Question 1

A client diagnosed with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, "These pills are making me sick. I think I'm getting a brain tumor because of the headaches." Which response by the nurse would be most appropriate?

Accepted Answer

Individuals with obsessive-compulsive disorder need frequent reassurance that the side effects are a common response to the medication and that they are not becoming ill. Ignoring the client's concerns will only increase the client's anxiety.

Question 2

A client diagnosed with obsessive-compulsive disorder (OCD) comes to the clinic with a spouse. During the visit, the spouse states, "It isn't normal to always be checking and rechecking to make sure that all of the appliances are turned off before we go out. It is nerve-wracking. We can never get out of the house on time. "Isn't checking once enough?" Which explanation of this behavior would the nurse need to incorporate into the response?

Accepted Answer

The nurse needs to explain to the spouse that the client's compulsion is done to relieve anxiety temporarily. The compulsion is necessary, not pleasurable, and if not performed, increased anxiety and distress occur. The compulsion is an anxiety response, not a means to control the situation or promote safety. Thought stopping is a mechanism used to control obsessions.

Question 3

A client diagnosed with severe obsessive-compulsive disorder who has been unresponsive to other medications is prescribed a tricyclic antidepressant as part of the treatment plan. Which agent would the nurse anticipate being prescribed?

Accepted Answer

Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, paroxetine, and sertraline are recommended medications. Clomipramine (a tricyclic antidepressant) is also frequently prescribed and was the first drug to produce significant advances in treating OCD. Other medications, such as venlafaxine and mirtazapine are also effective for some people.

Question 4

A client diagnosed with obsessive-compulsive disorder engages in storing many items that are considered to be useless. The nurse would categorize the client's symptoms as belonging to which symptom dimension?

Accepted Answer

Obsessive-compulsive symptoms tend to fall into different patterns or dimensions. Collecting/hoarding involves collecting or storing many things or useless objects. 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. The contamination/cleaning dimension involves worrying about being physically sick, contaminated by dirt or bacteria and is expressed through ritualized washing or cleaning excessively. 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.

Question 5

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?

Accepted Answer

Obsessive-compulsive symptoms tend to fall into different patterns of obsessive-compulsive symptom dimensions. 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. 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. The contamination/cleaning dimension involves worrying about being physically sick, contaminated by dirt or bacteria and is expressed through ritualized washing or cleaning excessively. Collecting/hoarding involves collecting or storing many things or useless objects.

Question 6

A psychiatric-mental health nurse is reading a journal article about obsessive-compulsive disorder (OCD) and the theories associated with its etiology. Which aspect would the nurse expect to be described as a behavioral explanation for the disorder?

Accepted Answer

Behavioral explanations for OCD stem from learning theory. From this viewpoint, obsessions are seen as conditioned stimuli. Through being associated with noxious events, stimuli that are usually considered neutral become anxiety provoking. The individual then engages in activities to escape or avoid the anxiety. Compulsions develop as the individual discovers behaviors that successfully reduce the obsessional anxiety. Isolation, undoing, and reaction formation are three unconscious defense mechanisms proposed by psychodynamic theory as the reason for the development of OCD symptoms.

Question 7

A psychiatric-mental health nurse is assessing a client and suspects that the client is experiencing obsessive-compulsive disorder. Which finding would support the nurse's suspicion?

Accepted Answer

Most individuals appear neatly dressed and groomed, cooperative, and eager to answer questions. Speech will be at normal rate and volume, but often, individuals with an obsessional style of thinking exhibit circumferential speech. This speech, loaded with irrelevant details, eventually addresses the question. Individuals with OCD do not have a higher prevalence of physical disease than others. However, they may report multiple physical symptoms.

Question 8

A psychiatric-mental health nurse is working with a client diagnosed with obsessive-compulsive disorder (OCD). The client engages in an intense handwashing ritual, usually once an hour. Which intervention would be most appropriate for the nurse to include in a teaching plan for this client?

Accepted Answer

For the client with cleaning or handwashing compulsions, attention to skin condition is necessary. Encourage the individual to use tepid water when washing and hand cream after washing. Remove harsh, abrasive soaps and replace them with moisturizing soaps. A strong antibacterial soap would be harsh. Attempt to decrease the frequency of washing by agreeing on a time schedule and time-limited washing. Setting up a schedule to wash hands every 20 minutes would increase the frequency of the activity.

Question 9

A psychiatric-mental health nurse is teaching a client with obsessive-compulsive disorder (OCD) about the prescribed antidepressant therapy. Which statement by the client indicates the need for additional teaching?

Accepted Answer

Nurses play an important interdisciplinary role in managing medication for persons with OCD, which includes educating clients and families about medications. Because clients may become discontented with a perceived lack of effect, they should be informed that these medications may take several weeks before their effects are realized. All clients should be warned not to stop taking prescribed medications abruptly. In addition, individuals should be instructed to avoid alcohol and not to operate heavy machinery while taking these medications until the sedative effects are known.

Question 10

A client is diagnosed with body dysmorphic disorder. When developing the plan of care for this client, which treatment would the nurse identify as the primary approach?

Accepted Answer

Cognitive-behavioral therapy is the primary treatment approach for body dysmorphic disorder. Antidepressant therapy, psychosurgery, and electroconvulsive therapy are used to treat obsessive-compulsive disorder.

Question 11

A psychiatric-mental health nurse is conducting a program for a group of nurses working at a primary care center about obsessive-compulsive disorder. One of the nurses asks, "So how would we know if the person's routine is a compulsion?" Which response by the nurse would be most appropriate?

Accepted Answer

Routines are a part of everyday life. Getting up in the morning at the same time and going to work or school structures our lives and helps us be productive. When routines become ritualistic and interfere with normal daily activity, they become compulsions. Compulsions are done to prevent or relieve anxiety; they do not cause anxiety unless the person does not perform the compulsion. Recurrent obsessions or compulsions or both must take up more than 1 hour a day to meet the criteria for diagnosis.

Question 12

A nurse is reading a journal article about obsessive-compulsive disorder. Which obsession would the nurse note as being the most common?

Accepted Answer

Common obsessions include fears of contamination, pathologic doubt, the need for symmetry and completion, thoughts of hurting someone, and thoughts of sexual images. Of these, the most common is fear of contamination.

Question 13

A client diagnosed with obsessive-compulsive disorder is receiving treatment that involves being subjected to situations that are known to trigger anxiety. The client is asked not to engage in performing the ritual behavior. Which type of therapy is being used?

Accepted Answer

With exposure and response prevention (ERP), the person is exposed to situations or objects that are known to induce anxiety but is asked to refrain from performing the ritualistic behaviors. One goal of this procedure is to help the person understand that resisting the rituals while exposed to the object of anxiety is less stressful and time-consuming than performing the rituals. With thought stopping, individuals who have obsessional thoughts are taught to interrupt obsessional thoughts by saying, "Stop!" either aloud or silently. This activity interrupts and delays the uncontrollable spiral of obsessional thoughts. With cognitive restructuring, the person is taught to restructure dysfunctional thought processes by defining and testing them with the goal of altering the person's immediate, dysfunctional appraisal of a situation, and perception of long-term consequences. Cue cards are tools used to help the individual restructure thought patterns. They contain statements that are positively oriented and pertain to the person's specific obsessions and compulsions.

Question 14

A client diagnosed with obsessive-compulsive disorder (OCD) is using cue cards to help restructure thought patterns. Which statement would be appropriate to include on a cue card? Select all that apply.

Accepted Answer

Cue cards are used to help the client restructure thought patterns. They contain statements that are positively oriented and pertain to the client's specific obsessions and compulsions, such as identifying the thoughts as OCD rather than the person, trusting one's self, and doing it right the first time. The statements "Keep on checking" and "Safety is the key" would reinforce the client's anxiety.

Question 15

A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? Select all that apply.

Accepted Answer

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are considered to be the most effective treatment agents used for OCD. Clomipramine was the first drug to produce significant advances in treating people with OCD. Other medications have proved effective, including sertraline, fluoxetine, fluvoxamine, and paroxetine. Lithium is used to treat bipolar disorder. Alprazolam may be used to treat panic disorder.

Question 16

A psychiatric-mental health nurse is preparing an in-service program about dysmorphic disorder (BDD) for a group of nurses working at the community mental health center. When describing this disorder, which information would the nurse include? Select all that apply.

Accepted Answer

BDD usually begins in adolescence and continues throughout adulthood. This disorder occurs in men and women. The risk of depression, suicide ideation, and suicide is high. The suicide risk in BDD is increased by the presence of other disorders such as substance use disorder, major depressive disorder, eating and personality disorders.

Question 17

A nurse is assessing a client with excoriation disorder. At which site would the nurse most commonly expect to assess damage? Select all that apply.

Accepted Answer

Repetitive and compulsive picking of skin causing tissue damage characterizes excoriation or skin-picking disorder. Although tissue damage can occur anywhere on the body, the face, arms, and hands are the most common sites.

Question 18

While assessing a client diagnosed with body dysmorphic disorder, the nurse would also be alert for signs and symptoms of which condition? Select all that apply.

Accepted Answer

Sixty percent of the persons with body dysmorphic disorder may also have an eating disorder. In addition, the risk of depression, suicide ideation, and suicide is high. Obsessive-compulsive disorder and trichotillomania are not associated with body dysmorphic disorder.

Question 19

A psychiatric-mental health nurse is developing a plan of care for a client just diagnosed with obsessive-compulsive disorder. Which intervention would the nurse most likely expect to include? Select all that apply.

Accepted Answer

For the newly diagnosed client, OCD is treated with medications, cognitive-behavioral therapy (CBT), and supportive therapy. If medications and therapy are not successful, electroconvulsive therapy (ECT) can be considered. In very severe instances, psychosurgery may be a treatment option.

Question 20

A client diagnosed with obsessive-compulsive disorder (OCD) is prescribed clomipramine. After teaching the client about the drug, the nurse determines that the teaching was successful when the client identifies which conditions as possible side effects of the drug? Select all that apply.

Accepted Answer

Side effects associated with clomipramine include sedation, decreased libido, ejaculation difficulty, muscle pain, and anticholinergic effects such as dry mouth.

Quiz 28: Obsessive-Compulsive and Related Disorders: Nursing Care of Persons With Obsessions and Compulsions