RN Somatic Symptom and Dissociative Disorders

A nurse in an outpatient clinic is working with a client who has been diagnosed with dissociative amnesia. Which of the following client statements would be an indication that the client is likely to experience an exacerbation of manifestations related to dissociative amnesia? "*Last week I learned that I have an aggressive form of skin cancer."* "I sometimes find it difficult to concentrate in the morning "There are times when I don't feel like eating much" "My family does not understand my condition and it makes me feel lonely."

"*Last week I learned that I have an aggressive form of skin cancer."* Manifestations of a dissociative disorder may be exacerbated by continued severe psychological trauma, such as experiencing intimate partner violence, abuse, or a severe medical illness.

A nurse on an inpatient unit is speaking with a client about their recent diagnosis of depersonalization/derealization disorder. The client asks the nurse, "What is the treatment for this disorder?" Which of the following responses should the nurse make? *"A combination of psychotherapy and medication is often used."* "Electroconvulsive therapy is the only approved treatment." "You need to ask your doctor about treatment options." "With medication and therapy, this condition will be cured."

*"A combination of psychotherapy and medication is often used."* The treatment for depersonalization/derealization disorder can include psychotherapy and medications. Cognitive-behavioral therapy combined with anxiolytics and/or an antidepressant can be successful in minimizing or eliminating manifestations.

A nurse is caring for a client who has somatic symptom disorder and reports frequent abdominal pain. Which of the following responses should the nurse make? "There is nothing wrong with your abdomen." "Your abdominal pain isn't real, it is imagined." *"What has worked in the past to relieve the pain?"* "Haven't several doctors determined your abdomen is fine?"

*"What has worked in the past to relieve the pain?"* This response is therapeutic, as the nurse is acknowledging the client's pain as real while requesting further input from the client about how to address the pain.

A nurse is discussing somatic syndrome disorder with a newly licensed nurse. Which of the following should the nurse identify as a risk factor for this disorder? A history of ADHD A family history of borderline personality disorder A physical disability *A history of alcohol use disorder*

*A history of alcohol use disorder* A history of alcohol use disorder is a risk factor for developing somatic symptom disorder.

A charge nurse is discussing illness anxiety disorder with a newly licensed nurse. Which of the following information should the charge nurse include? This disorder is most often diagnosed during adolescence *Clients who have this disorder can experience suicidal thoughts* This disorder causes significant neurological manifestations such as paralysis Clients who have this disorder intentionally injure themselves to gain attention

*Clients who have this disorder can experience suicidal thoughts* Illness anxiety disorder is chronic and relapsing, and clients can experience significant depression, increasing their risk for suicidal ideation. This disorder is most often diagnosed during adolescence Illness anxiety disorder is almost always diagnosed during adulthood and is very rarely seen in the pediatric population. This disorder causes significant neurological manifestations such as paralysis Functional neurologic symptom disorder, also called conversion disorder, causes neurological manifestations, such as paralysis, numbness, or blindness. Clients who have this disorder intentionally injure themselves to gain attention Clients who have factitious disorder, formerly called Munchausen syndrome, consciously injure or infect themselves in order to obtain attention via being ill. They may also fabricate or exaggerate manifestations.

A nurse is caring for a client who states they feel like they see themselves from outside of their body. The nurse should document that the client is experiencing which of the following manifestations? *Depersonalization* Delusion Hallucination Dissociative amnesia

*Depersonalization* Depersonalization is the feeling of being outside of one's body or detached from one's thoughts and feelings.

A nurse is caring for an adult client who was recently involved in a motor vehicle accident. The client states, "I feel strange, like I am outside of my own body watching myself talk." Which of the following is the client likely experiencing? Factitious disorder Dissociative identity disorder *Depersonalization/derealization* Dissociative amnesia

*Depersonalization/derealization* With depersonalization/derealization, the client would describe dissociative symptoms such as having an out-of-body experience. Factitious disorder With factitious disorder, the client would be falsifying events and symptoms. Dissociative identity disorder With dissociative identity disorder, the client would exhibit two or more distinct personalities. Dissociative amnesia With dissociative amnesia, the client would be unable to recall events related to their history in a way that is not consistent with normal forgetting.

A nurse is caring for a client who has been diagnosed with dissociative identity disorder. The client develops an alter personality when discussing the trauma. How should the nurse respond when this occurs? Inform the client that the nurse will not work with them until they return from their alter state. Flood the client with data from the previous trauma. Encourage the client not to switch to their alter personality *Display empathetic listening and keep the client comfortable and safe.*

*Display empathetic listening and keep the client comfortable and safe.* Empathetic listening and communication are always important for the client, but it is especially important for clients experiencing dissociative identity disorder.

A nurse is caring for a client who was sexually assaulted. The client is frustrated because they cannot recall any events or information related to the event. What condition is the client likely experiencing? Somatic syndrome disorder *Dissociative amnesia* Depersonalization/derealization disorder Dissociative identity disorder

*Dissociative amnesia* Dissociative amnesia is the inability to recall events from the past, such as a specific traumatic event.

A newly licensed nurse asks the charge nurse on a mental health unit which age groups are impacted by dissociative identity disorder. Which of the following responses should the charge nurse make? Dissociative identity disorder is only diagnosed after 18 years of age Dissociative identity disorder is not diagnosed in older adults Dissociative identity disorder disappears as clients become older adults *Dissociative identity disorder can be present throughout the lifespan*

*Dissociative identity disorder can be present throughout the lifespan* Dissociative identity disorder can occur at any age and can persist throughout a person's entire life.

A nurse is caring for a client who reports an extensive history of physical and sexual abuse as a child. The client states, "Sometimes I do things that I'm not aware of. I see pictures of myself on social media and I am wearing things that I would never wear, and I am in locations where I would never go. It makes me feel so frustrated." The client is exhibiting manifestations of which of the following disorders? *Dissociative identity disorder* Dissociative amnesia Depersonalization/derealization disorder Somatic symptom disorder

*Dissociative identity disorder* Dissociative identity disorder is characterized by two or more separate personalities that each have their own patterns of behavior and memories. Dissociative amnesia Dissociative amnesia is the inability to recall events from the past, such as a specific traumatic event. Depersonalization/derealization disorder Depersonalization/derealization disorder occurs when a client experiences feeling detached from themselves or that the outside world is unreal. Somatic symptom disorder Somatic symptom disorder is characterized by a client reporting and focusing on significant physical manifestations that disrupt daily functioning, such as severe pain.

A nurse is discussing the risk factors for developing a dissociative disorder with a client. Which of the following would place the client at a higher risk for developing dissociative disorder? Demonstrating poor concentration Having a parent diagnosed with major depressive disorder Reported difficulties with their academic career *Experiencing physical abuse as a child*

*Experiencing physical abuse as a child* A history of abuse or trauma is a risk factor for developing a dissociative disorder.

A nurse is caring fro a client who has a new diagnosis of dissociative identity disorder. Which of the following medications should the nurse expect the provider to prescribe? Loratadine Lithium Aripiprazole *Fluoxetine*

*Fluoxetine* The nurse should expect the provider to prescribe fluoxetine, a selective serotonin reuptake inhibitor, for a client who has dissociative identify disorder. Other medications used for this disorder include benzodiazepines and beta-blockers. Loratadine The nurse should identify that loratadine is an antihistamine used in the treatment of seasonal allergies. Therefore, the nurse should not expect the provider to prescribe this medication. Lithium The nurse should expect a provider to prescribe lithium, a mood stabilizer, to a client who has bipolar disorder. Aripiprazole The nurse should identify that aripiprazole is an antipsychotic medication used in the treatment of schizophrenia. Therefore, the nurse should not expect the provider to prescribe this medication.

A nurse is providing care to a client who is experiencing a loss of motor strength with no identifiable physical cause. The nurse would suspect the client to be diagnosed with which of the following disorders? Somatic syndrome disorder Illness anxiety disorder Factitious disorder *Functional neurological symptom disorder*

*Functional neurological symptom disorder* The client is describing manifestations with no identifiable physical cause as defined by functional neurological symptom disorder.

A nurse is caring for a client who seeks care frequently due to fear of having a serious illness. After learning that the laboratory results showed no abnormalities, the client begins to hyperventilate. The client is exhibiting manifestations of which of the following disorders? Functional neurological symptom disorder Factitious disorder Somatic symptom disorder *Illness anxiety disorder*

*Illness anxiety disorder* Illness anxiety disorder is when a client experiences constant thoughts about having a significant illness related to misinterpreted bodily symptoms. Functional neurological symptom disorder Functional neurological symptom disorder includes motor weaknesses such as paralysis or tremors. It may also include reduced tactile, visual, and auditory sensations. These symptoms have no underlying physical cause. Factitious disorder Factitious disorder is when a client falsifies their symptoms even when there is no external reward to do so. Somatic symptom disorder Somatic symptom disorder involves physical manifestations that are not explained by any physical or mental health disorder.

A nurse is planning care for a client who has dissociative identity disorder. Which of the following actions should the nurse plan to take? Refer the client for eye movement desensitization and reprocessing (EMDR) therapy *Provide one-on-one therapeutic interaction and support* Inform the client that their alter personalities are not real Teach the client thought-stopping techniques

*Provide one-on-one therapeutic interaction and support* Therapeutic interaction, which includes empathetic listening and support, is one of the most important nursing interventions. Refer the client for eye movement desensitization and reprocessing (EMDR) therapy EMDR is used to treat post-traumatic stress disorder. Inform the client that their alter personalities are not real The nurse should not tell the client that their alter personalities are not real, as this is non-therapeutic. Teach the client thought-stopping techniques Thought-stopping is a type of behavioral therapy that is used to treat obsessive-compulsive disorder to interrupt obsessive thoughts.

A nurse is caring for a client who has dissociative identity disorder. In the morning, the client was pleasant and cooperative. However, when the nurse goes to administer lunch time medications, the client is angry and refuses medication, stating, "I want to die." Which of the following actions should the nurse take? Instruct the client that they must take their medication Request another nurse assess the client *Stay with the client and ensure they are safe* Ask if the cleint can switch into a different alter

*Stay with the client and ensure they are safe* The nurse's priority is to ensure the client is safe. The nurse should assess the client for suicidal ideation or thoughts of self-harm.

A nurse is caring for a client who has somatic syndrome disorder. Which of the following assessments is the nurse's priority? Depression rating scale Anxiety level *Thoughts of suicide or self-harm* The presence of auditory or visual hallucinations

*Thoughts of suicide or self-harm* The priority assessment is to determine if the client is having suicidal ideation or thoughts of self-harm. Ensuring the client's *safety* is the priority.

A nurse is preparing to provide a presentation about somatic symptom disorder and related disorders at a local high school. Which of the following would be correct about prevalence of the somatic symptom disorder in the general population? *4% to 6%* 10% to 14% 18% to 20% 24% to 26%

4% to 6% It is estimated that the prevalence of somatic symptom disorder is 4% to 6% of the general population.

A nurse is admitting a client who has a somatic syndrome disorder and reports recurrent episodes of back pain. Which of the following actions should the nurse take first? Administer pain medication to the client Educate the client about somatic symptom disorders *Build a therapeutic relationship with the client* Encourage the client to participate in daily physical activity

Build a therapeutic relationship with the client The first action the nurse should take is to build a therapeutic rapport with the client. This occurs during the orientation phase of the nurse-client relationship.

A nurse is caring for a client who has illness anxiety disorder. The client says to the nurse, "I don't know what you can do for me. I have seen so many health care providers and no one has been able to help." Which of the following responses should the nurse make? "You should focus on thinking more positively." "Why do you sound so hopeless." *"I can help you learn new coping skills to better manage your symptoms."* "Tell me why you are here if nobody can help you."

I can help you learn new coping skills to better manage your symptoms The nurse should teach the client coping skills that will assist them to better manage their symptoms.

A nurse is caring for a client in an outpatient clininc. The nurse suspects the client may be experiencing dissociative amnesia. Select the 3 interventions the nurse should plan to take. *Inform the client that memory loss is a form of coping* Inform the client that nothing is medically wrong with them *Provide relaxation techniques to the client when they are experiencing anxiety* *Encourage the client to hold an object and focus on it* Limit the amount of time for the client to discuss concerns is incorrect

Inform the client that memory loss is a form of coping is correct. The nurse should inform the client that dissociative amnesia is a way of coping with a traumatic event. Inform the client that nothing is medically wrong with them is incorrect. The nurse should avoid expressing to the client who has dissociative amnesia that nothing is medically wrong with them or that it is all in their head. Provide relaxation techniques to the client when they are experiencing anxiety is correct. The nurse should provide relaxation techniques when the client is experiencing dissociative amnesia due to a traumatic event. Encourage the client to hold an object and focus on it is correct. The nurse should encourage the client to hold an object and focus on it to distract them from their feelings of anxiety, stress, or thoughts of a traumatic event. This is known as a grounding technique. Limit the amount of time for the client to discuss concerns is incorrect. The nurse should not limit the amount of time for the client to discuss their concerns. This intervention might be appropriate for a client who has somatic symptom disorder and spends endless amounts of time thinking about their medical condition.

A nurse is providing education to a client and their partner about dissociative identity disorder. Which of the following information should the nurse include in the teaching? *Manifestations of dissociation may include depersonalization and a lack of access to memories* The dissociative manifestations are consciously displayed in an attempt to attract attention from others Ignoring dissociative manifestations will alleviate the client's stress and anxiety Dissociative manifestations are a type of hallucination and indicate schizophrenia

Manifestations of dissociation may include depersonalization and a lack of access to memories Dissociation is an unconscious defense mechanism whereby a client has an interruption in consciousness. This causes impairments in memory and perception, including depersonalization, which is the feeling of being outside of one's body.

A nurse is planning care for a client who has a somatic syndrome disorder. Which of the following actions should the nurse include? *Teach the use of relaxation techniques* *Provide symptomatic relief measures as prescribed* Encourage the client not to talk with the nurse about somatic complaints Eliminate all physical symptoms Educate the client on new procedures that may be used to diagnose a physical condition *Provide education on basic cognitive behavioral and mindfulness interventions*

Teach the use of relaxation techniques is correct. Teaching and encouraging the use of relaxation techniques will help reduce the client's anxiety. Provide symptomatic relief measures as prescribed is correct. The nurse must assess interventions that have worked in the past to treat the client's concerns and lessen their symptoms. Encourage the client not to talk with the nurse about somatic complaints is incorrect. The nurse will have to spend some time talking with the client about somatic complaints but should shift the focus of the conversation from physical concerns to emotional ones. Eliminate all physical symptoms is incorrect. The objective is to help the client cope with physical symptoms and maladaptive behavior. Eliminating all physical symptoms is likely not possible. Educate the client on new procedures that may be used to diagnose a physical condition is incorrect. The client should have been given a medical evaluation in the process of receiving their diagnosis. The nurse should focus on educating the client on positive coping skills to manage stress. Provide education on basic cognitive behavioral and mindfulness interventions is correct. Cognitive behavioral therapy techniques and mindfulness are effective strategies for managing anxiety.