A patient with OCD tells the nurse, "Thinking these thoughts and doing all my rituals is beyond being silly
I have few friends and I know others laugh behind my back. I sometimes think I can control things, but I always find I can't. I don't know if I can continue to live this way." Which assessment question shows the nurse has an understanding of this patient's priority risk?
a. "Are you feeling hopeless?"
b. "Do you think you are socially isolated?"
c. "Have you been thinking about hurting yourself?"
d. "Do the rituals affect how you feel about yourself?"
ANS: C
Patients with anxiety disorders should always be assessed for the presence of depression and suicidal ideation, the priority risk to safety. This patient has admitted feeling powerless to control the symptoms, in addition to wondering if she can continue to live the way she has been. There is ample reason for asking about suicidal ideation. The remaining options address hopelessness, social isolation, and low self-esteem. While appropriate nursing concerns, they don't have the priority self-harm has for this patient.
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