A nurse is caring for a client with OCD who is taking a selective serotonin reuptake inhibitor (SSRI) The client reports that they are having difficulty sleeping. Which of the following interventions should the nurse recommend?

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.

Choice A rationale:

Impaired social interaction. This choice is not the most appropriate nursing diagnosis for a client with obsessive-compulsive disorder (OCD) experiencing recurrent thoughts about contamination. OCD primarily involves anxiety-driven behaviors and rituals rather than impaired social interaction.

Choice B rationale:

Anxiety. This is the correct answer. Given that the client is experiencing recurrent thoughts about contamination, the most appropriate nursing diagnosis is anxiety. OCD is characterized by intrusive thoughts and rituals driven by anxiety. Addressing the anxiety component is essential for effective treatment.

Choice C rationale:

Risk for self-harm. While individuals with severe OCD may experience distress, the given information does not indicate an immediate risk for self-harm. Anxiety is the more relevant issue in this scenario.

Choice D rationale:

Obsessive-compulsive disorder. This choice describes the client's condition rather than a nursing diagnosis. Nursing diagnoses are used to identify specific client problems that nurses can address through care and interventions.