The nurse is caring for an adolescent diagnosed with conduct disorder who is prescribed risperidone. Which statement by the client indicates additional teaching is needed?

Obsessive-Compulsive Disorder (OCD) is characterized by obsessions (intrusive, persistent thoughts) and compulsions (repetitive behaviors performed to alleviate the anxiety caused by the obsessions). Because OCD is often a chronic condition, the goal of psychiatric nursing is not necessarily the total eradication of thoughts, but rather functional restoration and the reduction of the symptoms' power over the client’s life.

Rationale:

A. The most realistic and desired outcome is that the client can function effectively in their social and occupational roles. Success is measured by the client’s ability to manage their time and energy so that compulsions do not prevent them from fulfilling their daily responsibilities or maintaining relationships.

B. Relieving a client of all responsibilities is a counterproductive intervention. This approach encourages the sick role and can actually increase the time a client has available to engage in ritualistic behaviors, ultimately worsening the severity of the disorder and decreasing the client’s self-esteem.

C. While total symptom remission is an ideal, it is often unrealistic for many clients with OCD. Expecting a complete absence of symptoms can lead to frustration and a sense of failure if an intrusive thought occurs. The clinical focus is on management and control rather than a cure.

D. Anxiety is a universal human emotion and a core component of the OCD cycle. The goal is to help the client develop coping mechanisms to manage anxiety without resorting to rituals (such as through Exposure and Response Prevention), rather than the impossible goal of never experiencing anxiety again.

Autism spectrum disorder is a neurodevelopmental condition characterized by impaired social interaction, restricted behaviors, communication deficits, and sensory abnormalities. Early signs include limited eye contact, reduced affective reciprocity, repetitive behaviors, and resistance to environmental or routine variability.

Rationale:

A. Thriving on changes in routine is inconsistent with autism spectrum disorder. Children typically exhibit rigidity and distress with environmental variation. Preference for sameness and predictable patterns is characteristic, making adaptability to frequent routine changes unlikely in affected individuals.

B. Avoidance of spontaneous play reflects impaired social and imaginative development. Restricted play patterns are common, with preference for repetitive or solitary activities. Lack of flexible, creative interaction indicates deficits in symbolic play and social engagement typical of autism spectrum disorder.

C. Limited facial expressions toward others indicate reduced social reciprocity. Affective blunting manifests as diminished emotional expression and poor responsiveness to social cues. This deficit interferes with interpersonal communication and is a core feature of autism spectrum disorder.

D. Rare eye contact is a hallmark early sign of autism. Eye gaze avoidance reflects impaired social attention and difficulty interpreting nonverbal cues. This behavior significantly affects bonding, communication development, and social interaction in young children.

E. Answering questions verbally suggests preserved communication ability. Language delay may occur, but verbal responsiveness generally indicates more typical social communication skills and does not strongly support suspicion of autism spectrum disorder.