Chapter 21

8. A client with somatic symptom illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. Which is this evidence of? A) Dysfunctional family unit B) Primary gain C) Role reversal D) Secondary gain

D

12. An actor has prepared extensively for his first stage production. On the morning of the opening of the play, the actor awakens with laryngitis. From which disorder is the actor most likely suffering? A) Acute upper respiratory infection B) Conversion disorder C) Hysteria D) Somatization disorder

B

19. A client is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the client was laid off 4 months ago from her job. Which statement made by the client would most strongly suggest a somatoform disorder? A) "I have been having a hard time lately. It's hard not working like I'm used to." B) "I seem to have more pain now that I got laid off." C) "I probably just overexerted myself working around the house. It's hard to slow down." D) "I'm sure they will figure out what is wrong with me."

B

28. The husband of a client with hypochondriasis has accompanied his wife to the follow-up doctor's visit. While waiting for the doctor, the husband expresses to the nurse his frustration with his wife's obsession about illness. He asks the nurse, "What can I do?" The best response by the nurse would be, A) "Try ignoring her complaints, and they should subside." B) "Try finding an activity you enjoy doing together to help her feel better overall." C) "Try to be the client and understand that she is worried that she is sick." D) "Try to give her some sort of reward when she resists complaining about her illnesses."

B

29. Which statement would indicate to the nurse that the client has understood somatic symptom illness? A) "As soon as my symptoms go away, I'll be my old self again." B) "How I handle stress and emotions can affect my physical health." C) "I have to avoid stress all my life to avoid getting sick again." D) "Taking medication won't help my pain since it's caused by stress."

B

3. The client asks the nurse, "What does having psychosomatic symptoms mean?" What should the nurse reply? A) "It means you're not physically sick." B) "It means that stress and/or emotions are causing your symptoms." C) "It means that you'll be well when you get your life in order." D) "It means that your symptoms are a product of your imagination."

B

4. Which is the primary gain associated with developing physical symptoms in response to stress? A) Accept dependency B) Decrease anxiety C) Experience attention D) Suppress anger

B

6. The husband of a woman with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong with her. Which would be the appropriate explanation for the nurse to offer? A) "She is not really experiencing the symptoms. She is making them up to get attention." B) "There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it." C) "She controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent." D) "There is a physical cause. It just has not been detected yet."

B

26. Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness? Select all that apply. A) The client will assume responsibility for self-care activities. B) The client will identify the relationship between stress and physical symptoms. C) The client will learn to vary his or her schedule. D) The client will verbally express emotional feelings. E) The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings.

B D E

13. The nurse is planning care for a client with somatic symptom illness disorder. Which should the nurse plan to reassess on a daily basis? A) Sensory deficits experienced by the client B) Character of pain reported by the client C) Frequency of generalized somatic complaints D) Signs of possible neurologic disorders

C

16. Which of the following accurately describes how somatic symptoms are distinguished from factitious disorders and malingering? A) Munchausen's syndrome cannot be controlled by persons who have it. B) Persons who experience somatic disorders intentionally produce symptoms for some external purpose or gain. C) In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. D) People who experience somatic symptom illnesses can stop the physical symptoms as soon as they have gained what they wanted.

C

17. Which of the following terms are applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim? A) Malingering B) Factitious disorder C) Munchausen's syndrome by proxy D) Induced illness

C

21. The client states, "I can't go to group today. I have a very upset stomach this morning." Which would be the nurse's most appropriate response? A) "You have to go to group. The doctor has ordered it." B) "Okay, you can miss this time." C) "I know you don't feel well, but it's important for you to participate in therapy." D) "You aren't really feeling nauseous. It is part of your illness."

C

25. A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response? A) To give the client some privacy and time to calm down B) To say nothing and sit quietly with the client C) "The pain in your head is very real." D) "Well, that's not what your doctor thinks."

C

27. The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, "I wish I could, but I feel so terrible." Which of the following approaches should the nurse suggest to encourage activity? A) "What does your pain feel like right now?" B) "You are fine, the doctor said so. Let's go." C) "I know this is difficult, but exercise is important. It will be a short walk." D) "I'll let you rest. Let me know when you feel better."

C

9. Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? A) Somatization B) Identification C) Internalization D) Repression

C

11. A client is seen in the primary care clinic complaining of headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which diagnosis is most probable for this client? A) Conversion disorder B) Pain disorder C) Brain cancer D) Hypochondriasis

D

18. The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." What condition might the nurse suspect? A) Hypochondriasis B) La belle indifference C) Conversion reaction D) Malingering

D

20. The nurse performs a thorough physical examination for a client being admitted for a somatic symptom illness. Which of the following is the best rationale for the physical exam? A) Ease the client's mind that the nurse is looking for physical illness. B) Physical disorders underlie somatic disorders. C) Physical exams are reimbursed by third-party payers. D) Underlying pathology should be ruled out.

D

22. The nurse has encouraged the client with a somatic symptom illness to keep a journal. Which treatment outcome might be met by journaling? A) The nurse will control external stressors that trigger the patient's physical symptoms. B) The nurse will assess the onset of physical symptoms. C) The client will express emotions privately. D) The client will identify the occurrence of physical symptoms when stressed.

D

23. The nurse is working with the client to develop emotion-focused coping strategies. Which should the nurse include as an emotion-focused coping strategy? A) Problem solving B) Assertiveness techniques C) Role-playing D) Deep breathing techniques

D

5. A client with a somatic symptom illness asks what is causing her physical symptoms. Which would be the appropriate explanation for the nurse to offer? A) Physical symptoms can be attributed to an organic cause. B) Physical symptoms are deliberately expressed in order to benefit in some way. C) Physical symptoms are independent of the amount of the client's psychic distress. D) Physical symptoms are an involuntary way of dealing with psychic conflict.

D

7. Which is the primary gain for a client with conversion disorder? A) Emotional detachment B) Emotional support from family C) Identification of anxious feelings D) Relief from emotional conflict

D

14. A newly graduated nurse is scheduled to take the NCLEX-RN examination in 3 days. On awakening today, the graduate cannot see anything at all but tells fellow classmates, "Oh, don't worry; it will all work out." Which might this statement result from? A) La belle indifference B) Regression C) Malingering D) Undoing

A

15. A middle-aged client goes to the physician falsely complaining of hip pain. The client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? A) Malingering B) Hypochondriasis C) Factitious disorder D) Munchausen's syndrome by proxy

A

24. The nurse is identifying outcomes for a client with a somatic symptom illness. Which is an appropriate outcome to include in the plan of care? A) The client will verbally express his or her emotions. B) The client will be free from stress. C) The client will demonstrate alternative ways to avoid stressful situations. D) The client will verbalize acceptance of physical symptoms.

A

30. A client yells at the nurse, "You are all quacks! Can't you see I am sick?" Which knowledge would help the nurse to work most effectively with this client? A) Client progress is expected to be very slow. B) Physical illness is the root of the client's problems. C) The client will never be free of somatic symptoms. D) The nurse has done everything possible to treat the client.

A

10. Which are the factors that are currently considered to be possible reasons for the increased incidence of somatization in women? Select all that apply. A) Boys in the United States are taught to be stoic and to "take it like a man," causing them to offer fewer physical complaints as adults. B) Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. C) Childhood sexual abuse, which is related to somatization, happens more frequently to girls. D) Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. E) Unexplained female pains result from migration of the uterus throughout the woman's body.

A B C D

2. Which of the following are possible with psychosomatic illness? Select all that apply. A) Real symptoms can begin. B) Real symptoms can continue. C) Real symptoms can worsen. D) Unrelated symptoms can occur. E) Clients can control these symptoms.

A B C D

1. Psychosomatic illness refers to physical symptoms that are either created or worsened by psychic influences. Which conditions are thought to be attributed to the connection between mind and body? Select all that apply. A) Diabetes B) Arthritis C) Hypertension D) Headache E) Colitis

A C D E