# A nurse is assessing a 35-year-old client who has been referred for evaluation of repetitive behaviors. Which assessment finding would be most indicative of obsessive-compulsive disorder (OCD)? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543349 > language: ko > subject: Mental Health ## 문제 A nurse is assessing a 35-year-old client who has been referred for evaluation of repetitive behaviors. Which assessment finding would be most indicative of obsessive-compulsive disorder (OCD)? ## 보기 1. The client exhibits periods of elevated mood alternating with depressive episodes over several months. 2. The client describes unwanted, persistent thoughts about germs that cause significant anxiety, leading to compulsive hand-washing behaviors. **✔ 정답** 3. The client reports hearing voices that command them to perform certain actions throughout the day. 4. The client demonstrates impaired memory and difficulty concentrating during the interview. **정답: 2** ## 해설 The correct answer demonstrates the classic presentation of OCD with obsessions (unwanted, persistent thoughts about germs) and compulsions (hand-washing) that cause significant anxiety and interfere with daily functioning. Other options describe symptoms of bipolar disorder, psychosis, or cognitive impairment, which are not characteristic of OCD. ## 심화 해설 Understanding the Core Features of OCD The correct answer is 2. To differentiate obsessive-compulsive disorder (OCD) from other psychiatric conditions, it is essential to recognize its two defining components: obsessions and compulsions. According to the clinical practice guidelines, a comprehensive evaluation of OCD symptoms is the foundation of assessment [1]. Obsessions are recurrent, unwanted, and intrusive thoughts, urges, or images that cause marked anxiety or distress. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession, aimed at reducing distress or preventing a dreaded event [1]. The scenario in option 2 directly illustrates this cycle. The client's description of "unwanted, persistent thoughts about germs" represents a classic obsession centered on contamination. The resulting "significant anxiety" drives the compulsion of "hand-washing behaviors." This specific pairing of an anxiety-provoking intrusive thought and a ritualistic behavior performed to neutralize it is the hallmark clinical presentation of OCD [1]. The review on compulsive checking reinforces this framework, noting that anxiety, uncertainty, and an inflated sense of responsibility are key drivers that elicit compulsive actions, which in turn affect cognitive functions like memory confidence [2]. Differential Diagnosis: Why Other Options Are Incorrect - Option 1 describes a cyclical pattern of elevated and depressed moods. This is the defining characteristic of bipolar disorder, not OCD. While mood disorders can co-occur with OCD, the primary symptoms of OCD are anxiety-driven obsessions and compulsions, not episodic mood swings [1]. - Option 3 involves auditory hallucinations ("hearing voices") that issue commands. This is a psychotic feature most consistent with a primary psychotic disorder, such as schizophrenia. A critical distinction is that individuals with OCD typically recognize their obsessions as a product of their own mind, whereas hallucinations are perceived as external stimuli. - Option 4 lists impaired memory and concentration. While research indicates that compulsive behaviors, such as checking, can negatively impact memory confidence and higher-level cognitive functions over time, this is a secondary consequence, not a primary diagnostic criterion [2]. These cognitive complaints are also nonspecific and common in major depressive disorder, generalized anxiety disorder, and other conditions. Clinical Significance and Underlying Mechanisms From a neurobiological perspective, the cycle of obsessions and compulsions is linked to dysfunction in the cortico-striato-thalamo-cortical (CSTC) circuitry . This brain network is crucial for action selection, habit formation, and the regulation of repetitive behaviors. Emerging evidence also points to modulatory factors like neuroinflammation and serotonin synthesis in the clinical expression of OCD severity . For the NCLEX-RN, the assessment priority is to accurately identify the patient's subjective experience of intrusive thoughts and the objective performance of ritualistic behaviors. A patient reporting that hand-washing temporarily relieves the overwhelming anxiety caused by contamination thoughts is providing a textbook description of the OCD cycle, which is precisely what option 2 captures.References (research sources) - [1]Clinical practice guidelines for obsessive-compulsive disorder: 2025 update.GuidelineArumugham SS, Narayanaswamy JC, Balachander S, Sharma E, Jaisoorya TS, Reddy SC, Siddiqui AM, Desouza A, Shah PS, Reddy YJ. (2026) · DOI: 10.4103/indianjpsychiatry_1259_25 - [2]The Etiology, Assessment and Treatment of Compulsive Checking: A Review.Research articleGuo S, Yadegar M, Khaw H, Chang S. (2025) · DOI: 10.2147/prbm.s431339 ## 임상 시나리오 Identifying OCD in Clinical AssessmentDifferentiating the obsession-compulsion cycle from other psychiatric presentations The core feature of Obsessive-Compulsive Disorder (OCD) is the presence of obsessions (unwanted, intrusive, anxiety-provoking thoughts) and compulsions (repetitive behaviors or mental acts performed to neutralize the obsession). A classic example is a contamination obsession leading to a hand-washing compulsion. When assessing a client, directly link the reported behavior to this cycle. Option 2 perfectly illustrates this: an obsession ("persistent thoughts about germs") causing anxiety, which drives a compulsion ("hand-washing behaviors"). CautionDo not confuse OCD with bipolar disorder (mood cycling), a psychotic disorder (command hallucinations), or general anxiety/depression (impaired concentration). The key differentiator is the specific, functional link between the intrusive thought and the ritualistic action. ## 핵심 개념 - **Obsessions** — Recurrent, unwanted, and intrusive thoughts, urges, or images that cause marked anxiety or distress. - **Compulsions** — Repetitive behaviors or mental acts an individual feels driven to perform in response to an obsession, aimed at reducing distress. - **Obsessive-Compulsive Disorder (OCD)** — A disorder characterized by the presence of obsessions and/or compulsions that are time-consuming and cause significant clinical distress. - **Differential Diagnosis** — The process of distinguishing a particular disease or condition from others that present with similar clinical features. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old client who reports spending 3-4 hours daily checking lo…](https://mymerci.kr/pages/nclex_q.php?qn_id=543348) - [A nurse is caring for a client with obsessive-compulsive disorder (OCD) who performs hand-…](https://mymerci.kr/pages/nclex_q.php?qn_id=543350) - [A nurse is caring for a client with obsessive-compulsive disorder (OCD) who performs hand-…](https://mymerci.kr/pages/nclex_q.php?qn_id=543351) - [A nurse is caring for a client with obsessive-compulsive disorder (OCD) who performs repet…](https://mymerci.kr/pages/nclex_q.php?qn_id=543352) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._