A nurse is providing behavioral therapy for a client who has obsessive-compulsive disorder.
The client repeatedly checks that the doors are locked at night.
Which of the following instructions should the nurse give the client when using thought stopping technique?
"Snap a rubber band on your wrist when you think about checking the locks.”.
"Keep a journal of how often you check the locks each night.”.
"Focus on abdominal breathing whenever you go to check the locks.”.
"Ask a family member to check the locks for you at night.”. .
The Correct Answer is A
Choice A rationale:
"Snap a rubber band on your wrist when you think about checking the locks.”. This choice suggests using a painful stimulus (the rubber band snap) as part of the thought-stopping technique. While it may interrupt the client's behavior temporarily, it is not a recommended or ethical approach, as it can cause harm and distress to the client.
Choice B rationale:
"Keep a journal of how often you check the locks each night.”. Keeping a journal may be useful for tracking behavior patterns, but it doesn't address the core issue of obsessive-compulsive disorder. It is essential to provide the client with a more active technique for managing their compulsions, like the one mentioned in choice C.
Choice D rationale:
"Ask a family member to check the locks for you at night.”. This choice does not promote independence or self-management, which is an important goal in treating obsessive-compulsive disorder. It may alleviate the client's anxiety temporarily but does not help the client develop skills to manage their obsessive-compulsive tendencies on their own.
Choice C rationale:
"Focus on abdominal breathing whenever you go to check the locks.”. This response is the most appropriate because it recommends a self-soothing and grounding technique (abdominal breathing) to help the client manage their obsessive thoughts and compulsions. It encourages the client to be more mindful and reduce the urge to perform repetitive behaviors, which is a key aspect of treating obsessive-compulsive disorder. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
"I'll take my medicine at bedtime because it will make me drowsy.”. This statement is not accurate and indicates a misunderstanding of the medication's effects. Methylphenidate, used to treat ADHD, is a stimulant medication and is not expected to cause drowsiness. Taking it at bedtime could interfere with the client's ability to sleep.
Choice B rationale:
"I need to tell my doctor if I start gaining weight.”. While it is important to report changes in weight to the healthcare provider, this statement does not indicate an accurate understanding of the medication's effects. Weight gain is not a typical side effect of methylphenidate, and this statement does not address the medication's primary purpose.
Choice C rationale:
"This medicine will help me relax and feel less anxious.”. This statement is incorrect as methylphenidate is not an anxiolytic medication. It is used to increase focus and reduce hyperactivity in individuals with ADHD. While some clients may experience a sense of calm as a result of improved focus, the primary purpose of the medication is not to reduce anxiety.
Choice D rationale:
"I know that I will be able to think more clearly now.”. This statement reflects an accurate understanding of the medication's effects. Methylphenidate is a central nervous system stimulant that can help individuals with ADHD improve their focus, attention, and cognitive function. Enhanced clarity of thought is one of the intended therapeutic effects of this medication. .
Correct Answer is A
Explanation
Choice A rationale:
The statement "I don't feel anything but numbness anymore" is indicative of anhedonia, which is a core symptom of clinical depression. Anhedonia is the inability to experience pleasure or interest in previously enjoyed activities. Reporting this statement to the provider is important as it suggests a significant emotional disturbance.
Choice B rationale:
While the statement "It'll be a long time before I'm happy again" does indicate a sense of hopelessness or prolonged sadness, it is not as specific to clinical depression as the presence of anhedonia. Clinical depression involves a range of symptoms, and the absence of pleasure or emotions (anhedonia) is a more concerning sign.
Choice C rationale:
Feeling angry at the world is a common emotional response to grief and loss and is not a direct indication of clinical depression. It is important to consider the context of grief when assessing client statements.
Choice D rationale:
Expressing reliance on family support is a healthy coping mechanism in response to grief and loss. It does not necessarily indicate clinical depression but rather a natural response to seeking support during a difficult time.
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