NSG221 Exam With 100 Questions & Correct Answers With
Rationales
The nurse is caring for an adolescent with dermatillomania. What does the nurse
tell the client's parent about this disorder? Select all that apply. - ANSWER-- It can
lead to loss of occupational functioning.
- It can lead to medical complications
- The client finds comfort in skin picking
Rationale: Dermatillomania is an obsessive-compulsive disorder (OCD) in which
the client seeks comfort in skin picking. This behavior can lead to the loss of
occupational functioning if the client refuses to interact with others due to
disfigurement. The condition can also lead to infections and other medical
complications. Dermatillomania is not caused by substance use nor is it a reward-
seeking behavior.
The nurse is caring for a client with obsessive-compulsive disorder (OCD). What
are the expected outcomes for the client who has been stabilized by medication and
behavior therapy? - ANSWER-- Continue follow-up therapy as needed.
Rationale: Clients with OCD who have been stabilized by medication and behavior
therapy may experience long-term difficulties in dealing with obsessive thoughts.
These clients are encouraged to continue follow-up therapy. The expected outcome
for clients in the stabilization phase of therapy is verbalizing knowledge of illness
and treatment plan. In the immediate phase of therapy, clients should be able to list
and review strengths and abilities with the nursing staff. These clients should also
be able identify stresses and anxieties to enable the nurse to develop a plan of care.
The nurse is caring for a client undergoing cognitive behavior therapy for
obsessive-compulsive disorder. How does the cognitive model describe the client's
,thought process? Select all that apply - ANSWER-- The client has intolerance for
uncertainty.
- The client overestimates the threats caused by the thoughts.
- The client wants to control own thoughts.
Rationale: According to the cognitive model, the person believes that "if I think, it
will happen." Therefore, the client wants to control the client's own thoughts. This
client tries to be perfect and has intolerance for uncertainty. The client feels
threatened by the thoughts. All this causes an increased anxiety in the client
leading to some compulsive ritualistic behavior. As per the cognitive model, the
client's thoughts are influenced by an inflated sense of responsibility. This may be
a result of strict moral or religious upbringing.
Which statement made by the nurse to the family of a client diagnosed with
obsessive-compulsive disorder (OCD) demonstrates the best general understanding
of the chronic nature of the disorder and its management? - ANSWER-- "It's
important to know that the symptoms will intensify during periods of stress."
Rationale: OCD is a chronic, progressive disease. Symptoms wax and wane over
time, increasing during periods of stress. While the other statements are accurate,
they do not provide the most general, encompassing information regarding the
management of this chronic, progressive disorder.
A client's older parent has been diagnosed with hoarding disorder. What does the
nurse instruct the client about the parent's hoarding disorder? - ANSWER--
Treatment may involve community agencies.
Rationale: The treatment for hoarding disorder in the older adult may involve
multiple community agencies besides medications and behavior therapy. Hoarding
disorder is an obsessive-compulsive disorder (OCD) with a late-age onset; any
other recently acquired OCD in the older client may be a degenerative disorder or
,the result of an injury to the basal ganglia. Long-term, not short-term, treatment
can result in a successful outcome.
Which medication does the nurse anticipate the health care provider will prescribe
for a client who is beginning treatment for obsessive-compulsive disorder (OCD)?
- ANSWER-- Fluvoxamine
Rationale: The client who is beginning treatment for OCD is prescribed the
selective serotonin reuptake inhibitor depressant fluvoxamine as a first-line choice.
Clients with treatment-resistant OCD may respond to second-generation
antipsychotics such as risperidone, quetiapine, and olanzapine.
A client spends hours stacking and unstacking towels. The client is repeatedly
checking to make sure that the towels are in order of color. What term is used to
identify this behavior? - ANSWER-- Compulsion
Rationale: Compulsions are ritualistic or repetitive behaviors or mental acts that a
person carries out continuously in an attempt to neutralize anxiety. A phobia is an
illogical, intense, persistent fear of a specific object or a social situation that causes
extreme distress and interferes with normal functioning. An obsession is a
recurrent, persistent, intrusive, and unwanted thought, image, or impulse that
causes marked anxiety and interference with interpersonal, social, or occupational
function. Derealization is sensing that things are not real.
The nurse is assessing a client recently diagnosed with obsessive-compulsive
disorder (OCD). What does the nurse tell the client about the onset of the disorder?
- ANSWER-- Early onset may indicate family history of OCD
Rationale: Early onset of OCD indicates the likelihood of a family history of OCD.
OCD starts in childhood especially in males. In females the onset is in the 20s.
, OCD is diagnosed only when the client's compulsive behavior interferes with the
client's personal, social, and occupational function.
What interventions does the nurse perform when caring for a client with obsessive-
compulsive disorder (OCD)? Select all that apply. - ANSWER-- Teach the client
social skills such as appropriate conversation topics.
- Encourage the client to perform activities of daily living within a fixed time.
- Teach the client to avoid trigger situations.
Rationale: Nursing interventions for OCD include encouraging the client to
perform activities of daily living within a fixed time, teaching the client social
skills such as appropriate conversation topics, and teaching the client to avoid
trigger situations. The nurse should not provide undue praise, such as rewarding
the client for every activity. Clients with OCD benefit from genuine praise that is
earned. The nurse should convey interest when speaking to the client; however, a
calm, reassuring voice is not necessary. This tone is used with clients experiencing
a panic attack.
A client performs ritualistic washing of the hands and dishes, along with
rearranging the table before settling down to a meal. What intervention does the
nurse implement to help this client complete this daily routine? Select all that
apply. - ANSWER-- Come to an agreement with the client on a time to stop the
ritual.
- Encourage a gradual decrease in the time allotted for the ritual.
- Include the time taken for the ritual in the day's timetable.
Rationale: The nurse includes the time taken for the ritual while planning the
client's schedule. Exposure and response prevention techniques are successful only
if the client agrees to cooperate during the treatment. Therefore, the nurse and
client should agree on a time to stop the ritual and continue daily activities. It does
not help to create distractions by asking the client to perform another activity
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