anxiety somatoform part 2

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds, "You need to calm yourself." "What is it that you would like me to do to help you?" "Can you tell me what you were feeling just before your attack?" "I will get you some medication to help calm you."

"Can you tell me what you were feeling just before your attack?" A response that helps the client identify the precipitant stressor is most therapeutic.REF: Page 284-285

An important question to ask during the assessment of a client diagnosed with anxiety disorder is "How often do you hear voices?" "Have you ever considered suicide?" "How long has your memory been bad?" "Do your thoughts always seem jumbled?"

"Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety.REF: 291

Which nursing diagnosis would be most useful for clients with anxiety disorders? Excess fluid volume Disturbed body image Ineffective role performance Disturbed personal identity

Ineffective role performance Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.REF: Page 287

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? a. Conversion (functional neurological) disorder b. Illness anxiety disorder (hypochondriasis) c. Somatic symptom disorder d. Factitious disorder

b. Illness anxiety disorder (hypochondriasis) Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease.

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: a. readily seek psychiatric counseling. b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms.

b. be resistant to accepting psychiatric help. Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms.

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: a. assume roles and functions of other family members. b. demonstrate performance of former roles and tasks. c. focus energy on problems occurring in the family. d. rely on family members to meet personal needs.

b. demonstrate performance of former roles and tasks. The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence.

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? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

b. expect the patient to feed self after explaining arrangement of the food on the tray. The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way.

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? a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your belief." b. "Let's see if there are any other possible explanations for your vomiting." c. "You seem so worried. Let's talk about how you're feeling." d. "We need to talk about something else."

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

The care plan for a patient diagnosed with a somatic disorder includes the nursing diagnosis Ineffective Coping. Which nursing diagnosis demonstrates a successful outcome for that diagnosis? A. Showers and dresses in clean clothes daily. B. Calls a friend to talk when feeling lonely C. Spends more time talking about pain in her abdomen D. Maintains focus and concentration

b. Calls a friend to talk when feeling lonely

10. Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille? a. Chlorpromazine (Thorazine) b. Diazepam (Valium) c. Carbamazepine (Tegretol) d. Duloxetine (Cymbalta)

d. Duloxetine (Cymbalta)

3. Nursing care for a client with somatic symptom disorder would focus on helping her to: a. Eliminate the stress in her life. b. Discontinue her numerous physical complaints. c. Take her medication only as prescribed. d. Learn more adaptive coping strategies.

d. Learn more adaptive coping strategies.

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to protect the nurse legally. establish the nursing diagnoses of priority. obtain information about the client's psychosocial background. determine whether the anxiety is primary or secondary in origin.

determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.REF: 291-292

Panic attacks in Latin American individuals often involve repetitive involuntary actions. blushing. fear of dying. offensive vebalizations.

fear of dying. Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.REF: Page 291

A symptom commonly associated with panic attacks is obsessions. apathy. fever. fear of impending doom.

fear of impending doom. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.REF: 282-283

The major distinction between fear and anxiety is that fear is a universal experience; anxiety is neurotic. enables constructive action; anxiety is dysfunctional. is a psychological experience; anxiety is a physiological experience. is a response to a specific danger; anxiety is a response to an unknown danger.

is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger.REF: 279

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to make jokes to relieve tension. miss appointments. justify illogical ideas and feelings. behave in ways that are the opposite of his or her feelings.

justify illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.REF: Page 283 (Table 15-2)

Selective inattention is first noted when experiencing anxiety that is mild. moderate. severe. panic.

moderate. When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events.REF: 279

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of a rude awakening. normal anxiety. trait anxiety. altruism.

normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.REF: Page 279-280

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing denial. compensation. normal anxiety. selective inattention.

normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.REF: Page 279-280

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: reinforce the preoperative teaching by restating it slowly. have Lana read the teaching materials instead of verbal instruction. have a family member read the preoperative materials to Lana. not attempt any teaching at this time.

not attempt any teaching at this time. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.Cognitive Level: ApplicationNursing Process: ImplementationNCLEX: Psychosocial IntegrityText page: 279

Generally, ego defense mechanisms: often involve some degree of self-deception. are rarely used by mentally healthy people. seldom make the person more comfortable. are usually effective in resolving conflicts.

often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception.REF: 290-291

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of panic attacks with agoraphobia. obsessive-compulsive disorder. posttraumatic stress response. generalized anxiety disorder.

panic attacks with agoraphobia. Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.REF: 291-292

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as mild. moderate. severe. panic.

panic. Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.REF: Page 293-294

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating projection. rationalization. reaction formation. undoing.

reaction formation. Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.REF: 283; Table 15-2

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is projection. repression. displacement. reaction formation.

repression. Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.REF: 283; Table 15-2

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as mild. moderate. severe. panic.

severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.REF: Page 279-280

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is sleep disturbance. excessive socialization. command hallucinations. altered state of consciousness.

sleep disturbance. Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.REF: 28

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to suddenly tremble severely. exhibit stoic behavior. report both nausea and vomiting. laugh inappropriately.

suddenly tremble severely. Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.REF: Page 291

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should question the physician's order because the dose is excessive. explain the long-term nature of benzodiazepine therapy. teach the client to limit caffeine intake. tell the client to expect mild insomnia.

teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication.REF: Page 296-297

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." A helpful response for the nurse to make would be "What things have you done in the past that helped you feel more comfortable?" "Let's try to focus on that adorable little granddaughter of yours." "Why don't you sit down over there and work on that jigsaw puzzle?" "Try not to think about the feelings and sensations you're experiencing."

"What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again.REF: Page 286-287

4. Carly has been diagnosed with somatic symptom disorder. As the nurse is talking with Carly and her family, which of the following statements suggest primary or secondary gains that the physical symptoms are providing for the client? A. The family agrees that Carly began having physical symptoms after she lost her job. B. Carly states that even though medical tests have not found anything wrong, she is convinced her headaches are indicative of a brain tumor. C. Carly's mother reports that someone from the family stays with Carly each night because the physical symptoms are incapacitating. D. Carly states she noticed feeling hotter than usual the last time she had a headache.

.C. Carly's mother reports that someone from the family stays with Carly each night because the physical symptoms are incapacitating. ANS: C It is important for the nurse to identify gains that the symptoms might be providing for the client, since these can reinforce illness behavior. Having family attend to the patient when she is symptomatic could reinforce increased dependency and attention needs

An obsession is defined as thinking of an action and immediately taking the action. a recurrent, persistent thought or impulse. an intense irrational fear of an object or situation. a recurrent behavior performed in the same manner.

a recurrent, persistent thought or impulse. Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.REF: 287-288

What can be said about the comorbidity of anxiety disorders? Anxiety disorders generally exist alone. A second anxiety disorder may coexist with the first. Anxiety disorders virtually never coexist with mood disorders. Substance abuse disorders rarely coexist with anxiety disorders.

A second anxiety disorder may coexist with the first. In many instances, when one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.REF: 290-291

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 c. Going from one doctor to another seeking the desired response d. Claims illness to obtain financial benefit or other incentive e. Difficulty describing symptoms

A, B

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 c. Rates pain as "1" on a scale of "10" d. First diagnosed with psoriasis at age 12 e. Reports insomnia often results from back pain

A, B, E

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 b. Decisional conflict c. Adult failure to thrive d. Impaired social interaction e. Ineffective role performance

A, E

5. A nursing instructor is teaching about the etiology of dissociative disorders from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred? A. "Dissociative behaviors occur when individuals repress distressing mental information from their conscious awareness." B. "When their physical symptoms relieve them from stressful situations, their amnesia is reinforced. C. "People with dissociative disorders typically have strong egos." D. "There is clear and convincing evidence of a familial predisposition to this disorder."

A. "Dissociative behaviors occur when individuals repress distressing mental information from their conscious awareness." ANS: A The nurse should understand that from a psychoanalytical perspective, dissociation occurs because of repression of painful information or experiences.

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 Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.DIF: Cognitive Level: Analyze (Analysis)REF: page 36TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

Melanie is a 38-year-old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may : A. Consciously be trying to maintain her role of a sick patient B. Not recognize her unmet needs to be cared for C. Protect her child from illness D. Recognize physical symptoms as a coping mechanism

A. Consciously be trying to maintain her role of a sick patient

2. A nurse is working with a client diagnosed with somatic symptom disorder. What predominant symptoms should a nurse expect to assess? A. Disproportionate and persistent thoughts about the seriousness of one's symptoms B. Amnestic episodes in which the client is pain free C. Excessive time spent discussing psychosocial stressors D. Lack of physical symptoms

A. Disproportionate and persistent thoughts about the seriousness of one's symptoms ANS: A The primary focus in somatic symptom disorder is on physical symptoms that suggest medical disease but which have no basis in organic pathology. Although the symptoms are associated with psychosocial distress, the individual focuses on the seriousness of the physical symptoms rather than the underlying psychosocial issues.

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. b. hip fractures. c. hypertension. d. immune disorders. e. cardiovascular disease.

A< C, D, E

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. a. Increase private visiting time for the parents to improve bonding. b. Keep careful, detailed records of visitation and untoward events. c. Place mittens on the child to reduce access to ports and incisions. d. Encourage family members to visit in groups of two or three. e. Interact with the patient frequently during visiting hours.

B, D, E

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.

3. Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with somatic symptom disorder? A. The client will admit to fabricating physical symptoms to gain benefits by day 3. B. The client will list three potential adaptive coping strategies to deal with stress by day 2. C. The client will comply with medical treatments for physical symptoms by day 3. D. The client will openly discuss physical symptoms with staff by day 4.

B. The client will list three potential adaptive coping strategies to deal with stress by day 2. ANS: B The nurse should determine that an appropriate outcome for a client diagnosed with somatic symptom disorder would be for the client to list three potential adaptive coping strategies to deal with stress by day 2. Because the symptoms of somatic symptom disorder are associated with psychosocial distress, increasing coping skills may help the client reduce symptoms.

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? A. Development of agoraphobia B. Treatment nonadherence C. Frequent hypoglycemic reactions D. Sleeping rather than checking blood sugar

B. Treatment nonadherence

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" A. "Your legs don't work because your brain is screwed up." B."Your emotional distress is being expressed as a physical symptom." C. "You are making up your symptoms as a cry for help." D. "You are overly anxious about having a severe illness."

B."Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety 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

Diane, a 63 year-old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since Diane has been complaining of a "severe pain in my neck." She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that: A. Showing for concern for Diane's pain will increase her obsessional thinking. B. Diane's symptoms are manipulative and under conscious control. C. Diane believes there is a physical cause for the pain and will resist a psychological explanation. D. Diane is trying to make her son feel bad about the argument.

C. Diane believes there is a physical cause for the pain and will resist a psychological explanation.

6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? A. Encourage exploration of sexual abuse B. Encourage guided imagery C. Establish trust and rapport D. Administer antianxiety medications

C. Establish trust and rapport ANS: C The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with dissociative identity disorder. DID was formerly called multiple personality disorder. Each personality views itself as a separate entity and must be treated as such to establish rapport. Trust is the basis of every therapeutic relationship.

1. A client diagnosed with somatic symptom disorder is most likely to exhibit which personality disorder characteristics? A. Uses "splitting" and manipulation in relationships B. Is socially irresponsible, exploitative, and guiltless and disregards rights of others C. Expresses heightened emotionality, seductiveness, and strong dependency needs D. Uncomfortable in social situations; perceived as timid, withdrawn, cold, and strange

C. Expresses heightened emotionality, seductiveness, and strong dependency needs ANS: C It has been suggested that in somatic symptom disorder, there may be some overlapping of personality characteristics and features associated with histrionic personality disorder. These features include heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and a preoccupation with symptoms and oneself. Somatic symptom disorder is characterized by the expression of multiple somatic complaints associated with psychosocial distress and without medical basis.

7. A client diagnosed with dissociative identity disorder (DID) switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function? A. It is a means to attain secondary gain. B. It is a means to explore feelings of excessive and inappropriate guilt. C. It serves to isolate painful events so that the primary self is protected. D. It serves to establish personality boundaries and limit inappropriate impulses.

C. It serves to isolate painful events so that the primary self is protected. ANS: C The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected. The transition between personalities is usually sudden, dramatic, and precipitated by stress.

A possible outcome criterion for a client diagnosed with anxiety disorder is Client demonstrates effective coping strategies. Client reports reduced hallucinations. Client reports feelings of tension and fatigue. Client demonstrates persistent avoidance behaviors.

Client demonstrates effective coping strategies

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A. Client will walk unassisted within 1 week. B. Client will return to a pre-illness level of functioning within 2 weeks. C. Client will be able to state two new effective coping skills within 2 weeks. D. Client will assume full self-care within 3 weeks.

Client will be able to state two new effective coping skills within 2 weeks. An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic

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

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. CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder.

Which patient is at greatest risk for developing a stress induced myocardial infarction? A. A patient who lost a child in an accidental shooting 24 hours ago B. A woman who has begun experiencing early signs of menopause C. A patient who has spent years trying to sustain a successful business D. A patient who was diagnosed with chronic depression 10 years ago

D. A patient who was diagnosed with chronic depression 10 years ago

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

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? A. Utilizing many different therapeutic strategies or modalities for enhanced coping B. Involving every member of the family as well as the patient in treatment C. Incorporating spirituality and religion into treatment D. Considering all dimensions of the patient, including biological, psychological, and sociocultural

D. Considering all dimensions of the patient, including biological, psychological, and sociocultural It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.

What precipitating emotional factor has been associated with an increased incidence of cancers? select all that apply A. Anxiety B. Job related stress C. Acute grief D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

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

8. A client is diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client? A. To recover memories and improve thinking patterns B. To prevent social isolation C. To decrease anxiety and need for secondary gain D. To collaborate among subpersonalities to improve functioning

D. To collaborate among subpersonalities to improve functioning ANS: D The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among subpersonalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client's ability to function appropriately and achieve optimal personal potential.

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: Jerry may become addicted faster than younger patients. Jerry is at risk for falls. Jerry has a history of nonadherence with medications. Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

Jerry is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.Cognitive Level: Apply (Application)Nursing Process: ImplementationNCLEX: Physiological IntegrityText page: 296-297

Which therapeutic intervention can the nurse implement personally to help a client diagnosed with a mild anxiety disorder regain control? Flooding Modeling Thought stopping Systematic desensitization

Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team.REF: Page 290-291

Which medication is FDA approved for treatment of anxiety in children? Lorazepam (benzodiazepine) Fluoxetine (selective serotonin reuptake inhibitor) Clomipramine (tricyclic antidepressant) None of the above

None of the above There are no medications with FDA approval for children with anxiety disorders; however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children (see the previous sentence).Cognitive Level: Understand (Comprehension)Nursing Process: PlanningNCLEX: Physiological IntegrityText page: 296

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? Having the client repeatedly touch "dirty" objects Not allowing the client to seek reassurance from staff Not allowing the client to wash hands after touching a "dirty" object Telling the client that he or she must relax whenever tension mounts

Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval.REF: Page 300

Which behavior would be characteristic of an individual with anxiety who is displacing anger? Lying Stealing Slapping Procrastinating

Procrastinating A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.REF: 283; Table 15-2

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder? Express mild amusement over symptoms. Arrange for client to spend time away from others. Advise client to minimize exercise to conserve endorphins. Reinforce use of positive self-talk to change negative assumptions.

Reinforce use of positive self-talk to change negative assumptions. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try."REF: Page 300-301

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of standard antipsychotic medication. tricyclic antidepressant medication. anticholinergic medication. a short-acting benzodiazepine medication.

a short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.REF: Page 296

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal a history of childhood trauma. a sibling with the disorder. an eating disorder. a phobia as well.

a sibling with the disorder. Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population.REF: Page 290

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." b. "The staff are concerned that you are not satisfied with the care you are receiving." c. "Let's talk about why you use your call light so frequently. It is a problem." d. "You frustrate the staff by calling them so often. Why are you doing that?"

a. "I'm wondering if you are feeling anxious about your illness and being left alone." This patient is experiencing anxiety associated with a serious medical condition.

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." b. "My family will see me through this. It won't be easy, but I will never be alone." c. "My heart attack was no fun, but it showed me up the importance of a good diet and more exercise." d. "I accept that I have heart disease. Now I need to decide if I will be able to continue my work daily."

a. "My employer should have paid for a health club membership for me." Blaming someone else and rationalizing one's failure to exercise are not adaptive coping strategies.

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." b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated." c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

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." Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms.

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?"

8. The ultimate goal of therapy for a client with DID is: a. Integration of the personalities into one b. For the client to have the ability to switch from one personality to another voluntarily c. For the client to select which personality he or she wants to be the dominant self d. For the client to recognize that the various personalities exist

a. Integration of the personalities into one

1. Lorraine has been diagnosed with somatic symptom disorder. Which of the following symptom profiles would you expect when assessing Lorraine? a. Multiple somatic symptoms in several body systems b. Fear of having a serious disease c. Loss or alteration in sensorimotor functioning d. Belief that her body is deformed or defective in some way

a. Multiple somatic symptoms in several body systems

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect: panic disorder. adult separation anxiety disorder. agoraphobia. social anxiety disorder.

adult separation anxiety disorder. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.Cognitive Level: Analyze (Analysis)Nursing Process: DiagnosisNCLEX: Psychosocial IntegrityText page: 282-283

The defense mechanisms that can only be used in healthy ways include suppression and humor. altruism and sublimation. idealization and splitting. reaction formation and denial.

altruism and sublimation. Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.REF: 281-282

The initial nursing action for a newly admitted anxious client is to assess the client's use of defense mechanisms. assess the client's level of anxiety. limit environmental stimuli. provide antianxiety medication.

assess the client's level of anxiety. The priority nursing action is the assessment of the client's anxiety level.REF: 279-280

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

7. In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must: a. Try to relate to Ellen as though she did not have multiple personalities. b. Establish a relationship with each of the personalities separately. c. Ignore behaviors that Ellen attributes to other subpersonalities. d. Explain to Ellen that he or she will work with her only if she maintains the status of the primary personality.

b. Establish a relationship with each of the personalities separately.

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. Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition.

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)? a. Voluntary control of symptoms b. Patient's style of presentation c. Results of diagnostic testing d. The role of secondary gains

b. Patient's style of presentation

9. The ultimate goal of therapy for a client with DID is most likely achieved through: a. Crisis intervention and directed association b. Psychotherapy and hypnosis c. Psychoanalysis and free association d. Insight psychotherapy and dextroamphetamines

b. Psychotherapy and hypnosis

2. Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? a. Denial of depression b. Repression of anxiety c. Suppression of grief d. Displacement of anger

b. Repression of anxiety

4. Lorraine, a client diagnosed with somatic symptom disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the basis for Lorraine's statement? a. She thinks her doctor wants to get rid of her as a client. b. She does not understand the correlation of symptoms and stress. c. She thinks psychiatrists are only for "crazy" people. d. She thinks her doctor has made an error in diagnosis.

b. She does not understand the correlation of symptoms and stress.

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? a. The patient is suppressing accurate feelings regarding the problem. b. The patient's anxiety is relieved through the physical symptom. c. The patient's optic nerve transmission has been impaired. d. The patient will not disclose genuine fears.

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

It can be said that the onset of most anxiety disorders occurs before the age of 20 years. before the age of 40 years. after the age of 40 years. scattered throughout the life span.

before the age of 40 years.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports that his symptoms started right after he was robbed at gunpoint. being so worried he hasn't been able to work for the last 12 months. that eating in public makes him extremely uncomfortable. repeatedly verbalizing his prayers helps him feel relaxed.

being so worried he hasn't been able to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer.REF: Page 28

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.

5. Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse? a. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." b. "Let's sit down here together and you can tell me about this new pain you are experiencing. You'll just have to miss group therapy today." c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time." d. "I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?"

c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time."

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 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: a. marginally successful. b. minimally successful. c. partially successful. d. totally achieved.

c. partially successful.

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to: reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her. use the call light to inquire whether Lana has any prn anxiety medication. call for help and assess Lana's vital signs. tell Lana you will stay with her until the anxiety subsides

call for help and assess Lana's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.Cognitive Level: Analyze (Analysis)Nursing Process: DiagnosisNCLEX: Physiological IntegrityText page: 287

Working to help the client view an occurrence in a more positive light is called flooding. desensitization. response prevention. cognitive restructuring.

cognitive restructuring. The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive.REF: 299-300

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? a. Dysthymic disorder b. Somatic symptom disorder c. Antisocial personality disorder d. Illness anxiety disorder (hypochondriasis)

d. Illness anxiety disorder (hypochondriasis) Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available.

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. The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.).

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. At the unconscious level, the patient's primary gain from the symptoms is anxiety relief.

6. Ellen has a history of childhood physical and sexual abuse. She was diagnosed with dissociative identity disorder (DID) 6 years ago. She has been admitted to the psychiatric unit following a suicide attempt. The primary nursing diagnosis for Ellen would be: a. Disturbed personal identity related to childhood abuse b. Disturbed sensory perception related to repressed anxiety c. Impaired memory related to disturbed thought processes d. Risk for suicide related to unresolved grief

d. Risk for suicide related to unresolved grief

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of altruism. denial. undoing. suppression

denial. Denial involves escaping unpleasant reality by ignoring its existence.REF: 283; Table 15-2

A client is experiencing a panic attack. The nurse can be most therapeutic by telling the client to take slow, deep breaths. verbalizing mild disapproval of the anxious behavior. asking the client what he means when he says "I am dying." offering an explanation about why the symptoms are occurring

telling the client to take slow, deep breaths. Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.REF: Page 284 (Table 15-3)