A nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder (OCD). Which of the following interventions should the nurse include?
Use detailed explanations when providing education to the client.
Maintain a stimulating environment for the client.
Provide the client with a structured schedule of daily activities.
Limit time for rituals to 30 minutes each day.
The Correct Answer is C
Choice A reason:
While detailed explanations can be helpful, they are not the primary intervention for managing OCD. The focus should be on structured activities and behavioral interventions.
Choice B reason:
Maintaining a stimulating environment is not appropriate for clients with OCD as it may increase anxiety and compulsive behaviors. A calm and structured environment is more beneficial.
Choice C reason:
Providing a structured schedule of daily activities helps clients with OCD manage their time and reduce the frequency of compulsive behaviors. It promotes routine and predictability, which can alleviate anxiety.
Choice D reason:
Limiting time for rituals to 30 minutes each day is not a practical intervention. Instead, the focus should be on gradually reducing the time spent on rituals through behavioral therapy techniques.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason:
Urinary retention can be a side effect of both diazepam and hydromorphone, but it is not typically life-threatening. While it should be monitored and addressed, it is not the most urgent concern compared to respiratory issues.
Choice B reason:
Blurred vision can occur with the use of diazepam and hydromorphone, but it is generally not an immediate threat to the client’s life. It should be reported and managed, but it is not the highest priority.
Choice C reason:
Headache is a common side effect of many medications, including diazepam and hydromorphone. While it can be uncomfortable and may need treatment, it is not usually a sign of a life-threatening condition.
Choice D reason:
Bradypnea, or slow breathing, is a serious side effect that can occur with the use of both diazepam and hydromorphone, as both medications depress the central nervous system. This can lead to respiratory depression, which is potentially life-threatening and requires immediate medical attention.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A reason:
Hallucinations, particularly if they are distressing or command hallucinations, can increase the risk of suicide attempts.
Choice B reason:
Depression is a major risk factor for suicide. Clients with a history of depression are at higher risk for attempting suicide again.
Choice C reason:
Delusions, especially those that are paranoid or persecutory, can contribute to suicidal thoughts and behaviors.
Choice D reason:
Catatonia, a state of psychomotor disturbance, can be associated with severe depression and increase the risk of suicide.
Choice E reason:
Tinnitus, while distressing, is not typically a direct risk factor for suicide attempts. It may contribute to overall distress but is not a primary indicator of suicide risk.
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