Mental: Ch 21 Somatic Symptom Disorders, Ch 21- Somatic Symptom Illnesses, NU245- Chapter 21: Somatic Symptom Illnesses, ch 21 NCLEX questions, Psychiatric - Chp 21

Munchausen syndrome

a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention and sympathy from health care providers, family, and others

la belle indifference

a seeming lack of concern or distress a key feature of conversion disorder

A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder. Which nursing diagnosis would the nurse most likely identify as the priority? a) Disturbed Body Image b) Risk for Other-Directed Violence c) Low Self-Esteem d) Ineffective Coping

a) Disturbed Body Image

Clients with a somatization disorder typically do what? a) Have a history of going to many different providers without satisfaction b) Avoid playing the sick role and resist attention from healthcare providers c) Minimize their medical history d) Discuss feelings and express needs verbally

a) Have a history of going to many different providers without satisfaction

involves unexplained, usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly

conversion disorder

pain disorder

has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance

the intentional production of false or grossly exaggerated physical or psychological symptoms

malingering

what is the focus of treatment of somatic symptom disorder?

managing symptoms improving QOL

a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention and sympathy from health-care providers, family, and others

munchausen

when a person inflicts illness or injury on someone else to gain attention of medical personnel or to be a "hero" for "saving" the victim

munchausen by proxy

the primary symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation and maintenance

pain disorder

disease conviction

preoccupation with the fear that one has a serious disease

hypochondriasis

preoccupation with the fear that one has a serious disease or will get a serious disease

disease phobia

preoccupation with the fear that one will get a serious disease

the relief of anxiety achieved by performing the specific anxiety-driven behavior or the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress

primary gain

hysteria

refers to multiple, recurrent physical complaints with no organic basis

preoccupation with the fear that one has a serious disease or will get a serious disease

hypochondriasis

characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medical basis

hysteria

internalization

keeping stress, anxiety, or frustration inside rather than expressing them outwardly

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures and being excused from usual responsibilities or tasks

secondary gain

conversion disorder

sometimes called conversion reaction involves unexplained, usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly

emotion-focused coping strategies

techniques to assist clients to relax and reduce feelings of stress

problem focused coping strategies

techniques used to resolve or change a person's behavior or situation or to manage life stressors

malingering

the intentional production of false or grossly exaggerated physical or psychological symptoms

somatization

the transference of mental experiences and states into bodily symptoms

psychosomatic

used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness

Munchausen syndrome by proxy

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 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.

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? A) Africa B) China C) North America D) Greece

A) Africa

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition? A) Depression B) Thought disorder C) Sleep disorder D) `Bipolar disorder

A) Depression

A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder. Which nursing diagnosis would the nurse likely identify as the priority? A) Disturbed body image B) Ineffective coping C) Low self-esteem D) Risk for other-directed violence

A) Disturbed body image

A nurse is working with a client diagnosed with somatic symptom disorder who is experiencing pain. Which would be an important focus of care? Select all that apply. A) Identifying strategies to relieve pain B) Administering opioid analgesics as neeeded C) Suggesting the use of complementary and alternative treatments. D) Addressing nonpharmacologic measures for symptom relief E) Examining stressors in the client's life

A) Identifying strategies to relieve pain C) Suggesting the use of complementary and alternative treatments. D) Addressing nonpharmacologic measures for symptom relief E) Examining stressors in the client's life

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse? A) It involves unexplained, usually sudden, deficits in sensory or motor function. B) It is characterized by multiple physical symptoms. C) It is a preoccupation with an imagined or exaggerated defect in physical appearance. D) It is a preoccupation with the fear that one has a serious disease.

A) It involves unexplained, usually sudden, deficits in sensory or motor function.

Which best describes the concept of somatization? A) Manifestation of physical symptoms from psychological distress B) Psychological origin of illness that is not real C) Physical symptoms that are all in one's head D) Symptoms that cannot be substantiated by physicians

A) Manifestation of physical symptoms from psychological distress

Which best describes the concept of somatization? A) Manifestation of physical symptoms from psychological distress B) Psychological origin of illness that is not real C) Symptoms that cannot be substantiated by physicians D) Physical symptoms that are all in one's head

A) Manifestation of physical symptoms from psychological distress

The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis? A) No physiologic cause has been found for the client's symptoms. B) The client's symptoms are related to conscious motives. C) The client is able to articulate the cause of psychological distress. D) The client's symptoms subside with appropriate medical treatment.

A) No physiologic cause has been found for the client's symptoms.

A nurse is preparing to interview a client diagnosed with somatic symptom disorder. The nurse anticipates that the client will most likely exhibit what? A) Rapidly changing moods during the interview B) Altered mental status C) Intermittent nodding and glancing at the clock on the wall D) No facial expression during the interview

A) Rapidly changing moods during the interview

Somatic symptom illness disorders are characterized by what? A) Severe physical symptoms that cannot be explained by any organic or physical pathology B) Self-inflicted injuries C) Self-induced disease states or faked symptoms to garner attention D) Physical symptoms coupled with extreme focus on emotional state

A) Severe physical symptoms that cannot be explained by any organic or physical pathology

A client complains of severe low back pain that began shortly after the death of the client's mother 2 years ago. No physical cause has been found to account for the pain. The client has been largely responsible for the care of four younger siblings because the client's father spends much of the week out of town on work-related business. Based on the client's symptoms, which nursing diagnosis is most appropriate for the client at this time? A) Somatic complaints due to anxiety related to life stressors B) Ineffective parenting due to poor coping C) Depression exhibited by repressed rage D) Altered comfort exhibited by poor school grades

A) Somatic complaints due to anxiety related to life stressors

The primary reason for considering cultural issues when caring for the client with somatization disorders is what? A) Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. B) Somatization disorders usually only occur in the United States. C) Somatization disorders are only seen in a few cultures. D) Somatization disorders are characterized by middle-class, Caucasian value expressions.

A) Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed.

A client reports a headache. On further assessment, the nurse finds that the client has been spending long hours on a difficult project at work. What should the nurse conclude from the assessment? A) The client may be stressed from work. B) The client may be lying about pain. C) The client may have conversion disorder. D) The client may be a hypochondriac.

A) The client may be stressed from work.

A client developed conversion blindness after witnessing the death of the client's twin in a car accident. When teaching the client's parent about the client's illness, the nurse explains what? A) The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. B) The clients blindness will gradually disappear if proper ophthalmologic care is provided. C) The client's blindness results in increased anxiety and attention from family and friends. D) The client's blindness requires a conscious effort to maintain the feigned symptom

A) The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis.

After teaching a group of nursing students about somatic symptom disorder (SSD), the instructor determines that additional education is necessary when the group identifies which statement as true? A) The condition is an acute short-term condition. B) The age of onset is usually before age 30 years. C) The condition is characterized by multiple physical symptoms. D) The disorder includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms.

A) The condition is an acute short-term condition.

A nursing instructor is describing complex somatic symptom disorder to a group of nursing students. The instructor determines that the teaching was successful when the students state what? A) The first symptom usually appears during adolescence. B) Highly educated individuals often develop this disorder. C) The disorder typically is diagnosed in men. D) The disorder commonly occurs with substance abuse.

A) The first symptom usually appears during adolescence.

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.

A client yells at the nurse, ìYou are all quacks! Can't you see I am sick?î 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.

Ans: A Feedback: Clients who cope through physical symptoms can be frustrating for the nurse. Initially, they are unwilling to consider that anything other than major physical illness is the root of all their problems. The client's progress is slow and painstaking, if any change happens at all. The nurse should be realistic about the small successes that can be achieved in any given period. To enhance the ongoing relationship, the nurse must be able to accept the client and his or her continued complaints and criticisms while remaining nonjudgmental.

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

Ans: A Feedback: Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Munchausen's syndrome by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a ìheroî for saving the victim.

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, ìOh, don't worry; it will all work out.î Which might this statement result from? A) La belle indifference B) Regression C) Malingering D) Undoing

Ans: A Feedback: People with a conversion disorder may be seemed to lack concern or distress about the functional loss. This is called la belle indifference. Regression would be when the person reverted to a previous level of functioning. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. This is not an example of undoing.

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

Ans: A Feedback: Treatment outcomes for clients with a somatic symptom illness may include the following: the client will identify the relationship between stress and physical symptoms; the client will verbally express emotional feelings; the client will follow an established daily routine; the client will demonstrate alternative ways to deal with stress, anxiety, and other feelings; the client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake. It is unrealistic for the client to be free from stress or avoid stressful situations.

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 ìtake it like a man,î 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.

Ans: A, B, C, D Feedback: Somatization is associated most often with women, as evidenced by the old term hysteria (Greek for ìwandering uterusî). Ancient theorists believed that unexplained female pains resulted from migration of the uterus throughout the woman's body. Psychosocial theorists posit that increased incidence of somatization in women may be related to various factors: ï Boys in the United States are taught to be stoic and to ìtake it like a man,î causing them to offer fewer physical complaints as adults. ï Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. ï Childhood sexual abuse, which is related to somatization, happens more frequently to girls. ï Women more often receive treatment for psychiatric disorders with strong somatic components such as depression.

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.

Ans: A, B, C, D Feedback: The term psychosomatic is used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness. Essentially, the mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors. Examples include diabetes, hypertension, and colitis, all of which are medical illnesses influenced by stress and emotions. In addition, stress can cause physical symptoms unrelated to a diagnosed medical illness. Clients do not willfully control the physical symptoms.

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

Ans: A, C, D, E Feedback: The term psychosomatic is used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness. Essentially, the mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors. Examples include diabetes, hypertension, and colitis, all of which are medical illnesses influenced by stress and emotions. In addition, stress can cause physical symptoms unrelated to a diagnosed medical illness such as ìtension headaches.î

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, ìWhat can I do?î The best response by the nurse would be, A) ìTry ignoring her complaints, and they should subside.î B) ìTry finding an activity you enjoy doing together to help her feel better overall.î C) ìTry to be the client and understand that she is worried that she is sick.î D) ìTry to give her some sort of reward when she resists complaining about her illnesses.î

Ans: B Feedback: Building a trusting relationship with the client, providing empathy and support, and being sensitive to rather than dismissive of complaints are skills that the nurse can use in any setting where clients are seeking assistance. Encouraging clients to find pleasurable activities or hobbies may help to meet their needs for attention and security.

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) ìShe is not really experiencing the symptoms. She is making them up to get attention.î B) ìThere is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it.î C) ìShe controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent.î D) ìThere is a physical cause. It just has not been detected yet.î

Ans: B Feedback: Clients are convinced they harbor serious physical problems despite negative results during diagnostic testing. They actually experience these physical symptoms as well as the accompanying pain, distress, and functional limitations such symptoms induce. Clients do not willfully control the physical symptoms. Nurses must remember that these clients really experience the symptoms they describe and cannot voluntarily control them.

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) ìI have been having a hard time lately. It's hard not working like I'm used to.î B) ìI seem to have more pain now that I got laid off.î C) ìI probably just overexerted myself working around the house. It's hard to slow down.î D) ìI'm sure they will figure out what is wrong with me.î

Ans: B Feedback: Clients are unlikely to be able to think about or to respond to questions about emotional feelings. They will answer questions about how they feel in terms of physical health or sensations. For example, the nurse may ask, ìHow did you feel about having to quit your job?î The client might respond, ìWell, I thought I'd feel better with the extra rest, but my back pain was just as bad as ever.î Recognizing the emotional difficulties of a lifestyle change or feeling relaxed about symptoms is not expected for a client with a somatic symptom illness.

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

Ans: B Feedback: Clients who come to understand that how they cope with stress affects their physical health demonstrate an understanding of somatization disorder. Clients with somatization disorder eventually may be treated in mental health settings. It is an unreality to avoid all stress in one's life.

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

Ans: B Feedback: Clients who do not cope well with stress or emotions develop physical symptoms that are real as a means of coping. Answer choices A, C, and D are inappropriate responses.

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

Ans: B Feedback: Conversion disorder, sometimes called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor function (e.g., blindness, paralysis). These deficits suggest a neurologic disorder but are associated with psychological factors. There is usually significant functional impairment. The term hysteria refers to multiple physical complaints with no organic basis; the complaints are usually described dramatically. Somatization disorder is characterized by multiple physical symptoms and includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms.

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

Ans: B Feedback: Primary gain is always relief of stress, anxiety, or conflicting/unacceptable emotions. They are the direct external benefits that being sick provides, such as relief from anxiety, conflict, or distress.

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.

Ans: B, D, E Feedback: Somatic symptom illnesses are chronic or recurrent, so changes are likely to occur slowly. If treatment is effective, the client should make fewer visits to the physician as a result of physical complaints, use less medication and more positive coping techniques, and increased functional abilities. Improved family and social relationships are also a positive outcome that may follow improvements in the client's coping abilities. Treatment outcomes for clients with a somatic symptom illness may include the following: ï The client will identify the relationship between stress and physical symptoms. ï The client will verbally express emotional feelings. ï The client will follow an established daily routine. ï The client will develop alternative ways to deal with stress, anxiety, and other feelings. ï The client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake.

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 ìheroî for saving the victim? A) Malingering B) Factitious disorder C) Munchausen's syndrome by proxy D) Induced illness

Ans: C Feedback: A variation of factitious disorder, imposed on others, is commonly called Munchausen's syndrome by proxy and occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a ìheroî for saving the victim. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Factitious disorder, imposed on self, occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Induced illness is another name for factitious disorder.

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.

Ans: C Feedback: In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. Munchausen's disorder is the common term for factitious disorder, imposed on self and occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. People with factitious disorders may even inflict injury on themselves to receive attention. Persons who experience somatic disorders are unable to control their symptoms. People who experience somatic symptom illnesses cannot stop their physical symptoms. However, people who malinger can stop the physical symptoms as soon as they have gained what they wanted.

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

Ans: C Feedback: Psychosocial theorists believe that people with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly. This is called internalization. Clients express these internalized feelings and stress through physical symptoms (somatization). Both internalization and somatization are unconscious defense mechanisms. Identification is trying to ease distress by emulating others whom one admires. Repression is the unconscious exclusion of distressing situations from one's memory.

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, ìI wish I could, but I feel so terrible.î Which of the following approaches should the nurse suggest to encourage activity? A) ìWhat does your pain feel like right now?î B) ìYou are fine, the doctor said so. Let's go.î C) ìI know this is difficult, but exercise is important. It will be a short walk.î D) ìI'll let you rest. Let me know when you feel better.î

Ans: C Feedback: The nurse must help the client and family learn how to establish a daily routine that includes improved health behaviors. Family members should expect resistance, including protests from the client that she or he does not feel well enough to do these things. The challenge is to validate the client's feelings while encouraging her or him to participate in activities.

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, ìThat just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach.î 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) ìThe pain in your head is very real.î D) ìWell, that's not what your doctor thinks.î

Ans: C Feedback: When the nurse says, ìThe pain in your head is very real,î the nurse is validating the client's pain as real. The client is asking for some type of validation. In the situation presented, the client's headaches are very real to him or her. The client needs to talk out the feelings regarding what the physician has told him or her. It would be inappropriate for the nurse to say nothing. To give the client some privacy and time to calm down is not indicated. ìWell, that's not what your doctor thinks,î would put the client on the defensive.

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

Ans: C Feedback: Somatic symptom illness is characterized by multiple physical symptoms. The frequency of generalized somatic complaints will give the nurse information about the current status of the disorder. Conversion disorder involves unexplained, usually sudden deficits in sensory or neurologic motor function and might be manifested by sensory deficits being experienced by the client. Pain disorder has the primary physical symptom of pain and would be reassessed with the description of the character of any pain reported by the client. If the nurse would reassess for signs of possible neurologic disorders, it may serve to reinforce to the client that there might be something wrong.

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

Ans: C Feedback: The challenge for the nurse is to validate the client's feelings while encouraging her or him to participate in activities. The nurse should not strip clients of their somatizing defenses until adequate assessment data are collected and other coping mechanisms are learned. The nurse should not attempt to confront clients about somatic symptoms or attempt to tell them that these symptoms are not ìreal.î They are very real to clients who actually experience the symptoms and associated distress.

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

Ans: D Feedback: An emotional conflict precedes the development of conversion disorder; the conversion disorder relieves that specific emotional conflict. Emotional detachment and emotional support from the family or identification of anxious feelings are not examples of primary gain in clients diagnosed with conversion disorder. Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members.

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

Ans: D Feedback: Emotion-focused coping strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities. Problem-focused coping strategies include learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others.

Which statement by the client indicates an understanding of somatic symptom disorder? A) "Taking medication won't help my pain since it's caused by stress." 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) "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."

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

Ans: D Feedback: Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions. Conversion disorder, sometimes called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor function. Pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance.

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 ìa big insurance settlement.î What condition might the nurse suspect? A) Hypochondriasis B) La belle indifference C) Conversion reaction D) Malingering

Ans: D Feedback: Malingering is suspected when the client is exaggerating physical complaints for some type of material gain. Hypochondriasis is a preoccupation with the fear that one has a serious disease. La belle indifference is a seeming lack of concern or distress about a functional loss. A conversion reaction involves unexplained, usually sudden, deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly.

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

Ans: D Feedback: Secondary gains involve increased attention and relief from normal responsibilities and expectations when clients are ill. This is not an example of a dysfunctional family unit or role reversal. A primary gain is the direct external benefits that being sick provides.

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.

Ans: D Feedback: Somatic symptom illnesses can be characterized as the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them. The three central features of somatic symptom are as follows: physical complaints suggest major medical illness, but have no demonstrable organic basis; psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms; and symptoms or magnified health concerns are not under the client's conscious control.

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.

Ans: D Feedback: Teaching about the relationship between stress and physical symptoms is a useful way to help clients begin to see the mindñbody relationship. Clients may keep a detailed journal of their physical symptoms. The nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth. The journal may help clients to see when physical symptoms seemed worse or better and what other factors may have affected that perception.

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.

Ans: D Feedback: The nurse must investigate physical health status thoroughly to ensure that there is no underlying organic pathology requiring treatment. When a client has been diagnosed with a somatic symptom illness, it is important not to dismiss all future complaints because at any time the client could develop a physical condition that would require medical attention.

The nurse is seeing a Chinese client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client? A) "It would be best for your to see a specialist until the underlying issue is properly diagnosed." B) "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too? C) "Is it common in your culture to talk about psychological distress like it is physical pain?" D) "The treatment that was recommended to you has worked for many clients. It is supported by research."

B) "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses? A) There are no known successful treatments for these disorders. B) Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented. C) Clients with these disorders find it difficult to go to a clinic setting. D) Clients are often embarrassed about the number and extent of their physical complaints.

B) Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? A) Alexithymia B) Hypochondriasis C) Conversion disorder D) Body dysmorphic disorder

B) Hypochondriasis

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? A) In somatic symptom disorder, clients consciously seek attention. B) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. C) Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder. D) In factitious disorders, clients are unaware that their symptoms are not real.

B) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this? A) Facilitate a repeat of the previous diagnostic testing in order to appease the client. B) Set limits with the client about the complaints. C) Have a different member of the care team present the test and assessment results to the client. D) Feign an assessment of the client in order to calm the client's anxiety.

B) Set limits with the client about the complaints.

Which statement about the etiology of somatic symptom disorder is accurate? A) The disorder is associated with substance abuse. B) The exact etiology is unknown. C) The disorder is more common in adults with a history of child abuse. D) Most clients with somatic symptom disorder also suffer from schizophrenia.

B) The exact etiology is unknown.

A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior? A) The nurse might have conversion disorder. B) The nurse might have Munchausen's syndrome by proxy. C) The nurse might have somatic symptom disorder. D) The nurse might have Munchausen's syndrome.

B) The nurse might have Munchausen's syndrome by proxy.

When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder? A) Clients are often embarrassed about the number and extent of their physical complaints. B) There are no known successful treatments for this disorder. C) Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. D) Clients find it difficult to go to a clinic setting.

C) Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented.

A client is admitted to a mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what? A) Borderline personality disorder B) Functional neurologic symptoms C) Factitious disorder imposed on another D) Schizoid personality traits

C) Factitious disorder imposed on another

The nurse has concluded the assessment of a client recently diagnosed with somatic symptom disorder. The client states the client's most significant source of stress is that "No one believes how sick I am." The client's physical complaints include fatigue, loss of appetite, and frequent urination. Based on these data, the most appropriate nursing diagnosis is what? A) Hopelessness related to chronicity of symptoms as evidenced by dependency B) Risk for spiritual distress related to feelings of isolation C) Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally D) Chronic low self-esteem related to physical symptoms that inhibit the client's daily functioning

C) Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally

When assessing a client with somatic symptom disorder, which would the nurse most likely note? A) Denial and repression are the chief defense mechanisms used. B) The client willfully controls the physical symptoms. C) Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. D) The client's symptoms are under the conscious control of the client.

C) Reports of physical symptoms do not have a demonstrable organic basis to fully account for them.

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which defense mechanism? A) Displacement B) Repression C) Somatization D) Dissociation

C) Somatization

In somatic symptom disorders, all except which are true? A) The client believes he/she has a serious illness. B) The client believes that his/her condition is catastrophic and disabling. C) The client usually believes he/she has some sort of anxiety disorder. D) The client embraces the "sick role."

C) The client usually believes he/she has some sort of anxiety disorder.

The nurse is seeing a an adolescent client who has attended the clinic frequently with vague reports of abdominal pain. Despite normal blood values, stool tests, and diagnotic imaging of the abdomen, the client continues to report symptoms. Which psychological factor may be contributing to the client's problem? A) The client is the head of the school debate team. B) The client is fearful of needles. C) The client's parents are considering getting divorced. D) The client recently received a low mark on an exam.

C) The client's parents are considering getting divorced.

A parent brings a teenaged child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer. A) The client reported having signs related to raised intracranial pressure, such as nausea. B) The client's symptoms may have been a result of stress caused by studying all night for an exam. C) The client's symptoms disappeared after getting the medical note. D) The client was not found to have any underlying cause of headache on assessment.

C) The client's symptoms disappeared after getting the medical note.

The nurse is teaching basic physical exercises and meditation techniques to a client recently diagnosed with conversion disorder. What outcome does the nurse expect from teaching the client these exercises? Choose the best answer. A) The exercises may help the client understand the conflict underlying the disorder B) The exercises may distract the client from the physical disability C) The exercises may help the client manage stress underlying the disorder D) The exercises may help the client express feelings of fear, anger, guilt, or inadequacy

C) The exercises may help the client manage stress underlying the disorder

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.

While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis? A) "The only time I felt loved and appreciated was when I made the honor roll at school." B) "I felt loved and accepted when my father apologized for spanking me so hard." C) "I never felt nurtured or loved when I was growing up." D) "The only time I ever felt loved was when I was sick enough to miss school."

D) "The only time I ever felt loved was when I was sick enough to miss school."

With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients? A) 10% B) 35% C) 50% D) 25%

D) 25%

The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care? A) Multiple provider evaluations B) Electroconvulsive therapy C) Mood stabilizers to manage the symptoms D) Cognitive behavior therapy

D) Cognitive behavior therapy

The la belle indifference occurs in which somatoform disorder? A) Somatization disorder B) Hypochondriasis C) Body dysmorphic disorder D) Conversion disorder

D) Conversion disorder

Which characteristic differentiates conversion disorder from malingering disorder? A) Conversion disorder is normally permanent, while malingering disorder is transient in response to stress. B) Conversion disorder has no pathophysiological cause, while malingering disorder has a neurological or endocrine basis. C) Conversion disorder produces reward, while malingering disorder normally results in punishment or difficulty. D) Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

D) Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

All of the following disease processes are caused by stress except which one? A) Diabetes B) Hypertension C) Colitis D) Deep vein thrombosis

D) Deep vein thrombosis

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? A) Assist in developing a daily routine B) Administer prescribed pharmacotherapy C) Ensure adherence to counseling D) Develop a sound, positive nurse-client relationship

D) Develop a sound, positive nurse-client relationship

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest? A) Ignore the client's complaints about physical discomfort and help the client focus on feelings instead. B) Encourage the client to acknowledge the spouse's frustration and helplessness. C) Keep a log of the client's physical symptoms to track improvement. D) Empathize about physical discomfort but encourage independence.

D) Empathize about physical discomfort but encourage independence.

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest? A) Keep a log of the client's physical symptoms to track improvement. B) Ignore the client's complaints about physical discomfort and help the client focus on feelings instead. C) Encourage the client to acknowledge the spouse's frustration and helplessness. D) Empathize about physical discomfort but encourage independence.

D) Empathize about physical discomfort but encourage independence.

A group of nursing students is reviewing information about somatic symptom and related mental health disorders. The students demonstrate understanding of the information when they identify which disorder as involving physical or psychological symptoms (or both) fabricated to assume the sick role? A) Alexithymia B) Conversion disorder C) Illness anxiety disorder D) Factitious disorder

D) Factitious disorder

In which disorder is the individual motivated solely by the desire to become a health care client? A) Conversion disorder B) Illness related disorder C) Somatic symptom disorder D) Factitious disorder

D) Factitious disorder

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? A) Alexithymia B) Body dysmorphic disorder C) Conversion disorder D) Hypochondriasis

D) Hypochondriasis

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what? A) Conversion disorder B) Factitious disorder C) Functional neurologic symptom disorder D) Illness anxiety disorder

D) Illness anxiety disorder

During a client interview, the nurse determines that the client has a fear of developing a serious illness based on a misinterpretation of body sensation. The nurse identifies this as being characteristic of what? A) Conversion disorder B) Factitious disorder C) Alexithymia D) Illness anxiety disorder

D) Illness anxiety disorder

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? A) Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder. B) In somatic symptom disorder, clients consciously seek attention. C) In factitious disorders, clients are unaware that their symptoms are not real. D) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

D) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which would a nurse most likely find? A) Parents who were restrictive B) Malingering to avoid work C) Pain to achieve a self-serving goal D) Intentional self-injurious behavior

D) Intentional self-injurious behavior

Assessment reveals that a client has been intentionally injuring the self so that the client can receive long-term disability and not have to work. The nurse interprets this behavior as suggesting which condition? A) Factitious disorder B) Functional neurologic symptom disorder C) Factitious disorder imposed on another D) Malingering

D) Malingering

Which is the name given to a direct external benefit that being sick provides, such as relief from anxiety? A) La belle indifference B) Secondary gain C) Malingering D) Primary gain

D) Primary gain

A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed? A) Antipsychotics B) Tricyclic antidepressants C) Mood stabilizers D) Selective serotonin reuptake inhibitors (SSRIs)

D) Selective serotonin reuptake inhibitors (SSRIs)

Which medication classification has been shown to be effective in some cases of somatoform disorders? A) Antibiotics B) Antipsychotics C) Antimanics D) Serotonin reuptake inhibitors (SSRIs)

D) Serotonin reuptake inhibitors (SSRIs)

Somatic symptom illness disorders are characterized by what? A) Self-inflicted injuries B) Self-induced disease states or faked symptoms to garner attention P C) Physical symptoms coupled with extreme focus on emotional state D) Severe physical symptoms that cannot be explained by any organic or physical pathology

D) Severe physical symptoms that cannot be explained by any organic or physical pathology

Which term describes the conversion of unexpressed emotions into physical symptoms? A) Psychosomatic B) Hysteria C) La belle indifference D) Somatization

D) Somatization

The nurse is assessing a client who reports severe chest pain. The client appears worried and frightened. Further assessment and laboratory testing does not reveal any abnormalities. The nurse observes that in the absence of any medical personnel, the client watches TV, is relaxed, and speaks to a friend on the phone in a normal tone of voice. What should the nurse suspect in this case? A) The client may have Munchausen's syndrome. B) The client may have silent angina. C) The client may be a hypochondriac. D) The client may be malingering.

D) The client may be malingering.

What is the major clinical finding in somatic symptom disorder? A) The client's inability to focus on emotional content B) Loss of voluntary motor or sensory functioning C) Pain with a history of "doctor shopping" D) The report of symptoms with no demonstrable pathology on testing or examination

D) The report of symptoms with no demonstrable pathology on testing or examination

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.

functional somatic syndrome

Physical symptoms and limitations of function that have no medical diagnosis to explain their existence

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.

what antidepressants are most commonly used to treat somatic symptom disorder?

SSRI's

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.

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.

A client who has been having difficulty functioning in his daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects which of the following? a) Hypochondriasis b) Functional neurologic symptom disorder c) Conversion disorder d) Factitious disorder

a) Hypochondriasis

The most severe form of factitious disorder includes which of the following? a) Munchausen's syndrome b) Hypochondriasis c) Alexithymia d) Malingering

a) Munchausen's syndrome

The nurse obtains a psychosocial history from a client who may have psychological factors affecting his medical condition. Which of the following should the nurse recognize as pertinent to this diagnosis? a) No physiologic cause has been found for his symptoms. b) His symptoms subside with appropriate medical treatment. c) He is able to articulate the cause of his psychological distress. d) His symptoms are related to conscious motives.

a) No physiologic cause has been found for his symptoms.

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression, and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which of the following defense mechanisms? a) Somatization b) Dissociation c) Repression d) Displacement

a) Somatization

A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which of the following would be most important for the nurse to keep in mind? a) The client's experience of pain is real. b) Outcomes need to reflect the biologic aspects of the pain. c) Opioid analgesics are the primary mode of therapy. d) Complementary therapies are usually of little benefit.

a) The client's experience of pain is real.

A client with somatic symptom disorder has been attending group therapy. Which statement indicates therapy is having a positive outcome for this client? a. "I feel better physically just from getting a chance to talk." b. "I haven't said much, but I get a lot from listening to others." c. "I shouldn't complain too much; my problems aren't as bad as others." d. "The other people in this group have emotional problems."

a. "I feel better physically just from getting a chance to talk."

Which is true about clients with illness anxiety disorder? a. They may interpret normal body sensations as signs of disease. b. They often exaggerate or fabricate physical symptoms for attention. c. They do not show signs of distress about their physical symptoms. d. All of the above.

a. They may interpret normal body sensations as signs of disease

The client's family asks the nurse, "What is illness anxiety disorder?" The best response by the nurse is, "Illness anxiety disorder is a. a persistent preoccupation with getting a serious disease." b. an illness not fully explained by a diagnosed medical condition." c. characterized by a variety of symptoms over a number of years." d. the eventual result of excessive worrying about diseases."

a. a persistent preoccupation with getting a serious disease."

The nurse understands that secondary gain for the client with a somatic symptom illness can include a. acceptable absence from work. b. freedom from daily chores. c. increased attention from family. d. provision of care by others. e. resolution of family conflict. f. temporary relief of anxiety.

a. acceptable absence from work b. freedom from daily chores c. increased attention from family d. provision of care by others

The nurse is caring for a client with complex somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of which of the following? a) Bipolar disorder b) Depression c) Avoidant personality disorder d) Delirium

b) Depression

A client's family member asks the nurse, "What is a conversion disorder?" Which of the following is the best response by the nurse? a) It is a preoccupation with the fear that one has a serious disease. b) It involves unexplained, usually sudden, deficits in sensory or motor function. c) It is a preoccupation with an imagined or exaggerated defect in physical appearance. d) It is characterized by multiple physical symptoms.

b) It involves unexplained, usually sudden, deficits in sensory or motor function.

A client is admitted to the mental health unit because she was found trying to inject diluted feces into her hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect which of the following? a) Functional neurologic symptoms b) Munchausen's syndrome by proxy c) Borderline personality disorder d) Schizoid personality traits

b) Munchausen's syndrome by proxy

Medications have been tried for somatization disorder. Which of the following drugs have been shown to be effective in some cases? a) Antianxiety agents b) SSRIs c) Antipsychotics d) Antihypertensive drugs

b) SSRIs

When planning care for a client with somatic symptom disorder, the nurse would include which intervention(s)? a. Confront the client with negative results from diagnostic testing. b. Encourage the client to participate in daily routine activities. c. Help the client see the relationship between physical symptoms and life stress/events. d. Provide additional 1:1 attention when the client discusses physical symptoms. e. Refuse to discuss or listen to any physical complaints the client may express. f. Validate the client's physical and emotional distress.

b. Encourage the client to participate in daily routine activities c. Help the client see the relationship between physical symptoms and life/stress events f. Validate the client's physical and emotional distress

Emotion-focused coping strategies are designed to accomplish which outcome? a. Helping the client manage difficult situations more effectively b. Helping the client manage the intensity of symptoms c. Teaching the client the relationship between stress and physical symptoms d. Relieving the client's physical symptoms

b. Helping the client manage the intensity of symptoms

The nurse is caring for a client with a conversion disorder. Which finding will the nurse expect during assessment? a. Extreme distress over the physical symptom b. Indifference about the physical symptom c. Labile mood d. Multiple physical complaints

b. indifference about the physical symptom

A client is being assessed for complex somatic symptom disorder. Which client statement would the nurse interpret as most likely supporting this diagnosis? a) "It seems like I am always having diarrhea at the most inconvenient times." b) "It's like my foot is asleep all the time; I can't feel anything that touches my foot." c) "I am always in pain; there is nothing I can do to relieve it." d) "I'm losing weight no matter what or how much I eat."

c) "I am always in pain; there is nothing I can do to relieve it."

The nurse is studying the medical record of a client who reports blindness. The record indicates there is no ocular abnormality. The client doesn't seem upset by the blindness. What is the client's most likely diagnosis? Choose the best answer. a) Hypochondriasis b) Optic nerve dysfunction c) Conversion disorder d) Somatic symptom disorder

c) Conversion disorder

All of the following disease processes are caused by stress except which one? a) Hypertension b) Colitis c) Deep vein thrombosis d) Diabetes

c) Deep vein thrombosis

A client has made multiple visits to the clinic. The nurse suspects that the client may be experiencing complex somatic symptom disorder based on which of the following? a) Indications that parents were always in "good health" b) Expressions of concern about psychological problems c) Reports of the same symptoms repeatedly d) Evidence of a need for social support from her friends

c) Reports of the same symptoms repeatedly

Which of the following drug classifications has been shown to be effective in treating somatization disorders? a) Antipsychotics b) Antimanics c) SSRIs d) Antianxiety medications

c) SSRIs

Somatoform disorders are characterized by which of the following? a) Self-induced disease states or faked symptoms to garner attention b) Physical symptoms coupled with extreme focus on emotional state c) Severe physical symptoms that cannot be explained by any organic or physical pathology d) Self-inflicted injuries

c) Severe physical symptoms that cannot be explained by any organic or physical pathology

Which statement would indicate that teaching about somatic symptom disorder has been effective? a. "The doctor believes I am faking my symptoms." b. "If I try harder to control my symptoms, I will feel better." c. "I will feel better when I begin handling stress more effectively." d. "Nothing will help me feel better physically."

c. "I will feel better when I begin handling stress more effectively."

A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as a. emotion-focused coping. b. phobia. c. primary gain. d. secondary gain.

c. primary gain

somatic symptom disorder

characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medical basis also called somatization disorder

The nurse is caring for a client in the neighborhood clinic. The client tells the nurse that ever since he was an adolescent, he has avoided social situations because he has "one ear that is obviously bigger than the other ear." The nurse observes that one of the client's ears does not appear to be larger than the other ear. The nurse suspects that the client may be experiencing which of the following? a) Factitious disorder b) Functional neurologic symptoms c) Complex somatic symptom disorder d) Body dysmorphic disorder

d) Body dysmorphic disorder

Which of the following mental health disorders is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? a) Alexithymia b) Conversion disorder c) Body dysmorphic disorder d) Hypochondriasis

d) Hypochondriasis

A client diagnosed with factitious disorder tells the nurse an incredible story about how he overcame a tremendous disability. Based on the client's history, the nurse knows that the story is not all true. The client is exhibiting which of the following? a) Hypochondriasis b) Alexithymia c) Malingering d) Pseudologia fantastica

d) Pseudologia fantastica

Paroxetine (Paxil) has been prescribed for a client with a somatic symptom illness. The nurse instructs the client to watch out for which side effect? a. Constipation b. Increased appetite c. Increased flatulence d. Nausea

d. Nausea

cyberchondria

excessive or repeated online searches for health-related information that is distressing or anxiety-provoking for the person

characterized by physical symptoms that are feigned or inflicted on one's self (or another) for sole purpose of gaining attention other emotional benefits

fabricated/induced illness

fabricated and induced illness

factitious disorders characterized by physical symptoms that are feigned or inflicted on one's self or another person for the sole purpose of gaining attention or other emotional benefits also called factitious disorder, imposed on self or others