A 35-year-old client with OCD spends several hours each day arranging and rearranging household items in a specific order. The client becomes extremely distressed if the items are not arranged correctly. Which nursing intervention is most appropriate?

Assist the client in developing a structured schedule for activities of daily living

Provide education about the irrationality of the behavior

Collaborate with the client to set realistic goals for behavior change

Encourage the client to resist the urge to rearrange items

Answer and Explanation

The Correct Answer is C

A. A structured schedule may help with overall daily functioning, but it does not specifically address the compulsive behavior.

B. Educating the client about the irrationality of the behavior is unlikely to reduce the compulsions, as this is a hallmark of OCD, where the individual is often unable to control the urges despite understanding their irrationality.

C. Collaborating with the client to set realistic, gradual goals for changing the compulsive behavior is key in treating OCD. This approach allows the client to have input into their treatment plan and promotes realistic, achievable progress.

D. Encouraging the client to resist the urge to rearrange items without providing a structured approach may lead to increased anxiety and frustration. Gradual exposure and behavior modification are more effective.

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Correct Answer is D

Explanation

A. A level of 1.8 mEq/L is too high for initial treatment, as it is above the therapeutic range.

B. A level of 1.8 mEq/L is not within the maintenance treatment level, which is typically 0.6–1.2 mEq/L.

C. The level is above the therapeutic level, not below it.

D. A lithium level of 1.8 mEq/L is above the therapeutic range (0.6–1.2 mEq/L) and is considered toxic. Toxicity can lead to serious side effects like tremors, confusion, and renal dysfunction.

A. Schedule daily seclusion times. B. Provide a stimulating environment. C. Discourage daytime napping. D. Have consistent unit routines.

Correct Answer is D

Explanation

A. Seclusion should be avoided unless absolutely necessary for safety, as it may increase agitation in a manic client.

B. A stimulating environment could worsen mania, leading to increased agitation and impulsivity.

C. While maintaining a regular sleep-wake cycle is important, discouraging naps could increase irritability and fatigue, which may worsen manic symptoms.

D. Consistent routines help provide structure and security for clients in the manic phase, reducing confusion and promoting stability.

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A 35-year-old client with OCD spends several hours each day arranging and rearranging household items in a specific order. The client becomes extremely distressed if the items are not arranged correctly. Which nursing intervention is most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse reviews the laboratory report for a client who is receiving lithium three times daily PO. The client's current blood lithium level is 1.8 mEq/L. The nurse identifies that this lab value indicates which of the following?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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