Chapter 20

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which action would the nurse take? 1. Deal with physical symptoms in a detached manner. 2. Challenge the validity of physical symptoms. 3. Meet dependency needs until the physical limitations subside. 4. Encourage a discussion of feelings about the lower-extremity problem.

1

The nurse is working with a client diagnosed with somatic symptom disorder (SSD). Which distinguishing criterion is present in SSD but absent in illness anxiety disorder (IAD)? 1. Experiences significant physical symptoms 2. Has a change in the quality of self-awareness 3. Has a perceived disturbance in body image or appearance 4. Experiences anxiety about acquiring an illness

1

Which statement by the nurse indicates a correct understanding of psychopharmacology for somatic disorders? 1. "Somatization disorders with depression can be treated with selective serotonin reuptake inhibitors." 2. "Anxiety associated with these disorders can be treated long-term with benzodiazepines." 3. "Conversion disorder can be treated with intravenous administration of antidepressants." 4. "First-line treatment for depersonalization-derealization disorder is antianxiety agents."

1

The client is diagnosed with functional neurological symptom disorder. Which symptoms would the nurse most likely observe? (Select all that apply.) 1. Anosmia 2. Abreaction 3. Akinesia 4. Aphonia 5. Amnesia

1,3,4

The client is diagnosed with illness anxiety disorder (IAD). Which symptoms would the client most likely exhibit? (Select all that apply.) 1. Doctor shopping 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Avoids hospitals

1,3,5

The client is exhibiting symptoms of generalized amnesia. Which questions should the nurse ask to help confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?"

1,3,5

The nurse discovers the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder? 1. Illness anxiety disorder 2. Factitious disorder 3. Functional neurological symptom disorder 4. Depersonalization-derealization disorder

2

Which finding would alert the nurse that a client is exhibiting selective amnesia? 1. Cannot relate any lifetime memories. 2. Can describe driving to Iowa but cannot remember the car accident that occurred. 3. Can explain abstract concepts. 4. Cannot provide personal demographic information during admission assessment.

2

Which outcome would the nurse add to the plan of care for an inpatient client diagnosed with somatic symptom disorder (SSD)? 1. The client will admit to fabricating physical symptoms to gain benefits by day three. 2. The client will list three potential adaptive coping strategies to deal with stress by day two. 3. The client will identify the connection between function loss and severe stress by day three. 4. The client will maintain a sense of reality during stressful situations by day four.

2

9. Which criteria according to the DSM-5 would need to be present for a client to be diagnosed with dissociative fugue? 1. An inability to recall important autobiographical information 2. Clinically significant distress in social and occupational functioning 3. Sudden unexpected travel or bewildered wandering 4. "Blackouts" related to alcohol toxicity

3

The client diagnosed with dissociative identity disorder (DID) switches personalities when confronted by the nurse about inappropriate actions. The nurse recognizes that this dissociation serves which function? 1. It is a means to attain secondary gain. 2. It is a means to explore feelings of excessive and inappropriate guilt. 3. It serves to isolate painful events so the person's awareness and anxiety are decreased. 4. It serves to establish personality boundaries and limit inappropriate impulses.

3

The client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? 1. Encourage exploration of sexual abuse. 2. Suggest guided imagery. 3. Establish trust and rapport. 4. Administer antianxiety medications.

3

The nurse is assessing a client diagnosed with somatic symptom disorder (SSD). Which findings would the nurse expect to observe? 1. Presence of multiple personalities, depersonalization, derealization, and "gaps" in memory 2. Aphonia, la belle indifference, paralysis with no physical reason, and possible hallucinations 3. Anxious, seeing several health-care providers simultaneously, overmedicates, and vague symptoms 4. Pretends to be ill, aggravates existing symptoms, inflicts self-injury and has many hospitalizations

3

The nurse is caring for a client diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client? 1. To recover memories while improving thinking patterns 2. To prevent social isolation 3. To decrease anxiety and need for secondary gain 4. To collaborate among subpersonalities to improve functioning

4

The nurse is teaching about the etiology of illness anxiety disorder (IAD) from a psychodynamic perspective. Which statement by a staff member about clients diagnosed with this disorder indicates that learning has occurred? 1. "When there is a familial predisposition to this disorder, they may develop this disorder." 2. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." 3. "They misinterpret and cognitively distort their physical symptoms." 4. "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

4

The nursing instructor is teaching about the DSM-5 diagnostic criteria for depersonalization-derealization disorder. Which student statement indicates a need for follow-up instruction? 1. "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time." 2. "Clients with this disorder can experience unreality or detachment with respect to their surroundings." 3. "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted." 4. "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

4

Which are examples of primary and secondary gains that a client diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new health-care provider; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new health-care provider 3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion 4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

4