A client with obsessive-compulsive disorder (OCD) has been cleaning a bathroom for most of the morning. When the roommate demands that the client leave the bathroom so that the roommate can shower, the client becomes angry and says, "You can’t make me leave, everything is still dirty." What is the best nursing action?
Engage other staff members to remove the client from the bathroom.
Give a reminder that the client has been cleaning the bathroom for 1.5 hours and it is time to take a break.
Tell the client that the bathroom is very clean and that this behavior is unreasonable.
Tell the roommate to use the shower in another location.
The Correct Answer is B
Choice A reason: Forcibly removing the client escalates anxiety and can increase resistance. This action does not support therapeutic management of OCD.
Choice B reason: Providing a clear, respectful, and time-limited reminder supports structure and helps the client redirect behavior without confrontation. It balances therapeutic boundaries with empathy.
Choice C reason: Dismissing the client’s concern as unreasonable invalidates their experience, increasing defensiveness and mistrust. This does not support treatment goals.
Choice D reason: Avoiding the problem by redirecting the roommate fails to address the client’s compulsive behavior and disrupts the care environment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Focusing only on medications neglects the interpersonal development central to Peplau’s model. The orientation phase emphasizes relationship building, not task-centered care.
Choice B reason: Allowing expression without structure or guidance does not fulfill the orientation phase, which requires the nurse to actively build trust and clarify roles.
Choice C reason: Excessive distance prevents rapport, which is essential in the orientation phase where the foundation for a therapeutic relationship must be established.
Choice D reason: Establishing trust, being consistent, and clarifying client expectations define the orientation phase of Peplau’s theory. This phase sets the groundwork for collaboration and progress in treatment.
Correct Answer is ["A","B","D"]
Explanation
Choice A reason: Planning alternate escape routes is a core part of safety planning, ensuring the victim can exit safely even if blocked.
Choice B reason: Having an emergency bag ready allows quick departure and reduces risk of having to return to the abuser’s home.
Choice C reason: Giving the abuser information about location compromises safety and places the victim at greater risk.
Choice D reason: Establishing a signal with trusted individuals ensures the victim can get help quickly if violence escalates.
Choice E reason: Encouraging firearm purchase is not an appropriate nursing intervention due to safety risks and escalation potential. Safer protective strategies should be emphasized.
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