A nurse is contributing to the plan of care for a client who has obsessive-compulsive disorder (OCD) regarding brushing his teeth. The client brushes his tongue several times a day and has developed several ulcerations. Which of the following interventions should the nurse identify as a priority?
Provide information on stress reduction methods.
Assist the client to identify triggers to obsessive behaviors.
Speak to the client in a calm and soothing manner.
Assist the client in identifying his anxiety level.
The Correct Answer is B
Choice A reason: While providing information on stress reduction is helpful, it is not the immediate priority.
Choice B reason: Assisting the client to identify triggers is a priority as it directly addresses the cause of the OCD behaviors.
Choice C reason: Speaking to the client in a calm manner is supportive but does not address the underlying OCD behaviors.
Choice D reason: Identifying anxiety levels can be part of the intervention, but it is not as specific as identifying triggers for the OCD behaviors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: While patients with HbA1c levels below 6% are generally considered to have good glycemic control, this does not guarantee they will be free from complications.
Choice B reason: Diabetes complications often involve vascular issues, affecting both large (macrovascular) and small (microvascular) blood vessels, leading to a range of complications such as cardiovascular disease and neuropathy.
Choice C reason: Chronic hypoglycemia can lead to various health issues, but it is not typically classified as a long-term complication of diabetes. Instead, it is a risk associated with diabetes management, particularly with insulin use.
Choice D reason: Both Type 1 and Type 2 diabetics are at risk for complications. Tight glycemic control can reduce the risk, but it does not eliminate it, and Type 1 diabetics are not necessarily at the greatest risk.
Correct Answer is C
Explanation
Choice A reason: Regression involves reverting to an earlier stage of development when faced with stress, which is not what Marie is doing.
Choice B reason: Repression involves unconsciously blocking out painful thoughts or feelings, which is different from Marie's conscious rationalization of her failure.
Choice C reason: Rationalization is a defense mechanism where an individual justifies an unacceptable behavior or feeling with a logical reason, avoiding the true explanation for the behavior. Marie is rationalizing her failure by blaming the instructor rather than accepting her own role in the outcome.
Choice D reason: Reaction formation involves behaving in a way that is opposite to what one truly feels, which is not applicable in Marie's case.
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