Chapter 17 Somatic Symptom Disorders

A class of medications commonly prescribed for somatic disorders is

anxiolytics.

Which statement about somatoform disorders is true?

Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder?

Dependence on medication

Which nursing diagnosis should be investigated for clients with somatoform disorders?

Ineffective coping

Which behavior by a client would not support a diagnosis of somatoform disorder?

Performing activities of daily living unassisted

The information that is least relevant when assessing a patient with a suspected somatization disorder is:

Potential for violence

You are caring for Aaron, a 38-year-old patient diagnosed with somatic symptom 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?

Shift focus from Aaron's somatic concerns to feelings and effective coping skills.

A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive reframing?

b. "Let's see if there are any other possible explanations for your vomiting."

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise?

Treatment nonadherence

Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?

b. Antidepressant medications to treat underlying depression

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic?

a. "I'm wondering if you are feeling anxious about your illness and being left alone."

Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies?

a. "My employer should have paid for a health club membership for me."

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."

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?"

A patient with blindness related to conversion (functional neurological) disorder says, "All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don't find me as interesting." Which nursing diagnosis is most relevant?

b. Chronic low self-esteem

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?

b. Illness anxiety disorder (hypochondriasis)

A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder by proxy is suspected. Which nursing interventions are appropriate? Select all that apply.

b. Keep careful, detailed records of visitation and untoward events. d. Encourage family members to visit in groups of two or three. e. Interact with the patient frequently during visiting hours.

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

b. Patient's style of presentation

A suitable outcome criterion for the nursing diagnosis Ineffective coping related to dependence on pain relievers to treat chronic pain of psychological origin is:

patient will learn and practice effective coping skills

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff will

regularly discuss their feelings about the client during the unit's interprofessional care meetings.

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved?

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

An example of a somatoform disorder is

conversion disorder.

Therapeutic intervention for a client with a somatoform disorder would include

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

What is an essential difference between somatic symptom disorders and factitious disorders?

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

A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?

d. Illness anxiety disorder (hypochondriasis)

A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? Select all that apply.

a. Female b. Reports frequent syncope e. Reports insomnia often results from back pain

Which presentations suggest the possibility of a factitious disorder, self-directed type? Select all that apply.

a. History of multiple hospitalizations without findings of physical illness b. History of multiple medical procedures or exploratory surgeries

A nurse's neighbor says, "I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?" The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including: (select all that apply)

a. cancer. c. hypertension. d. immune disorders. e. cardiovascular disease.

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

c. Relaxation techniques

A patient diagnosed with a somatic symptom disorder says, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient? Select all that apply.

a. Spiritual distress e. Ineffective role performance

A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient?

b. The patient's anxiety is relieved through the physical symptom.

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably:

b. be resistant to accepting psychiatric help.

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will:

b. demonstrate performance of former roles and tasks.

A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should:

b. expect the patient to feed self after explaining arrangement of the food on the tray.

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as:

c. partially successful.

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:

c. secondary gains.

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority:

c. shift focus from somatic symptoms to feelings.

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient:

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:

d. provide relief from health anxiety.