A nurse is teaching a client who has a depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching?

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: Limit the amount of time available to interact with others

While the client's behavior may indirectly limit their interactions with others by occupying their time, this is not the primary function of their actions. The core motivation lies in reducing anxiety, not social avoidance.

Choice B: Manipulate and control others' behaviors

Although the client's cleaning may influence others to tidy up, this is not a deliberate attempt to control their behavior. The primary drive stems from the client's internal need for order and cleanliness, not a desire to dictate the actions of others.

Choice C: Focus attention on meaningful tasks

While the act of cleaning can be productive and contribute to a pleasant environment, it's not the primary function or intention behind the client's behavior. Their actions are primarily driven by the need to quell anxiety, not necessarily to accomplish meaningful tasks.

Choice D: Decrease anxiety to a tolerable level

This is the most accurate rationale for the client's behavior. Individuals with OCD engage in compulsions, like excessive cleaning, to alleviate the intense anxiety associated with their intrusive thoughts and obsessions. In this case, the act of picking up after others provides the client with a sense of order and control, thereby reducing their anxiety to a manageable level.

Elaboration:

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Individuals with OCD experience significant anxiety due to their obsessions and feel compelled to engage in compulsions to manage that anxiety.

In the scenario presented, the client's constant cleaning behavior likely stems from an obsession with order and cleanliness. This obsession triggers anxiety when the environment is perceived as messy or disorderly. The act of picking up after others serves as a compulsion, a ritualistic behavior performed to reduce the anxiety caused by the obsession. By restoring order and cleanliness, the client temporarily alleviates their anxiety and achieves a sense of control over their environment.

It's important to recognize that the client's cleaning behavior, while seemingly productive, is primarily driven by their internal need to manage anxiety, not by a genuine desire to help others or maintain a tidy environment. This understanding is crucial for the nurse to effectively support the client and guide them towards healthier coping mechanisms for managing their OCD symptoms.