An adult is admitted because of ritualistic behaviour. She is also constipated and dehydrated. Which nursing intervention would the client be most likely to comply with?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Patients exhibiting ritualistic behaviors, often associated with conditions like OCD, thrive on structure and predictability to manage anxiety.
The instruction 'Drinking 8 oz water every hour between meals' provides a highly specific, measurable, and time-bound plan.
This approach transforms the necessary task of rehydration into a therapeutic ritual that aligns with the patient's psychological needs, thereby maximizing the likelihood of compliance.
It effectively addresses the patient's physiological problems (constipation and dehydration) in a psychologically acceptable and non-threatening manner.

Option A: This option focuses on nutritional supplementation (Ensure) rather than primarily addressing dehydration. While the instruction is somewhat specific, it may not be the most direct or effective intervention for the patient's stated problems of constipation and dehydration.
Option B: The term 'extra fluids' is vague and subjective. For a patient who needs structure, this ambiguity can increase anxiety because there is no clear goal or endpoint, making it difficult for them to know if they have complied correctly.
Option D: This is the most ambiguous option. 'Adequate amounts' is an abstract concept that provides no guidance, schedule, or measurable goal. This lack of structure would likely be very stressful and counterproductive for a patient with ritualistic behaviors.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing interventions for patients with ritualistic behavior to guide bedside assessment, documentation, and the next nursing action.
When caring for patients with psychiatric conditions, nurses must tailor physical health interventions to the patient's psychological needs to ensure cooperation and reduce distress.
A key nursing skill is therapeutic communication, which involves giving clear, simple, and structured instructions, especially for patients with anxiety or obsessive-compulsive disorders.
What if the patient refused to drink plain water? The nurse should offer a limited, structured choice, such as 'Would you prefer 8 oz of water or 8 oz of clear juice every hour?' This maintains the structured intervention while giving the patient a small, manageable degree of control.

How to Approach the Question

First, identify the two main issues in the question: the patient's psychological state (ritualistic behavior) and their physical condition (constipation and dehydration).
Recognize that the psychological state is the primary factor influencing compliance. 'Ritualistic behaviour' is the key; these patients need structure, predictability, and clear, measurable goals to reduce anxiety.
Evaluate each option based on how well it provides structure. Ask yourself: 'Is this instruction specific, measurable, and time-bound?'
Eliminate options that are vague or abstract. Words like 'extra' and 'adequate' are red flags because they lack specificity and can increase anxiety for this patient population.
Select the option that provides a concrete plan, effectively creating a new, therapeutic ritual that the patient can easily follow and feel successful in completing.

Concept Tested & Keywords

Concept Tested: Nursing interventions for patients with ritualistic behavior
Stem keywords: ritualistic behaviour, constipated, dehydrated, nursing intervention
Lead-in keywords: most likely to comply with
Clinical cues: Ritualistic behaviour: This is a key cue indicating a patient's need for structure, predictability, and clear, measurable instructions to reduce anxiety.

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E6 Nursing Fundamentals Taylor p. 86-88

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 35-37

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.