A nurse is assessing a client with obsessive-compulsive disorder (OCD) The client reports that they have been having recurrent thoughts about contamination. Which of the following is the most appropriate nursing diagnosis for this client?

Choice A rationale:

Encouraging the client to "talk about their fears" might be a beneficial intervention in some cases, but for individuals with OCD who are struggling with compulsive behaviors driven by their fears, directly addressing exposure to those fears is a more effective approach.

Choice B rationale:

While setting limits on the client's behavior is important, it may not be the priority in this situation. Instead, assisting the client in gradually confronting their fears through exposure therapy can help them develop healthier coping mechanisms.

Choice C rationale:

The correct response emphasizes gradual exposure therapy, a well-established approach in treating OCD. This intervention helps the client confront their fears in a controlled and systematic manner, leading to desensitization and reduction in their anxiety over time.

Choice D rationale:

Providing relaxation techniques can be helpful for managing anxiety, but for someone with OCD who is avoiding situations due to contamination fears, the primary intervention should focus on exposure therapy to address the specific OCD-related fears.

Choice A rationale:

Avoiding situations that cause anxiety is counterproductive in exposure therapy, which is a common treatment for OCD. Exposure therapy involves gradual and controlled exposure to feared stimuli to reduce anxiety. Avoidance reinforces the anxiety response and prevents habituation. Facing the situations that trigger anxiety is crucial for desensitization.

Choice B rationale:

This choice is correct because exposure therapy for OCD involves facing feared situations while refraining from engaging in compulsions. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. By gradually exposing the individual to these situations and preventing them from performing compulsions, the anxiety response diminishes over time.

Choice C rationale:

Telling the patient that their fears will go away on their own is inaccurate and dismissive of the distress that OCD can cause. OCD is a chronic condition that typically requires evidence-based interventions for symptom reduction. Ignoring the fears and hoping they will disappear without intervention is not a valid therapeutic approach.

Choice D rationale:

Focusing only on situations that are easy to tolerate would not be effective in exposure therapy. The essence of exposure therapy is to confront situations that provoke anxiety gradually, starting with less anxiety-provoking situations and progressing to more challenging ones. This process helps the individual build resilience against anxiety triggers.