1.

The nursing student correctly identifies which of the following statements are true of the
etiology of OCD? Select all that apply.
A) The cognitive model for OCD etiology focuses on childhood and environmental
experiences of growing up.
B) The etiology of OCD is not definitively explained at this time.
C) OCD is caused by immune dysfunction.
D) The primary etiology of OCD is genetics.
E) Cognitive models may partially explain why people develop OCD.
Ans: A, B, E
Feedback:
Different studies of the etiology of OCD show promise, but have yet to definitively
explain how or why people develop OCD. Cognitive models of OCD have been long
accepted as a partial explanation for OCD. The cognitive model focuses on childhood
and environmental experiences of growing up. Heritable, genetic factors are a

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significant influence on thinking, and environmental influences are not solely

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responsible. Immune dysfunction may play a role in the etiology of OCD.

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2. Which of the following are features of the thinking of a person who has OCD according

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to the cognitive model? Select all that apply.
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A) The person with OCD employs a minimalist approach to all aspects of his or her
life.
B) The person with OCD believes one's thoughts are overly important and has a need
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to control those thoughts as they overestimate the threat posed by their thoughts.
C) The person with OCD is always aware that his or her behavior is related to OCD.
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D) The person with OCD is concerned with perfectionism and has an intolerance of
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uncertainty.
E) The person with OCD has an inflated personal responsibility
Ans: B, D, E
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Feedback:
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The cognitive model describes the person's thinking as (1) believing one's thoughts are
overly important; that is, “If I think it, it will happen,” and therefore having a need to
control those thoughts; (2) perfectionism and the intolerance of uncertainty; and (3)
inflated personal responsibility (from a strict moral or religious upbringing) and
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overestimation of the threat posed by one's thoughts. The person with OCD would not
employ a minimalist approach to all aspects of his or her life—he or she is likely to
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perform some tasks at extreme levels. The persons with OCD may not always be aware
that their behavior is related to OCD.

3. The nurse is caring for her first client with obsessive–compulsive disorder. During the
treatment team meeting, the nurse shares her frustration as to the client's inability to stop
washing his hands. The nurse manager offers which one of the following explanations?
A) The hand washing represents a way to exert independence from the staff.
B) The client is not aware of the excessive hand washing.
C) The client does not think anything is abnormal with washing his hands repeatedly.

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 D) The client feels terrible but cannot stop washing his hands to try to get rid of his
anxiety.
Ans: D
Feedback:
It may be difficult for nurses and others to understand why the person cannot simply
stop performing the bizarre behaviors interfering with his or her life. Nurses must
understand what anxiety behaviors are and how anxiety behaviors work, not just for
client care but to help understand the role anxiety plays in performing nursing
responsibilities.

4. The nurse correctly identifies that which of OCDs self-soothing behaviors may involve
self-destruction of the body of a person who has OCD? Select all that apply.
A) Dermatillomania

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B) Trichotillomania

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C) Onychophagia

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D) Kleptomania

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E) Oniomania
Ans: A, B, C

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Feedback:
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Dermatillomania, or skin-picking, is a self-soothing behavior; that is, the behavior is an
attempt of people to soothe or comfort themselves, not that picking itself is necessarily a
positive sensation. Trichotillomania, or chronic, repetitive hair pulling, is a self-soothing
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behavior that can cause distress and functional impairment. Onychophagia, or nail
biting, is a self-soothing behavior. Kleptomania, or compulsive stealing, and oniomania,
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or compulsive buying, are reward-seeking behaviors.

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5. The student nurse correctly identifies that which of the following are characteristics of
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hoarding disorder? Select all that apply.

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A) Excessive acquisition of animals or apparently useless things

B) Cluttered living spaces that become uninhabitable
C) Significant distress or impairment for the individual
D) Obsessive cleaning of environment
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E) Disposing of articles that are of no value

Ans: A, B, C
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Feedback:
Hoarding involves excessive acquisition of animals or apparently useless things;
cluttered living spaces that become uninhabitable; and significant distress or impairment
for the individual. Obsessive cleaning of the environment and disposing of articles that
are of no value are not characteristics of hoarding.

6. The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a
perceived flaw in his or her appearance may have which of the following disorders?
A) Hoarding disorder

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 B) Body dysmorphic disorder
C) Pyromania
D) Body identity integrity disorder
Ans: B
Feedback:
Body dysmorphic disorder is a preoccupation with imagined or slight defect in physical
appearance that causes significant distress for the individual and interferes with
functioning in daily life. Elective cosmetic surgery is sought repeatedly to “fix the flaw,”
yet after surgery, the person is still dissatisfied or finds another flaw in appearance. It
becomes a vicious cycle. Hoarding disorder is a progressive, debilitating, compulsive
disorder that involves excessive acquisition of animals or apparently useless things;
cluttered living spaces that become uninhabitable; and significant distress or impairment
for the individual. Pyromania is the desire to start fires. Body identity integrity disorder
is the term given to people who feel alienated from a part of their body and desire

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amputation.

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7. Which of the following statements about the typical history of illness that would be
assessed in a client who has OCD is consistent with OCD?

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A)
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OCD usually requires hospitalization.
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B) OCD treatment is usually outpatient.
C) OCD only affects the client's ability to perform ADLs and work, not his or her
leisure life.
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D) Most people seek treatment as soon as they observe the symptoms.

Ans: B
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Feedback:
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The client usually seeks treatment only when obsessions become too overwhelming or
when compulsions interfere with daily life (work, ADLs, or leisure) or both. Clients are
hospitalized only when they have become completely unable to carry out their daily
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routines. Most treatment is outpatient. The client often reports that rituals began many
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years before; some begin as early as childhood. The more responsibility the client has as
he or she gets older, the more the rituals interfere with the ability to fulfill these
responsibilities.
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8. Which of the following would be appropriate outcomes for a client with OCD? Select
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all that apply.

A) The client will stop engaging in the compulsive activity.
B) The client will spend less time performing rituals.
C) The client will complete daily routine activities within a realistic time frame.
D) The client will conceal the behavior from all persons to avoid anxiety.
E) The client will demonstrate effective use of behavior therapy techniques.
Ans: B, C, E
Feedback:
Outcomes for clients with OCD include the following:
• The client will complete daily routine activities within a realistic time frame.

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 • The client will demonstrate effective use of relaxation techniques.
• The client will discuss feelings with another person.
• The client will demonstrate effective use of behavior therapy techniques.
• The client will spend less time performing rituals.

9. Which of the following is the most important variable in determining the likelihood of
success in improving life for a client with OCD?
A) The client must be willing to make changes in his or her behavior.
B) The client must acknowledge that the behavior is not in his or her control.
C) The client must allow the nurse to decide the appropriate intervention for him or
her.
D) The client must be willing to try all new relaxation techniques.
Ans: A

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Feedback:

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The most important variable is that the client is willing to make changes in his or her

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behavior. The nurse must not interrupt the client from performing rituals as this will

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cause anxiety, and the client will need to begin the ritual again. The client and nurse
together must determine which interventions will be used. The client will likely need to

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use relaxation techniques but should have input into deciding which ones.
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10. Which of the following is an important part of therapeutic communication for clients
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who have OCD?

A) To encourage the client to keep the obsession secret.
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B) To encourage the client to discuss his or her obsession with the nurse.
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C) The nurse must have the same obsession as the client.

D) The nurse must instruct the client to discuss the obsession.
Ans: B
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Feedback:
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The nurse encourages the client to talk about the feelings and to describe them in as
much detail as the client can tolerate. Because many clients try to hide their rituals and
to keep obsessions secret, discussing these thoughts, behaviors, and resulting feelings
with the nurse is an important step. It is not necessary for the nurse to have the same
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obsession as the client.

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11. Which of the following interventions by the nurse will increase the client's sense of
security?
A) Allowing the client to perform the rituals
B) Distracting the client from rituals with other activities
C) Encouraging the client to talk about the purpose of the rituals
D) Stopping the client from performing the rituals
Ans: A
Feedback:
The client performs rituals to decrease anxiety and will feel most secure when

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 performing the rituals. The other choices would not promote a sense of security of the
client.

12. Before eating a meal, a client with obsessive–compulsive disorder must wash her hands
for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times.
When evaluating the progress of the client, what is the most important treatment
objective for this client?
A) Allow ample time for completion of all rituals before each meal.
B) Gradually decrease the amount of time spent for performing rituals.
C) Increase the client's acceptance of the need for medication to control rituals.
D) Omit one ritualistic behavior every 4 days until all rituals are eliminated.
Ans: B
Feedback:

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Treatment has been effective when OCD symptoms no longer interfere with the client's

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ability to carry out responsibilities. When obsessions occur, the client manages resulting

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anxiety without engaging in complicated or time-consuming rituals. He or she reports

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regained control over his or her life and the ability to tolerate and manage anxiety with
minimal disruption. Ritualistic behaviors may be decreased gradually over time.

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13. Which of the following treatment modalities is most effective for OCD?
A) Behavioral techniques
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B) Medication
C) Behavioral techniques and medication
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D) Ignoring it
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Ans: C
Feedback:
Behavioral techniques and medication are the most effective treatment modalities for
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OCD. This would be more effective than either behavioral techniques or medication
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alone. It is not appropriate to ignore OCD as it will only get worse until the client is
unable to engage in activities of daily living.
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14. Which of the following is essential for the nurse to communicate to the client with OCD
and to the client's family?
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A) The client's diagnosis should be kept secret from everyone outside the immediate
family and friends.
B) The importance of medication compliance and that it may be necessary for
medication to be changed to find the one that works best.
C) It is important for the client to avoid following a routine.
D) It is helpful for others to give unsolicited advice about other activities the client
with OCD can engage in.
Ans: B
Feedback:
Teaching about the importance of medication compliance to combat OCD is essential. It

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 is neither possible nor desirable to keep the client's diagnosis a secret. To accomplish
tasks efficiently, the client initially may need additional time to allow for rituals. When
the client has completed the ritual or the tie allotted has passed, the client must then
engage in the expected activity. At home, the client can continue to follow a daily
routine or written schedule that helps him or her to stay on tasks and accomplish
activities and responsibilities. It is not helpful for others to give unsolicited advice about
other activities the client with OCD can engage in as this will add to the guilt and shame
that people with OCD experience.

15. The nurse is providing education to a group of persons from several community
agencies about hoarding by elder persons. Which of the following is important for the
nurse to emphasize?
A) Treatment will likely start to be effective in the short term.

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B) If the person had help to clean up his or her environment, the hoarding would be

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cured.

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C) It is not beneficial to tell the client that his or her thoughts and rituals interfere

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with his or her life or that his or her ritual actions really have no lasting effect on
anxiety.

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D)
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One agency should be able to address all of the client's needs.
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Ans: C
Feedback:
Treatment for hoarding in older adults may need to continue over a long period of time
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to reach successful outcomes. Most persons who are hoarders will not seek assistance to
clean up their environment because they feel ashamed. If the environment were to be
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cleaned up and no other intervention employed, the person would continue to hoard. It is
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not beneficial to tell the clients that their thoughts and rituals interfere with their life or
that their ritual actions really have no lasting effect on anxiety—they already know that.
Multiple community agencies may be needed to deal with hoarding in the older adult.
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16. Which of the following is the desired outcome for a client with OCD?
A) That the client will no longer experience any signs or symptoms of OCD
B) That the client will no longer experience anxiety
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C) That the OCD symptoms no longer interfere with the client's responsibilities
D) To relieve the client with OCD of any responsibilities
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Ans: C
Feedback:
Treatment has been effective when OCD symptoms no longer interfere with the client's
ability to carry out responsibilities. The client will likely continue to experience signs or
symptoms of OCD and anxiety, but the client will be able to manage the resulting
anxiety without engaging in complicated or time-consuming rituals. It is not possible or
desirable to relieve the client with OCD of any responsibilities.

17. Which of the following are important for the nurse to remember when teaching

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 relaxation and behavioral techniques to a client with OCD? Select all that apply.
A) It is important to teach the client to use relaxation techniques when the client's
anxiety is low.
B) The nurse may teach the client about relaxation techniques when the client is
experiencing anxiety.
C) The client must be willing to engage in exposure and response prevention.
D) The client must be forced to use relaxation techniques.
E) It is unnecessary to assess the baseline of ritualistic behaviors in the client with
OCD.
Ans: A, B, C
Feedback:
The intervention should take place when the client's anxiety is low, so he or she can
learn more effectively. The nurse may teach the client about relaxation techniques when
the client is experiencing anxiety. The client must be willing to engage in exposure and

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response prevention. The client cannot be forced to use relaxation techniques. It is

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necessary to assess the baseline of frequency and duration of anxiety and ritualistic

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behaviors in the client with OCD.

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18. The student nurse correctly identifies that which one of the following statements is true
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regarding clients with OCD?
A) Since the client is aware that his or her behavior is bizarre, the client should just
stop the behavior.
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B) Clients with OCD seem normal on the outside but suffer from overwhelming fear
and anxiety.
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C) Once a person is successfully treated for OCD, he or she has been cured.
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D) Persons with OCD must avoid stress.

Ans: B
Feedback:
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Most times, clients with OCD seem normal on the outside but suffer from
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overwhelming fear and anxiety. OCD is often chronic in nature, with symptoms that
wax and wane over time. Just because the client has some success in managing thoughts
and rituals, it does not mean he or she will never need professional help in the future. It
is not likely possible for persons with OCD to avoid stress.
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