Question

within several days of hospitalization, a client is repeatedly washing the top of the same table. which initial intervention is best for the nurse to implement to help the client cope with anxiety related to this behavior?

administer a prescribed prn antianxiety medication.
assist the client to identify stimuli that precipitates the ritualistic activity.
allow time for the ritualistic behavior, then redirect the client to other activities.
teach the client relaxation and thought stopping techniques.

Explanation:

Analyze the client's behavior and clinical needs

The client is exhibiting a repetitive, ritualistic behavior (repeatedly washing a table), which is characteristic of Obsessive-Compulsive Disorder (OCD) compulsions used to decrease severe anxiety.

Evaluate the intervention options

• Administer a prescribed PRN antianxiety medication: Chemical restraint or medication is not the first-line nursing intervention for managing ritualistic behaviors unless the client is a danger to themselves or others.
• Assist the client to identify stimuli that precipitates the ritualistic activity: This is a long-term therapeutic goal, not the immediate, initial intervention to help the client cope during the behavior.
• Allow time for the ritualistic behavior, then redirect the client to other activities: Initially, stopping the ritualistic behavior increases anxiety to panic levels. The nurse must allow time for the ritual to prevent overwhelming anxiety, then gradually redirect the client.
• Teach the client relaxation and thought stopping techniques: Teaching is ineffective when anxiety is high during the ritualistic behavior; this should be done when anxiety is low.

Determine the best initial intervention

Allowing the client to perform the ritual initially prevents panic-level anxiety, followed by redirection to other activities to gradually limit the behavior.

Answer:

• Administer a prescribed PRN antianxiety medication.
• Assist the client to identify stimuli that precipitates the ritualistic activity.
• Allow time for the ritualistic behavior, then redirect the client to other activities. (Correct answer)
• Teach the client relaxation and thought stopping techniques.