A nurse is reinforcing teaching with a client who has a history of depression about a new prescription for fluoxetine.
Which statement by the client indicates understanding of the teaching?

The rationale for Choice A:

Limiting time for rituals to 30 minutes each day may not be effective and could potentially increase anxiety. Individuals with OCD often feel a strong compulsion to perform their rituals, and abruptly restricting their ability to do so can heighten distress and lead to increased attempts to engage in the rituals, even in a covert manner. This can create a cycle of anxiety and frustration.

Gradual exposure and response prevention (ERP) therapy is a more effective approach to reducing ritualistic behaviors. It involves gradually exposing the individual to anxiety-provoking stimuli while helping them to resist engaging in their compulsions. This process is done in a controlled and supportive environment, to help the individual learn to manage their anxiety and reduce their reliance on rituals.

Rationale for Choice B:

Providing a stimulating environment is not generally recommended for individuals with OCD. Excessive stimulation can exacerbate anxiety and trigger compulsive behaviors. A calmer and more structured environment is often more beneficial.

Individuals with OCD often thrive in environments that provide predictability and a sense of control. A structured schedule can help to reduce uncertainty and create a sense of order, which can in turn help to reduce anxiety and the urge to engage in compulsive behaviors. Rationale for Choice C:

Negative reinforcement is not an appropriate or effective intervention for OCD. It involves punishing or removing a desired stimulus in response to a behavior, with the aim of decreasing the likelihood of that behavior occurring again. However, this approach can be counterproductive in OCD, as it can increase anxiety and make the individual more likely to engage in their rituals in order to avoid the negative consequences.

Positive reinforcement, such as praise and encouragement, is more effective in promoting desired behaviors. This approach focuses on rewarding the individual for making progress in reducing their ritualistic behaviors, which can help to increase motivation and create a more positive and supportive environment for change.

Rationale for Choice D:

Providing a structured schedule of activities can be a very effective intervention for OCD. It can help to reduce anxiety, provide a sense of control, and minimize the time available for engaging in compulsive rituals.

A structured schedule can include a variety of activities, such as:

Mealtimes

Personal hygiene routines

Work or school activities

Leisure activities

Relaxation exercises

Social interactions

The schedule should be tailored to the individual's specific needs and preferences. It is important to ensure that the activities are enjoyable and meaningful to the individual, as this will increase their motivation to participate.

The nurse can work with the individual to develop a schedule that is realistic and achievable. The schedule should be reviewed and adjusted regularly as the individual makes progress.

1. Answer and explanation The correct answers are:

Condition:

1. Mania Actions:
2. Daily weight

D. Suicidal behavior

Parameters to monitor:

Blood pressure and pulse rate

Food intake during meals

Rationale for condition:

Choice A: Mania

The client's presentation is consistent with the manic phase of bipolar disorder.

Key features of mania include:

Elevated mood or irritability

Increased energy and activity levels

Racing thoughts and rapid speech

Decreased need for sleep Impulsive behavior

Distractibility

Poor judgment

Grandiosity

Auditory hallucinations Rationale for actions:

Choice B: Daily weight

Weight loss is a common symptom of mania due to increased activity levels and decreased appetite.

Monitoring weight helps assess the severity of mania and the need for nutritional interventions.

Choice D: Suicidal behavior

Individuals with bipolar disorder are at increased risk for suicide, especially during manic episodes.

Close monitoring for suicidal ideation and behavior is crucial for safety.

Rationale for parameters to monitor:

Choice A: Blood pressure and pulse rate

Mania can lead to physiological changes such as increased heart rate and blood pressure.

Monitoring these vital signs helps assess the physical impact of mania and the potential need for medical interventions.

Choice C: Food intake during meals

As mentioned, decreased appetite is common in mania.

Monitoring food intake ensures adequate nutrition and prevents dehydration.