NCLEX-PN® ExaminationPsychosocial IntegrityHard
A practical nurse is caring for a client who is diagnosed with obsessive-compulsive disorder (OCD). The client spends several hours each day meticulously organizing personal belongings and washing hands excessively, causing skin breakdown. Which of the following is the most appropriate initial nursing intervention?
- AAssist the client in scheduling a gradual reduction of ritualistic behaviors.
- BAdminister an anxiolytic medication to stop the compulsive behaviors.
- CConfront the client about the irrationality of their rituals.
- DPrevent the client from engaging in any rituals immediately.
Show answer & explanationAnswer & explanation
Correct answer: A. Assist the client in scheduling a gradual reduction of ritualistic behaviors.
For clients with OCD, abruptly stopping rituals can cause extreme anxiety. A more therapeutic approach involves assisting the client in gradually reducing the time spent on rituals or delaying them, often combined with exposure and response prevention therapy, to help them cope with the increasing anxiety.
Why the other options are wrong
- B. While anxiolytic medication may be part of the treatment plan, it is not the initial nursing intervention for managing the compulsive behaviors themselves and does not teach coping skills.
- C. Confrontation is non-therapeutic and can increase the client's anxiety and resistance, making them less likely to cooperate.
- D. Immediately preventing rituals will lead to severe anxiety and distress for the client, which is counterproductive and harmful.
OCD Ritual Reduction
Interventions for OCD rituals focus on gradual reduction and delay of compulsive behaviors to help clients manage associated anxiety.
- Abrupt cessation of rituals can cause extreme anxiety.
- Gradual reduction or delaying rituals helps build coping skills.
- Exposure and Response Prevention (ERP) is a key therapy.
Memory trick: OCD: Delay, reduce, then free and loose.