Chapter 17

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A. A court date this week for drunk driving B.Was adopted at the age of 5 years C. A history of physical abuse by his stepfather D. A history of oppositional-defiant disorder E. Raised primarily in a single parent household

A. A court date this week for drunk driving

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause in conversion disorder. Which statement is true?A. People with conversion disorder are extremely upset about often dramatic symptoms. B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder. C. An organic cause is usually found in most cases of conversion disorder. D. Symptoms can be turned on and off depending on the patient's choice

B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder.

You are caring for a 67-year-old patient who has been receiving hemodialysis for three months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to: A. Organic changes in Yolanda's brain B. A flaw in Yolanda's personality C. A normal response to grief and loss D. Denial of the reality of a poor prognosis

C. A normal response to grief and loss

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? A. "A combination of antianxiety and antidepressant therapy is the most effective therapy." B. "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." C. "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

You are caring for Aaron, a 38 year-old patient diagnosed with somatic disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following interventions would be appropriate? A. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis B. Educate Aaron on alternative therapies to deal with pain. C. Improve reality testing by telling Aaron that you do not believe the headaches are real D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: A. Once lower level needs are satisfied, no further growth feels necessary B. Self-actualization is easier to achieve with financial stability C. Esteem is more highly valued than safety. D. Focusing on materialism reduces interests in love, belonging, and family

D. Focusing on materialism reduces interests in love, belonging, and family

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient: a. sees a relationship between symptoms and interpersonal conflicts. b. has little difficulty communicating emotional needs to others. c. rarely derives personal benefit from the symptoms. d. has altered comfort and activity needs.

d. has altered comfort and activity needs.

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: a. are generally chronic. b. have a physiological basis. c. can be voluntarily controlled. d. provide relief from health anxiety.

d. provide relief from health anxiety.

Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder? a. "What are you unable to do now but were previously able to do?" b. "How many doctors have you seen in the last year?" c. "Who do you talk to when you're upset?" d. "Did you experience abuse as a child?"

a. "What are you unable to do now but were previously able to do?"

A physician describes a client as "malingering." The nurse knows this means that the client: a. is falsely claiming to have symptoms. b. experiences symptoms that cannot be explained medically. c. experiences symptoms that have a physiological basis. d. is seeking medication to ease pain of psychological origin.

a. is falsely claiming to have symptoms.

The most likely client to initially demonstrate behaviors suggesting a somatic disorder is a: a. 13-year-old male b. 23-year-old female c. 33-year-old male d. 43-year-old female

b. 23-year-old female

Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder? a. Narcotic analgesics for use as needed for acute pain b. Antidepressant medications to treat underlying depression c. Long-term use of benzodiazepines to support coping with anxiety d. Conventional antipsychotic medications to correct cognitive distortions

b. Antidepressant medications to treat underlying depression

Therapeutic intervention for a client with a somatic disorder would include: a. steering conversation away from the client's feelings. b. conveying an interest in the client rather than in the symptoms. c. encouraging the client to use benzodiazepines liberally. d. encouraging the client to rely on the nurse to meet the client's needs.

b. conveying an interest in the client rather than in the symptoms.

The primary difference between a factitious disorder and other somatic disorders is that factitious disorders: a. respond well to confrontation as a primary therapeutic technique. b. have a symptomatology that is actually controlled by the client. c. have their origins in depression and anxiety. d. are always self-directed.

b. have a symptomatology that is actually controlled by the client.

Which item of data should be routinely gathered during assessment of a client with a somatic disorder? a. Potential for violence b. Level of confusion c. Dependence on medication d. Personal identity disturbance

c. Dependence on medication

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? a. Somatic disorder b. Factitious disorder c. Illness anxiety disorder d. Conversion disorder

c. Illness anxiety disorder

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively? a. Flooding b. Response prevention c. Relaxation techniques d. Systematic desensitization

c. Relaxation techniques

A class of medications commonly prescribed for somatic disorders is: a. mood stabilizers. b. antidepressants. c. anxiolytics. d. antipsychotics.

c. anxiolytics.

An example of a somatic disorder is: a. depersonalization. b. dissociative fugue. c. conversion disorder. d. dissociative identity disorder.

c. conversion disorder.

A patient diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess: a. mood. b. cognitive style. c. secondary gains. d. identity and memory.

c. secondary gains.

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority: a. explain the pathophysiology of symptoms. b. help these patients suppress feelings of anger. c. shift focus from somatic symptoms to feelings. d. investigate each physical symptom as it is reported

c. shift focus from somatic symptoms to feelings.

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? a. "I feel less anxiety than before." b. "My memory is better than it was a month ago." c. "I take my medications just as the physician prescribed." d. "I don't think about my symptoms all the time as I used to."

d. "I don't think about my symptoms all the time as I used to."

What is an essential difference between somatic symptom disorders and factitious disorders? a. Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic. b. Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress. c. Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound. d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.

d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.