The nurse plans care for a client newly admitted with obsessive-compulsive disorder who is repeatedly counting magazines in the commons room. Which of the following should the nurse include in the initial plan of care? Select all that apply.

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Obsessive-compulsive disorder is characterized by obsessions (ie, persistent and intrusive thoughts, impulses, or images) and compulsions (ie, ritualistic, repetitive behaviors performed to reduce anxiety or prevent an adverse event). Clients are aware that such behavior is irrational, but performing the actions provides relief, which compels them to continue. Initially, nursing care includes: Assisting the client to identify circumstances that increase anxiety (Option A) Offering positive feedback when the client engages in nonritualistic behavior (eg, group activities, board games) (Option B) Remaining nonjudgmental and empathetic and using reflective communication (Option C) Cognitive-behavioral therapy (eg, thought stopping) (Option E) (Option D) Suddenly denying the client the ability to perform the ritualistic activity can cause panic-level anxiety. Instead, the nurse should gradually limit the time allotted to the ritualistic behavior, once the client is equipped with new coping mechanisms. Educational objective: Obsessive-compulsive disorder is characterized by persistent, intrusive thoughts (obsessions) and behaviors performed ritualistically and repetitively to try to reduce anxiety (compulsions). Nursing care includes assisting the client to identify anxiety-producing situations, allowing time for the ritualistic behavior (initially), remaining nonjudgmental, offering positive feedback, and providing cognitive-behavioral therapy.

The Nurse Plans Care for a Client Newly Admitted with Obsessive-Compulsive