a client with obsessive compulsive disorder ocd spends several hours each day washing her hands which intervention should the nurse implement a client with obsessive compulsive disorder ocd spends several hours each day washing her hands which intervention should the nurse implement
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Nursing Elites

ATI RN

ATI Mental Health Proctored Exam 2019

1. A client with obsessive-compulsive disorder (OCD) spends several hours each day washing her hands. Which intervention should the nurse implement?

Correct answer: B

Rationale: Setting a time limit for hand washing is an appropriate intervention for a client with OCD who spends excessive time on this compulsive behavior. By setting a time limit, the nurse can help the client gradually reduce the compulsive behavior, promoting a more manageable approach to hand washing without completely discouraging it. Encouraging the client to wash her hands less frequently (Choice A) may not address the root of the issue and could lead to increased anxiety. Teaching relaxation techniques (Choice C) may be helpful for overall anxiety management but may not directly address the excessive hand washing behavior. Discouraging the client from washing her hands (Choice D) may increase anxiety and resistance, making it a less effective intervention.

2. In an adult patient suspected of having an androgen deficiency and considering treatment with testosterone, the use of testosterone would be most complicated by the presence of what preexisting health problem?

Correct answer: B

Rationale: The correct answer is BPH (Benign Prostatic Hyperplasia). Testosterone therapy can worsen symptoms of BPH by potentially increasing prostate size and stimulating the growth of prostate tissue. This can lead to complications such as urinary retention and the need for further medical interventions. Urinary incontinence (choice A) can have various causes but is not directly related to testosterone therapy. Chronic renal failure (choice C) and Type 2 diabetes (choice D) are not typically contraindications for testosterone therapy in the context of androgen deficiency.

3. When measuring the leg circumference of a client with bipedal edema, what position is best to ensure accurate measurements?

Correct answer: A

Rationale: When measuring the leg circumference of a client with bipedal edema, the best position to ensure accurate and consistent measurements is the dorsal recumbent position. This position allows the legs to be positioned comfortably, and the individual is lying on their back with legs extended, facilitating accurate measurement of the circumference without the influence of gravity. Sitting, standing, and supine positions may not provide optimal conditions for accurate leg circumference measurements, particularly in clients with bipedal edema where positioning and consistency are crucial. Sitting and standing positions may not allow for consistent leg positioning and could introduce errors due to the effects of gravity on the fluid distribution. The supine position, while similar to dorsal recumbent, may not be as comfortable for the client and could still be influenced by gravity when measuring leg circumference.

4. When educating a client prescribed diazepam for anxiety, which statement indicates an accurate understanding of the medication?

Correct answer: B

Rationale: The correct answer is B. Clients prescribed diazepam for anxiety should avoid drinking alcohol while taking this medication. Alcohol can potentiate the side effects of diazepam, such as drowsiness and dizziness, increasing the risk of harm. Choice A is incorrect because diazepam is typically taken regularly as prescribed, not just when feeling anxious. Choice C is also important but not directly related to the medication itself. Choice D is dangerous advice; stopping diazepam abruptly can lead to withdrawal symptoms and should only be done under medical supervision.

5. Which of the following best describes a blood clot stimulating further clotting?

Correct answer: a positive feedback mechanism.

Rationale: A blood clot stimulating further clotting is an example of a positive feedback mechanism. In positive feedback, the response enhances or amplifies the original stimulus, leading to an increase in the activity. In this case, the formation of a blood clot triggers more clotting activity, creating a cycle of increasing clot formation. Negative feedback mechanisms, on the other hand, work to maintain homeostasis by counteracting changes. Choices B, C, and D are incorrect as they do not accurately describe the situation of a blood clot stimulating further clotting.

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