ch 21 NCLEX questions
The la belle indifference occurs in which somatoform disorder? Body dysmorphic disorder Hypochondriasis Somatization disorder Conversion disorder
Conversion disorder Rationale:La belle indifference occurs in clients diagnosed with conversion disorder.
Which drug classification has been shown to be effective in treating somatization disorders? Antimanics Antipsychotics Selective serotonin reuptake inhibitors Antianxiety medications
Selective serotonin reuptake inhibitors Rationale:Selective serotonin reuptake inhibitors have been shown to be effective in treating somatization disorders.
A nurse is assessing a client with conversion disorder. The client complains that the client's left side is paralyzed. Which statement made by the client would indicate "la belle indifférence"? "I am not able to walk or do anything at all. I am totally dependent on my mom." "My paralysis doesn't bother me. I have accepted my disability." "I am sure I will get well soon. This problem won't persist for long." "Please do something to cure me. I am a burden to everybody."
"My paralysis doesn't bother me. I have accepted my disability." Rationale:A client with conversion disorder shows a seeming lack of concern or distress about the functional loss. This behavior is referred to as "la belle indifférence." The statement that the client wants to be cured indicates that the client is worried about the condition, which is not characteristic of conversion disorder. The statement that the client will get well soon indicates that the client is hopeful about getting rid of the illness soon. This attitude is not seen in clients with conversion disorder. The statement that the client is dependent on others indicates that the client is very concerned about the illness; this is not an indication of conversion disorder.
The spouse of a client diagnosed with complex somatic symptom disorder asks the nurse, "What causes this condition?" Which response by the nurse would be most accurate? "The symptoms reflect an emotion that your spouse cannot verbalize." "The symptoms reflect an internal preoccupation with events." "Your spouse is experiencing chronic stress that causes hypoarousal." "There is definitely an underlying genetic link for this disorder."
"The symptoms reflect an emotion that your spouse cannot verbalize." Rationale:Complex somatic symptom disorder has been explained as a form of social or emotional communication, meaning that the body symptoms express an emotion that cannot be verbalized by the individual. Although there is some evidence to support a genetic component, the exact transmission mechanism is unclear. In individuals with this disorder, chronic activation of the hypothalamic-pituitary-adrenal axis indicates a hyperarousal condition from chronic stress. Additionally, the personality trait alexithymia is associated with somatic symptoms. These individuals have difficulty identifying and expressing their emotions, have a preoccupation with external events, and are described as concrete thinkers.
With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients? 0.25 0.35 0.5 0.1
0.25 Rationale:With treatment, conversion disorder often remits in a few weeks but recurs in 25% of clients.
A student nurse asks the mental health nurse about when somatic symptom disorder (SSD) usually begins. The nurse responds by saying that the first symptoms often appear during which time? After age 40 years Mid 30s Early 20s Adolescence
Adolescence Rationale:SSD usually begins before the age of 30 years with the first symptoms often appearing during adolescence; however, it is rarely diagnosed until several years later.
Clients from which continent or country may have symptoms of somatization disorder that include the nondelusional sensation of worms in the head or ants under the skin? China Greece Africa North America
Africa Rationale:Pseudoneurologic symptoms of somatization disorder in Africa and South Asia include burning hands and feet and the nondelusional sensation of worms in the head or ants under the skin.
Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? Ensure adherence to counseling Administer prescribed pharmacotherapy Develop a sound, positive nurse-client relationship Assist in developing a daily routine
Develop a sound, positive nurse-client relationship Rationale:Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.
Which disease process is influenced by stress and emotions? Bipolar disorder Hypotension Diabetes Deep vein thrombosis
Diabetes Rationale:Diabetes can be influenced by stress and emotions, as can other conditions such as hypertension and colitis. Deep vein thrombosis, biopoal disorder, and hypotension are not psychosomatic conditions.
The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain? Talking about family and friends with the client Teaching the client techniques of meditation and relaxation Feeding the client during mealtime Discussing coping strategies that the client used in the past
Feeding the client during mealtime Rationale:Secondary gains refer to the personal benefits that the client experiences from being considered sick. In this case, being fed is considered the secondary gain. Discussion about family and friends with the client is a treatment strategy that may help the client develop insight into the cause of the condition. Teaching the client techniques of meditation and relaxation is a treatment strategy that may help the client relieve stress. Discussing the coping strategies that the client used in the past may help the client identify and integrate those coping strategies in the future.
A client is prescribed sertraline for treatment of a somatoform disorder. The nurse would instruct the client to be alert to which side effect? Constipation Headache Vomiting Increased appetite
Headache Rationale:Side effects of sertraline include loss of appetite, diarrhea, nausea, and headache.
The major difference between somatoform disorders and factitious disorders is what? In somatoform disorders, clients consciously seek attention. In somatoform disorders, clients are not consciously aware that they are meeting needs through physical complaints. In factitious disorders, clients are unaware that their symptoms are not real. Factitious disorders respond much more readily to psychopharmacologic treatment than do somatoform disorders.
In somatoform disorders, clients are not consciously aware that they are meeting needs through physical complaints. Rationale:Affected clients do not intentionally cause and have no conscious or voluntary control over their symptoms. Lack of voluntary control is in contrast to factitious disorder and malingering. In factitious disorder, clients deliberately make up or inflict symptoms.
A nurse is caring for a client with somatic symptom illness. The health care provider has prescribed sertraline, 80 mg, to the client. What should the nurse monitor the client for after administering the drug? Select all that apply. Insomnia Rashes Diarrhea Sweating Dry mouth
Insomnia Diarrhea Rationale:Sertraline is an antidepressant drug used to treat underlying depression in a client with somatic illness. Headache, diarrhea, and insomnia are side effects associated with this drug. The nurse should monitor for these signs after administering this drug. Unlike fluoxetine, rashes are not a side effect related to sertraline. Unlike paroxetine, dry mouth is not a side effect associated with sertraline.
A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse? It involves unexplained, usually sudden, deficits in sensory or motor function. It is a preoccupation with the fear that one has a serious disease. It is a preoccupation with an imagined or exaggerated defect in physical appearance. It is characterized by multiple physical symptoms.
It involves unexplained, usually sudden, deficits in sensory or motor function. Rationale:A conversion disorder involves an unexplained, usually sudden, deficit in sensory or motor function.
Which is an inaccurate statement regarding malingering? People who malinger have no real physical symptoms. It is the intentional production of false or grossly exaggerated physical or psychological symptoms. People who malinger usually do not stop the physical symptoms when given a reward. It is motivated by external incentives.
People who malinger usually do not stop the physical symptoms when given a reward. Rationale:The purpose noted in people who malinger is some external incentive or outcome that they view as important and results directly from illness.
Which is the name given to a direct external benefit that being sick provides, such as relief from anxiety? Primary gain Secondary gain La belle indifference Malingering
Primary gain Rationale:Primary gains are the direct external benefits that being sick provides. Secondary gains are the internal or personal benefits received from others because one is sick. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. The la belle indifference is a seeming lack of concern or distress for sudden deficits in sensory or motor function, as seen in conversion disorder.
A client has been admitted to a hospital with the inability to move the client's right arm. The client has a diagnosis of conversion reaction. Which consequence of this condition would be an example of primary gain? Medical leave from the client's high-stress job Avoidance of jury duty Attention from the client's spouse and children Relief from anxiety
Relief from anxiety Rationale:Primary gain is the immediate gain by the client to remove himself or herself from an overwhelming situation. In this case, relief from anxiety would be an example of primary gain. The other three answers reflect secondary gain, or mechanisms to remove the client from stress and provide an opportunity to meet dependency needs.
Which medication classification has been shown to be effective in some cases of somatoform disorders? Serotonin reuptake inhibitors (SSRIs) Antipsychotics Antimanics Antibiotics
Serotonin reuptake inhibitors (SSRIs) Rationale:SSRIs have been shown to be effective in some cases of somatoform disorders.
Which term describes the conversion of unexpressed emotions into physical symptoms? Psychosomatic Somatization La belle indifference Hysteria
Somatization Rationale:Somatization is a term used to describe the conversion of unexpressed emotions into physical symptoms. The la belle indifference is a seeming lack of concern or distress for deficits seen in conversion disorder. Hysteria refers to multiple physical complaints with no organic basis. The term psychosomatic is used to convey the connection between the mind and the body in states of health and illness.
The primary factor that differentiates somatization disorders from conversion disorders is what? Conversion disorders are always targeted at the respiratory system. Somatization disorders affect multiple organ systems, whereas conversion disorders usually involve only one system. Somatization disorders are conscious, whereas conversion disorders are unconscious. Somatization disorders usually affect the cardiac system, whereas conversion disorders do not.
Somatization disorders affect multiple organ systems, whereas conversion disorders usually involve only one system. Rationale:Somatization disorders differ from other somatoform disorders because of the multiple complaints voiced and the multiple organ systems affected. Conversion disorder is a somatoform disorder that involves motor or sensory problems suggesting a neurological condition. Anxiety-provoking impulses are converted unconsciously into functional symptoms.
The primary reason for considering cultural issues when caring for the client with somatization disorders is what? Somatization disorders are characterized by middle-class, Caucasian value expressions. Somatization disorders usually only occur in the United States. Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. Somatization disorders are only seen in a few cultures.
Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. Rationale:The type and frequency of symptoms in somatization disorders differ depending on the culture in which they are expressed. For example, there is a higher reported frequency of somatization disorder in Greek and Puerto Rican men than in men in the United States. Therefore, the symptom reviews must be adjusted to the culture.
A nurse is assessing a client with hypochondriasis. Which signs could the nurse expect to find in the client? Select all that apply. The client is reluctant to participate in psychiatric treatment programs. The client reports having visited many physicians or hospitals. The client does not believe in the use of over-the-counter medications. The client will discuss many emotional problems. The client is preoccupied with the self.
The client is reluctant to participate in psychiatric treatment programs. The client reports having visited many physicians or hospitals. The client is preoccupied with the self. Rationale:Clients with hypochondriasis are extremely preoccupied with themselves, especially with their physical functioning. They are most likely to visit many physicians and hospitals for their complaints. Such clients do not believe that their illness is due to an underlying psychiatric cause, thus they are reluctant to participate in psychiatric treatment programs. Such clients deny having emotional problems and are not expressive. Hypochondriac clients would extensively use over-the-counter medications for relieving their physical illnesses.
A nurse is caring for a client with conversion disorder. What immediate outcomes (within a week) indicate successful therapy for the client? Select all that apply. The client will express feelings related to inadequacy and fear. The client will identify the conflict underlying the physical symptoms experienced. The client will communicate the steps to solving the problems. The client will communicate knowledge of the illness. The client will discuss problems and solve conflicts with family or friends.
The client will identify the conflict underlying the physical symptoms experienced. The client will communicate the steps to solving the problems. Rationale:The immediate outcomes of successful therapy for a client with conversion disorder are that the client will be able to communicate the steps needed to solve the problems and to identify the conflict underlying the physical symptoms experienced. Outcomes such as expressing knowledge of the illness and feelings related to inadequacy and fear cannot be attained immediately. Similarly, the outcome that the client can discuss problems and solve conflicts with family members or friends is a long-term goal.
A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for the nurse to keep in mind? Opioid analgesics are the primary mode of therapy. Complementary therapies are usually of little benefit. The client's experience of pain is real. Outcomes need to reflect the biologic aspects of the pain.
The client's experience of pain is real. Rationale:Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.
