A client newly admitted to an inpatient psychiatric unit is diagnosed with obsessive-compulsive disorder. Which behavioral symptom would the nurse expect to assess?
The client uses excessive hand washing to relieve anxiety
The client rates anxiety at 8/10
The client uses breathing techniques to decrease anxiety
The client exhibits diaphoresis and tachycardia
The Correct Answer is A
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by persistent obsessions and repetitive compulsions performed to alleviate anxiety. Behavioral symptoms often manifest as ritualistic actions, such as excessive hand washing, checking, or ordering. These compulsions are not connected in a realistic way to the feared event but are driven by internal distress. The DSM-5 outlines that compulsions must be time-consuming or cause significant impairment. Behavioral symptoms are observable and often interfere with daily functioning, distinguishing them from emotional or physiological responses.
Rationale for correct answers
1. Excessive hand washing is a classic behavioral compulsion in OCD, typically performed to neutralize obsessive fears of contamination. It reflects the repetitive, ritualistic nature of compulsions aimed at reducing anxiety.
Rationale for incorrect answers
2. Anxiety rating is a subjective emotional report, not a behavioral symptom. It reflects internal distress but does not demonstrate the compulsive actions characteristic of OCD.
3. Breathing techniques are adaptive coping strategies, not compulsive behaviors. They are voluntary and therapeutic, unlike the involuntary rituals seen in OCD.
4. Diaphoresis and tachycardia are physiological symptoms of anxiety, not behavioral manifestations. They may occur in panic or generalized anxiety but are not specific to OCD compulsions.
Take Home Points
- Behavioral symptoms in OCD are repetitive actions performed to reduce distress from obsessions.
- Excessive hand washing is a hallmark compulsion, especially in contamination-related OCD.
- Emotional and physiological symptoms may accompany OCD but are not diagnostic behavioral features.
- OCD must be differentiated from anxiety disorders based on the presence of compulsive rituals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Obsessive-compulsive disorder (OCD)is a chronic psychiatric condition marked by intrusive obsessionsand repetitive compulsionsthat aim to reduce anxiety. These compulsions are often rigid and time-consuming, and any disruption to them can provoke significant distress. The disorder is ego-dystonic, meaning the individual recognizes the irrationality of their behaviors but feels compelled to perform them. Treatment involves gradual exposure and response prevention, often supported by SSRIs and cognitive behavioral therapy.
Rationale for correct answers
2.Limiting ritualistic acts abruptly increases anxiety by disrupting the client’s primary coping mechanism. Without gradual desensitization, this approach risks emotional destabilization and noncompliance.
Rationale for incorrect answers
1.Understanding the nature of anxiety is therapeutic and promotes insight. It does not provoke anxiety but rather supports cognitive restructuring.
3.Involving the client in care planning enhances autonomy and reduces anxiety. Collaborative approaches foster trust and therapeutic engagement.
4.Nonjudgmental environments reduce shame and stigma. They are essential for building rapport and do not contribute to increased anxiety.
Take Home Points
- OCD rituals serve as maladaptive coping mechanisms that temporarily relieve anxiety but reinforce obsessive thought patterns.
- Abrupt restriction of compulsions without client preparation can escalate anxiety and hinder therapeutic progress.
- Effective care planning for OCD requires gradual exposure and response prevention, not immediate behavioral suppression.
- OCD must be differentiated from obsessive-compulsive personality disorder, which lacks the ego-dystonic nature and ritualistic distress.
Correct Answer is A
Explanation
Obsessive-compulsive disorderinvolves persistent obsessions and compulsions driven by anxiety, often reinforced through temporary relief after the ritual. Long-standing compulsions like repetitive hand washing may be linked to contamination fears or other intrusive thoughts. Identifying the underlying purposeof the compulsion allows for targeted interventions and supports the development of exposure and responseprevention strategies. Understanding triggers is essential for addressing both psychological distress and related physicalconsequences, such as skin damage.
Rationale for correct answers
1.Determining the underlying functionof the ritual helps guide individualized interventions and ensures therapy addresses the specific anxiety or intrusive thought driving the compulsion.
Rationale for incorrect answers
2.Immediate time restriction without assessment can heighten anxietyand provoke resistance, worsening the compulsive cycle before trust and readiness are established.
3.Symptom substitution ignores the underlying obsession, risking a shift to another compulsion without resolving the core anxiety.
4.Rigid activity scheduling may offer some distractionbut does not directly address the cause or meaning of the compulsive behavior.
Take Home Points
- Understanding the purpose of a compulsion is critical before modifying or restricting it.
- Abrupt limitation of rituals can worsen anxiety and hinder rapport.
- Substitution techniques may mask but not resolve the underlying obsession.
- Effective OCD management integrates assessment, gradual exposure, and anxiety regulation strategies.
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