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Walkthrough: Psychosocial Integrity Q1

by Rhonda Lawes

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    00:01 The nurses caring for a client admitted with a diagnosis of obsessive-compulsive personality disorder.

    00:07 Which behavior most concerns the nurse.

    00:11 All right, this is a short and succinct one.

    00:13 But it's got a lot going on in that stem.

    00:16 I'm a nurse, caring for a client who's been admitted.

    00:20 All right. So we know that this patient is not able to function at home safely right now.

    00:24 So I'm caring for a client who's been admitted.

    00:27 The diagnosis is obsessive-compulsive personality disorder.

    00:32 So I think back in my mind, anytime I see a diagnosis, what are the challenges the problems with that? I'll remember, there's these rituals involved with obsessive-compulsive disorder.

    00:41 You think you have to keep going through this entire ritual, or something bad is going to happen.

    00:48 Well, do you know what the bad thing is? Sometimes they do. Sometimes they don't.

    00:53 But they just know the way their mind is working, that if they don't go through their rituals, something really bad is going to happen.

    01:00 Which is why they obsess and feel like they can't choose to stop doing it.

    01:05 Now, the last part, that second sentence that focuses the question, what we're looking for, it says which behavior most concerned the nurse? All right, why did I say it like...? Because look at that word, it's telling you right there.

    01:22 Even on the NCLEX.

    01:23 That type of word will be bolded.

    01:26 So it should jump off the page at you.

    01:28 That means, you're going to have to prioritize.

    01:32 Now this question will likely have more than one correct answer.

    01:37 Ooo, I know you don't like that.

    01:39 But that's how the game is played.

    01:41 So we're looking for most concerning about this patient with obsessive compulsive personality disorder.

    01:49 What's the most concerning behavior? Now, let's bring in the answer choices.

    01:56 Okay, you've got four options there.

    02:00 Now, I want you to pause the video, work through these four options on your own.

    02:05 Have the numbers 1, 2, 3, and 4 numbers only.

    02:09 Written on your practice sheet.

    02:11 Now pause it.

    02:12 And I want you to work through these answer choices asking yourself that topic of that question.

    02:18 Which behavior is most concerning to the nurse for a client who has obsessive compulsive personality disorder? Ready? I'll see you back in a few minutes.

    02:28 Please take your time.

    02:29 Take all the time you need to do your very best on this question.

    02:41 Welcome back.

    02:43 All right, we've got four behaviors.

    02:45 So we know that we're gonna have to eliminate three and end up with one correct or most correct answer.

    02:54 So let's see.

    02:55 The topic of the question is OCD.

    02:58 Number one, cleaning the room constantly.

    03:02 Is Adeline with OCD? Yes.

    03:05 Without sleeping in the past two days.

    03:08 Whoa, okay, not getting rest. That's a problem.

    03:11 So for now, I'm gonna leave that one in.

    03:14 I am not ready to cross it off.

    03:16 Number two.

    03:18 Hand washing after touching every surface and after handshakes.

    03:24 Does that line up with obsessive compulsive? Yes, it sure does.

    03:30 Now, let me compare it to number one, because I hadn't eliminated that yet.

    03:34 So it was hand washing after touching every surface and after handshakes worse than cleaning the room constantly without sleeping in the past two days.

    03:44 Which one of those behaviors is a bigger risk to the patient's safety? Because all questions are about keeping particular patients in particular settings, the safest.

    03:55 So Nope. Number one is worse.

    03:58 It's a bigger risk to the patient's safety, because they're not sleeping for the past two days.

    04:04 So number two, I know that you will line up with obssesive compulsive, but it's not as dangerous to the patient as number one.

    04:11 Now number three.

    04:13 Going back to the room three or four times to make sure the doors are closed.

    04:18 I kind of do this when I leave the house.

    04:20 That always pops up like, "Ooh, did I close that? Did I turn that off?" So those thoughts can be come kind of locked in your brain" And that does line up with someone who would be admitted with this personality disorder.

    04:33 However, is it worse than number one? Is it a bigger risk to the patient's safety? Is number three a bigger risk to patient safety or number one? Nope, it's still number one.

    04:45 Because they're not sleeping.

    04:47 That's a bigger risk to the patient safety.

    04:49 And then just going back and forth to the room three or four times to make sure the doors are closed.

    04:54 All right, so we're down to number one and number four.

    04:57 Feeling sad and hopeless about getting into college.

    05:02 All right. That's not a real pleasant thing. Right? That can be anxiety. That might be depression.

    05:10 But are we more at risk there for a client with obsessive compulsive disorder? You may be tempted to pick number four.

    05:18 But really the answer is, number one.

    05:22 Why? Number four doesn't give us any indication that the patient is going to harm themselves.

    05:27 They're just feeling sad and hopeless.

    05:30 Patients can experience these feelings and not be intending to harm themselves.

    05:35 But number one, we know in the here, in the now is a significant problem.

    05:41 And that's why that one most concerns the nurse.

    05:46 All right, it's time to reflect on how you did.

    05:49 Now, I know sometimes mental health questions are really frustrating to a lot of students.

    05:54 But I promise you as you slow down and start practicing, you're going to pick up some patterns.

    06:00 Sometimes when you see sad or feeling hopeless, you want to go boom, right to that's the person we need to follow up.

    06:06 But remember, look at the topic of the question.

    06:09 And keep in mind, don't assume something.

    06:13 Don't assume that they're going to harm themselves.

    06:16 And we're comparing number four, to number three, to number two, to number one.

    06:21 So this isn't always a wrong answer. It's not always a right answer.

    06:27 It's always a relative process. You're looking for the top priority.

    06:32 So in this case, it was number one.

    06:35 Now what do you need to write in your notebook? What do you need to remember? What can you take from this question that you can apply to other questions? Now, let's go on to another question.


    About the Lecture

    The lecture Walkthrough: Psychosocial Integrity Q1 by Rhonda Lawes is from the course NCLEX-RN® Question Walkthrough: Psychosocial Integrity.


    Included Quiz Questions

    1. Cleaning a room over and over again.
    2. Handwashing after touching every surface.
    3. Going back into a room and checking to ensure the doors are locked.
    4. Handwashing after using the bathroom.
    5. Cleaning once a week.
    1. The client is washing their hands excessively and causing skin to become raw.
    2. The client has checked six times in ten minutes that the doors are locked.
    3. The client is cleaning the floors for the third time today.
    4. The client has changed outfits four times this morning.

    Author of lecture Walkthrough: Psychosocial Integrity Q1

     Rhonda Lawes

    Rhonda Lawes


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