A nurse is developing a care plan for a client with an obsessive-compulsive behavior disorder. Which nursing intervention will most likely increase the client’s anxiety?
Helping the client understand the nature of the anxiety
Limiting the client’s ritualistic acts to three times a day
Involving the client in establishing the therapeutic plan
Providing the client with a nonjudgmental environment
The Correct Answer is B
Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition marked by intrusive obsessions and repetitive compulsions that 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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Obsessive-compulsive disorderis an anxiety disorder marked by intrusive obsessionsand repetitive compulsions performed to prevent or reduce distress. These rituals are strongly linked to relief from mounting anxiety. If they are interrupted, the discomfort escalates rapidly, often resulting in intense emotional distress rather than calm acceptance. The interruption disrupts the individual’s coping mechanism, triggering heightened physiological arousal and emotional reactivity.
Rationale for correct answers
1.Stopping a ritual abruptly increases anxiety, as the act serves to neutralize distress caused by obsessive thoughts, leaving the individual without their main coping strategy.
Rationale for incorrect answers
2.While frustration can occur, sustained hostilityis less likely; the primary response is heightened anxiety, not prolonged antagonistic feelings.
3.Aggressionis uncommon unless anxiety becomes extreme and the person feels threatened, making it a less predictable primary reaction.
4.Withdrawalis unlikely immediately after interruption; the person typically experiences an acute anxiety spike before any retreat from interaction.
Take Home Points
- OCD rituals function as coping tools to reduce distress from intrusive thoughts.
- Interrupting rituals removes the individual’s immediate anxiety control mechanism.
- The most immediate reaction is a surge in anxiety rather than aggression or withdrawal.
- Managing OCD requires balancing therapeutic limits with strategies that minimize distress spikes.
Correct Answer is D
Explanation
Obsessive-compulsive disorderis a chronic mental health condition involving intrusive thoughts(obsessions) and repetitive acts (compulsions) performed to reduce anxiety. Symptoms often intensify under stress, and compulsions can significantly impair social and occupational functioning. Management focuses on anxiety reduction, gradual exposure, and response preventionwhile maintaining therapeutic rapport. Interventions require a balance between respecting the patient’s coping mechanisms and promoting healthy behavior change.
Rationale for correct answers
4.Supporting rituals initially allows the patient to maintain a sense of control, which reduces acute anxiety, while setting realistic limits prevents the compulsion from dominating daily functioning. This balance fosters trust during the working phase, making gradual modification more acceptable.
Rationale for incorrect answers
1.Restricting movements can abruptly remove a coping mechanism, triggering heightened distressand potentially causing the patient to withdraw from therapeutic engagement.
2.Calling attention to the behavior in a critical manner can increase shame, leading to resistance and decreased openness in the therapeutic relationship.
3.Simply keeping the patient busy may provide temporary distraction, but it fails to address the underlying anxiety and the compulsive drive sustaining the behavior.
Take Home Points
- OCD involves obsessions and compulsions that temporarily relieve anxiety but reinforce the cycle of symptoms.
- Supportive limits help reduce compulsions without causing defensive withdrawal.
- Abrupt restriction of rituals can worsen anxiety and damage trust.
- Effective management combines therapeutic rapport with gradual exposure and response prevention.
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