NCLEX® QUESTION OF THE WEEK

Question of the Week – January 19, 2022

A newly admitted client with an obsessive-compulsive personality disorder frequently performs a hand-washing ritual. When attempts are made to set limits on the frequency or length of the ritual, the client’s anxiety escalates and the client becomes verbally aggressive. What is most important for the nurse to do when the client performs the ritual?

Show Answer Answer
Correct! The answer is number 1

Rationale:

  1. Rituals provide a means for the individual to control anxiety. If not permitted to carry out the ritual, the client probably will experience unbearable anxiety. The client has exhibited verbally aggressive behavior in the past, and this behavior may escalate. Safety of the client and others becomes an issue.

 

2. The client probably understands this already but is unable to stop the activity.

3. Clients with obsessive-compulsive disorder have no idea what the ritual means, only that they must continue the ritual.

4. Interrupting the ritual will have the effect of increasing anxiety, possibly to panic levels.

 

Additional info:

Clinical Area: Comprehensive Examination

Client Needs: Safe and Infection Control

Cognitive Level: Application

Nursing Process: Planning/Implementation

Integrated Process: Caring

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN® Examination, 8th Edition

Evolve Resources for Saunders Q & A Review for the NCLEX-RN® Examination, 8th Edition
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