What should a nurse include in the initial plan of care for a client with the long-standing, obsessive-compulsive behavior of hand washing?
Determine the purpose of the ritualistic behavior
Limit the time allowed for the ritualistic behavior
Suggest a symptom substitution technique to refocus the ritualistic behavior
Develop a routine schedule of activities to reduce the need for the ritualistic behavior
The Correct Answer is A
Obsessive-compulsive disorder involves persistent obsessions and compulsions driven by anxiety, often reinforced through temporary relief after the ritual. Long-standing compulsions like repetitive hand washing may be linked to contamination fears or other intrusive thoughts. Identifying the underlying purpose of the compulsion allows for targeted interventions and supports the development of exposure and response prevention strategies. Understanding triggers is essential for addressing both psychological distress and related physical consequences, such as skin damage.
Rationale for correct answers
1. Determining the underlying function of the ritual helps guide individualized interventions and ensures therapy addresses the specific anxiety or intrusive thought driving the compulsion.
Rationale for incorrect answers
2. Immediate time restriction without assessment can heighten anxiety and provoke resistance, worsening the compulsive cycle before trust and readiness are established.
3. Symptom substitution ignores the underlying obsession, risking a shift to another compulsion without resolving the core anxiety.
4. Rigid activity scheduling may offer some distraction but does not directly address the cause or meaning of the compulsive behavior.
Take Home Points
- Understanding the purpose of a compulsion is critical before modifying or restricting it.
- Abrupt limitation of rituals can worsen anxiety and hinder rapport.
- Substitution techniques may mask but not resolve the underlying obsession.
- Effective OCD management integrates assessment, gradual exposure, and anxiety regulation strategies.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Obsessive-compulsive personality disorderis characterized by a pervasive preoccupation with orderliness, perfectionism, and control, often at the expense of flexibility and efficiency. In cases involving ritualistic behavior, these actions serve to reduce underlying anxiety, even when the behavior seems unreasonable to others. The compulsion is not simply a habit but a psychologically necessary act to relieve mental discomfort caused by intrusive or rigid thought patterns.
Rationale for correct answers
4.Rituals, though illogicalto observers, function as an essential coping mechanism for controlling anxiety or distress, making them psychologically necessary to the individual’s functioning at that moment.
Rationale for incorrect answers
1.While rituals may seem uselessfrom an outsider’s view, they have a clear anxiety-reducing function for the individual and are not purposeless to them.
2.Ritualistic acts are not usually performed after prolonged urging; they are initiated by an internal drive or compulsion to alleviate discomfort.
3.The behavior may look willing, but it is driven by an internal compulsion rather than free choice or genuine desire.
Take Home Points
- Obsessive-compulsive personality disorder involves inflexible patterns of behavior aimed at maintaining control and order.
- Ritualistic acts serve a psychological purpose in reducing anxiety, even if they appear unreasonable.
- Compulsions are internally driven, not externally encouraged.
- Understanding the function of rituals is key to forming effective therapeutic interventions.
Correct Answer is A
Explanation
Obsessive-compulsive disorderresponds best to pharmacologic agents that enhance serotoninneurotransmission. Selective serotonin reuptake inhibitors (SSRIs) are first-line therapy because they increase synaptic serotonin and normalize activity in overactive cortical-subcortical pathways. Compared to older antidepressants, SSRIs have better tolerability and lower toxicity in overdose, making them safer for long-term management.
Rationale for correct answers
1.Fluoxetine, an SSRI, effectively reduces intrusive thoughts and compulsions by enhancing serotonergic activity in the cortico-striatal circuitry.
Rationale for incorrect answers
2.Imipramine, a tricyclic antidepressant, is mainly used in depressionand enuresis, not first-line for OCD due to more side effects.
3.Alprazolam, a benzodiazepine, targets acute anxietybut does not address the intrusive thought-compulsion cycle in OCD.
4.Chlorpromazine, a typical antipsychotic, is for psychosis, not OCD, and can cause significant extrapyramidal and sedative effects.
Take Home Points
- SSRIs are first-line pharmacotherapy for OCD.
- Fluoxetine, sertraline, and fluvoxamine are commonly prescribed.
- Tricyclic clomipramine is effective but has more adverse effects.
- Therapy is most effective when combined with cognitive behavioral interventions.
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