ch15: ocd
A client checks and rechecks the lock on the door five times before leaving home. What statement by the client indicates that this behavior is a result of obsessive-compulsive disorder (OCD)? "I check until my anxiety subsides." "I don't think the lock is secured." "This part of the city is unsafe." "There is nothing wrong in rechecking."
"I check until my anxiety subsides." The client engages in the ritualistic behavior of rechecking the lock when the anxiety becomes overwhelming. The client is unable to control the client's thoughts. This is a behavior distinctive of OCD. The client with OCD can make sound judgments and recognizes that obsessions are irrational. A person may recheck because the lock is not secure or just to make sure the door is locked. A person may simply double-check the lock. These people are not exhibiting irrational thought process and therefore do not have OCD.
Which statement made by the nurse to the family of a client diagnosed with obsessive-compulsive disorder (OCD) demonstrates the best general understanding of the chronic nature of the disorder and its management? "It's important to know that the symptoms will intensify during periods of stress." "The symptoms will require lifelong medication therapy." "There are several comorbid conditions that can develop from the anxiety." "OCD often lasts well into adulthood."
"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 me help you find something less time consuming to do to manage your anxiety." "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." "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.
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? "The process you're describing sounds like it must require quite a bit of time and energy." "Is there a history of OCD or any other mental health disorders in your family?" "It sounds like you're trying to address a problem that in all likelihood doesn't exist." "What would you say to me if I had similar rituals with locking and unlocking doors?"
"The process you're describing sounds like it must require quite a bit of time and energy." 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 nurse is planning care for a client who has been diagnosed with trichotillomania. Which outcome should the nurse include in the client's plan of care? Client will accurately describe the etiology and clinical course of trichotillomania Client will reestablish mutually supportive relationships with family members Client will consistently refrain from skin picking Client will demonstrate healthy coping strategies for dealing with stressors
Client will demonstrate healthy coping strategies for dealing with stressors 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.
The nurse plans care for a client who is diagnosed with obsessive-compulsive disorder (OCD). Which strategy should the nurse include in the client's plan of care to address the wellness challenge of coping effectively with daily obsessions and compulsions? Establish healthy sleep hygiene routines. Explore the availability of support groups. Maintain a structured living environment. Develop strategies to interrupt thoughts.
Develop strategies to interrupt thoughts. The client who is diagnosed with OCD will experience wellness challenges, one of which is coping effectively with daily obsessions and compulsions. Coping strategies that can be included in the client's plan of care to address this issue include practicing resisting urges to perform compulsive behaviors and developing strategies to avoid obsessive thoughts through reframing. Establishing healthy sleep hygiene routines addresses the challenge of recognizing the need for physical activity, healthy foods, and sleep. Maintaining a structured living environment addresses the challenge of seeking environments that reduce the need for using compulsive behaviors. Exploring the availability of support groups addresses the wellness challenge of developing a sense of connection and belonging.
A client diagnosed with body dysmorphic disorder (BDD) will primarily focus on what? Analyzing why others think the client looks fine and that the client should just get on with life Researching the client's family tree to pinpoint when the client's body part became defective Discussing real or imagined defects in appearance, such as having a "long" nose Raising money to surgically repair a body part so that everything will return to "normal"
Discussing real or imagined defects in appearance, such as having a "long" nose 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.
A client with obsessive-compulsive disorder (OCD) is being discharged from the health care facility. What does the nurse teach the client and the family? Encourage the client to participate in follow-up therapy. Encourage the family to assist the client in completing daily activities. Apply relaxation techniques when anxiety level is low. Discontinue medications after mastering behavior therapy.
Encourage the client to participate in follow-up therapy. Clients with OCD experience long-term difficulties in dealing with obsessive thoughts. The nurse helps the client identify supportive resources in the community. Medications are just as important as mastering behavior therapy. The client must not stop medications without consulting the health care provider. The nurse asks the client to practice relaxation techniques when the client's anxiety level is low and apply them when anxiety levels increase. The client must learn to tolerate obsessive thoughts and complete daily activities without help from others.
The nurse is caring for clients with obsessive-compulsive disorder (OCD). Which progressive and debilitating disorder is most commonly seen with a late onset? Onychophagia Hoarding Oniomania Ordering
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.
What relaxation technique does the nurse teach the client with obsessive-compulsive disorder (OCD)? Practicing deep breathing Writing a diary Listening to music Scheduling a timetable
Practicing deep breathing The nurse teaches the client deep breathing for relaxation. The nurse encourages the client to practice deep breathing when anxiety increases. The client is taught to maintain a diary to note down situations that trigger obsessions. The nurse sets a timetable for the client's daily routine. This helps to ensure that the client completes tasks within a scheduled time. The effect of music on clients with OCD is not known.
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 how to complete the client's rituals in less time Educate the client about the negative effects of obsessions and compulsions Administer mood stabilizers as prescribed Teach the client nonpharmacologic relaxation techniques
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.
The nurse is educating the client's family about compulsive behavior. The nurse is correct when making which statement? The behavior eventually leads to insanity. The behavior neutralizes anxiety caused by obsessive thoughts. The client's thoughts and behaviors are realistically connected. The client stops the ritual only when prompted by external stimuli.
The behavior neutralizes anxiety caused by obsessive thoughts. The client attempts to suppress or ignore the intrusive thoughts by indulging in ritualistic behavior. This behavior neutralizes the anxiety caused by obsessive thoughts. However, the thoughts and behaviors are not realistically connected. The client becomes agitated and anxiety levels increase when prompted to stop by external stimuli. The client has normal intellectual functioning and is not on the verge of insanity.
During a follow-up visit, the nurse is assessing for signs of stabilization in a client undergoing behavior therapy for obsessive-compulsive disorder (OCD). What sign not seen previously in therapy does the nurse recognize as an indication of stabilization? 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 verbalizes conflicting thoughts and fears.
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 repercussion of substance use. It is a reward-seeking behavior. It can lead to medical complications.
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 has the will power to stop intrusive thoughts. The client has a fear of "going crazy." The client feels that the images and thoughts are real.
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 compulusions 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.
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? The client has a high comorbidity for depression. The client distributes the items among the needy. The client purchases several items required for daily use. The client is exhibiting a self-soothing behavior.
The client has a high comorbidity for depression. Compulsive buying runs in families that have a high comorbidity for depression and substance use. The client enjoys the thrill of acquiring new items and does not distribute it among the needy. The client purchases objects that may be used infrequently or never be used. Oniomania or compulsive buying is a reward-seeking behavior.
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 has intolerance for uncertainty. The client overestimates the threats caused by the thoughts. The client wants to control own thoughts. The client lacks religious sentiments. The client believes the client has no personal responsibilities.
The client has intolerance for uncertainty. The client overestimates the threats caused by the thoughts. The client wants to control own thoughts. According to the cognitive model, the person believes that "if I think, it will happen." Therefore, the client wants to control the client's own thoughts. This client tries to be perfect and has intolerance for uncertainty. The client feels threatened by the thoughts. All this causes an increased anxiety in the client leading to some compulsive ritualistic behavior. As per the cognitive model, the client's thoughts are influenced by an inflated sense of responsibility. This may be a result of strict moral or religious upbringing.
The nurse is caring for a client receiving fluvoxamine and behavior therapy for obsessive compulsive disorder. What outcome does the nurse expect of this client? The client is able to identify individual strengths and abilities after 2 weeks. The client establishes adequate nutrition after 1 to 2 days. The client is able to sleep for at least 4 hours per night after 5 days. The client is able to identify the cause of anxiety after 1 week.
The client is able to sleep for at least 4 hours per night after 5 days. The client responding effectively to treatment must be able to sleep for at least 4 hours per night. Adequate nutrition must be established within 4 to 5 days. The client is expected to identify the cause of stress and anxiety within 2 to 3 days. Individual strengths and abilities must be identified and reviewed with staff within 3 to 4 days.
The nurse is assessing a client who spends several hours arranging and rearranging items around the house. What does the nurse anticipate is the cause of this compulsive behavior? The client is preoccupied with perfection. The client is obsessed with cleanliness. The client has a fear of contamination. The client is obsessed with blasphemous thoughts.
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.
Which goal is appropriate for the client being treated for obsessive-compulsive disorder with response prevention therapy? 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. The client will implement relaxation techniques to help manage his or her anxiety within 2 days.
The 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.
The nurse is providing care for a client who has obsessive-compulsive disorder (OCD). What aspect of this client's history was the most likely contributor to its etiology? The client's mother had OCD The client abused alcohol heavily as a teenager The client was neglected as a child The client has a type D personality
The client's mother had OCD 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.
What does the nurse find on assessment of the thought processes of a client with obsessive-compulsive disorder (OCD)? Obsessions occur when the client is not engaged in an activity. The client's intellectual functioning is deteriorating. The obsessions become intense as the client tries to stop the behavior. The client has gradual memory loss.
The obsessions become intense as the client tries to stop the behavior. Clients with OCD do not willingly have obsessions or images, and their obsessions become more intense when they try to prevent them. Clients with OCD do not experience effects in memory or intellectual functioning. However, they have difficulty concentrating when the obsessions are strong. For most, the obsessions arise out of nowhere, during other activities.
A client's older parent has been diagnosed with hoarding disorder. What does the nurse instruct the client about the parent's hoarding disorder? It is a degenerative disorder. Treatment may involve community agencies. Short-term treatment can provide a successful outcome. It is caused by an injury to the basal ganglia.
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? Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants is effective. It is an attention-seeking behavior. It is a generalized anxiety disorder. The behavior typically decreases by age 50.
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.
What kinds of thoughts does the nurse identify in a client with obsessive-compulsive disorder (OCD)? Select all that apply. Unwanted Impulsive Intelligent Interesting Intrusive
Unwanted Impulsive Intrusive 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.
A client with obsessive-compulsive disorder tells the nurse, "I never thought I'd be able to survive the feeling of leaving a room without going back through the door eight times, but I just did it with my therapist!" This client's treatment most likely included: cue cards. thought stopping. progressive relaxation. exposure and response prevention.
xposure and response prevention. "Pushing through" a client's compulsion in order to face the resulting anxiety is characteristic of ERP. Thought stopping, cue cards and relaxation do not involve this direct form of confrontation with compulsions.
The mental health nurse explains that the difference between an obsession and a compulsion can correctly be identified as what? The client experiencing an obsession usually experiences delusions as well. The client experiencing compulsions has insight into the disorder. A compulsion involves repeating a seemingly purposeful action. An obsession responds well to psychiatric treatment.
A compulsion involves repeating a seemingly purposeful action. An obsession is a persistent, painful, and intrusive thought, emotion, or urge that the client is unable to suppress or ignore, while a compulsion is the performance of a repetitious, seemingly purposeful act to prevent some future event or situation.
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? Learn deep breathing exercises. Chronicle situations that trigger obsessions.
Chronicle situations that trigger obsessions. 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. Relaxation techniques to assist in managing anxiety can be performed regardless of participation in exposure and response prevention therapy. This is also true of following a written schedule with specified times for completion. The client must be able to complete daily activities without assistance in a scheduled time frame.
The nurse is assessing a client recently diagnosed with obsessive-compulsive disorder (OCD). What does the nurse tell the client about the onset of the disorder? It starts in the 20s in male clients. Early onset may indicate family history of OCD. It starts in childhood in female clients. It is diagnosed very early in most clients.
Early onset may indicate family history of OCD. Early onset of OCD indicates the likelihood of a family history of OCD. OCD starts in childhood especially in males. In females the onset is in the 20s. OCD is diagnosed only when the client's compulsive behavior interferes with the client's personal, social, and occupational function.
A client 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. 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. Include the time taken for the ritual in the day's timetable. Come to an agreement with the client on a time to stop the ritual.
Encourage a gradual decrease in the time allotted for the ritual. Include the time taken for the ritual in the day's timetable. Come to an agreement with the client on a time to stop the ritual.
How does the nurse help to decrease anxiety and build confidence in a client with obsessive-compulsive disorder? Provide the client with a quiet and dimly lit room. Help the client find alternative methods to deal with anxiety. Provide opportunities to perform tasks usually avoided by the client. Permit minimal interactions with other clients during the therapy.
Help the client find alternative methods to deal with anxiety. The nurse teaches the client alternative methods such as deep breathing to deal with anxiety. The nurse provides opportunities to allow the client to perform tasks enjoyed by the client. Accomplishing these tasks in a set time enhances confidence and self-esteem. The client is encouraged to develop social skills by interacting with other staff members and clients. The client is given a room that is quiet and dimly lit room to promote sleep and rest.
A client states that the client copes with anxiety by cleaning compulsively, which irritates the client's spouse. What does the nurse consider this? Maladaptive, because it bothers the client's spouse Maladaptive, because it is an avoidance response
Maladaptive, because it is an avoidance response Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. Functional responses tend to be voluntary, conscious behaviors that address and acknowledge the stressful situation and help clients to find solutions. Dysfunctional responses tend to be involuntary, inflexible, avoidance-type solutions that impair productivity. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms. In other words, it is not appropriate to expect a client to just stop worrying, compulsively checking doors, or otherwise trying to cope with anxiety.
A client spends an hour cleaning and rearranging the client's desk prior to starting work after every break. This occurs about five to six times a day. How does the nurse rate the client according to the Yale-Brown Obsessive Compulsive Scale? Moderate Severe Extreme Mild
Severe The nurse records severe OCD for the client who spends greater than 3 and up to 8 hours/day performing compulsions. The client loses several productive hours during the day. The client with mild traits of OCD spends less than an hour per day in ritualistic behavior. The client who spends 1 to 3 hours in repetitive behavior every day is said to have moderate OCD. Extreme OCD causes a person to spend more than 8 hours a day performing compulsions.