Somatic Symptom & Illness Anxiety Disorders

A woman wears a size 7 shoe. She says, My feet are huge. Ive asked three orthopedists to surgically reduce my feet. The patient tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Dissociative amnesia with fugue b. Illness anxiety disorder c. Body dysmorphic disorder d. Dissociative identity disorder

C Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patients feet are proportional to the rest of her body. Dissociative amnesia with fugue is characterized by sudden, unexpected travel away from the customary locale and the inability to recall ones identity and information about some or all of the past. Illness anxiety disorder involves a belief that one has a serious, life-threatening illness when none exists. Dissociative identity disorder involves the existence of two or more personality states that take control of ones behavior.

A patient diagnosed with 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. unsuccessful. b. minimally successful. c. partially successful. d. totally achieved.

C ~ Decreased preoccupation with symptoms and an increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

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. c. partially successful. b. minimally successful. d. totally achieved.

C ~ Decreased preoccupation with symptoms and increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

A patient has a somatization disorder. Which statement by the patient would indicate a need for additional patient teaching? a. I have learned that my family can be a support system. b. I will let my therapist know if I think suicidal thoughts. c. Drinking strong coffee really helps me combat my fatigue. d. Nicotine makes my heart race, so I need to stop smoking.

C ~ Educating the patient about the importance of limiting caffeine, nicotine, and other central nervous system stimulants is important since these substances can increase physical symptoms of anxiety (e.g., rapid heart rate, jitteriness) that may cue other somatic concerns. Drinking strong coffee each day may cause physical symptoms that could cue other somatic concerns; this statement indicates a need for more teaching. The remaining options are all positive thoughts or actions for a patient.

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, "My heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely? a. Body dysmorphic disorder b. Antisocial personality disorder c. Illness anxiety disorder (hypochondriasis) d. Persistent depressive disorder (dysthymia)

C ~ Illness anxiety disorder (hypochondriasis) involves a preoccupation with fears of having a serious disease, even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Body dysmorphic disorder involves a preoccupation with ones perceived defective body parts or appearance. Persistent depressive disorder (dysthymia) is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.

A family member asks the nurse about possible medications to treat somatization disorders. Which statement by the nurse shows an understanding of the recognized medication therapy for this disorder? a. Hypnotics, taken appropriately will help with your major complaints. b. Lithium will require regular monitoring to assure therapeutic blood levels. c. Antidepressant therapy may take several weeks to bring about symptom relief. d. Anticonvulsants are often used to treat the side effects of these type of disorders

C ~ Pharmacologic therapy for somatization disorders commonly include antidepressants, which can take weeks of administration before positive effects are noted. The remaining classifications are not generally used to treat somatization disorders.

A patient diagnosed with a somatic symptom disorder says, My pain is from an undiagnosed injury. I cant 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. c. secondary gains. b. cognitive style. d. identity and memory.

C ~ Secondary gains should be assessed. The patients dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patients diagnosis has been established.

A patient diagnosed with somatic symptom disorder says, I have pain from an undiagnosed injury. I cant 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 should be assessed. The patients dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patients diagnosis has been established.

To assist a patient diagnosed with a somatic system disorder, a nursing intervention of high priority is to: a. imply that somatic symptoms are not real. b. help the patient suppress feelings of anger. c. shift the focus from somatic symptoms to feelings. d. investigate each physical symptom as soon as it is reported.

C ~ Shifting the focus from somatic symptoms to feelings or to neutral topics conveys an interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome is that the patient expresses feelings, including anger, if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them.

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 ~ 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. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively? a. Flooding c. Relaxation techniques b. Response prevention d. Systematic desensitization

C ~ Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patient's perceptions of pain and reduce muscle tension. The distracters are modalities useful in treating selected anxiety disorders.

DEFINE: echopraxia

mimicking the movements of another

The nurse reinforces the recommendation of group therapy for a patient with a somatization disorder. What knowledge is this recommendation based upon? a. Group therapy is the one therapy of choice for this anxiety disorder. b. Group therapy is therapist driven and managed to eliminate stress on the patients. c. The group will support the patient in all complaints of physical illness as well as emotional distress. d. This therapy allows the patient to learn what has successfully worked for other patients with the disorder.

D ~ An advantage of group therapy is that it is an opportunity for the patient to learn from the successes and failures of others with similar symptoms. The group therapist will not allow members to support dysfunctional verbalizations. This disorder is treated with a variety of treatment modalities. This therapy is done with cooperation between therapist and patients.

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. c. can be voluntarily controlled. b. have a physiological basis. d. provide relief from health anxiety.

D ~ At the unconscious level, the patients primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.

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. Im often absent from work. I dont 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) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question.

What is the primary difference between somatic system disorders and dissociative disorders? a. Somatic system disorders are under voluntary control, whereas dissociative disorders are unconscious and automatic. b. Dissociative disorders are precipitated by psychological factors, whereas somatic system disorders are related to stress. c. Dissociative disorders are individually determined and related to childhood sexual abuse, whereas somatic system disorders are culture bound. d. Dissociative disorders entail stress-related disruptions of memory, consciousness, or identity, whereas somatic system disorders involve the expression of psychological stress through somatic symptoms.

D ~ The correct response is the only fully accurate statement. Somatic system disorders are not under voluntary control and are not culture bound.

Which nursing assessment finding would support a diagnosis of somatoform disorder? a. Patient reports a family history of depression b. The onset of symptoms beginning at age 38 c. An abnormality of the patients left heart ventricle d. Complaints of diarrhea and an erratic menstrual cycle

D ~ The diagnosis of somatization disorder requires that symptoms indicate there is involvement of multiple organ systems (e.g., gastrointestinal, reproductive, neurologic). Structural anomalies would indicate a medical problem exists. An early onset of symptoms (prior to age 30) is not recognized as a criterion for the diagnosis. A family history of depression is not a criterion for the diagnosis.

A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note that the patient: a. readily sees a relationship between symptoms and interpersonal conflicts. b. rarely derives personal benefit from the symptoms. c. has little difficulty communicating emotional needs. d. has unmet needs related to comfort and activity.

D ~ The patient diagnosed with a somatic system disorder frequently has altered comfort and activity needs. In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic system disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

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 ~ The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: a. are generally chronic in nature. b. have a physiological basis. c. can be voluntarily controlled. d. provide relief from health anxiety.

D ~ the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide a secondary gain, patients frequently and fiercely cling to the symptoms. The symptoms tend to be chronic; however, this does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.

A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)? 1. The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not. 2. The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not. 3. The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not. 4. The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.

1 ~ Individuals experiencing somatic symptoms without corroborating pathology are considered to have SSD, and those with minimal or no somatic symptoms would be diagnosed with IAD, a diagnosis new to the DSM-5. Clients diagnosed with IAD have minimal or no somatic complaints, but present with intense anxiety and suspiciousness of the presence of an undiagnosed, serious medical illness.

LIST the steps of mental illness ONSET & PROGRESSION

1) Premorbid phase 2) Prodromal phase 3) Active phase 4) Residual phase

A client is diagnosed with IAD. Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) 1. Obsessive-compulsive behaviors 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Depression

1, 3, 5 ~ Rationale: The nurse should expect that a client diagnosed with IAD would exhibit obsessive-compulsive behaviors, anxiety, and depression. Hypochondriasis involves an unrealistic or inaccurate interpretation of physical symptoms or sensations that can lead to preoccupation and fear of having a serious disease.

Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with 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 comply with medical treatments for physical symptoms by day three. 4. The client will openly discuss physical symptoms with staff by day four.

2 ~ The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day two. Because the symptoms of SSD are associated with psychosocial distress, increased coping skills may help the client reduce symptoms.

A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics? 1. Experiences intense and chaotic relationships with fluctuating attitudes toward others. 2. Socially irresponsible, exploitative, guiltless, and disregards rights of others. 3. Self-dramatizing, attention seeking, overly gregarious, and seductive. 4. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.

3 ~ The nurse should anticipate that a client diagnosed with SSD would be self-dramatizing, attention seeking, and overly gregarious. 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 symptoms include heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and a preoccupation with symptoms and oneself.

Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor 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 ~ The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion) and that secondary gains are those in which the client receives emotional support or attention (get-well cards).

A nursing instructor is teaching about the etiology of IAD from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred? 1. They tend to have a familial predisposition to 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 nurse should understand that from a psychoanalytical perspective, IAD occurs because physical problems are more acceptable than psychological problems. Psychodynamicists view IAD as a defense mechanism.

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 ~ Secondary gains should be assessed. Secondary gains reinforce maladaptive behavior. The patient's dependency needs may be evident through losses of abilities. When secondary gains are prominent, the patient is more resistant to giving up the symptom. There may be a history of abuse or doctor shopping, but the question does not assess the associated gains.

The causes of somatic system disorders may be related to: a. faulty perceptions of body sensations. b. traumatic childhood events. c. culture-bound phenomena. d. mood instability.

A ~ Structural or functional abnormalities of the brain have been suggested to lead to the somatic system disorders, resulting in disturbed processes of perception and interpretation of bodily sensations. Furthermore, cognitive theorists believe patients misinterpret the meaning of certain bodily sensations and then become excessively alarmed by them. Traumatic childhood events are related to the dissociative disorders. Culture-bound phenomena may explain the prevalence of some symptoms but cannot explain the cause. Somatic system disorders are not a facet of mood instability; however, depression may coexist with a somatic system disorder.

What discharge criteria would be appropriate for a patient with a somatization disorder? (SATA) a. Increased willingness to relinquish the sick role b. Decreased anxiety related to possible health issues c. Increased caloric intake and demonstrated weight gain d. Decrease the use of laxatives, sleeping pills, and diuretics e. Experiencing decreased frequency of auditory hallucinations

A, B ~ Minimization of the use of sickness to gain control and decreased anxiety related to health and wellness are the outcomes that relates specifically to somatization disorder. The remaining options are not typically associated with this disorder.

A nurse assesses a patient suspected to have somatic system disorder. Which findings support the diagnosis? Select all that apply. a. Female b. Reports frequent syncope c. Complains of heavy menstrual bleeding d. First diagnosed with psoriasis at 12 years of age e. Reports of back pain, painful urination, frequent diarrhea, and hemorrhoids

A, B, C, E ~ No chronic disease explains the symptoms for patients with somatic system disorder. Patients report multiple symptoms; gastrointestinal, sexual, and pseudoneurological symptoms are common. This disorder is more common in women than in men.

A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? (SATA) 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 ~ There is no chronic disease to explain the symptoms for patient's with somatic symptom disorder. Patients report multiple symptoms; gastrointestinal and pseudoneurological symptoms are common. This disorder is more common in women than in men. Patients with conversion disorder would have a tendency to underrate pain.

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? (SATA) a. Spiritual distress b. Decisional conflict c. Adult failure to thrive d. Impaired social interaction e. Ineffective role performance

A, E ~ The patient's verbalization is consistent with spiritual distress. The patient's description of being unable to provide for & burdening the family indicates ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.

A patient diagnosed with 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 ~ The patients verbalization is consistent with spiritual distress. Moreover, the patient's description of being unable to provide for and burdening the family suggests ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.

A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by the 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 the other family members. b. demonstrate a resumption of former roles and tasks. c. focus energy on problems occurring in the family. d. rely on family members to meet his or her personal needs.

B The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and the resumption of former roles are necessary to change this pattern. The distractors are inappropriate outcomes.

Which treatment modality should a nurse recommend to help a patient diagnosed with somatic symptom disorder cope more effectively? a. Flooding b. Relaxation c. Response prevention d. Systematic desensitization

B ~ Pain, a common complaint in patients diagnosed with somatic symptom disorder, increases when the patient has muscle tension. Relaxation can diminish the patient's perceptions of the intensity of pain. The distractors are modalities useful in treating selected anxiety disorders.

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 ~ Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both.

A medical-surgical nurse works with a patient diagnosed with a somatic system 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 ~ Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling is offered, these patients reject both.

A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurses planning for this patient? The patient is: a. suppressing accurate feelings regarding the problem. b. relieving anxiety through the physical symptom. c. meeting needs through hospitalization. d. refusing to disclose genuine fears.

B ~ Psychoanalytic theory suggests conversion reduces anxiety through the production of a physical symptom that is symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. The other distractors oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).

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 & 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 ~ Questioning the evidence is a cognitive reframing technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

A patient says, "I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring? a. You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking. b. Lets see whether any other explanations for your vomiting are possible. c. You seem so worried. Lets talk about how youre feeling. d. We should talk about something else.

B ~ Questioning the evidence is a cognitive restructuring technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should: a. establish a buddy system with other patients who can feed the patient at each meal. b. expect the patient to feed himself or herself after explaining the arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed himself or herself unassisted. d. address the needs of other patients in the dining room, and then feed this patient.

B ~ The patient is expected to maintain some level of independence by feeding himself or herself, whereas the nurse is supportive in a matter-of-fact way. The distractors support dependency or offer little support.

A patient with blindness related to a functional neurological (conversion) disorder says, "All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

B ~ The patient mentions that the symptoms make people more interested, which indicates that the patient believes he or she is uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of Chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in this scenario.

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patients 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 ~ The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. The distracters are inappropriate outcomes.

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 ~ Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of anti-anxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.