provide the most general, encompassing information regarding the management of this chronic, progressive disorder.
Which statement by the nurse providing care for a client diagnosed with obsessive-compulsive disorder (OCD), indicates a need for additional education regarding the client's ritualistic hand washing? "Let's talk about how you plan to manage your anxiety in the years to come." "Let's talk about how this ritualistic behavior makes you feel." "Let me help you find something less time consuming to do to manage your anxiety." "I believe you when you say you just can't stop washing your hands."
"Let me help you find something less time consuming to do to manage your anxiety." People with OCD are usually aware that their ritualistic behavior appear senseless or even bizarre to others. Given that, family and friends may believe that the person "should just stop" the ritualistic behavior. "Just find something else to do" or other unsolicited advice only adds to the guilt and shame that people with OCD experience. It is important for the nurse (and other health professionals) to avoid taking that same point of view. Most times, people with OCD appear "perfectly normal" and therefore capable of controlling their own behavior. The nurse must remember that overwhelming fear and anxiety interfere with the person's ability to monitor or control their own actions. In addition, OCD is often chronic in nature, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals doesn't mean they will never need professional help in the future.
What intervention does the nurse perform to assist the client in decreasing the frequency of repetitive behaviors? Teach the client to practice conversation and attentive listening. 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.
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.
A client performs ritualistic washing of the hands and dishes, along with rearranging the table before settling down to a meal. What intervention does the nurse implement to help this client complete this daily routine? Select all that apply. Come to an agreement with the client on a time to stop the ritual. Include the time taken for the ritual in the day's timetable. Interrupt the client after three rounds of washing. Encourage a gradual decrease in the time allotted for the ritual. Ask the client to read the newspaper instead of performing the ritual.
Come to an agreement with the client on a time to stop the ritual., Include the time taken for the ritual in the day's timetable., Encourage a gradual decrease in the time allotted for the ritual. The nurse includes the time taken for the ritual while planning the client's schedule. Exposure and response prevention techniques are successful only if the client agrees to cooperate during the treatment. Therefore, the nurse and client should agree on a time to stop the ritual and continue daily activities. It does not help to create distractions by asking the client to perform another activity instead of the daily ritual. The nurse does not interrupt the client during the ritual because this can escalate the client's anxiety. The nurse supports and encourages the client to gradually decrease the time allotted for the ritual each day. This helps to gradually eliminate the client's ritualistic behavior.
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? Phobia Compulsion Derealization Obsession
Compulsion Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. 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. 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. Derealization is sensing that things are not real.
The nurse is caring for a client with obsessive-compulsive disorder (OCD). What are the expected outcomes for the client who has been stabilized by medication and behavior therapy? Verbalize knowledge of illness and treatment term-24plan. Continue follow-up therapy as needed. List strengths and abilities to the nursing staff. Identify stresses and anxieties.
Continue follow-up therapy as needed. Clients with OCD who have been stabilized by medication and behavior therapy may experience long-term difficulties in dealing with obsessive thoughts. These clients are encouraged to continue follow-up therapy. The expected outcome for clients in the stabilization phase of therapy is verbalizing knowledge of illness and treatment plan. In the immediate phase of therapy, clients should be able to list and review strengths and abilities with the nursing staff. These clients should also be able identify stresses and anxieties to enable the nurse to develop a plan of care.
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 is diagnosed very early in most clients. It starts in childhood in female clients. 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 is diagnosed very early in most clients. It starts in childhood in female clients. Early onset may indicate family history of OCD. It starts in the 20s in male 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.
What interventions does the nurse perform when caring for a client with obsessive-compulsive disorder (OCD)? Select all that apply. Encourage the client to perform activities of daily living within a fixed time. Talk to the client in a calm, reassuring voice. Teach the client to avoid trigger situations. Teach the client social skills such as appropriate conversation topics. Reward the client for every activity that is performed.
Encourage the client to perform activities of daily living within a fixed time., Teach the client to avoid trigger situations., Teach the client social skills such as appropriate conversation topics. Nursing interventions for OCD include encouraging the client to perform activities of daily living within a fixed time, teaching the client social skills such as appropriate conversation topics, and teaching the client to avoid trigger situations. The nurse should not provide undue praise, such as rewarding the client for every activity. Clients with OCD benefit from genuine praise that is earned. The nurse should convey interest when speaking to the client; however, a calm, reassuring voice is not necessary. This tone is used with clients experiencing a panic attack.
A teenager and the teenager's parents visit the clinic to discuss the teen's skin picking. There are many bleeding wounds and various stages of scabs located up and down both arms. The parents are very upset about this behavior and want it to stop. Which would the health care provider document? Excoriation disorder Body dysmorphic disorder Control dysfunction Disrupted family dynamics
Excoriation disorder Excoriation disorder (skin picking) is the inability to stop recurrent picking at skin for emotional release or anxiety release. Body dysmorphic disorder is a preoccupation with slight or imagined physical defects that are not apparent to others. There is not enough information to diagnose disrupted family dynamics or control issues within the family unit.
What interventions does the nurse use to promote therapeutic communication with the client diagnosed with obsessive-compulsive disorder (OCD)? Explore the thoughts and feelings that trouble the client. Explain to the client that anxiety is irrational. Inform the client that these thoughts cannot be controlled. Ask the client to avoid discussing ritualistic behaviors with friends.
Explore the thoughts and feelings that trouble the client. Rationale:The nurse discusses the client's thoughts and feelings in as much detail as possible. This helps to relieve the client of some of the "burden" the client has been keeping to the self. The client is aware that the anxiety is irrational. The nurse validates the irresistible feelings that the client experiences but assures the client that these can be controlled. OCD clients tend to hide their rituals and obsessions from friends and family. However, discussing them with the nurse is an important step in treatment.
The nurse is interviewing the parents of a child who is exhibiting obsessive-compulsive disorder (OCD). The nurse would anticipate that the parents would report the occurrence of which situation with the child? Appearing jittery and nervous all the time. Failing classes due to a lack of concentration. Frequently "staring off into space." Spending excessive amount of times in the child's room.
Failing classes due to a lack of concentration. Assessment reveals intact intellectual functioning. The client may describe difficulty concentrating or paying attention when obsessions are strong. Because children subscribe to myths, superstition, and magical thinking, obsessive and ritualistic behaviors may go unnoticed. Behaviors such as touching every third tree, avoiding cracks in the sidewalk, or consistently verbalizing fears of losing a parent in an accident may have some underlying pathology but are common behaviors in childhood. Typically, parents notice that a child's grades begin to fall as a result of decreased concentration and great amounts of time spent performing rituals. Isolating themselves, staring off into space, and being nervous could be considered normal behavior at certain developmental ages.
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 Risperidone Quetiapine
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 nurse is caring for clients with obsessive-compulsive disorder (OCD). Which progressive and debilitating disorder is most commonly seen with a late onset? Ordering Oniomania Hoarding Onychophagia
Hoarding Hoarding is a progressive, debilitating, and late-onset disorder. It increases with age. Onychophagia or nail biting is a self-soothing behavior. Typical onset is in childhood and gradually decreases by age 18. Oniomania is a compulsive buying disorder. 80% of the clients are female with onset of the behavior in the early 20s. Ordering is a commonly seen compulsion in clients with OCD, in which the client arranges and rearranges objects in a perfect order. It is treated with medication and behavior therapy.
While planning care for a child who has excoriation disorder, which would be the priority NANDA nursing diagnosis? Ineffective role performance Dysfunctional family processes Impaired skin integrity Hopelessness
Impaired skin integrity The nursing diagnoses applied to patients with obsessive-compulsive disorder can run the gamut from the primary diagnosis of anxiety to other physiologic disturbances of the compulsion, such as impaired skin integrity, which may result from continuous hand washing or picking at the skin.
The nurse is caring for a client who performs ritualistic hand washing and cleaning for about 30 minutes several times a day. What does the nurse tell the client's partner about caring for this client? Monitor own health and anxiety levels. Ignore the client's behavior, it will phase out with time. Assist the client to complete daily activities. Ask the client to divert attention to other activities.
Monitor own health and anxiety levels. The nurse asks the client's partner to monitor the partner's own health and anxiety levels. The partner may benefit from an occasional break in the routine. The client must undergo therapy to complete daily activities without assistance. Diverting the client's attention to other activities or ignoring the client's behavior does not help either of them. The partner must understand the client's problem and encourage the client to undergo behavior therapy and take medications.
The nurse is assessing an older client with late onset of obsessive-compulsive disorder (OCD). What assessment does the nurse perform for this client? Select all that apply. Obtain history of recent infections. Assess for possible brain injury. Assess for degenerative disorders. Check for a family history of OCD. Assess client for onychophagia.
Obtain history of recent infections., Assess for possible brain injury., Assess for degenerative disorders. Late onset of OCD may be triggered by an organic cause such degenerative disorders, infections, or brain injury. The nurse must alert the health care provider about the cause for the disorder. The nurse does not assess the client for onychophagia or nail biting. This disorder begins in childhood and subsides by age 18 for most clients. Clients with an early onset of OCD have a greater likelihood of family history of OCD. OCD other than hoarding rarely manifests after the age of 50.
The nurse is assisting a client with behavior therapy for OCD. What nursing intervention may help enhance self-esteem? Ask client to perform deep breathing exercises instead of ritual behaviors. Provide opportunities for the client to accomplish an activity. Interrupt the client when performing a ritualistic behavior. Reduce instances of stimuli that activate compulsive behavior.
Provide opportunities for the client to accomplish an activity. The nurse should provide the client with the opportunity to participate in activities that are easily accomplished or enjoyed by the client. The nurse teaches the client to confront situations that activate compulsive behavior during the "exposure" training. The nurse does not interrupt the client when performing a ritualistic behavior. This elevates anxiety levels in the client. Deep breathing exercises are performed when anxiety levels rise.
A client with obsessive-compulsive disorder (OCD) states making a concerted effort to reduce the frequency and duration of rituals. What intervention should the nurse include to assist in these efforts? Teach the client nonpharmacologic relaxation techniques Educate the client about the negative effects of obsessions and compulsions Teach the client how to complete the client's rituals in less time Administer mood stabilizers as prescribed
Teach the client nonpharmacologic relaxation techniques 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.
What signs of stabilization does the nurse recognize during the follow-up visit of a client undergoing behavior therapy for obsessive-compulsive disorder (OCD)? The client verbalizes conflicting thoughts and fears. The client completes daily routine within a specified time. The client recognizes and lists strengths and abilities. The client identifies stresses and anxieties.
The client completes daily routine within a specified time. The client who has achieved stabilization following behavior therapy for OCD is able to complete the daily routine within a specified time. The other outcomes are expected in a client in the immediate phase of behavior therapy. In that phase, the client is able to identify stresses and anxieties, talk to the nurse about conflicting thoughts and fears and, with nursing staff help, recognize personal strengths and abilities.
The nurse is caring for an adolescent with dermatillomania. What does the nurse tell the client's parent about this disorder? Select all that apply. The client finds comfort in skin picking. It can lead to loss of occupational functioning. It is a reward-seeking behavior. It can lead to medical complications. It is a repercussion of substance use.
The client finds comfort in skin picking., It can lead to loss of occupational functioning., It can lead to medical complications. 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. Dermatillomania is not caused by substance use nor is it a reward-seeking behavior.
When assessing the insight and self-concept of a client with obsessive-compulsive disorder (OCD), what does the nurse note? The client is unable to make sound judgments. The client feels that the images and thoughts are real. The client has a fear of "going crazy." The client has the will power to stop intrusive thoughts.
The client has a fear of "going crazy." Clients with OCD express concern that they may be "going crazy." Feelings of powerlessness to control the obsessions or compulsions contribute to their low self-esteem. These clients also feel that they could control the thoughts and behaviors if they had stronger willpower. These clients are able to make sound judgments but are unable to act on them. Clients with OCD are aware that the intrusive images and thoughts are irrational, but they cannot control the overwhelming anxiety.
The nurse is assessing a client who spends several hours arranging and rearranging items around the house. What does the nurse anticipate is the cause of this compulsive behavior? The client is obsessed with blasphemous thoughts. The client has a fear of contamination. The client is preoccupied with perfection. The client is obsessed with cleanliness.
The client is preoccupied with perfection. 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.
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 reports unwanted weight gain. The client is energetic and completes activities quickly. The client is unable to maintain adequate personal hygiene
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 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 believes the client has no personal responsibilities. The client wants to control own thoughts. The client has intolerance for uncertainty. The client lacks religious sentiments. 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.
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 a degenerative disorder. It is caused by an injury to the basal ganglia. Short-term treatment can provide a successful outcome. 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 assessing a teenage client with onychophagia. What does the nurse teach the parent about the disorder? The behavior typically decreases by age 50. It is a generalized anxiety disorder. Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants is effective. It is an attention-seeking behavior.
Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants is effective. SSRI depressants are found to be effective in the treatment of onychophagia or nail biting disorder. The typical onset of the disorder is in childhood with a decrease in behavior by age 18. It is a self-soothing behavior. It cannot be classified as a generalized anxiety disorder. It is known to be an obsessive-compulsive disorder. The client bites the nails to overcome anxiety caused by obsessions.
The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When does the nurse teach relaxation techniques to the client? Just before the client goes to bed. When the client is experiencing low anxiety levels. After the client has taken medication. When the client is performing a repetitive ritual.
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.
Which goal is appropriate for the client being treated for obsessive-compulsive disorder with response prevention therapy? The client will implement relaxation techniques to help manage his or her anxiety within 2 days. The client will demonstrate an understanding of the benefits of deep breathing within 2 days. The client will experience notably less anxiety when engaged in delaying the ritual within 3 months. The client will deliberately confront the trigger of his or her anxiety within 3 months.
vThe client will experience notably less anxiety when engaged in delaying the ritual within 3 months. Response prevention focuses on delaying or avoiding performance of rituals. The client learns to tolerate the thoughts and the anxiety and to recognize that it will recede without the disastrous imagined consequences. Other techniques, such as deep breathing and relaxation, can also assist the person to tolerate and eventually manage the anxiety. Exposure involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids.
