A nurse is preparing to administer diphenhydramine 50 mg PO every 6 hr to a client who has acute dystonia. The available medication is diphenhydramine 25 mg tablets.

How many tablets should the nurse administer per dose?

Choice A rationale: Clients who are admitted involuntarily cannot be hospitalized for as long as the provider deems necessary. There are legal and ethical guidelines that dictate the length and conditions of involuntary hospitalization. These guidelines vary by jurisdiction, but they generally require periodic review and reevaluation of the client’s condition and the necessity of continued hospitalization.

Choice B rationale: Clients cannot be given medications against their will under normal circumstances. Informed consent is a fundamental right in healthcare, including mental health care. This means that clients have the right to be fully informed about the potential benefits, risks, and alternatives of a proposed treatment, and to make an informed decision about whether to accept or refuse the treatment. There are exceptions in emergency situations where the client poses an immediate danger to self or others, but these are governed by strict legal and ethical guidelines.

Choice C rationale: Clients who are involuntarily admitted do have the right to informed consent. This means that even if a client is admitted to a mental health facility against their will, they still have the right to be informed about their treatment and to make decisions about their care. This includes the right to be informed about the potential benefits, risks, and alternatives of proposed treatments, and the right to refuse treatment.

Choice D rationale: The laws regarding restraints are not different for clients who are admitted involuntarily. Restraints can only be used as a last resort when less restrictive interventions have failed and the client poses an immediate danger to self or others. The use of restraints is governed by strict legal and ethical guidelines, and these apply to all clients, regardless of whether they were admitted voluntarily or involuntarily.

Choice A rationale:

Anxiety reduction is the core motivation for ritualistic behaviors in OCD. Individuals with OCD experience intrusive, distressing thoughts (obsessions) that trigger intense anxiety. To neutralize this anxiety, they engage in repetitive behaviors (compulsions) that provide temporary relief.

The relief is often short-lived, leading to a cycle of obsessions and compulsions. This cycle can become debilitating and significantly impair daily functioning.

Research supports the anxiety-reduction model of OCD. Studies have shown that engaging in compulsions reduces anxiety in individuals with OCD, both subjectively and physiologically.

Neuroimaging studies have also demonstrated that ritualistic behaviors activate brain regions involved in anxiety and fear processing. This suggests that compulsions have a direct effect on the brain's anxiety circuitry.

Choice B rationale:

Sexual satisfaction is not a typical motivation for ritualistic behaviors in OCD. While some compulsions may have a sexual component (e.g., checking for arousal), the primary goal is to reduce anxiety, not to achieve sexual gratification.

Choice C rationale:

Feelings of shame may be associated with OCD, but they are not the primary driving force behind ritualistic behaviors. Shame often arises from the content of obsessions (e.g., thoughts about contamination, harm, or taboo subjects) or the perceived social stigma of OCD. However, the urge to perform compulsions stems from the need to alleviate anxiety, not to decrease shame.

Choice D rationale:

Boosting self-esteem is not a common motivation for ritualistic behaviors in OCD. In fact, many individuals with OCD experience low self-esteem due to the impact of the disorder on their lives. Compulsions may provide a temporary sense of control or mastery, but they do not typically lead to lasting improvements in self-esteem.